Rosie D.
Reforming the Mental Health System in Massachusetts

Step 7:  The Care Plan


The final step along the Pathway to Home-Based Services is the completion of a care plan that sets forth the child’s treatment goals and describes in detail the services to enable him or her to meet those goals, as well as the providers who will deliver those services.


The care planning team will develop a single care plan that focuses on the strengths of the child and family.  This plan must integrate all other agency plans to ensure that all services are coherent and coordinated. 


Every child’s plan will include the following components:


·         a description of the child’s treatment goals and objectives, and the timetables to achieve those goals;

·         a description of the home-based services to be provided, and specifically, the frequency and intensity of those supports; and

·         the identification of the appropriate service providers and a description of the specific services they will deliver; and

·         the integration of the child and family’s crisis plan.


Single Care Plan


For children served by multiple agencies or providers, the care plan will integrate the plans, services, and coordination from these entities into a single treatment plan that is used to plan, coordinate, provide, and monitor all services for the child.  The plans from different agencies must be integrated or incorporated into the single care plan.


Click here for Step 8, Covered Services


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