COE Care Planning II - JHF

May 6, 2026

Participants will strengthen their ability to engage in effective, client-centered care planning by integrating assessment data, shared decision-making, and motivational interviewing, enhancing coordination and collaboration across the interprofessional healthcare team to improve care quality and outcomes. This session will also include an emphasis on the role of COE staff in setting goals and strategies for documentation, logistics and ongoing maintenance and effective use of the care plan.

Agenda:

  1. Introduction
  2. Care Plan Background
    1. Defining Care Plans
    2. Care Plan Guidance for COEs
    3. Care Plan Purposes
    4. Care Plan Considerations
    5. Shared Decision Making
    6. Translation to Care Plan 
    7. From Conversation to Care Plan
  3. Deciding on Care Plan Goals, Objectives, Interventions
    1. Care Planning Steps
    2. Role of COE staff in goal development
  4. Care Plan Document
    1. Care Plan Inclusions
    2. Care Plan Components
    3. SMART Goals
    4. Objectives
    5. Interventions
    6. Care Plan Best Practices
  5. Care Plan Logistics
    1. COE Team Role Discussion
    2. Client Permission for Sharing of the Care Plan
    3. Types of COE Care Plans
    4. Access and Sharing of the Care Plan
  6. Care Plans and Progress Notes
    1. Care Plans and Encounter/Progress Notes
    2. Examples of Appropriate notes
  7. Ongoing Use and Updating of the Care Plan
    1. Implementation of the Care Plan
    2. Care Plan as a Living Document
    3. Effective Monitoring Activities
    4. Role of Team, Client, Family in Ongoing Monitoring
  8. Key Takeaways
  9. Discussion

Target Audience

  • Nurse
  • Physician
  • Social Worker

Learning Objectives

  • Apply shared decision-making techniques to prioritize client needs and translate them into actionable care plan components.
  • Develop client-centered care plans that clearly link goals, objectives, and interventions to identified needs and recovery priorities.
  • Integrate care plan activities into ongoing documentation and team-based care coordination to support engagement and retention.
 

 

Additional Information

AttachmentSize
File Audience Disclosure slides (1.25).pptx50.71 KB
File Care Planning II-Agenda- References.docx41.73 KB
PDF icon Care Planning II Slides.pdf1 MB
Course summary
Available credit: 
  • 1.25 AMA PRA Category 1 Credit™
    The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
  • 1.25 ANCC
    UPMC Provider Unit is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation
  • 1.25 ASWB
  • 1.25 Attendance
Course opens: 
05/06/2026
Course expires: 
06/06/2026
Event starts: 
05/06/2026 - 12:00pm EDT
Event ends: 
05/06/2026 - 1:30pm EDT
Add to calendar: 

Participants will strengthen their ability to engage in effective, client-centered care planning by integrating assessment data, shared decision-making, and motivational interviewing, enhancing coordination and collaboration across the interprofessional healthcare team to improve care quality and outcomes. This session will also include an emphasis on the role of COE staff in setting goals and strategies for documentation, logistics and ongoing maintenance and effective use of the care plan.

Agenda:

  1. Introduction
  2. Care Plan Background
    1. Defining Care Plans
    2. Care Plan Guidance for COEs
    3. Care Plan Purposes
    4. Care Plan Considerations
    5. Shared Decision Making
    6. Translation to Care Plan 
    7. From Conversation to Care Plan
  3. Deciding on Care Plan Goals, Objectives, Interventions
    1. Care Planning Steps
    2. Role of COE staff in goal development
  4. Care Plan Document
    1. Care Plan Inclusions
    2. Care Plan Components
    3. SMART Goals
    4. Objectives
    5. Interventions
    6. Care Plan Best Practices
  5. Care Plan Logistics
    1. COE Team Role Discussion
    2. Client Permission for Sharing of the Care Plan
    3. Types of COE Care Plans
    4. Access and Sharing of the Care Plan
  6. Care Plans and Progress Notes
    1. Care Plans and Encounter/Progress Notes
    2. Examples of Appropriate notes
  7. Ongoing Use and Updating of the Care Plan
    1. Implementation of the Care Plan
    2. Care Plan as a Living Document
    3. Effective Monitoring Activities
    4. Role of Team, Client, Family in Ongoing Monitoring
  8. Key Takeaways
  9. Discussion

 

Zoom Meeting
Pittsburgh, PA
United States

Elizabeth Schrage, MA, MPP, Senior Program Implementation Specialist

Brian Issi, MSW, LSW, MBA, Associate Program Implementation Specialist

Julie Brewer, MSW, MPH, Senior Program Implementation Specialist

 

In support of improving patient care, this activity has been planned and implemented by the University of Pittsburgh and The Jewish Healthcare Foundation. The University of Pittsburgh is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
As a Jointly Accredited Organization, University of Pittsburgh is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. University of Pittsburgh maintains responsibility for this course. Social workers completing this course receive 1.25 continuing education credits.

Physician (CME)
The University of Pittsburgh designates this live activity for a maximum of 1.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing (CNE)
The maximum number of hours awarded for this Continuing Nursing Education activity is 1.25 contact hours.

Social Work (ASWB)
The maximum number of hours awarded for this Continuing Social Work Education activity is 1.25 contact hours.

Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.

Available Credit

  • 1.25 AMA PRA Category 1 Credit™
    The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
  • 1.25 ANCC
    UPMC Provider Unit is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation
  • 1.25 ASWB
  • 1.25 Attendance
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