System of Care

Community Inclusion Planning Meetings use a System of Care approach by being strength-based, community-based and member-driven. CIPM action plans are built around what members do well and fit their beliefs. Community Inclusion Planning Meetings are in place to help a person or family meet with community and agency representatives to discuss their needs and desires across multiple areas and put a plan in place to meet those needs and desires. These areas may include mental and physical health, housing, transportation, employment, social activities, and legal, financial, educational and spiritual needs.

The Community Inclusion Planning (CIP) team will help with brainstorming and creating a CIPM action plan with the member or family to access community resources and provide support throughout the process. The member or family leads this process and should be informed and willing to participate in the CIPM for the meeting to take place. It is the responsibility of the person completing the application with the member to explain the purpose of CIPMs to ensure they are interested in participating.

A CIPM is a time for members to meet with their CIP teams to express their needs and wishes across multiple areas including behavioral health, physical health, housing, transportation, and legal, financial, educational, vocational, social and spiritual needs.

Community inclusion planning teams can:

• Support timely access to services to members transitioning from treatment facilities and incarceration
• Support service coordination
• Develop ideas and provide connections to community resources to enhance the members quality of life

Community inclusion planning teams cannot:

• Provide a clinical recommendation for a particular treatment service or level of care (such a recommendation is the product of a comprehensive clinical assessment)
• Overturn decisions made by Alliance’s Utilization Management Department with regard to the denial or reduction of authorizations of MH/DD/SA services
• Guarantee a particular MH/DD/SA service will be approved by Alliance’s Utilization Management Department as meeting medical necessity
• Approve or guarantee housing funds, such as Independent Living Initiative (ILI) funding
• Determine eligibility for funding sources (Medicaid or state-funding)

The CIPM team represents the member/family needing support, natural supports (friend, family, people the member/family trusts) and various agencies and organizations in the community.

While CIPM teams represent their organizations, they are expected not to advocate for the interest of their organizations, but rather to focus on the interest of the member. The individuals selected for the team are invited by the community inclusion planning coordinator. Members are welcome to bring whomever they want.

Each CIPM is scheduled for one hour. That is usually enough time for you to share assistance needs and to create an action plan.

Everyone will introduce themselves and their role at the meeting. The member and/or referral source should be prepared to present information goals. A CIPM action plan will be developed and reviewed at the conclusion of the meeting. The member and anyone the member wishes will receive a copy of the CIPM action plan.

Each person in attendance is responsible for ensuring the action plan can be carried out through assigned support and tasks. This is a collaborative effort and each person has responsibility in ensuring successful outcomes. If there are barriers/challenges with tasks being completed, whoever is responsible for that task will contact another individual in the community who can assist with support for this task (while ensuring confidentiality). If this is not successful, the individual will contact the community inclusion planning coordinator.

Alliance community inclusion planning coordinators:
Mecklenburg: Tiffany Brown, [email protected].
Durham, Cumberland, Johnston, Orange, Wake: Noah Swabe, [email protected].

You, your support team, and the CIPM team will work together to follow up on the CIPM action plan. The community inclusion planning coordinator or member inclusion and outreach specialist assigned to the team will follow up with the member or guardian and referral source at 21, 60, 90, 180, and 365 days (one year) after a CIPM to check on the progress of the CIPM action plan.

CIPMs can be held in-person or virtually.

As we work hard to include representatives/individuals from various community agencies, please extend the courtesy of notifying us within 5 days (or as soon as you are aware) if you are not able to attend. To schedule a CIPM, please complete the referral form and submit it to [email protected].