The role of the case manager is to help participants achieve the goals that they identify. To maximize the chance that progress will be maintained once the participant is no longer in the program, the case manager, with input from the participant and support persons, creates a transition plan. The plan can be continually developed over the participant\u2019s time in the program, so that there is not a \u201csudden scramble\u201d when the participant is ready to move on. The transition plan sets out participant objectives and goals going forward and identifies resources that may be needed in the future. It will also specify steps to be taken by the participant, case manager, or members of their support system to ensure access to follow-up services: for example, making appointments and establishing contact with relevant service providers. The transition plan should include resources and contact information for referrals that the participant may need in the short term or over time and, whenever possible, should provide centralized contact information or websites in case contact information changes. <\/p>\n\n\n\n
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