Desired Outcomes - Oregon ISP



Person’s legal name: FORMTEXT Linh Shawna TiemPreferred name: FORMTEXT ShawnaPlan effective dates: FORMTEXT 7/1/15- FORMTEXT 6/30/16One Page Profile for:Home How to best support STYLEREF PrefName2 \* MERGEFORMAT ShawnaShawna likes to have her family's privacy respected.She doesn't like to talk a lot about herself or get help from others besides her mom.Shawna doesn't like it when people come to her house and tell her how to live her life.She likes people around who know her well.Shawna needs time to respond to information. Give her some time to think about things and don't rush her.She likes to have her mom with her if there will be important information that she is meant to remember or do something about.Shawna likes to have meetings at the office and not at her home.Shawna likes meetings to be quick so that she doesn't have to spend a lot of time that she could be spending with her son, plete this page based on communicating directly with the person. If additional information is needed, include information from people who have direct knowledge of the person’s perspective. For alternate templates and additional instructions, visit 1ppWhat people like and admire about STYLEREF PrefName2 \* MERGEFORMAT ShawnaShawna is kind and considerate. She will always check in with others to make sure they are feeling well, and she loves to send thoughtful notes to those in her life.Shawna is a great cook. She loves to make dinner each night with her mom.Shawna is an immaculate housekeeper.Shawna has beautiful eyes.What is important to STYLEREF PrefName2 \* MERGEFORMAT ShawnaShawna likes her privacy and doesn't like people interfering with her life.Shawna's son, David, is her number one priority. If he is happy, she is happy.Her mom--she is very close to her.Shawna wants her son's dad to be out of her life forever.Shawna wants to keep getting help from her mom and not from anyone who don't know her.To edit the footer: NAME and EFFECTIVE DATES fields are located on the top of the One Page Profile.Before printing: View the document in “Print Preview.” This purple prompt text will disappear, which may affect page breaks.Desired OutcomesDesired OutcomeWhat is the desired result?Key steps to work toward the outcomeIs there a paid service that supports this outcome? If so, what is it?Who is responsible?TimelinesFrequency or by when?Where to record progressNote if written implementation strategies (Action Plans, Service Agreement, etc.) are expectedShawna will be able to live with her son and care for him independently.Shawna will continue to work with her mom on gaining more parenting skills.Natural Supports and other Community ResourcesShawna and her mom, AnhShawna will decide in the future when she feels she is ready to live alone with her son. She and her mom will work together to decide when she is ready.Progress NotesShawna will be able to ride the bus without getting lost.PA will add Community Transportation services (transit pass) to ISP.PA will send Shawna a bus pass each month.Stacy, Shawna’s friend, will help Shawna navigate her community safely so she will not get munity Transportation and Natural SupportsPA and ShawnaPlan start date of 7/1/15 and each month thereafter for 12 months of plan yearProgress NotesA General Business contract will be sent to Public Transit CompanyPress Tab to add additional rowsrighttopOregon is an “Employment First” state. We believe that each person:can work and there is a job for everyone.has something to contribute and needs to contribute.has the right to a competitive job in a typical community work setting, including self-employment, making comparative wages with sufficient hours to make a difference.may identify the direction of his/her employment based on skills, interests, and strengths.has a right to be informed about the employment services options that are available to him/her.To receive an employment service, you must have a goal of pursuing individual, integrated employment.00Oregon is an “Employment First” state. We believe that each person:can work and there is a job for everyone.has something to contribute and needs to contribute.has the right to a competitive job in a typical community work setting, including self-employment, making comparative wages with sufficient hours to make a difference.may identify the direction of his/her employment based on skills, interests, and strengths.has a right to be informed about the employment services options that are available to him/her.To receive an employment service, you must have a goal of pursuing individual, integrated employment.Career Development Plan (CDP)Education level completed: FORMDROPDOWN Students (age 