Better Together Mesa
Service Plan (Due DOE and every 90 days)
Youths Name
*
First Name
Last Name
Today's Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Facility Name
*
KJ House
Participation ID Number
*
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date of Intake
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Service Plan Timeline
*
Initial Service Plan
90 Day Service Plan
Program Progress
Family Outreach Update/Plan
*
Describe contact youth has with any family and plan to include family in program participation
Better Together Recommendations
Counseling Recommendations
*
None
Aggression Awareness
Family
Independent Living
Therapeutic Socialization
Substance Abuse
Psychiatric/Psychological
Motivation Therapy
Other
Explain Other
Services Recommendations
*
None
Employment
GED
Community College
4 Year College
Vocational Training
JPTA
Job Corps
Sports
Creative Arts
Other
Explain Other
Goals and Objectives
Youth Specific Goals and Time Frames
*
Provide a Summary of Program Progress
*
Plan for post-discharge
*
Identify the transition plan (if any) for the youth after program discharge
Additional Comments/Notes
Person or Person's responsible for Implementing service plan
*
Person's Role in Implementation:
Case Manager Information
Case Manager Name
*
First Name
Last Name
Case Manager Email
*
example@example.com
Staff Name
*
First Name
Last Name
Tags
To do
In Progress
Done
Print
Submit
Should be Empty: