Support coordination is a direct service that is intended to coordinate the delivery of all services and supports provided by DSPD and identified in the Person Centered Support Plan. The categories listed above represents all of the knowledge, skills and abilities that are needed to coordinate the services for the person in services.
The purpose of Support Coordination is to assist people who are enrolled in one of DSPD’s service delivery programs or waivers to select supports and services that address their needs, help them accomplish their personal goals and live a self-directed life.
Support Coordinators use the Person Centered Support Plan (PCSP) process to describe the supports and prescribe the services that are delivered to the person over its twelve month duration. The plan also contains information about the person’s personal preferences, the assessments that have been used to identify supports and services, and the personal goals the person wants to achieve in life. As a result, the plan represents a holistic view of what the person wants and needs to move forward in their life over the next twelve months.
After the plan is implemented, the Support Coordinator monitors the person’s progress in achieving their personal goal (s), the status of their health and safety, and the manner in which the services are being delivered. If the person’s needs change over the course of the plan cycle, then the support coordinator documents the changes in the plan. Changes can involve the amount or duration of a specific service, the terms or conditions by which the provider / employee delivers the support, the nature and focus of the person’s goal, etc.
The Support Coordinator’s primary means for monitoring the person’s plan is to visit them at the locations in the community where they live, work and engage in recreational activities. They also communicate with the provider / family who oversee the delivery of the person’s services to determine if they are being implemented as specified in the plan. Based on the provider’s / family’s report, the support coordinator approves the billing invoices used to document how much of each service the person received during the month or two week billing period. In addition to reviewing invoices, the support coordinator monitors the person’s spending in order to ensure they use the funds as they are prescribed in the plan and have enough funding to last the entire twelve month plan cycle.
The Entry Into Services process consists of the following:
Eligibility Review (both state eligibility and level of care eligibility)
Changing the person's status to "In Services"
Completing the SIS Assessment
Generating a Request for Services (which details the service codes, rates and units the person needs)
Building the person's pro forma budget.
Creating the Initial Plan (in conjunction with holding the person's first planning meeting)
Establishing the person's financial eligibility
The Person Centered Support Planning process defines what the person's goals will be, how paid and non-paid supports will help the person achieve their goals and how they will be kept healthy and safe.
After the person's goals and supports are identified, the budget specifies how they will be funded by defining the service code's rate and units.
When the plan comes to the end of its 12 month cycle, the support coordinator review's the plan's goals, supports and services to determine what, if any of its content, should be continued in the new plan cycle.