TRANSITION PLAN	TP Date
Individual
Social Security #	Medicaid #	Medicare #
The Transition Plan (TP) is a temporary document used when the IP cannot be written because a Support Plan has not been received by the client in a timely manner. Complete the first page with all required information. Complete one TP-Goal Action Plan for ALL goals. When the TP is completed, submit to the office for review. When the TP is approved, obtain signatures and submit a copy to the client, the guardian, the office, and to the WSC. Document your request for a copy of the SP every month until it is received.
Client Address

Phone #
Cell #
Date Services Began
TP Effective Date
Date TP Written
Dates SP Requested from WSC (mm/dd/yy)
SPA Form Received
SUPPORTS
Support	Name	Phone #
Emergency Contact/Relationship
Guardian/Family
Friend(s)
Support Coordinator/Agency
Program Administrator	Amy Martinez	727-841-7161
Staff
SIGNATURES
Individual	Signature	Date
Client
Guardian
Staff
WSC
EVALUATION: The instrument used for evaluation of the individual's goal progress is the service logs.
WSC IP RECEIPT: State how the TP was received by WSC (by hand, by fax, meeting, etc.)
STAFF ACCESS: The method for accessing a supported living staff person 24/7 is through staff pagers/cell phones.
DATA COLLECTION: The system used to assess client progress: service log, monthly summary, and quarterly summary. Satisfaction of service will be noted in service log, quarterly status report, and annual satisfaction survey. Projected outcomes will be monitored quarterly to assess progress as long as no SP has been received to determine the need for changes to TP.
STAFF AND NATURAL SUPPORTS: Describe the supports that are available to assist the individual with his goals.
HEALTH AND MEDICAL ISSUES: Describe health and medical issues that may impact the client's work on his goals.
HOME & COMMUNITY SAFETY NEEDS & SUPPORTS: Describe the client's needs and the supports required to address safety.
OTHER SUPPORTS/SERVICES NEEDED: State any supports and services not related to the goals needed to ensure the health, safety, and well-being of the client that are not on the SP. Areas include health, safety, household tasks, meal preparation, community inclusion, self care, personal growth, financial, leisure time, shopping, etc.

TRANSITION PLAN: GOAL/ACTION PLAN	Transition Plan Date
Individual	Meeting Date with WSC
If staff does not have a copy of the client's Support Plan even though it has been requested, discuss with the client and/or client guardian the goals he is interested in working on until the SP has been received. Once the Support Plan has been received, staff and client will complete the person-centered planning and Implementation Plan.
1. Write all goals in a list, numbering each and show the service that will help with the goal. If more than 1 service will help with the same goal, number each differently (1a, 1b, 1c, etc) and specify distinct tasks for each service in the Action Plan.

2. State any Other Supports/Services not related to the goals needed to ensure the health, safety, and well-being of the client. Areas include health, safety, household tasks, meal preparation, community inclusion, self care, personal growth, financial, leisure time, shopping, etc.

3. State in the Action Plan what the client will do and what staff will do to help the client achieve each goal. Identify the most appropriate training methods (demonstrate, verbal prompts, physical prompts, repetition, explanation, pictures) to use for each goal,

how often staff will provide help/support the client, and how long the client wants to work on the goal/when he should be finished.

4. Show in the Assessment how progress will be measured, including how the client will know he is making progress on the goal, his satisfaction with the goal, and the projected results of the training.
PERSON-CENTERED GOALS: Write the goals, numbering each goal and showing the support service responsible for each goal.
OTHER SUPPORTS/SERVICES NEEDED: Write any supports or services needed to ensure the client's health, safety, and well-
being. Areas include health, safety, household tasks, meal preparation, community inclusion, self care, personal growth, financial, leisure time, shopping, etc.
ACTION PLAN: By goal #, describe the client's plan of action for accomplishing each goal. Include Performance (what the client will do to accomplish the goal), Strategies and Training Methods (what staff will do to help the client accomplish the goal), Frequency (how often to work on the goal), and Time Limit (how long to work on the goal) from the Person-Centered Planning.
ASSESSMENT: In a brief statement, describe how goal progress will be measured for each goal, by number. State how the client will know he is making progress on each goal, his satisfaction with his goals and his progress, and what the projected results of the training should be.