Model for the Coordination of Services to Children and Youth
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GUIDELINES TO BE FOLLOWED
BY EDUCATION, HEALTH
HUMAN RESOURCES & EMPLOYMENT
JUSTICE 
PERSONNEL TO FACILITATE THE IMPLEMENTATION
OF THE
INDIVIDUAL SUPPORT SERVICES PLANNING PROCESS

NOVEMBER 1997

GUIDELINES TO BE FOLLOWED
TO FACILITATE THE IMPLEMENTATION OF THE
INDIVIDUAL SUPPORT SERVICES PLANNING PROCESS

The Departments of Education, Health, Human Resources and Employment and Justice adopted the Model for the Coordination of Services to Children and Youth in 1995. Subsequently, the Ministers' signed an interdepartmental protocol endorsing the components of the Model setting departmental directions for a common child specific planning process known as the Individual Support Services Planning Process (ISSP). The Guidelines to facilitate implementation of the Interdepartmental Services Planning Process will apply to all employees of the Departments of Education, Justice, Health and Human Resources and Employment and to all individual providing professional services under contract to any of these Departments during the individual support services planning process. The Guidelines will also bind all boards and agencies established by, and subject to the jurisdiction of, any of the four Departments.

The following statements outline the key components of the ISSP process which are to be implemented by each department and its respective agencies ensuring implementation of this element of the Model.

  1. The ISSP process is a collaborative, integrated approach to planning and delivery of services to child/youth at risk or in need.
  2. The ISSP is a process with a preventative approach, designed to promote early intervention to respond to children at-risk and children and youth with special needs.
  3. Children at risk include those who have an identified congenital or acquired handicap or health challenge; infants and preschool children in families with interaction and/or social problems; children at risk of developmental delay in the adaptive, social, motor, cognitive or language areas; and/or circumstances which indicate that one or more of the following risk factors are present:
    • inadequate pre-natal care,
    • lifestyle - either parent or child,
    • lack of stimulation,
    • poor parental support,
    • academic failure,
    • truancy and other school problems,
    • low literacy, low level of education,
    • lone parent, teen parent headed household,
    • known genetic risks,
    • atypical development,
    • birth trauma/birth defects,
    • identified disability,
    • known health conditions,
    • childhood trauma,
    • child abuse/neglect,
    • conflict with the law,
    • learning difficulties.
  4. The process will apply to children 0-21 and may apply at the pre-birth stage where circumstances warrant.
  5. The ISSP process will replace all existing departmental planning processes directed at services to children and youths (e.g. General Service Plans, Care Plans, Case Plans, Program Plans).
  6. The ISSP is a working plan which identifies strengths, needs, child-specific goals, context-specific interventions, accountability and time frames for completion of objectives.
  7. The precise elements of the ISSP are contained in the Coordination of Services to Children and Youth in Newfoundland and Labrador Individual Support Services Plans (September 1997).
  8. Stages in the process of planning for children and youth shall include: screening and identification; assessment and exploration of strategies; establishment of an Individual Support Services Planning Team; team meeting; development and implementation of the Individual Support Services Plan; monitoring and review of the plan.
  9. The Individual Support Services Planning Team shall be composed of the child, parent/guardian, service provider(s) and other relevant parties as determined by the needs of the child. There may be exceptions to the general rule of participation in the following circumstances:
    • The Child may be excluded from the Team or from an Individual Team meeting where:
      1. the child chooses not to participate,
      2. child's level of development indicates that he/she is unable to constructively participate in the process,
      3. the child has demonstrated in a prior meeting(s) that he/she is unable to constructively participate in the process from a behaviourial perspective, or
      4. the information to be shared between the team members and the parent/guardian is considered harmful to the well-being of the child or to the family-child relationship.
    • Parent/guardian may be excluded from the Team or from a Team meeting where:
      1. he parent/guardian voluntarily chooses not to become involved, or
      2. where the participation of the parent/guardian is considered detrimental to the welfare of the child or harmful to the parent/child relationship.
    • Service Providers may be excluded from the Team or from a Team meeting where:
      1. they are not actively involved in the provision of services to the child, or
      2. where a single service provider has been designated as the representative of multiple service providers from a single agency.
    • Non-governmental personnel shall be excluded from individual Team meetings where the information may only be shared among government personnel in accordance with the Freedom of Information Act and the Interdepartmental Protocol on Information Sharing.
    • Any individual may be excluded from the Team or from a Team meeting where: the child/youth or parent/guardian does not provide consent for the sharing of information to such persons.
  10. The composition of the team is determined by the nature and complexity of the child's needs. Whenever possible the number of team members is to be kept to a minimum. Service providers in attendance at Team meetings should be those most directly involved in the delivery of services to children and/or youth. Where there is more than one professional from an agency serving the child, each agency may designate a single representative as a team member or spokesperson.
  11. An ISSP Team will be established when a child/youth at risk or with special needs receives a service. The Team membership will expand as other service providers become involved.
  12. The Team shall be headed by an Individual Support Services Manager who may be the parent/guardian, child, service provider or relevant other. The selection of the Individual Support Services Manager is made by the Team, based upon the individual's:
    • understanding of and commitment to the role,
    • ability to facilitate a collaborative and team approach,
    • ability to maintain contact with those involved in the case,
    • projected ability to remain as a Team leader for the duration of the Team's activities,
    • ability to support the involvement of ALL members equally,
    • knowledge of related services and supports.
  13. The ISSP Manager will be responsible for:
    • scheduling meetings,
    • determining membership of the team,
    • ensuring the profile is completed and sent to the Regional Child Services Coordinator,
    • facilitating the ISSP meetings,
    • ensuring the ISSP is written and signed during meeting,
    • ensuring the issues and concerns regarding the ISSP process are constructively communicated to the Regional Integrated Services Management Team,
    • setting the date of the next meeting,
    • utilizing a problem solving approach during the planning process,
    • accepting written reports from members who cannot be present and tabling them at the team meeting,
    • maintaining the child's ISSP file when such is active.
  14. The child's needs will be profiled in accordance with the process outlined in the document Coordination of Services to Children and Youth In Newfoundland and Labrador: Profiling the Needs of Children and Youth, with particular attention to the following categories of need:
    • academic learning difficulties,
    • attendance problems,
    • behavioral difficulties,
    • cognitive delay,
    • developmental delay (0-8),
    • environmental needs,
    • gifted,
    • hearing impaired,
    • health difficulties,
    • learning difficulties,
    • mental health needs,
    • physical difficulties,
    • speech/language difficulties,
    • victimization,
    • visual difficulties,
    • any other factors which may put child "at risk".
  15. Information will be shared in accordance with the Protocol on Information Sharing (1997), as agreed to by the Departments of Education, Health, Justice and Human Resources and Employment.
  16. The Team shall develop an Individual Support Services Plan which must be agreed to and signed by all members. The Plan will contain a record of the team membership, a consensus of the child's strengths and needs, prioritized goals, responsibility for implementation, the environment/context in which implementation will occur, date of review, service needs, and service options.
  17. The Team shall meet at least twice annually and may meet more often if warranted by the needs of the child.
  18. The ISSP may be continued, extended or discontinued by the Team during the review of the Plan. Where the Plan is discontinued and the Team dissolved, the ISSP Manager shall include a letter of explanation in the child's file.
  19. Records shall be maintained in accordance with the procedures outlined in the documents Coordination of Services to Children and Youth in Newfoundland and Labrador: Individual Support Services Plan (September 1997) and Information Sharing Protocol (1997).

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