Episodes of extreme Anxiety and Panic attacks
Need help filling out Jim is 18 years old and experiences episodes of extreme anxiety and panic attacks. He says this is his PTSD from a childhood car accident where both his parents were killed and he was severely injured, leaving him with hearing impairment. He has never been to counselling because he says “it is too hard to talk about”. He regularly engages in alcohol and cannabis misuse, which he says helps him calm down. However, he has recently been charged with disorderly conduct and public intoxication and spent a night in the watchhouse. He misses many days after a hard night of drinking and smoking and he once arrived at work under the influence of cannabis. His boss has said he is at risk of losing his job.
ndividual Support Plan
Client Name: ________________________________________Contact no: ___________________
Ethnicity: (circle) Aboriginal Torres Strait Islander
Aboriginal and Torres Strait Islander Other culture: (please specify)
Primary Case Worker: _________________________________Contact no: ___________________
Support worker(s):
Other agencies: ________________________________________________
Other agencies: _________________________________________________
Nominated family support person: ______________________________________________________
Contact details for family support person: ________________________________________________
This Case Management Plan has been developed in consultation with: _________________________
_________________________________________________________________________________
What support will be provided?
Within the organisation: _____________________________________________
By other agencies: _____________________________________________
For approximately how long will support be required?
Within the organisation: _____________________________________________
By other agencies: _____________________________________________
Commencement date for plan: _____________________________________________
Review date for individual case plan: _____________________________________________
People to be involved in review meeting: _________________________________________________
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INDIVIDUAL’S SUPPORT NEEDS
Individuals skills/knowledge/attributes/experience: __________________________________________
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Physical and mental Health needs, e.g. medications, conditions: ______________________________
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Behavioural needs, e.g. diagnosis and related medication: ___________________________________
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Physical/transport needs, e.g. restricted mobility: ___________________________________________
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Recreational needs, e.g. sporting interests: _______________________________________________
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Relationships with partner/family: _______________________________________________________
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Communication needs: _______________________________________________________________
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Justice/Legal issues: _________________________________________________________________
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Cultural needs: _____________________________________________________________________
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Other needs: __________________________________________________________________________________
Client’s desired or expected outcomes:
__________________________________________________________________________________
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Short-term (ST) goals:
1. ______________________________________________________________________________
______________________________________________________________________________
2. ______________________________________________________________________________
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3. ______________________________________________________________________________
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Long-term (LT) goals:
1. ______________________________________________________________________________
______________________________________________________________________________
2. ______________________________________________________________________________
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RISK MANAGEMENT PLAN
What risks are involved in implementing the plan? Mark the level of risk, e.g. high, medium and low.
__________________________________________________________________________________
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How will risks be assessed and managed? ________________________________________________
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Who will manage risks? _______________________________________________________________
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Who are the clients’ support networks? __________________________________________________
What is the clients’ motivation level for change? ____________________________________________
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What are the barriers that may prevent change? ___________________________________________
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MEASURING AND EVALUATING PROGRESS IN ACHIEVEMENT OF INDIVIDUAL GOALS
The organisation will measure progression towards achieving these goals in the following manner:
Short-term (ST) goals:
1. Indicators: _____________________________________________________________________
______________________________________________________________________________
2. Indicators: _____________________________________________________________________
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3. Indicators: _____________________________________________________________________
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Long-term (LT) goals:
1. Indicators: _____________________________________________________________________
______________________________________________________________________________
2. Indicators: _____________________________________________________________________
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SUPPORT PROVIDED
AREA OF SUPPORT Y/N
ID/BIRTH CERTIFICATE/OTHER DOCUMENTS
CLOTHING
FOOD/VOUCHER
ACCOMODATION OR SHORT TERM RESPITE
FINANCIAL ASSISTANCE OR ASSIST TO SECURE CENTRELINK BENEFITS
TRAVEL CARD/SMART RIDER
PREPARE FOR COURT APPEARANCES
MEDICAL NEEDS AND/OR DOCTOR APPOINTMENT
MENTAL HEALTH ASSESSMENT
SCHOOL ENGAGEMENT AND/OR ENROLMENT
ACCESS TO SCHOOL RECORDS
REFERRAL TO OTHER SERVICES
INVOLVEMENT IN RECREATION/SPORTS
CREATE SAFETY PLAN/PROTECTIVE BEHAVIOUR PLAN
ADVOCACY OR REPRESENTATION SERVICES
OTHER (PLEAASE SPECIFY)
CASE PLAN REVIEW
1. Reviewed by: ___________________________________________________________________
2. Proposed dates for review: ________________________________________________________
3. Actual date of review: ____________________________________________________________
4. Names and Signature of people involved in the review:
Name:___________________________________ Signature:_______________________________
Name:___________________________________ Signature:_______________________________
Name:___________________________________ Signature:_______________________________
POST REVIEW RECOMMENDATIONS:
1. _____________________________________________________________________________
2. _____________________________________________________________________________
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