Course Title: Implement goal directed care planning

Part B: Course Detail

Teaching Period: Term1 2014

Course Code: HWSS5716C

Course Title: Implement goal directed care planning

School: 365T Global, Urban & Social Studies

Campus: City Campus

Program: C0045 - Vocational Graduate Certificate in Community Services Practice(Client assessment & case management)

Course Contact : Bronwyn Tanti

Course Contact Phone: +61 3 9925 9079

Course Contact

Name and Contact Details of All Other Relevant Staff

Nominal Hours: 75

Regardless of the mode of delivery, represent a guide to the relative teaching time and student effort required to successfully achieve a particular competency/module. This may include not only scheduled classes or workplace visits but also the amount of effort required to undertake, evaluate and complete all assessment requirements, including any non-classroom activities.

Pre-requisites and Co-requisites

None required.

Course Description

This course describes the knowledge and skills required to plan care for clients through provision of services and resources aimed at maximising and enhancing their independence and quality of life. This course may apply to work in a range of community sector contexts where high level care planning skills and knowledge are required.

National Codes, Titles, Elements and Performance Criteria

National Element Code & Title:

CHCCM702B Implement goal directed care planning


1.Undertake care planning to address identified client needs and goals

Performance Criteria:

1.1Work with client to identify realistic and relevant goals as a basis for care planning
1.2Undertake care planning to address identified goals and in line with needs assessment and document in line with organisation requirements
1.3Undertake consultation with other organisation representatives to plan care in complex situations where multi-organisation involvement is required
1.4Ensure care plan recognises and supports person's strengths and abilities as well as addressing their needs
1.5Recognise and respect person's right to self-determination within legal parameters
1.6Plan care in consultation with the person, their carer/s and family, friends or others involved in advocacy or decision-making on their behalf
1.7Support person to make informed decisions about their care, reflecting understanding of their current situation, probable future situation and ensuing care needs
1.8Investigate range of options available to address client-identified needs and achieve their goals
1.9In conjunction with client, structure a range of services in a manner that supports informal care arrangements such as family support, and support of friends and/or neighbours
1.10Devise alternative strategies to meet identified client needs when specific services are not available
1.11Provide the person with cost details as required and work with them to ensure care plan is within their financial resources
1.12Identify work health and safety (WHS) risks and plan for their management
1.13Write care plan and clearly identify all work tasks and who is to perform them


2.Implement care plan in conjunction with relevant others

Performance Criteria:

2.1Seek and obtain person's consent before undertaking any referrals
2.2Provide person with clear understanding of available services and choices, so they are an informed participant in all stages of care planning
2.3Work in collaboration with appropriate professionals and organisations to ensure services are provided in a manner that maximises person's potential for achieving their goals and addresses identified needs
2.4Ensure planning clearly articulates roles and responsibilities of each service provider, including coordination role/s
2.5Maximise involvement of client and carer/s in care planning processes and decision-making
2.6Ensure effective involvement of relevant health/ community services professionals in care planning where clients have chronic or complex needs
2.7Establish and maintain communication strategy and processes to ensure effective implementation of care plan
2.8Ensure mechanisms are in place to support sharing of information between organisations and maintenance of updated information to all involved organisations
2.9Support and develop person's ability to independently access alternative resources to ensure their needs are addressed in an appropriate manner


3.Monitor implementation of client care plan

Performance Criteria:

3.1Regularly monitor planned services, support and resources against client-identified goals to ensure effective implementation of their care plan
3.2Ensure appropriate level of rapport and communication with client is maintained as required to support disclosure of information regarding delivery of services and resources in line with care plan
3.3Maintain collaborative relationships with clients, carers and other service providers to support people with complex needs
3.4Promptly identify problems with implementation of care plan and make adjustment as necessary to best meet person's needs
3.5Document and report any variations to care plan in line with organisation requirements and communication strategy


4.Undertake review of care plan

Performance Criteria:

4.1Respond appropriately to informal monitoring of health and well being of the person and/or their carer by volunteers, carers or family
4.2Undertake regular and systematic reviews to ensure assessed needs of clients are being addressed effectively
4.3Use regular reviews to re-prioritise client needs for service and to ensure equitable access based on ongoing appraisal of prioritised needs
4.4Contribute to adjustments in care plan in response to changes in client or carer health; review of risk management/WHS needs; or as specified in person's care plan or as required by personal circumstances


5.Respond appropriately to diversity

Performance Criteria:

5.1Ensure care planning for CALD and Aboriginal and Torres Strait Islander clients is culturally sensitive
5.2Ensure appropriate interpreter support is provided in line with organisation protocols
5.3Where appropriate, work in conjunction with ethno-specific and multicultural organisations and with Aboriginal and Torres Strait Islander communities and organisations
5.4Recognise and support the role of these organisations in linking their communities into the service system
5.5Where appropriate involve Aboriginal and Torres Strait Islander community and/or organisation representatives in the care planning process


