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HIV/AIDS

  • General Information
    • 1-800-541-AIDS
    • 1-800-233-7432 Spanish
  • AIDS Drug Assistance Program (ADAP)
    • 1-800-542-2437
  • HIV Confidentiality Hotline
    • 1-800-962-5065

CEI Program & Services for clinicians

  • (315) 477-8479 or visit www.ceitraining.org
    • Post-Exposure Prophylaxis Hotline (PEP Line)
      • 1-866-637-2342
  • HIV/Hepatitis C
    • 1-866-637-2342
  • STDs
    • 1-866-637-2342

Brief Service Plan

In the Supportive Case Management model, the Brief Service Plan is completed in conjunction with the Brief Intake/Assessment and guides all case management activities until it is updated following a reassessment or a change in client circumstances.

In the Comprehensive Case Management model, the Brief Service Plan is an interim guide for case management, enabling clients to secure services to meet immediate needs while more extensive information is being collected for the Initial Comprehensive Case Management Assessment.

Standard Criteria

Needs identified in the Brief Intake/Assessment are prioritized and translated into a Brief Service Plan.

Time Requirement: At completion of Brief Intake/ Assessment.

  1. A. Brief Service Plan is developed and includes:
    • Goal(s)
    • Activities (work plan, action to be taken, follow up tasks)
    • Individuals responsible for the activity (case manager or team member, client, family member, agency respresentative)
    • Anticipated time fram for each activity
    • Client signature and date, signifying agreement
    • Supervisor's signature and date, indicating review and approval (if required by AIDS Institute initiative, or agency/program Policies and Procedures)
  2. Documentation includes:
    • Service plan format developed by the ;program including the above information
    • Progress notes recording activities on behalf of the clients to implement the service plan
    • Actual outcomes of case management goals and activities.
  3. Agency has an ongoing monitoring process to assess the client's ability and motivation to complete service plan activities and to address any other barriers to achieving goals. (For example if client is unable to perform specific activities alternative approaches to meet goal are explored such as skills development or staging of activities.)

Exceptions

If the Brief Intake/Assessment process determines the client has no presenting issues to be addressed, no service plan is required.

Clients enrolled in an ADHC do not receive a Brief Service Plan. Instead, a comprehensive care plan is completed immediately following completion of a Comprehensive Case Management Assessment 30 days after enrollment.
 
In Supportive Case Management programs, supervisory review and signoff on the Brief Service Plan can provide proactive monitoring for quality and ensure identified needs are prioritized and activities well planned. In Comprehensive Case Management, where an Initial Comprehensive Assessment and Comprehensive Service Plan are performed, supervisory review and signoff on the Brief Service Plan may not be necessary. For both Supportive and Comprehensive case management programs, each AIDS Institute program type will determine whether a supervisor must review and signoff on the Brief Service Plan.  Individual program practices will be described in the Policies and Procedures manual of that program.

Best Practices

Service plans developed during face-to-face meetings and negotiated between client and case manager encourage a client’s active participation and empowerment. A copy of the service plan offered to the client emphasizes the partnership necessary in the case management process.

Measurable goals and activities, taking into consideration cognitive and physical abilities, available resources, support networks, and client interest, result in a more realistic, client-specific plan. Although client signature denotes acceptance of a plan, a client may decline all or any portion of a service plan.

Documenting changes or updates to a service plan as well as actual outcomes provides a simple method of tracking client progress.

Family members and collaterals may assist in ensuring a client receives needed service. They can be included in the service plan to carry out activities.

Additional Resources

Sample Brief Service Plan form is available on the New York State Department of Health web site under the category "Clinical Guidelines, Standards, and Quality of Care."