	Services for Substance Use Conditions

Introduction

Administration and Management

Service Delivery Administration Standards

Service Standards

PA-SA 3: Service Planning and Monitoring

Individuals participate in the development and ongoing review of a service plan that is the basis for delivery of appropriate services and support.

NA The agency provides Diagnosis, Assessment, and Referral Services only.

PA-SA 3.01

A service plan is developed in a timely manner with the full participation of the individual receiving services, and expedited service-planning is available when crisis or urgent need is identified.

Interpretation: Service planning is conducted so that the service recipient retains as much personal responsibility and self-determination as possible and desired. Individuals with limited ability in making independent choices receive help with making or learning to make decisions.

PA-SA 3.02

The service plan is based on the assessment, and includes:

agreed upon goals, desired outcomes, and timeframes for achieving them;
services and supports to be provided, and by whom; and
the service recipient’s signature.

PA-SA 3.03

During the service planning process the agency explains:

available options;
how the agency can support the achievement of desired outcomes; and
the benefits, risks, alternatives, and consequences of planned services.

PA-SA 3.04

The service plan addresses, as appropriate:

unmet service and support needs;
possibilities for maintaining and strengthening family relationships; and
the need for the support of the individual’s informal social network.

PA-SA 3.05

The worker and a supervisor, or a clinical, service, or peer team, review the case to assess:

service plan implementation;
progress toward achieving service goals and desired outcomes; and
the continuing appropriateness of the agreed upon service goals.

Interpretation: Experienced workers may conduct reviews of their own cases. In such cases, the worker's supervisor reviews a sample of the worker's evaluations as per the requirements of the standard.

PA-SA 3.06

The service plan is reviewed and updated:

weekly for individuals at high risk for relapse;
every 30 days for people assessed as having acute needs or during or following a period of relapse; and
quarterly for all other service recipients.

Interpretation: Timeframes for review should be adjusted depending upon: issues and needs of persons receiving services; and frequency and intensity of services provided.

PA-SA 3.07

The worker and the individual or legal guardian regularly review progress toward achievement of agreed upon goals and sign revisions to service goals and plans.

PA-SA 3.08

Family members and significant others, as appropriate, and with the consent of the service recipient, may be invited to participate in case conferences and may be advised of ongoing progress.

Interpretation: The agency facilitates the participation of family and significant others by, for example, helping arrange transportation or including them in scheduling decisions.

QUICK JUMP TO


	PURPOSE: Individuals who participate in Services for Substance Use Conditions on an on-going basis improve social, emotional, psychological, cognitive, and family functioning, and attain the recovery they seek.

RELATED FILES


	SERVICE One or more organization-operated programs or activities that have a common general objective and deploy the organization's material and human resources in a planned and systematic manner. An organization that publicly promotes or identifies itself in writing as offering a service, is licensed to deliver a service, assigns personnel and/or space to a service, or allocates financial resources to a service is considered to offer that service.


	FAMILY Two or more people who consider themselves family and who assume obligations, functions, and responsibilities generally essential to healthy family life. Child care and child socialization, income support, long-term care, and other caregiving are among the functions of family life. The definition of "family" will rest with an individual's indication of who plays a family member role, including current or former foster family, adoptive family, extended family members, fictive kin, or significant others. Organizations that believe family is the central constellation in a child's life, and that family attachments are of primary importance for human development, will strive to work with professional staff to develop a common understanding of "family."


	SERVICE PLAN A written plan of action based on the assessment of consumer needs and strengths that identifies problems, sets goals, and describes a strategy for achieving those goals and engaging in joint problem solving with the consumer. Also known as a "treatment plan".


	DIAGNOSIS The process by which a social, physical, or mental health problem and its underlying cause are identified and a plan of action formulated toward resolution of the problem. The diagnostic process involves collection and analysis of relevant information. See also ASSESSMENT.


	ASSESSMENT An evaluation, which utilizes professional expertise and skills in the collection and analysis of data to understand and describe the nature of service needs of an individual, family, or group. Assessment, as in needs assessment, is also used to determine priorities of program planning and service development for the organization as a whole. See also DIAGNOSIS.


	PLANNING The process of specifying objectives, evaluating the means for their achievement, and exercising deliberate decision making about appropriate courses of action.


	SERVICE RECIPIENT The individuals, groups, organizations, or communities that use, receive, or benefit from programs and services. Service recipients can include consumers, patients, family members, legal guardians, advocates, public/private organizations, employers, and purchasers. All are regarded as significant stakeholders served in a variety of agencies and practice settings.


	CLINICAL The study, assessment, and diagnosis of the client situation followed by direct treatment to help the client achieve prescribed goals.


	CASE A general term used to designate clients (including individuals, families, and groups) served by an organization for purposes of monitoring the provision of services. A foster care case is generally based on the placement of an individual child, although casework for the child may include services to the child's family. A child protective services case is based on an entire family household if a family assessment model is used; otherwise a case is defined as a child.


	SERVICE GOALS Broad, issue-oriented statements that reflect the realistic achievements to be accomplished in the short or long term. Goals are achieved through the accomplishment of specific quantifiable objectives.


	APPROPRIATENESS The degree to which a particular service, placement, treatment, intervention, or activity is: best suited to an individual's needs; not excessive, unduly intrusive, or restrictive; anticipated to be effective in achieving the desired and specified outcomes; and adequate or sufficient in quantity to address the problem.


	SAMPLE A portion or representative percentage of a greater whole.


	ACUTE NEEDS Intense conditions of sudden onset and short duration, typically lasting less than 6 months. In the context of substance abuse treatment, those needs that require immediate attention and treatment without which the health of the consumer is at serious risk.


	EVALUATION The review and assessment of organizational operations, programs and services.


	LEGAL GUARDIAN A person who has legal responsibility for the care and management of a person incapable of administering his/her own affairs. In the case of a minor child, the guardian is charged with the legal responsibility for the care and management of the child and of the minor child's estate.