Developing Personal Goal Plans And The Recording Progress

Personal Goal Plans

The personal goal plan is a "living" document that clearly articulates the goals of the consumer, that lists specific steps the consumer and the peer counselor will take so that the stated goals can be reached, identifies person(s) responsible for each step, and sets the target date for completion and review. The development of the personal goal plan should include the participation of not only the consumer (to the best of their ability), but of other service providers (of the consumer's choice) involved in the consumer's treatment.

An important part of the personal goal plan is the section that specifies the steps of the behaviors that the consumer will engage in to accomplish his or her stated goals. It is here that personal goal plans are individualized. It is here that the strengths of the consumer will be translated into action. It is best to formulate treatment goals in terms of the presence of a coping behavior, not the absence of a symptom. Goals therefore become something to work toward (in the future), not something you work away from (in the past).

The personal goal plan guides the direction of treatment and is the focus of the majority of the Peer Support Counselor's interactions and scheduled activities with each consumer. The final plan is signed and dated by the consumer, the peer counselor, and by any other service providers responsible for the treatment specified in the plan. The plan is facilitated and signed by the Friends Connection Supervisor and reviewed by the Clinical Manager.

• Individuals with disabilities need to develop skills and supports to fulfill the demands of their living, learning, social and working environments. The Friends Connection is founded on the principles of consumer choice and the active involvement of consumers in their rehabilitation.
• A personal goal plan is signed by the program participant and expresses his or her preferences for goals, objectives and priorities.
• Initial plan must be developed within 20 days of the individual being accepted as a member of the Friends Connection. This plan is completed with the program participant, the assigned Peer Support Counselor, a Friends Connection Supervisor, and other support persons of the participant's choice.

Progress Notes

The progress note is the vehicle by which staff documents the progress the consumer is making toward the achievement of his or her goals. Notes are a "snapshot" of the consumer's progress and setbacks experienced on the journey toward goal attainment, and chronicle the following:

• Document the activity that took place including appropriate clinical and activity codes, duration of face-to-face contact, travel time and billable units.
• Document consumer's participation in the activity and plan for next face-to-face contact.
• Record significant changes made by the consumer with respect to the outcome focus areas and stated goals;
• All notes relate to consumer strengths, needs and goals stated in the personal goal plan.
• Record significant events with respect to Friends Connection activities as they pertain to outcome focus areas and stated goals;
• Purpose and outcome of collateral contact with other agency service providers.
• Reviews of consumer progress, service plan updates, etc. with consumer, staff, and/or other service providers.

The process notes are a chronological record of events and observations relevant to the consumer's strengths and needs with respect to overall progress in meeting program goals.

Criteria And Concurrent Review For Continued Stay

Personal goal plans are reviewed on a regularly scheduled basis (every 3 months) with each program participant. Program Supervisors conduct the review to assure that the person is progressing in the program and that goals and benefits of the program have been maximally achieved.

Next step: Discharge Planning And Developing A Plan For Independence