EXAMPLE INTEGRATED CASE PLAN
INTEGRATED CASE PLANNING
GOAL: The goal of the Integrated Case Plan is to reduce risk of recidivism though the development of an individualized plan that matches the participant to
effective interventions to address his or her own risks and needs, as identified by validated and standardized assessments. The Integrated Case Plan achieves this
by:
Explicitly identifying for the participant and the team the areas that the participant needs to address to reduce his/her risk of recidivating as identified by
validated and standardized assessments.
Developing clear and explicit individualized goals that a participant can work toward to make progress toward reducing risk of recidivism
Helping the participant and the members of the multidisciplinary team focus their individual treatment, case management, supervision, and recovery
coaching plans to support the overall goals of the case plan.
Providing a clear framework to assess and measure a participant’s progress.
Documenting interventions and strategies used to address risk factors and achieve goals and objectives.
PROCESS:
1. The initial assessments will be completed and reviewed with participants within the first 30 days of entry (sooner if possible):
a. The PPO will complete the criminogenic risk/needs assessment as part of the initial screening process to drug court and will review with the
participant again after plea. Upon completion and review, the PPO will enter relevant information into the Case Plan document.
b. The Therapist will complete the clinical assessment and review with the participant, entering relevant information into the Case Plan document.
c. The Case Manager will complete the DLA-20 and review with the participant, entering relevant information into the Case Plan document.
1. The Case Manager and the participant will identify 2-3 risk areas to address during that phase and develop a goal for each area. Goals will be written as
SMART goals and designed to be achievable within that Phase.
2. The participant will share each goal with the therapist, PPO, and (when applicable) Recovery Coach and develop objectives to meet each goal and address
critical responsivity factors.
3. The participant and CM will review the draft Case Plan, and the CM will review with the team for feedback and/or approval. In the event of significant
feedback, the participant will meet jointly with members of his team to discuss recommended changes.
4. Upon approval of the Case Plan, Treatment and Case Management Plans will incorporate the objectives developed in the Case Plan, detailing more specific
objectives and interventions to achieve the larger objective and overall goal.
5. The CM will upload the Integrated Case Plan in to AIMS.
6. The participants’ team members will review the Case Plan with the participant on a regular basis to assess progress and make changes as necessary. Lack
of progress and recommended changes will be discussed with the participant and team.
7. At court hearings, team members will report on progress on the objectives outlined in the Case Plan.
8. For Phase Promotion, the participant will meet the Identified Goals and objectives.
9. A new Plan will be developed each Phase. Substance Use will be addressed during each phase.
10. In the event of significant lack of progress, Integrated Case Plans will be reviewed during Care and Concern, Small Team Case Conferences, and Large Team
Case Conferences and adjusted as necessary. Progress toward these goals will be reviewed at the end of the agreed-upon time period as the team
discusses and makes recommendations regarding a participants’ status.
5.3.19 version
EXAMPLE INTEGRATED CASE PLAN
Participant Name: Program Start Date: Date:_____________
Moderate or High Risk Factors from Assessment – Date of Screen:
Risk Factor Details
X Substance Use
□ Education/Emp/Financial
□ Social Support (Family)
□ Neighborhood Problems
□ Peer Associations
□ Criminal Attitudes and
Behavior Patterns
Substance Use Disorder/Clinical Assessment – Date of Assessment:
Primary Drug of Choice: Current Recommended Level of
Care (ASAM criteria):
Other Drugs Used:
On MAT: □ yes: □ not indicated □ no/interested □ no/not interested
MH/Trauma Sx: □ yes □ no
Additional Diagnosis:
Treatment Goals
Case Management Assessment – Date of Assessment:
Dimension
Behavioral
Communic
Substance
Productivi
Resources
Grooming
Nutrition
Manage.
Network
Problem
Hygiene
Housing
Solving
Leisure
Comm.
Money
Coping
Norms
Health
Health
Family
SCORE
Sexual
TOTAL
Safety
Social
Dress
ation
Skills
Time
Use
ty
Score
Goal?
DLA-20 Score <6.3? Refer for ANSA? Y / N; If “no” provide rationale:
5.3.19 version
EXAMPLE INTEGRATED CASE PLAN
Name: _________________________________________ Integrated Case Plan for Phase _____ Date: _________
Indicate Risk areas to be targeted during this phase along with specific details:
X Substance Use:
□ Attitudes, Values, Beliefs:
□ Peer Associations:
□ Personality Characteristics:
□ Family:
□ Education/Employment:
□ Leisure/recreation:
Responsivity Factors to be addressed:
□ Instability or Lack of Social Supports (e.g. safe housing, etc.):
□ Mental Health Symptoms:
□ Medical/Health Needs:
□ Transportation:
□ Motivation:
□ Insurance:
□ Child Care/Family Needs
□ OTHER ________________________________________________________________________________________________________________
Resiliency factors that support success:
□ ___________________________________________________________________________
□ ___________________________________________________________________________
□ ___________________________________________________________________________
5.3.19 version
EXAMPLE INTEGRATED CASE PLAN
Name: _________________________________________ Date: _________
GOALS PHASE ___ Treatment Objectives Case Management Objectives Probation and/or Recovery Coach
Review in ____ Days Objectives
Area of Focus: SUBSTANCE USE
GOAL:
Responsivity factors to address:
Area of Focus:
GOAL:
Responsivity factors to address:
Area of Focus:
GOAL:
Responsivity factors to address:
Area of Focus:
GOAL:
5.3.19 version
EXAMPLE INTEGRATED CASE PLAN
Responsivity factors to address:
Area of Focus:
GOAL:
Responsivity factors to address:
Area of Focus:
GOAL:
Responsivity factors to address:
Area of Focus:
GOAL:
Responsivity factors to address:
_____________________________________________________________ ____________________________________________________
Participant Signature Date CM Signature Date
5.3.19 version
