Youth Service Plan DOE/90 Day

Better Together Mesa

Service Plan (Due DOE and every 90 days)
Youths Name*

First NameLast Name
Today's Date*

MonthDayYear
Date
Facility Name*

KJ House
Participation ID Number*
Date of Birth*

MonthDayYear
Date
Date of Intake*

MonthDayYear
Date
Service Plan Timeline*

Initial Service Plan90 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*

NoneAggression AwarenessFamilyIndependent LivingTherapeutic SocializationSubstance AbusePsychiatric/PsychologicalMotivation TherapyOther
Explain Other
Services Recommendations*

NoneEmploymentGEDCommunity College4 Year CollegeVocational TrainingJPTAJob CorpsSportsCreative ArtsOther
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 NameLast Name
Case Manager Email*
example@example.com
Staff Name*

First NameLast Name
Tags

To doIn ProgressDone
Should be Empty:

Better Together Mesa