PA-DV 5: Service Planning and Monitoring
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Survivors participate in the development and ongoing review of
service plans that are the basis for delivery of services and supports that respond to their circumstances, needs, and preferences.
A service plan is developed within an appropriate timeframe with the full participation of the survivor, and expedited service
planning is available when crisis or urgent need is identified.
Interpretation: Service planning is to be conducted so that the survivor retains as much personal responsibility and self-determination as possible and desired. Individuals with limited ability in making independent choices can receive help with making or learning to make decisions. When the survivor is a minor, or an adult under the care of a guardian, the agency should follow applicable state laws or regulations requiring involvement or consent of survivors’
legal guardians.
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 survivor’s signature.
During service planning the agency explains:
- available options;
- how the agency can support the achievement of desired outcomes; and
- the benefits, alternatives, and risks or consequences of planned services.
Survivors are the primary planners of their goals and
objectives, and have the right to decline services.
Interpretation: Although
personnel should help identify available services and evaluate options, survivors should ultimately make their own decisions.
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Research Note: Some research suggests that survivors find services more helpful and effective when they have a greater sense of control and when staff listen to and respect them. |
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The service plan addresses, as appropriate and with the survivor’s consent:
- relationships with family members; and
- the need for support from family and informal social networks.
Interpretation: Non-offending family members and significant others, as appropriate and with the consent of the survivor, can be advised of ongoing progress and invited to participate in
case conferences. The agency can facilitate their participation by, for example, helping arrange transportation or including them in scheduling decisions.
The provider and survivor regularly review progress toward achievement of agreed upon goals and sign revisions to
service goals and plans.
The provider and a supervisor, or a clinical, service, or peer team, review the case to assess:
- service plan implementation;
- progress toward achieving goals and desired outcomes; and
- the continuing appropriateness of agreed upon goals.
Interpretation: Experienced providers may conduct reviews of their own cases. In such cases, the provider’s supervisor reviews a sample of the provider’s evaluations as per the requirements of the standard.
Agencies providing non-residential services should review plans quarterly, and agencies providing housing services should review plans biweekly. Timeframes for service plan review should be adjusted depending upon issues and needs of persons receiving services, and the frequency and intensity of services provided.