Standards for public agencies

2020 Edition

Case Management (PA-CM) 6: Case Closing and Aftercare

The agency works with individuals and families to plan for case closing and, when possible, to develop aftercare plans.
2020 Edition

Currently viewing: CASE MANAGEMENT (PA-CM)



Individuals and families who receive Case Management services access and use resources and supports that build on their strengths and meet their service needs.
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Case closing procedures
  • Aftercare planning and follow-up procedures
  • Relevant portions of interagency agreement, as applicable
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Persons served
  • Review case records


PA-CM 6.01

Planning for case closing:
  1. is a clearly defined process that includes assignment of staff responsibility;
  2. begins at intake; and
  3. involves the worker, persons served, and others as appropriate to the needs and wishes of the consumer.


PA-CM 6.02

Upon case closing, the agency notifies any collaborating service providers, as appropriate.


PA-CM 6.03

If an individual or family has to leave the program unexpectedly, the agency makes every effort to identify other service options and link them with appropriate services.


The agency must determine on a case-by-case basis its responsibility to continue providing services to persons whose third-party benefits are denied or have ended and who are in critical situations.


PA-CM 6.04

When appropriate, the agency works with persons served and their family to:
  1. develop an aftercare plan, sufficiently in advance of case closing, that identifies short- and long-term needs and facilitates the initiation or continuation of needed supports and services; or
  2. conduct a formal case closing evaluation, including an assessment of unmet need, when the agency has an interagency agreement that does not include aftercare planning or follow-up.


PA-CM 6.05

The agency follows up on the aftercare plan, as appropriate, when possible, and with the permission of the individual or family.
NA The agency has an interagency agreement that does not include aftercare planning or follow-up.
Examples: Reasons why follow-up may not be appropriate include, but are not limited to, cases where participation is involuntary, or where there can be a risk to persons served such as in cases of domestic violence.