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1、.Appendix ETRANSITION PLANSTATE RESOURCE CENTERSName: Identification Number: Date Plan Developed: Plan Updated: Anticipated Date of Transfer: Transition Plan Meeting Participants: Exit Staffing Participants: I. Essential SupportsEssential supports are supports that are absolutely essentia
2、l to health and safety and make the difference between success and failure for the individual. They are required to be in place before a person moves.In this section, list all essential health and safety supports that must be in place prior to the person moving to the new facility.I. ESSENTIAL SUPPO
3、RTS (Due prior to move)MEDICAL_ PSYCHIATRIC / MENTAL HEALTH VOCATIONALBEHAVIORAL HEALTHHOUSING / RESIDENTIAL CASE MANAGEMENT / COMMUNITYFINANCIAL /MONEY MANAGEMENT TRANSPORTATIONEDUCATIONAL LEISURESOCIAL/COMMUNITYADVOCACYFAMILY SUPPORTPERSONAL ASSISTANCE SERVICESLEGALOTHERII. Non-essential Sup
4、portsNon-essential supports are other supports that the person/guardian/IDT believe are important enough to the person that they must be in place within 60 days following the move; or, they will not support the move happening.In this section, list these other supports that the person would like, and
5、 staff believe the person needs, but which are not essential to have in place prior to the move. The non-essential supports must be in place within 60 days following the move. Need to verify that these supports are meaningful and realistic.II. NON-ESSENTIAL SUPPORTS (due within 60 days following mov
6、e)MEDICALPSYCHIATRIC / MENTAL HEALTH VOCATIONALBEHAVIORAL HEALTHHOUSING / RESIDENTIAL CASE MANAGEMENT / COMMUNITYFINANCIAL /MONEY MANAGEMENTTRANSPORTATIONEDUCATIONAL LEISURESOCIAL/COMMUNITYADVOCACY·FAMILY SUPPORTPERSONAL ASSISTANCE SERVICESLEGALOTHERIII. Activities of TransitioningI
7、n this section, list:· Activities that will need to be done before the move. · Whatever steps are necessary to verify the supports essential to health and safety (from section I above) are in place prior to the move· Projected transition activities following the move.For each item, sp
8、ecify who at the RC is responsible and the time frame in which it is to be completed.Required activities are included in the formIII. ACTIVITIES OF TRANSITIONINGIV. Crisis PlanIn this section, list:o People at the Resource Center that the fa
9、cility can contact in a crisis situation.o Community resources that the facility might contact in a crisis situation.· Possible interventions (these would be specific to the person and would be specific to concerns that the Team might have about the person's need for interventions in a cris
10、is situation.CRISIS PLAN AND CONTACT INFORMATIONCOMMUNITY PROVIDERSTATE RESOURCE CENTERCOMMUNITY RESOURCESFAMILYTRANSITION AGREEMENTThe State Resource Centers (RC) and Community Provider mutually agree to provide the essential and non-essential supports and services developed for _ as outlined in th
11、e RC Transition Plan dated 6/8/06. (Client) (Plan Date)Essential supports will be in place, provided by State Resource Centers Waiver for (Community Provider)_ care upon transfer. (Client) The Resource Center will provide support (ability for the provider to call RC and for RC to respond to requests
12、 for assistance) and follow-up, as described in the Transition Plan. Non-essential supports will be in place no later than 60 days following _s transfer to the community. Residential Community Provider Information:Name:State Resource Centers WaiverAddress:Phone:_Provider RepresentativeDate_RC RepresentativeDate*;