6.Respond appropriately to people with different levels of need including those with complex needs

Performance Criteria:

6.1Facilitate access to assessment for people with different levels of need including those in complex circumstances and identified as having high levels of need
6.2Maintain and promote inter-organisation relationships and agreements as appropriate to address client, family and carer needs
6.3Ensure care planning builds on person's strengths and motivation to improve their quality of life


7.Evaluate client outcomes

Performance Criteria:

7.1Undertake periodic evaluation of care planning based on analysis of outcomes
7.2Obtain information from clients, carers, families and other service providers to determine progress and evaluate against identified goals in care plan
7.3Take into account adjustments made to services and resources to better address person's ongoing situation and changing needs
7.4Ensure evaluation includes determination of client satisfaction, comparison of costs against benefits received and assessment of quality and effectiveness of service delivery and case management components
7.5Work with person to evaluate ongoing support needs to meet their goals, including review of parameters for disengagement, where applicable
7.6Demonstrate accountability for adjustments to the care plan and associated financial outcomes
7.7Identify opportunities for person to maintain or develop independence within any aspects of their overall care
7.8Document and report quantifiable impacts experienced by person as a result of implementation of care plan and indicate how client-centred outcomes have been achieved

Learning Outcomes

On successful completion of this course you will have developed and applied the skills and knowledge required to demonstrate competency in the above elements

Details of Learning Activities

You will be involved in learning activities in a day long workshop. Activities will include group discussions, critique of reading material and self-reflection exercises. Reflecting on your own work context is a significant aspect of this course, and you will be given opportunities during the workshop to discuss and think about your practice.

Teaching Schedule

There are 10 workshops scheduled for this program.  Workshop 4 covers this unit.
WorkshopTitleDateExplanatory NotesUnit(s) of Competency
4Case management of complex cases, including risk assessment and responseMay 2014This workshop explores knowledge and skills required to plan care for clients through provision of services and resources aimed at maximising and enhancing their independence and quality of life. Complex situations to be explored include unemployment, financial distress, homelessness, or drug or alcohol misuse, disability, mental health, child abuse and domestic violence.

CHCCM702B: Implement goal directed care planning (E1, E2, E3, E4, E5, E6 and E7)

CHCCM703A: Apply effective case management practice. (E1, E2, E3, E4, E5, E6)

Learning Resources

Prescribed Texts

None required


Other Resources

A set of readings will be made available to you prior to each workshop. These readings will be available in Blackboard.

Overview of Assessment

Assessment for this course is based on a written case plan for a client.

Assessment Tasks

This unit has been clustered (grouped) for assessment. For this unit CHCCM702B – Implement goal directed care planning you will be required to complete the relevant sections of one assessment task as described below:

Case Plan Task: for this course you will be required to write a case plan for a client. Your case plan will outline goals, objectives, activities to achieve goals, timelines and responsibilities, and others involved. You will need to describe and critique how you undertook the initial and ongoing client assessments, from the first stage of determining eligibility, priority and need for services as part of a case management process or as part of an assessment service.

Further details of how assessment tasks are mapped to individual units of competency are available from the Program Coordinator.

Assessment Matrix

The assessment matrix demonstrates alignment of assessment tasks with the relevant Unit of Competency. These are available from the Program Coordinator. This program in delivered in accordance with competency-based assessment, grades include:

CA: Competency Achieved
NYC: Not Yet Competent
DNS: Did Not Submit for assessment

Other Information

Assessment Tasks Submission Cover Sheet
You must complete a submission cover sheet for every piece of submitted work, including online submissions. This signed sheet acknowledges that you are aware of the plagiarism implications.

It is strongly advised that you attend all workshops in order to engage in the required learning activities, ensuring the maximum opportunity to gain the competency.

You will receive verbal and written feedback by teacher on your work. This feedback also includes suggestions on how you can proceed to the next stage of developing your competency. Information regarding student feedback can be found at:;ID=9pp3ic9obks7

Student Progress
Monitoring academic progress is an important enabling and proactive strategy to assist you to achieve your learning potential. The student progress policy can be found at:;ID=vj2g89cve4uj1

Special consideration Policy (Late Submission)
All assessment tasks are required to be completed to a satisfactory level. If you are unable to complete any piece of assessment by the due date, you will need to apply for an extension. Information regarding application for special consideration can be found at:;ID=g43abm17hc9w

Academic Integrity and Plagiarism
RMIT University has a strict policy on plagiarism and academic integrity. For more information on this policy go to Academic Integrity Web site:;ID=kw02ylsd8z3n

Course Overview: Access Course Overview