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.
Service planning and monitoring procedures
No On-Site Evidence
Interviews may include:
Review case records
An assessment-based service plan is developed in a timely manner with the full participation of persons served, and includes:
agreed upon goals, desired outcomes, and timeframes for achieving them;
services and supports to be provided, and by whom;
procedures for expedited service planning when crisis or urgent need is identified; and
the individual’s signature.
In an effort to accommodate the unique needs and circumstances of persons served:
pregnant individuals are helped to explore the potential benefits and any concerns about involving family members and significant others, including the birth father, in service planning and provision; and
family members and significant others, including the birth father, are involved in service planning and provision, when appropriate.
When the birth father or family requests counseling and the pregnant woman is opposed, the organization should either make a referral or create a separate case, as addressed in PS 5.03.
The organization works in active partnership with persons served to:
assume a service coordination role, as appropriate, when the need has been identified and no other organization has assumed that responsibility;
ensure that they receive appropriate advocacy support;
assist with access to the full array of services to which they are eligible; and
mediate barriers to services within the service delivery system.
The worker and a supervisor, or a clinical, service, or peer team, review the case at designated milestones during the pregnancy, or more frequently depending on the needs of persons served, to assess:
service plan implementation;
progress toward achieving service goals and desired outcomes; and
the continuing appropriateness of the agreed upon service goals.
The organization will define what constitutes a milestone during the pregnancy. When providing Pregnancy Options Counseling or Birth Options Counseling, timeframes for review should be adjusted to reflect the length of time counseling services are offered.
When experienced workers are conducting reviews of their own cases, the worker’s supervisor must review a sample of the worker’s evaluations as per the requirements of the standard.
The worker and individual, and his or her family when appropriate:
review progress toward achievement of agreed upon service goals; and