Care Plan Template Page 3
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1
2
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4Agency Key
Date
Objective/Goal/
Timescale for
How progress will be
Tasks required to achieve
Named worker
Objective
Workers
objective set
Issue
achievement
measured
objective
supporting client
Outcome & date
making up the
with the
with Tasks or when a
-
care team for
client
referral is required
this plan
Name it here
Fergus O’Shea
27.6.11
Referral to inpatient
By 28.6.11
Referral Form
Fill in the referral form and
Cuan Dara
Referral posted
SMT Kilkenny
detox Cuan Dara
completed and
meet the criteria for admission
28.6.11
posted
Participation 2x a week in pre-
Susie Allbright,
Admission to
admission week to detox
Intake Counsellor
Cuan Dara
group in Kickham Street
16.7.11
Attended pre-
admission group
Fergus O’Shea
27.6.11
Stabilise from 70mls
Fortnight
Attendance records
Kilkenny Methadone
Achieved 50mls
SMT Kilkenny
to 50mls methadone
15.7.11
to clinic on daily basis
Comprehensive Assessment
Clinic
methadone
daily in order to
28.6.11
Counsellor
12.7.11
enter inpatient detox
Urines/Swabs
in Cuan Dara
Attend clinic GP/Nurse for
Nurse/GP
Attendance 1.1
assessment & care plan 30.6.11
Attended clinic 12
counselling sessions
sessions
Induction to the Methadone
DEO
Self-report
Clinic
Attended
counselling
Detox agency report
Provide 3 ‘6 am’ samples of
Nurse
sessions: 7
of attendance pre-
urines
sessions
admission
Swabs analysis daily at clinic
Nurse
Completed
1.1 counselling session 3x week
Counsellor
urine/swabs
samples
Fiona
25.5 11
Improve level of
Over 12 week
Self-report
Attend all literacy classes within
Referred to SMT
Course work
Fitzpatrick
reading and writing
course
the 12 week programme
following
suspended until
VEC
VEC Teacher Report
problematic drug
Client finishes
use: Colin Masters
detox programme
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