ScenarioPlusby Waiver Academy
‹ Support Coordination

Pocket guide · Case management

Support Coordination

Her plan. Her choices. Your follow-through.

  1. Ask the person firstA person-centered plan starts with the person. Speak to them directly, ask what they want, and write their goals in their own words. Family input matters, but it doesn't replace the person's voice. Episode 1: Her Plan, Her Words
  2. The person chooses the providerPeople have the right to choose their providers. Share the full list, explain the options without steering, and help them visit or meet staff. Never favor a provider because of a relationship, a referral deal or convenience. Episode 2: Choice of Provider
  3. Check what's really happeningMonitoring means more than ticking boxes. Ask the person how their services are going, look at whether the goals are being worked on, and follow up with the provider when something isn't right. Document what you found and what changed. Episode 3: The Monitoring Visit
  4. Follow up on missing servicesWhen approved services aren't delivered, the person misses out. Track hours used against hours approved, ask the provider for a plan, follow up on a set date, and remind the person they can change providers if it doesn't improve. Episode 4: Hours Not Delivered
  5. Support decisions, don't take themAdults have the right to make their own choices, including some risk. Unless a court has said otherwise, the person decides. Help families voice their worries, and build supports that make the person's choice safer instead of replacing it. Episode 5: Mom Disagrees
  6. Update the plan when needs changePlans aren't only updated once a year. When someone's needs change, review and update the plan promptly, arrange any interim supports, and tell the person they can ask for a review whenever their life changes. Episode 6: A Change in Need
  7. No gifts from providersSupport coordinators must stay neutral. Politely decline gifts from providers and follow your agency's conflict-of-interest rules. If you're unsure, ask your supervisor and document what you did. Episode 7: The Gift Basket
  8. Have a back-up plan that people knowEvery plan needs a back-up for when staff don't arrive: who to call, in what order. A back-up plan only works if the person knows it and can find it. Review it with them, and report missed visits to the provider. Episode 8: Back-Up Plan
  9. Report concerns right awayIf you suspect abuse or neglect, report it right away through your state's required process. You don't need proof. Reassure the person, act to keep them safe, and stay involved while it's looked into. Episode 9: Something Isn't Right
  10. Celebrate progress, set new goalsAn annual review looks at what the person achieved, what helped and what didn't, and what they want next. Celebrate progress, update the plan in the person's own words, and keep building toward the life they choose. Episode 10: The Annual Review