Individual Service Plan (Isp) For Individuals With Developmental Disabilities Living In The Community Template (Page 3 of 17) in pdf

WORK, EDUCATION, AND/OR VOLUNTEER HISTORY: EMPLOYMENT FIRST-IDT members are required to offer Community

Integrated Employment Services as a priority service over other day service options for all working age adults.

Describe the individual’s successes and goals in school (past and/or current), including his/her areas of interest (e.g., favorite subjects and activities) and

particular learning style. Provide detailed information about the individual’s complete volunteer and paid work history (e.g., length of employment, job

responsibilities, strengths, preferences, and dislikes). Mention any awards or certifications the individual has received. This section is reviewed on an

annual basis to update/integrate vocational assessments into the ISP. Individuals receiving Supported Employment services are required to have a VAP.

Personal Connections/Contact People/Relationships Relevant to Work/Education and/or Volunteering:

Is the individual currently employed?_____Yes_____No. (If Yes, a career development plan must be reflected in this ISP through outcomes, action

plans and TSS to address how the individual will maintain and grow in their current position.)

Requesting additional hours of Individual Community Integrated Employment. (Explain below the reason additional hours are needed and

a plan for fading supports.)

If not currently employed, is employment desired? _____Yes_____No

If Yes, a career development plan must be reflected in this IP through outcomes, action plans and TSS to address opportunities and supports

to obtain employment or obtain VAP and/or DVR referral.

List Employment Service Options Discussed which best supports the individual:

_____Job Development

_____Self-Employment

_____Individual Community Integrated Employment

_____Group Community Integrated Employment

DVR Referral needed:_____Yes_____No (If yes, list in the action step the person or agency who will refer the individual to DVR)

No If no, develop work/education/volunteer vision, outcomes and action plans for supports for activities linked to their meaningful day description and that

may lead to work in the future.



Consider whether the individual would like to participate in a VAP to more fully explore future vocational possibilities.



Consider personal planning processes such as: MAP,PATH, Personal Profile or agency developed assessment



Give a detailed explanation of the reason why work is not desired at this time here: (How did the IDT ensure that these decisions are based on

informed choice made by the individual with assistance from the guardian?)

HEALTH & SAFETY:

Provide summary information about significant health/medical/dental/behavioral/environmental concerns (past and present) and diagnosis(es) that have

implications for planning or impact on the individual’s health and safety, including what has been done to date to address these concerns. If the

person’s health or skills are regressing, include that information here.

If Supported Living, justification should go here to address why natural supports with Respite and Customized In-Home supports will not meet the

individuals needs.

For individuals in Family Living, indicate choices regarding Adult Nursing Services here.

Reason for Referral for Adult Nursing Services for individuals who receive only Customized Community Supports and/or Community Integrated

Employment (without accessing any Living Supports) and those who receive Customized In-Home Supports are made here (Prior authorization using the

ANSPAR required)

Community Inclusion Aid justification:

Referral for Personal Support Technology: (Prior authorization from Regional Office required)

Referral for Therapy Services and BSC Services here: (Prior authorizations using the TSPAR and BSCPAR required unless it is an initial evaluation)

Individual Intensive Behavioral Customized Community Supports Referral: (Prior authorization from OBS required)

Does this individual have an existing Assistive Technology Inventory? ____Yes____No

NAME: ______ DOB: ____

EFFECTIVE DATE of ISP: ____

PAGE 3 OF 17

version 3/13

Individual Service Plan (Isp) For Individuals With Developmental Disabilities Living In The Community Template Page 3

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