Individual Service Plan (Isp) For Individuals With Developmental Disabilities Living In The Community Template Page 15
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17INDIVIDUAL-SPECIFIC TRAINING REQUIREMENTS: OTHER SUPPORTS
For each targeted area, document the urgency of training, as follows:
For each IDT member who must complete training, specify the type, as follows:
1 – Prior to working with the individual
A – Awareness level (e.g., obtains basic familiarity with the plan)
2 – Prior to working alone with the individual
K – Knowledge level (e.g., learns specifics strategies/techniques)
3 – Within 30 days of working with the individual
S – Skill level (e.g., demonstrates ability to follow procedures)
4 – Other (specify)
TOPIC AREA
WHO RECEIVES TRAINING
URGENCY
TYPE
WHO PROVIDES TRAINING
Case Manager
SAFETY
EMERGENCY PROCEDURES
Residential Staff
EMERGENCY CONTACTS
INCIDENT REPORTING
Day Support Staff
EVACUATION AND ESCAPE ROUTES
Ancillary Supports:
STATUS OF RIGHTS (E.G., PRIVACY)
OTHER (SPECIFY):
Others:
Case Manager
CHOICE
Residential Staff
SKILL LEVEL
LEVEL OF INFORMED CONSENT
Day Support Staff
LIKES, DISLIKES, AND PREFERENCES
Ancillary Supports:
OTHER (SPECIFY):
Others:
Case Manager
COMMUNICATION
Residential Staff
METHODS OF COMMUNICATION
EXPRESSIVE AND RECEPTIVE PREFERENCES
Day Support Staff
KEY VOCABULARY
PERSONAL SPACE AND TOUCH
Ancillary Supports:
OTHER (SPECIFY):
Others:
Case Manager
STRENGTHS AND CAPABILITIES
Residential Staff
ACTIVITIES OF DAILY LIVING
INTERESTS AND HOBBIES
Day Support Staff
SUPPORT STRATEGIES
Ancillary Supports:
OTHER (SPECIFY):
Others:
Case Manager
LEARNING STYLE
Residential Staff
ENVIRONMENTAL FACTORS
MOTIVATORS
Day Support Staff
PROMPT LEVELS
VISUAL/AUDITORY/TACTILE PREFERENCES
Ancillary Supports:
OTHER (SPECIFY):
Others:
Case Manager
INDIVIDUAL SERVICE PLAN
Residential Staff
IDT MEMBER ROLES AND RESPONSIBILITIES
NARRATIVE SECTION
Day Support Staff
ACTION PLANS
STRATEGIES
Ancillary Supports:
OTHER (SPECIFY):
Others:
Case Manager
SUPPORT NETWORK
Residential Staff
NATURAL SUPPORTS
COMMUNITY SUPPORTS
Day Support Staff
VISITATION RIGHTS
Ancillary Supports:
OTHER (SPECIFY):
Others:
Case Manager
CULTURAL/SPIRITUAL VALUES AND BELIEFS
Residential Staff
SPIRITUALITY
CULTURAL PREFERENCES
Day Support Staff
TRADITIONS AND CELEBRATIONS
Ancillary Supports:
OTHER (SPECIFY):
Others:
Case Manager
MEDICATIONS
LEVEL(S) OF SUPPORT
Residential Staff
ROUTE-SPECIFIC INFORMATION
PURPOSES
Day Support Staff
SIDE EFFECTS
Ancillary Supports:
ALLERGIES
OTHER (SPECIFY):
Others:
NAME: ______ DOB: ____
EFFECTIVE DATE of ISP: ____
PAGE 15 OF 17
version 3/13
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