The goal for team membership is to have a balance of natural (informal) support people such as relatives, friends and neighbors and service providers such as therapist, teacher, and social worker. To qualify for team involvement, individuals should:
- Have a role in the lives of the child and/or family
- Be supportive of the child and family
- Be approved for membership by the parent
- Be committed to the process (includes regular attendance at meetings, participation in decisions, and involvement in the plan of care)
1. Assessment & Planning
Phases of Team Involvement
2. Ongoing Monitoring
- Intensive team involvement consisting of team meetings at least once every two weeks, lasting no longer than 60 minutes each (for approximately 2 months)
- Determine strengths and needs of the child, family, and team
- Complete Assessment Summary, which assesses 12 areas of the child and family’s life, including: Living Situation; Basic Need/Financial; Family; Mental Health; Social; Community; Cultural; Spiritual; Educational; Legal; Medical; and AODA
- Develop Plan of Care. The team selects the top three priorities from the Assessment Summary domains—these are then the areas of focus in the Plan of Care
- Develop Crisis Response Plans for home and school. In developing crisis response plans, teams preplan crisis intervention with the people and/or agencies who may be involved in the crisis resolution—outlining responsibilities and communication procedures
3. Transition & Closure
- Implementation of the Plan of Care. When the plan is completed, it will be reviewed, approved, and signed by all team members—once this occurs, the plan will be implemented.
- Team provides on-going support and monitoring; meeting when necessary to review the plan, progress toward goals, and need for plan modification. Teams typically meet every 3 to 6 weeks, depending on individual team’s needs (the statutory minimum is at least every 6 months). This phase typically lasts 6-9 months
- The family has knowledge of and access to services and a voice in decisions that are made about their child and family.
- Team develops a Transition Plan, which focuses on planning around long-term services the family will continue to use or will need to access after the formal team process has ended
- Team provides minimum contact and monitoring, typically meeting every 2 to 3 months (statutory minimum is at least every 6 months)
- Formal team participation is ended. Once families feel they know how to plan for the future (they have ownership of their plan) and no longer need the support of the team, the formal team process should end
- Family utilizes community support network. The family knows who to contact and how to get their needs met without the ongoing support of a formal team
- Family members become part of an alumni effort. Family members may choose to participate in alumni efforts which could include advocating for other families, helping coordinate a support group, and participating on a Coordinating Committee.