Standards for Canadian organizations

2020 Edition

Child and Family Development and Support Services (CA-CFD) 4: Service Planning and Monitoring

All family members participate in the development and ongoing review of a service plan that is the basis for delivery of appropriate services and support.
NA The organization provides only parent education groups.
2020 Edition




Families participating in Child and Family Development and Support Services gain new competencies, improve child health and well-being, improve family functioning, and make family-community connections.
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • In a few instances, client or staff signatures are missing and/or not dated; or
  • With few exceptions, staff work with persons served, when appropriate, to help them receive needed support, access services, mediate barriers, etc.; or
  • Active client participation occurs to a considerable extent.
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • In several instances, client or staff signatures are missing and/or not dated; or
  • Quarterly reviews are not being done consistently; or
  • Level of care for some clients is clearly inappropriate; or
  • Service planning is often done without full client participation; or
  • Appropriate family involvement is not documented; or  
  • Documentation is routinely incomplete and/or missing; or
  • Individual staff members work with persons served, when appropriate, to help them receive needed support, access services, mediate barriers, etc., but this is the exception.
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.  
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Service planning and monitoring procedures
No On-Site Evidence
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Persons served
  • Review case records

CA-CFD 4.01

An assessment-based, family-centred service plan is developed in a timely manner with the full participation of family members, and includes:
  1. agreed-upon goals, desired outcomes, and timeframes for achieving them;
  2. services and supports to be provided, and by whom;
  3. procedures for expedited service planning when crisis or urgent need is identified; and
  4. a parent’s or legal guardian’s signature.


Generally children age six and over should be included in service planning, unless there are clinical justifications for not doing so.


If the timeframe is not specified by legislation, regulations, and/or contracts, the first service plan needs to be developed no longer than 90 days after intake.

CA-CFD 4.02

The service plan is tailored to meet the family’s unique needs, and:
  1. builds on family strengths;
  2. addresses family risks; and
  3. reflects the family’s description of its resources, concerns, and priorities.

CA-CFD 4.03

The organization works in active partnership with family members to:
  1. coordinate service delivery with other community providers;
  2. ensure that they receive appropriate advocacy support;
  3. assist with access to the full array of services to which they are eligible; and
  4. mediate barriers to services within the service delivery system.
Examples: Community stakeholders such as community leagues, police, schools, churches, and neighbourhoods might not be service providers but might be important in “village parenting.”

CA-CFD 4.04

The provider and a supervisor, or a clinical, service, or peer team, review the case quarterly, or more frequently depending on the needs of the family, to assess:
  1. service plan implementation;
  2. progress toward achieving goals and desired outcomes; and
  3. the continuing appropriateness of the agreed upon service goals.


When experienced providers are conducting reviews of their own cases, the provider’s supervisor must review a sample of the provider’s evaluations as per the requirements of the standard. 

CA-CFD 4.05

The provider and family:
  1. review progress toward achievement of agreed upon service goals; and
  2. sign revisions to service goals and plans.