© 2015 National Skill Set For Effective Case Management in AUS & NZ: Skills Workbook

2. Care Planning and Goal Setting Unskilled

Standard 1A – 1G, Standard 2A – 2F CM does not take time to explain or clarify Client’s understanding [S1A] CM cannot demonstrate how Client feedback was sought [S1A] CM is unable to demonstrate the process of utilising available information including previous assessments/referrals [S1B] CM does not discuss the priority areas identified from assessment with the Client [S1C] CM practises outside of professional scope or job role [S1C] The care plan developed by the CM and Client does not reflect the information gathered [S1C] CM does not comply with agency/ program guidelines [S1D] CM does not communicate identified risks and management strategies to Client [S1E] CM does not respect a Client’s right to the voluntary assumption of risk when the Client is competent to make this decision [S1E] CM does not individualise communication to suit the Client’s special needs [S1F] CM does not document they have discussed program information with the Client [S1F] Documentation by CM does not demonstrate ongoing person centred planning in consultation with the Client and key stakeholders [S1G] Inadequate documentation by CM of Client goals [S1G] CM is unaware of the Client’s quality of life to assist in needs identification and planning [S1G] Documentation by CM does not demonstrate communication of disengagement parameters to Client [S1H] CM does not source or provide information to the Client [S2A] CM is unable to demonstrate either knowledge of services or a strategy to determine appropriateness of services [S2A] CM cannot demonstrate research into local networks and new services [S2A] No evidence Client is involved in the decision making [S2A] CM documentation does not demonstrate Client driven initiative or decision making [S2B] CM does not discuss barriers or options with Client [S2C] CM not aware of any barriers [S2C] CM does not prepare Client for barriers [S2C] CM does not utilise supports. CM has no knowledge of program/ agency guidelines [S2C] CM identifies barriers but is unable to identify avenues to eliminate/ minimise effects of barriers [S2C] CM does not liaise with agency/key stakeholders over their risk concerns [S2C] Care plan developed by CM with focus only on the available financial resources and not the Client’s goals and needs (including individual, diverse and/or special needs) [S2D] CM is unable to justify rationale for expenditure of resources in relation to care plan and agreed goals [S2D] CM does not maintain accurate records [S2D] CM is unable to demonstrate financial management of budget to meet Client goals within the budgetary constraints [S2D] Alternative sources of funding are identifiable but no application has been made by the CM [S2D] CM does not discuss or disclose financial limitations of care plan [S2D] CM does not discuss privately paid options available to Client to procure additional services outside of the care plan [S2D] No comprehensive assessment is completed by CM. There is no demonstrable link between the Client’s goals and the CM’s assessment [S2E] CM is unable to explain how goal setting and review processes were discussed with Client [S2E]

National Skill Set for Effective Case Management Workbook

8

Chapter One