Planning and Implementation Resource Manual

							                       Planning and Implementation Resource Manual
                                      Feedback Form

In order to collect information about the people who are providing feedback regarding the
Planning and Implementation Resource Manual, please mark one of the following
categories that most closely describes you:

   Person Receiving DMRS Services                     Family Member

   Legal Conservator                                  Paid Advocate

   Residential Provider/Direct Support Professional   Day Provider/Direct Support Professional

   Personal Assistance Provider/Direct Support        Therapeutic Services Provider
   Professional
   Behavior Analyst or Behavior Specialist            Nurse/Medical Professional

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For each identified Section or Appendix of the manual, please provide suggested
improvements, identify missing information and identify information that should be
deleted as well as the reasons you are making the suggestions. Please note that some
Appendices cannot be altered as they are current policy. These have not been included as
a part of this feedback process. Your participation in this process is greatly appreciated
and will ensure a useful final product that will help us all improve the quality of
Individual Support Planning and Implementation.
                                     Section One
                         Pre Admission Evaluation Plan of Care

   The information in this section is acceptable.
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   change(s):

I believe these changes are needed because:



                                       Section Two
                             Initial Individual Support Plan

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                                     Section Three
                                  Assessments – ICAP

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                                     Section Three
                                   Assessments – Risk

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                                     Section Three
                               Assessments – Therapeutic

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                                    Section Three
                                Assessments – Behavior

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                                   Section Three
                          Assessments – Healthcare Oversight

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                                    Section Three
                               Assessments – Vocational

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                                      Section Four
                                 Pre-Planning Activities

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                                     Section Five
                          Annual Individual Support Planning

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                                      Section Six
                               Behavior Support Planning

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                                     Section Seven
               Individual Support Plan Review and Service Authorization

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                                  Section Eight
           Implementation and Documentation of the Individual Support Plan

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                                   Section Nine
               Monitoring Implementation of the Individual Support Plan

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                                    Appendix B4
                      Family Model Residential Services Tip Sheet

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   change(s):


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                                   Appendix B5
                 Supported Living With Live In Companion Tip Sheet


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   change(s):


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                                    Appendix B6
                     Supported Living with Shift Staffing Tip Sheet

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                                     Appendix B7
                           Residential Habilitation Tip Sheet

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                                     Appendix B8
                           Semi-Independent Living Tip sheet

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                                   Appendix B9
           Determining the Amount of Personal Assistance Needed Tip Sheet

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                                      Appendix C3
                Possible Indicators for Therapeutic Service Assessments

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                                    Appendix C4
                           Therapeutic Services Plan of Care

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                                    Appendix C4a
                    Therapeutic Services Plan of Care with Actions

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   change(s):


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                                    Appendix C5
                               Behavior Issues Tip Sheet

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                                     Appendix C8
                           Vocational Evaluation Instructions

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                                     Appendix C9
                            Vocational Assessment Tip Sheet

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                                    Appendix D1
                           ISP Meeting Preparation Checklist

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                                      Appendix E1
                            Personal Focus: Home Tip Sheet

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                                    Appendix E2
                       Personal Focus: Day Activities Tip Sheet

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                                    Appendix E3
         Personal Focus: Relationships and Community Membership Tip Sheet

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                                   Appendix E4
                Personal Focus: Chronic Medical Conditions Tip Sheet

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                                     Appendix E5
                          Personal Focus: Allergies Tip Sheet

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                                    Appendix E6
                      Personal Focus: Mealtime Issues Tip Sheet

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                                   Appendix E7
           Personal Focus: What Else is Important to This Person Tip Sheet

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                                    Appendix E8
                Personal Focus: Personal Funds Management Tip Sheet

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                                     Appendix E9
                      Personal Focus: Decision Making Tip Sheet

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                                    Appendix E10
                       Personal Focus: Communication Tip Sheet

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                                    Appendix E11
      Personal Focus: Other Important Things That Supporters Should Know Tip Sheet

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   change(s):


I believe these changes are needed because:



                                   Appendix E12
        Action Plan: Personal Outcomes and Supports for Daily Life Tip Sheet

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                                    Appendix E13
                            Action Plan: Actions Tip Sheet

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                                     Appendix E14
 Action Plan: Making Outcomes, Goals and Actions Measurable and Meaningful to the Person
                                        Tip Sheet

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                                     Appendix E15
                                     Rates Tip Sheet

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                                    Appendix F1
               Documentation Criteria for Residential, Day, PA, Respite
                          and Behavioral Respite Services

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                                   Appendix F2
             Monthly Review of Progress – Residential and Day Providers

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                                    Appendix F4
                    Monitoring Implementation of Behavior Services

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                                       Appendix F5
                  Staff Instructions – Other Important Things to Know

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   change(s):


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                                     Appendix F6
                            Monitoring Therapeutic Services

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   change(s):


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                                       Appendix I1
                                Staff Instructions Sample

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   change(s):


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                                      Appendix I2
                          Staff Instructions – Communication

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   change(s):


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                                       Appendix I3
                              Staff Instructions – Mealtime

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                                      Appendix I4
                                     Staff Schedule

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