Short Term Planning List Plan

Short Term Planning List Plan

Date Completed:

Name: / DOB:
Address:
City: / State: / Zip:
Phone: / County of residence:
Family or guardian name:
Address:
City: / State: / Zip:
Phone:

Current Daily Activities and Environment:

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People Map for

______/ / Family
People who support the person at work, school, training / People whose job is to support the person at home and other places
Person’s Name
Friends

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What is important to ______, include what they are saying with words and behavior

/ What is important to ______. This includes what others see as important to help the person be a valued member of the community
My Introduction – What people like and admire about me. What are the good things they say about me? How would I like to be introduced?
What are the characteristics of people who support me best?
What do others need to know or do to support me (If I am going to have the things that are important to me, and stay healthy and safe, what do people need to know about me? What do they need to do? How do I need to be supported at home, at work, and I am out in the community?
What needs to stay the same?
What needs to change?

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PERSON CENTERED THINKING SKILLS
Where people communicate more clearly with behavior…
What is happening / ______does / We think it means / And we should
Are there communication strategies that work best?

ACTION PLANS

DESIRED OUTCOME 1

HOW WILL THIS BE ACCOMPLISHED

DESIRED OUTCOME 2

HOW WILL THIS BE ACCOMPLISHED

DESIRED OUTCOME 3

HOW WILL THIS BE ACCOMPLISHED

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