Assessor Resource

CHCCM702B
Implement goal directed care planning

Assessment tool

Version 1.0
Issue Date: March 2024


This unit may apply to work in a range of community sector contexts where high level care planning skills and knowledge are required

This unit 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

You may want to include more information here about the target group and the purpose of the assessments (eg formative, summative, recognition)

Prerequisites

Not Applicable


Employability Skills

This unit contains Employability Skills




Evidence Required

List the assessment methods to be used and the context and resources required for assessment. Copy and paste the relevant sections from the evidence guide below and then re-write these in plain English.

The evidence guide provides advice on assessment and must be read in conjunction with the Performance Criteria, Required Skills and Knowledge, the Range Statement and the Assessment Guidelines for this Training Package.

Critical aspects for assessment and evidence required to demonstrate this unit of competency:

The individual being assessed must provide evidence of specified essential knowledge as well as skills

This unit of competence will be most appropriately assessed in the workplace or in a simulated workplace and under the normal range of workplace conditions e.g. writing care plans based on case studies, writing case notes based on case studies

Assessment may be conducted over one or more occasions and should include both the development and promotion of best practice

Access and equity considerations:

All workers in community services should be aware of access, equity and human rights issues in relation to their own area of work

All workers should develop their ability to work in a culturally diverse environment

In recognition of particular issues facing Aboriginal and Torres Strait Islander communities, workers should be aware of cultural, historical and current issues impacting on Aboriginal and Torres Strait Islander people

Assessors and trainers must take into account relevant access and equity issues, in particular relating to factors impacting on Aboriginal and/or Torres Strait Islander clients and communities

Context of and specific resources for assessment:

This unit can be assessed independently, however holistic assessment practice with other community services units of competency is encouraged

Resources required for assessment include access to:

an appropriate workplace where assessment can take place

simulation of realistic workplace setting

Method of assessment:

Assessment may include observation, questioning and evidence gathered from the workplace setting

Examination of written examples of care plans and written examples of case notes


Submission Requirements

List each assessment task's title, type (eg project, observation/demonstration, essay, assingnment, checklist) and due date here

Assessment task 1: [title]      Due date:

(add new lines for each of the assessment tasks)


Assessment Tasks

Copy and paste from the following data to produce each assessment task. Write these in plain English and spell out how, when and where the task is to be carried out, under what conditions, and what resources are needed. Include guidelines about how well the candidate has to perform a task for it to be judged satisfactory.

This describes the essential skills and knowledge and their level required for this unit.

Essential knowledge:

The candidate must be able to demonstrate essential knowledge required to effectively do the task outlined in elements and performance criteria of this unit, manage the task and manage contingencies in the context of the identified work role

These include knowledge of:

Literature on models and practices in goal-directed care planning

The range of services, resources and holistic solutions available to clients with complex needs

Components of service delivery system

Gaps in the service system

Characteristics and needs of identified client population

Significance of the service setting, such as working in the client's home

Organisation policies and practices relating to care planning

Professional standards/code of ethics and relevant legislative requirements

Government legislation, regulations, policies and standards

Documentation requirements and practices

Duty of care requirements when developing and implementing care plans

Current research in area of practice

Essential skills:

It is critical that the candidate demonstrate the ability to:

Work within professional standards and applicable government legislation, regulations, policies and standards

Use data drawn from a range of client needs assessment information as a basis for planning care services to address client needs

Review and apply outcomes data as a means to continually improve practice and make adjustments to care plan

Practise in an ethical manner noted by professional discipline or defined ethical standards

Work within guidelines for currently identified best practices

Minimise client dependency by developing their self management skills

Examine issues related to sustainability of care to address client's level of need

Demonstrate actions to support improvement/maintenance of quality of life for clients

Navigate the service delivery system to meet client needs and support encouragement of client independence where possible

Apply communication and leadership skills with providers to services and resources meet client needs

Maintain client confidentiality when engaging stakeholders

In addition, the candidate must be able to effectively do the task outlined in elements and performance criteria of this unit, manage the task and manage contingencies in the context of the identified work role

These include the ability to:

Demonstrate application of skills in:

consultation, liaison and negotiation

analysis of assessment and other data

report, case note and care plan writing

liaison with other organisations and service providers

facilitation

advocacy

The Range Statement relates to the unit of competency as a whole. It allows for different work environments and situations that may affect performance. Add any essential operating conditions that may be present with training and assessment depending on the work situation, needs of the candidate, accessibility of the item, and local industry and regional contexts.

Care planningmay include, for example:

Identifying range and type of specific services to be provided

Planning details of each specific service to be provided, such as

domestic assistance

respite

nursing care

Consideration of WHS and risk management issues and strategies to address these

Referral strategies as required to address breadth of client needs

Information about services, resources or activities the client may follow up independently, such as:

Health promotion

Local social or active living opportunities

Self management strategies and activities

Self-referral to other services

Complex needs may refer to:

Client needs requiring multiple service types with heightened needs for collaboration between service providers

Clients with a range of needs that may not be met by available services and resources

Clients who have family and carer needs that require additional service inputs

People who have broad range of care needs related to chronic and/or multiple health issues and who require assistance to access the service system as well as a high level of ongoing advocacy

People in complex circumstances and identified as having high levels of need may refer, for example, to:

Families with children with disabilities where a number of different organisations are providing support

People with disabilities with a diverse range of needs arising from physical and behavioural causes

People with disabilities requiring the development of appropriate responses for personal and/or respite care

People with complex medical issues which may pose critical issues for assessment and care planning

