Key messages

  • Care plans allow clinicians to collaborate with individual consumers in making decisions and articulating goals around treatment and care.
  • In preparing a care plan, it is important to follow local or jurisdictional documentation guidelines and care plan templates.

The collection of accurate and consistent consumer outcome measures is critical for the planning, implementation and review of care plans.

Care plans provide an important opportunity for clinicians to collaborate with individual consumers (and carers, where appropriate) in making decisions and articulating goals around treatment and care. They are particularly important where there are several clinicians or agencies involved – providing a space in which to clarify specific roles and perspectives.

Preparing care plans

Care plans are informed by assessments and dialogue between the consumer, clinician and carer, of which consumer outcomes – as rated by the clinician and the consumer – form a core part.

In preparing a care plan, it is important to follow local or jurisdictional documentation guidelines and care plan templates.

It is also important to provide consumers and their carers with sufficient notice, time and information to complete any self-assessment measures. Self-assessed consumer outcomes offer a unique opportunity for consumers to rate how they think they are going – providing additional information that should complement and enrich a clinician’s own assessments and ratings.

Involving the consumer in care plans

Care plans should always give prominence to the needs and mental health goals identified by consumers themselves.

Consumers and clinicians will naturally have different perspectives on the role and content of a care plan, but exploring these differences can be healthy – helping to build a stronger therapeutic relationship between the consumer and their clinical team.

In drawing up a care plan, it is important to consider different perspectives that may arise from:

  • perceived goals and expectations of the care plan
  • the quality and detail of the information included
  • the degree of collaboration with consumers in its completion and review
  • the frequency with which the plan will be reviewed
  • requirements for the plan to be reviewed by the clinician, treating doctor or multidisciplinary team.
It is also important to consider the requirements of the specific health service for the plan to be either:
  • written with the consumer in their ‘own’ language
  • developed by the clinician with subsequent input by the consumer
  • signed by the consumer, with some requiring indication of whether they (a) agree, (b) were involved in developing the plan, or (c) were simply provided with a copy.