CTI Phase Plan
CTI Phase Plan
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|Date phase starts: ____ / ____ / ____ | Due date for end of phase: ____ / ____ / ____ |
| |(blank for pre-CTI) |
|CHECK THE GOALS FOR THIS PHASE: (Choose only 1 to 3 areas) |
|Psychiatric treatment/medication management | | Housing crisis prevention & management | | |
|Daily Living Skills training | |Natural supports/social supports intervention | | |
|Benefits/money management | |Medical Care | | |
|Substance Use Treatment | |Legal issues | | |
|GOAL #1 ____________________ |
|Reason for this goal: |
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|Strategies: |
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|Overall goals: |
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|GOAL #2 ____________________ |
|Reason for this goal: |
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|Strategies: |
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|Overall goal: |
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|GOAL #3 ____________________ |
|Reason for choosing this goal: |
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|Strategies: |
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|Overall goal: |
|Phase #: _____ Phase Plan Date: ____________ Client’s Name: ____________________________ |
|Medicaid Number:_______________ Record Number: __________________ Client DOB: __________________ |
|SUMMARY OF GOALS IN EACH AREA |
|Describe the progress made in each area that was identified for the previous phase and whether it will be a focus of the next phase. Include |
|achievements and obstacles to connecting the individual to supports and improving his/her skills in that focus area and whether listed objectives were |
|met. Complete this section at the end of Phase 1 and Phase 2 only. Use this information to plan for the next phase. |
|At the end of Phase 3, write the Closing Progress Note instead. |
|Goal #1: _______________________________________ |
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|Goal #2: _______________________________________ |
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|Goal #3: _______________________________________ |
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CTI Worker signature/credentials: ___________________________ Date: ____________
CTI Client signature/credentials: ____________________________ Date: ____________
Supervisor signature/credentials: ____________________________ Date: ____________
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