Older people with chronic illness and unstable health conditions requiring coordinated management across acute, sub acute and community health sectors

Older people with dementia and/or other cognitive impairment

Older people who are extremely socially isolated and withdrawn

Circumstances involving difficult WHS issues for community sector workers

People with mental health issues, whose functional limitations may fluctuate substantially over time

People with psychiatric disabilities where inter-organisation agreements may be required to access specialist assessment expertise

People with family and carer needs that require additional service inputs

Inter-organisation relationships and agreementsmay relate to:

Access to specialist expertise for secondary consultations , advice or assessment

Extent and type of information provided on referral

Joint assessment

Case conferencing

Care planning and ongoing support

Use of specialist assessment tools

Involvement in assessment of family members and other organisations providing services

Receiving relevant information from health practitioners and/or support workers

Copy and paste from the following performance criteria to create an observation checklist for each task. When you have finished writing your assessment tool every one of these must have been addressed, preferably several times in a variety of contexts. To ensure this occurs download the assessment matrix for the unit; enter each assessment task as a column header and place check marks against each performance criteria that task addresses.

Observation Checklist

Tasks to be observed according to workplace/college/TAFE policy and procedures, relevant legislation and Codes of Practice Yes No Comments/feedback
Work with client to identify realistic and relevant goals as a basis for care planning 
Undertake care planning to address identified goals and in line with needs assessment and document in line with organisation requirements 
Undertake consultation with other organisation representatives to plan care in complex situations where multi-organisation involvement is required 
Ensure care plan recognises and supports person's strengths and abilities as well as addressing their needs 
Recognise and respect person's right to self-determination within legal parameters 
Plan care in consultation with the person, their carer/s and family, friends or others involved in advocacy or decision-making on their behalf 
Support person to make informed decisions about their care, reflecting understanding of their current situation, probable future situation and ensuing care needs 
Investigate range of options available to address client-identified needs and achieve their goals 
In 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 
Devise alternative strategies to meet identified client needs when specific services are not available 
Provide the person with cost details as required and work with them to ensure care plan is within their financial resources 
Identify work health and safety (WHS) risks and plan for their management 
Write care plan and clearly identify all work tasks and who is to perform them 
Seek and obtain person's consent before undertaking any referrals 
Provide person with clear understanding of available services and choices, so they are an informed participant in all stages of care planning 
Work 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 
Ensure planning clearly articulates roles and responsibilities of each service provider, including coordination role/s 
Maximise involvement of client and carer/s in care planning processes and decision-making 
Ensure effective involvement of relevant health/ community services professionals in care planning where clients have chronic or complex needs 
Establish and maintain communication strategy and processes to ensure effective implementation of care plan 
Ensure mechanisms are in place to support sharing of information between organisations and maintenance of updated information to all involved organisations 
Support and develop person's ability to independently access alternative resources to ensure their needs are addressed in an appropriate manner 
Regularly monitor planned services, support and resources against client-identified goals to ensure effective implementation of their care plan 
Ensure 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 
Maintain collaborative relationships with clients, carers and other service providers to support people with complex needs 
Promptly identify problems with implementation of care plan and make adjustment as necessary to best meet person's needs 
Document and report any variations to care plan in line with organisation requirements and communication strategy 
Respond appropriately to informal monitoring of health and well being of the person and/or their carer by volunteers, carers or family 
Undertake regular and systematic reviews to ensure assessed needs of clients are being addressed effectively 
Use regular reviews to re-prioritise client needs for service and to ensure equitable access based on ongoing appraisal of prioritised needs 
Contribute 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 
Ensure care planning for CALD and Aboriginal and Torres Strait Islander clients is culturally sensitive 
Ensure appropriate interpreter support is provided in line with organisation protocols 
Where appropriate, work in conjunction with ethno-specific and multicultural organisations and with Aboriginal and Torres Strait Islander communities and organisations 
Recognise and support the role of these organisations in linking their communities into the service system 
Where appropriate involve Aboriginal and Torres Strait Islander community and/or organisation representatives in the care planning process 
Facilitate access to assessment for people with different levels of need including those in complex circumstances and identified as having high levels of need 
Maintain and promote inter-organisation relationships and agreements as appropriate to address client, family and carer needs 
Ensure care planning builds on person's strengths and motivation to improve their quality of life 
Undertake periodic evaluation of care planning based on analysis of outcomes 
Obtain information from clients, carers, families and other service providers to determine progress and evaluate against identified goals in care plan 
Take into account adjustments made to services and resources to better address person's ongoing situation and changing needs 
Ensure 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 
Work with person to evaluate ongoing support needs to meet their goals, including review of parameters for disengagement, where applicable 
Demonstrate accountability for adjustments to the care plan and associated financial outcomes 
Identify opportunities for person to maintain or develop independence within any aspects of their overall care 
Document and report quantifiable impacts experienced by person as a result of implementation of care plan and indicate how client-centred outcomes have been achieved 

Forms

Assessment Cover Sheet

CHCCM702B - Implement goal directed care planning
Assessment task 1: [title]

Student name:

Student ID:

I declare that the assessment tasks submitted for this unit are my own work.

Student signature:

Result: Competent Not yet competent

Feedback to student

 

 

 

 

 

 

 

 

Assessor name:

Signature:

Date:


Assessment Record Sheet

CHCCM702B - Implement goal directed care planning

Student name:

Student ID:

Assessment task 1: [title] Result: Competent Not yet competent

(add lines for each task)

Feedback to student:

 

 

 

 

 

 

 

 

Overall assessment result: Competent Not yet competent

Assessor name:

Signature:

Date:

Student signature:

Date: