General Provisions for All DMH Services Planning Activities

(1) Planning activities incorporate strengths, preferences, service needs and goals of clients, and where appropriate, of their families and include assessments, the development and review of individual service plans and community service plans. Clients who receive Case Management will have individual service plans developed in accordance 104 CMR 29.06 and 104 CMR 29.07. Clients who receive DMH community services will have community service plans developed in accordance with 104 CMR 29.06 and 104 CMR 29.11. (2) DMH Services planning activities are: (a) trauma informed, person centered, and strength based; and when the client is a youth, are also youth guided and family driven; (b) sensitive and responsive to a client's cultural, ethnic, linguistic background, sexual orientation, gender identity, parental status, and other individual family needs, where appropriate; (c) based on the results of assessments which are reviewed and modified as the client's service needs, preferences or circumstances change; (d) informed by information obtained through interactions with the client, when appropriate the client's family, other natural supports, and the client's service providers with the appropriate authorizations, as well as previous records as available; (e) conducted in the client's preferred language by staff fluent in the language or through competent interpreters; and (f) coordinated with the client, the client's legally authorized representative, current and potential service providers, other Department staff, and any other person, including family members, whose participation is requested or consented to by the client or the client's legally authorized representative. (3) The goals of DMH Services planning activities are to: (a) promote client recovery and resiliency; (b) identify the services, treatment and other community supports a client needs that are culturally competent and age and developmental-stage appropriate; (c) facilitate or provide access to those services, treatment, and supports, including strategies to ensure client engagement in such services; and (d) ensure that the provision of services is consistent with the client's strengths, preferences, service needs, and goals, is provided in the least restrictive setting possible, and promotes community participation and independence to the fullest extent possible. (e) identify goals demonstrating successful completion of service and plans for transition. All planning activities will be conducted in partnership with clients, client’s families as authorized, and client’s legally authorized representatives. Clients will be: (a) engaged and supported to participate actively in the planning processes to the maximum extent possible; (b) present at all applicable planning and review meetings, unless client is unwilling or unable to attend; (c) encouraged and assisted to engage family members or other persons of the client's choice to participate; and (d) encouraged to identify and discuss their goals, preferred services and programs during planning meetings and shall otherwise be supported to participate in a meaningful way in the discussions and decision making process. When clients are unable or choose not to take part in a meaningful way in planning activities, steps shall be taken to minimize obstacles to such participation. Such steps may include, but are not be limited to: (a) developing plans for increasing the ability of clients to participate; (b) modifying the schedule or structure of the meetings or making other accommodations designed to increase client participation; (c) educating clients to facilitate and increase their participation; and (d) continuing to actively engage clients in ways that assist them to make choices regarding their services to the maximum extent possible.