16-20) Expected date of exit from school: FORMTEXT ????? Date by which CDP will be completed: FORMTEXT ????? FORMCHECKBOX Attending school and wants to work now. FORMCHECKBOX Attending school and receiving employment supports elsewhere. FORMCHECKBOX Has an IEP Post-Secondary Goal with employment or training focus. FORMCHECKBOX Attending school and not receiving any employment supports.Status with Vocational Rehabilitation (VR) (age 16 and up) FORMCHECKBOX Currently receiving VR services FORMCHECKBOX Want a referral to VR FORMCHECKBOX Other/Not applicable, explain: FORMTEXT ?????Working age adults (age 21-60) must choose one of the following statements: If the person is at least 18 years old and has exited school, complete this section instead of the “Students (age 16-20)” section. FORMCHECKBOX Employed in integrated employment and chooses to: Check all that apply. FORMCHECKBOX Retain current job. FORMCHECKBOX Advance in current job (more hours, raise, new skills, promotion, etc.) FORMCHECKBOX Get a new job. FORMCHECKBOX Get an additional job. FORMCHECKBOX Retire – is at least 60 or will be this ISP year. Employment Outcomes are not required. FORMCHECKBOX No longer continue in integrated employment at this time. Complete Decision Not to Explore Employment section. FORMCHECKBOX Currently not working in integrated employment and chooses to: Check all that apply. FORMCHECKBOX Get integrated employment. FORMCHECKBOX Explore interests in integrated employment through an Employment Path, Discovery, or other time-limited service. FORMCHECKBOX Retire – is at least 60 or will be this ISP year. Employment Outcomes are not required. FORMCHECKBOX Not explore integrated employment at this time. Complete Decision Not to Explore Employment section.Potential barriers to working in an individualized, integrated jobHow will this obstacle be addressed?Shawna has no barriers to maintaining her current integrated job. Things are working very well. N/ADecision Not To Explore Employment *** Not applicable; Decision Not To Explore Employment section removed. *** This section may be removed if not applicable; indicate by using the provided dropdown.Desired Employment OutcomesIs there a paid service that supports this outcome? If so, what is it?Who is responsible?TimelinesFrequency or by when?Where to record progressNote if written implementation strategies (Action Plans, Service Agreement, etc.) are expectedDesired OutcomeWhat is the desired result?Key steps to work toward the outcomeShawna works with her mom at her cleaning service.Continue with what is currently happening.Natural SupportsShawna and MomOngoingProgress NotesPress Tab to add additional rowsRisk Management PlanEmergency preparedness (natural disasters, power outages, community disasters, etc.)Preventing abuse (physical, emotional, financial, sexual, neglect)What happens if the person can’t be reached? (timelines for notifying others, who to contact, etc.)Shawna is on her county's Disaster Registry. She lives next door to her mom and would go there in case of an emergency. She has been given additional resources from her PA to respond to emergencies, including an Emergency handbook from local emergency response center and an emergency response sheet to put on her fridge to provide information to emergency responders when necessary.Shawna has a rep payee for SSI. She has good skills for being safe in the community and around strangers.Shawna’s mom is in constant contact with Shawna. If she is unable to contact Shawna and fears Shawna is in danger, she will contact 911. PA let Shawna know that she will need to contact her monthly to check on fire safety and Shawna said she would be available. If PA cannot get ahold of Shawna, she will call Shawna’s mom and see if she has heard from her.RiskX if High riskHow is the risk addressed?Fire Evacuation SafetyShawna’s PA gave her a “911” emergency sticker to put on her phone so she would remember the number to call. Her PA and Mom also reminded Shawna that if she ever smells smoke in the house or sees fire, to go outside and call “911.” Shawna’s mom will remind Shawna of this ongoing, and PA will monitor monthly until he feels Shawna has a plan she can follow safely in case of fire.Press Tab to add additional rowsDoes this person have a Nursing Care Plan? FORMCHECKBOX No FORMCHECKBOX Needed FORMCHECKBOX Yes, where found:Home: FORMTEXT ?????Work: FORMTEXT ?????Back-up Plans, in the event that primary support is not available Focus on known, significant support needs and immediate health and safety support needs of the person that must be addressed if primary support is not available. Example: Cell phone of back-up contact.HomeCall neighbor Julie Ross (555-555-5555)Work/School/Day SupportsCall neighbor Julie Ross (555-555-5555)Other: Other: Chosen Case Management Services Type: FORMDROPDOWN Chosen provider: FORMTEXT TQC BrokeragePrime number: FORMTEXT 00000003Authorized dates: FORMCHECKBOX Plan yearStart and end, if not same as plan year: FORMTEXT ?????Required frequency of case management monitoring: FORMDROPDOWN FORMTEXT ?????Case management comments/descriptors of anticipated case management services during the year; unless already described elsewhere in this plan. (Include any risks marked “Possible” on the Risk Identification Tool.): FORMTEXT PA will monitor monthly by checking in with Shawna about how she is gaining skills to respond appropriately in the event of a fire or other emergency situation. PA will also check in with Shawna to give her information about community resources that might support her to meet her Desired Outcomes, like parenting classes and children/family play groups. PA will coordinate Shawna’s ISP each year and make revisions as needed based on changes in need and desired outcomes. Person’s preference on how case management is provided: FORMTEXT Shawna likes to meet at PAs office unless absolutely necessary for PA to come to the house. Shawna likes her PA to call her mom and coordinate meetings.Natural Supports, Community Resources, and Other Voluntary Services and SupportsDescribe chosen services/supportsProvided byShawna needs support shopping for and preparing meals. She needs support to find items in the store, purchase the most cost effective items, make healthy choices, prepare ingredients and using the stove and oven safely (e.g. setting the temp and timer correctly and remembering to turn off appliances). Shawna needs support budgeting for bills and other items she needs, paying for items (monetary exchanges), and managing her finances so she pays her bills on time and in the correct amount. Shawna needs support to communicate effectively with people in her community to conduct business (i.e. utilities companies, banks, medical professionals) and to understand complicated information she receives from day to day so that she can make informed decisions about her life. Shawna needs support for reading and writing. She can read some signs, but needs support for most information, especially if it is complicated.(Mom) Anh TienSupport for navigating the community while on the bus. Shawna needs support reading signs and finding her way to and from her destination. She needs support for communicating effectively with the bus driver, waiting safely at the bus stop, finding the proper bus route and knowing when to get on and off the bus.Stacy (Shawna’s friend)Shawna needs support at work to stay on task, knowing what tasks need to be completed, and finishing a task to completion. She is very skilled at most all the tasks at work, but needs periodic redirection from her mom. She needs support to learn new tasks and support for transportation to all the places she needs to go while performing her work (i.e. she goes from place to place while performing cleaning duties).(Mom) Anh TienPress Tab to add additional rowsChosen State Plan Personal Care (SPPC) services *** Not applicable; State Plan Personal Care section removed. *** This section may be removed if not applicable; indicate by using the provided dropdown.Chosen K Plan Services ------ This section may be removed if not applicable; indicate by using the provided dropdown.Service Element & Service Code# UnitsUnit Type (Hour(s), Mile(s), Day(s), Each, Event(s), Dollars)Per(Day, Week, Month, Plan year)Authorized datesChosen provider type(s) & current rate(s)PSW, independent contractor, provider organization, general business, etc.Same as plan yearStart and end, if not same as plan year149-OR554-Svc Rlt Com Trans,Indv Transit Pass-1EachMonth?---General Business ($35/mo)List needs identified by the needs assessment that this service will address:Shawna needs support navigating the community; reading signs and finding her way to and from her destination. She might become lost or confused without support while riding the bus, so she needs someone to help her get to and from her destination safely; getting on and off at the correct spot, and waiting safely at the bus stop.Person’s preference on how this service is delivered: Shawna wants her bus pass mailed to her mom's house each month.Shawna has a friend, Stacy, whom she wishes to help her while navigating the community. Shawna trusts Stacy and Stacy is very skilled at navigating the bus routes.Chosen Waiver Services *** Not applicable; Waiver services section removed. *** This section may be removed if not applicable; indicate by using the provided dropdown.Chosen K Plan Residential Service *** Not applicable; Residential services section removed. *** This section may be removed if not applicable; indicate by using the provided dropdown.Additional Chosen ServicesUse to record General Fund services as well as overflow for any of the above Chosen Services.Describe service setting, service code, # units, frequency, authorized dates, and chosen provider type as applicableList identified needs that this service will addressPerson’s preference on how this service is deliveredNone at this timePress Tab to add additional rowsDifferences Note any differences between the contents of this plan and what the person wants. Consider if a change to this plan is needed to address the difference(s) and describe the decision.N/ANote any differences between the contents of this plan and what any other ISP contributor wants. Consider if a change to this plan is needed to address the difference(s) and describe the decision.N/ALegal RelationshipsParent(s) of minor child who retain parental rights: FORMTEXT N/ALegal Representative/Guardian(s), if any: FORMTEXT N/AScope of authority: FORMTEXT N/ADesignated Representative(s) for service planning, if any: FORMTEXT N/ADesignated Representative(s) for employer representative/employer of record issues, if any: FORMTEXT N/AHealth Care Representative, if any: FORMTEXT N/AAppointment Date: FORMTEXT N/A FORMCHECKBOX Self-Appointed FORMCHECKBOX ISP Team AppointedRepresentative Payee(s), if any: FORMTEXT Anh TienConservator(s), if any: FORMTEXT N/AAny other Legal Documents on file limiting personal decision making: FORMTEXT N/AAcknowledgments Describe the supports the person needs to understand his/her rights or to understand this plan, if any: Indicate who will be responsible for supporting the person and timelines for completing this.Check here if no support is needed FORMCHECKBOX Shawna needs help reading and writing and understanding complex information. Her mom will help her understand her plan and support her to advocate for the chosen services she wants to meet her needs.Person Receiving Services YesNoDeclinedDoes this ISP reflect the services the person chooses and the outcomes the person wants to work toward? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Has the person been provided information about the planning process and how to request changes and updates to the ISP? FORMCHECKBOX FORMCHECKBOX Did the person choose the location of their ISP meeting? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Did the person choose who participated in their ISP development? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Did the SC/PA review the services that are available to the person? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Did the person receive notification of his/her DHS rights? FORMCHECKBOX FORMCHECKBOX Families and/or Guardian who provide support YesNoN/ADoes this ISP reflect what is needed for the family to effectively provide supports? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX ISP Team – Does this ISP reflect…YesNoIndependence: Having control and choice over one’s own life. FORMCHECKBOX FORMCHECKBOX Integration: Living near and using the same community resources and participating in the same activities as, and together with, people without disabilities. FORMCHECKBOX FORMCHECKBOX Productivity: Engaging in contributions to a household or community; or engaging in income-producing work that is measured through improvements in income level, employment status, or job advancement. FORMCHECKBOX FORMCHECKBOX Describe the reason for any question above remaining “no” and the plan to address it:N/AAgreement to this PlanThese people agree to this plan and associated documents as reflecting the person’s strengths and preferences, support needs as identified by an assessment, and the services and supports that will assist the person to achieve identified desired outcomes.Services Coordinator/Personal Agent/ODDS Residential Specialist: Ensure the plan meets the person’s current service needs and complies with requirements for the chosen service setting(s) and associated funding.Providers: Agree to implement and provide the supports that have been designated as their responsibility in this ISP. A signed contract, job description, or service agreement may be used in lieu of this signature page.NameRelationship to this personPresent at meeting?SignatureDateComments STYLEREF FirstName \* MERGEFORMAT Linh Shawna TiemSelf / Person Receiving ServicesYesRory CaptainPersonal AgentYesAnh TiemMomYesYes or NoYes or NoYes or NoYes or NoYes or NoYes or NoYes or No ................
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