"Person Centered Recovery Plan - Dmhas Wise Program" - Connecticut

Person Centered Recovery Plan - Dmhas Wise Program is a legal document that was released by the Connecticut Department of Mental Health & Addiction Services - a government authority operating within Connecticut.

Form Details:

  • Released on January 20, 2009;
  • The latest edition currently provided by the Connecticut Department of Mental Health & Addiction Services;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Connecticut Department of Mental Health & Addiction Services.

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Download "Person Centered Recovery Plan - Dmhas Wise Program" - Connecticut

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DMHAS WISE Program
Person Centered Recovery Plan
Initial Plan
Final Plan
Client Name:
Goal #:
Date Goal Established:
Linked to
Assessment dated
Participant’s Desired Goal (Note: In the person’s own words):
Strengths:
Barriers:
Objective:
Specific Services/Activities/Supports/Tasks
Provider/Service Type Intervention & Purpose
Frequency,
Intensity
Duration
(Actions by person served/staff/ and natural supports)
(e.g., 1X/wk)
(e.g., 30 min.)
(e.g., for 3
mos.)
Objective:
Specific Services/Activities/Supports/Tasks
Provider/Service Type Intervention & Purpose:
Frequency,
Intensity
Duration
(Actions by person served/staff/ and natural supports)
(e.g., 1X/wk)
(e.g., 30 min.)
(e.g., for 3
mos.)
DMHAS WISE Program
Person Centered Recovery Plan
Initial Plan
Final Plan
Client Name:
Goal #:
Date Goal Established:
Linked to
Assessment dated
Participant’s Desired Goal (Note: In the person’s own words):
Strengths:
Barriers:
Objective:
Specific Services/Activities/Supports/Tasks
Provider/Service Type Intervention & Purpose
Frequency,
Intensity
Duration
(Actions by person served/staff/ and natural supports)
(e.g., 1X/wk)
(e.g., 30 min.)
(e.g., for 3
mos.)
Objective:
Specific Services/Activities/Supports/Tasks
Provider/Service Type Intervention & Purpose:
Frequency,
Intensity
Duration
(Actions by person served/staff/ and natural supports)
(e.g., 1X/wk)
(e.g., 30 min.)
(e.g., for 3
mos.)
Client Name:
Recovery Plan
Goal #:
Date Goal Established:
Linked to
Assessment dated
Participant’s Desired Goal (Note: In the person’s own words):
Strengths:
Barriers:
Objective:
Specific Services/Activities/Supports/Tasks
Provider/Service Type Intervention & Purpose
Frequency,
Intensity
Duration
(Actions by person served/staff/ and natural supports)
(e.g., 1X/wk)
(e.g., 30 min.)
(e.g., for 3
mos.)
Objective:
Specific Services/Activities/Supports/Tasks
Provider/Service Type Intervention & Purpose:
Frequency,
Intensity
Duration
(Actions by person served/staff/ and natural supports)
(e.g., 1X/wk)
(e.g., 30 min.)
(e.g., for 3
mos.)
01/20/09
page_____ of _____
Client Name:
Recovery Plan
Client Involvement:
I have actively participated in the development of this assessment/plan.
I have had an opportunity to review it and to ask questions.
I have been offered a written copy to keep for my reference.
Comments:
Client Signature: ____________________________________________________________________________
Date: ____________________
Community Support Clinician Signature: ________________________________________________________ Date: ____________________
Community Support Clinician & Credential (please print):
Representative Signature: _____________________________________________________________________
Date: ____________________
Representative Name & Relationship (please print):
Reviewer/Supervisor Signature: ________________________________________________________________ Date: ____________________
Strengths = Past accomplishments, current aspirations, personal attitudes, attributes, etc. which can be used to help accomplish goals.
Barriers = Challenges to reaching the goal. Be certain to identify barriers as a result of the mental illness or addictive disorder. You may also identify resource or environmental
barriers.
Objectives = Incremental step toward goal/measure of progress. HOW will person know they are making progress? Using action words, describe the near-term specific changes
expected in measurable and behavioral terms. Include the target date for completion, e.g., “Within 90 days, Mr. S will…”
NOTES: Participation in services is NOT an objective; Maximum of 2-3 objectives per goal recommeded
Services/Activities/Action Steps = Consider Action Steps Person in Recovery will take; Services to be Provided by STAFF; Services/Assistance to be provided by Natural
Supporters. Include PURPOSE of support.)
01/20/09
page_____ of _____
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