Leading Practice Guidelines

Accessing, Using, & Exiting Services

Type: Core Practice

Guideline: The organization has a transparent, timely and responsive process that people can use to access, use and exit services. This process, while consistent, is flexible enough to be shaped by the unique needs, wishes and circumstances of the person requiring services and their support network.

What does this look like?

The organization has a documented process that sets out the scope of service options, eligibility, and how prioritizing or access is determined. Key aspects of this process are:

  • Information about the process to access services is readily available to people and their families in a format accessible to them.
  • Service options are fully explained to people requesting service. Any limits or conditions of service, fees or costs, and how long they may have to wait are outlined. Information is shared in a manner and format that is both accessible and easily understood.
  • Access to services is provided based on relative need and available resources.
  • Possible timelines for responses and stages of the process are outlined.
  • Service options and target population are shaped by the skills and expertise the organization possesses.
  • The process outlines if wait lists are maintained and how they are managed.
  • Service options are offered and delivered based upon information gathered from the person and their support network.
  • Information is sought to better understand the person and their circumstances and includes information about their needs, strengths, risks, interests, wants, goals and scope of service requested. Collection is done in a culturally sensitive manner that takes into account the person’s communication style and method.
  • The organization has systems and staff with skills in place to determine what resources or services are required to meet the person’s needs.
  • The service provider actively advocates for service options that best meet the person’s needs.
  • Service planning is then shaped and directed by the person to the extent possible.
  • Upon commencement of service, the organization ensures that people are told about their rights and responsibilities as a recipient of services as well as what they can expect from the organization. Input and information about funding and how resources will be used and/or allocated are provided.
  • Identifies that if the organization cannot serve a person, they will immediately notify the person and help them to find another option.
  • People living in a home are informed of the possibility of a new roommate and given the chance to meet them in advance of any move. Information is shared about the potential roommate, balancing the rights of privacy with the desire to choose whom they live with.
  • People enjoy the security and continuity of home and/or supports and are not required to leave against their wishes unless there are compelling reasons. Each person is consulted in advance of any move and has access to an advocate if they wish to object.
  • There is a clear process and transition plan for those exiting services. The organization collaborates with other organizations to support the transition and to meet the person’s needs (as guided or consent to by the person).
  • Information is provided on how to re-access services.
  • If an individual is asked to leave the organization, they provide robust notice periods and make every effort to link the person with appropriate services.

Staff who are responsible for these processes are trained and knowledgeable about how to discover, collect and match people’s goals and preferences with available resources and supports.

How would you know this is happening? (Evidence)

What you see in systems:

  • An accessible document is available for those seeking services that explains how to access services and what to expect throughout that process.
  • Information is collected and used to make decisions about accessing and planning services.
  • Information is prepared and shared upon discharge to assist future service providers to support the person successfully (with the person’s consent).

What you see in actions:

  • People or families seeking services receive clear information that helps them navigate the process.
  • People understand all possible options that they could access and are involved in all stages of service planning.
  • People are informed of changes that impact their services or home.

Resources to support achieving guideline:

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