PERMANENT RULES
SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)
Effective Date of Rule: June 1, 2007.
Purpose: The purpose of these new rules in chapter 388-828 WAC is to govern and support the administration of the division's newly developed, computer-based assessment tool that is designed to measure the support needs of clients for service determination. The DDD assessment will replace existing paper-based methods resulting in a universal assessment and support planning process. The purpose of the DDD assessment is to provide a comprehensive assessment process that: (1) Collects a common set of assessment information for reporting purposes to the legislature and the department; (2) promotes consistency and accuracy in evaluating client support needs for purposes of planning, budgeting, and resource management; (3) identifies a level of service and/or number of care hours that is used to support the assessed needs of clients who have been authorized to receive Medicaid/waiver personal care, waiver respite care, and/or voluntary placement program services; and (4) records clients' service requests.
Statutory Authority for Adoption: RCW 71A.12.030.
Other Authority: Title 71A RCW.
Adopted under notice filed as WSR 07-03-158 on January 23, 2007.
Changes Other than Editing from Proposed to Adopted Version: There have been no changes other than minor editing to improve clarity in the proposed rule.
(Strikeouts indicate words deleted from proposed rules. Underlines indicate words added to proposed rules.)
(1) You have not identified a person willing to receive notice or correspondence on your behalf regarding specific DDD decisions as required per RCW 71A.10.060 and DDD does not believe you are capable of understanding department decisions that may affect your care (see WAC 388-828-1140); or
(2) A respondent cannot be identified to participate in your DDD Assessment (see WAC 388-828-1540(c));
If there is no one available to receive notice or correspondence on your behalf regarding specific DDD decisions, DDD will do all of the following:
(2) You or your legal guardian has have not identified an
ADSA contracted provider.
If you are unable to identify an ADSA contracted provider, DDD will provide you or your legal guardian with contact information for ADSA contracted agency providers.
DDD intends to assess all clients per WAC 388-828-1100 by
June 30, 2008 based on available resources.
(4) You are not receiving a paid service and You are
approved for funding of a DDD paid service and an assessment
must be performed prior to the authorization of services;
(8) Private Duty Nursing services per chapter 388-106551
WAC; or
A final cost-benefit analysis is available by contacting Mark R. Eliason, P.O. Box 45310, Lacey, WA 98504-5310, phone (360) 725-2517, fax (360) 407-0995, e-mail eliasmr@dshs.wa.gov.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 126, Amended 0, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 126, Amended 0, Repealed 0.
Date Adopted: April 23, 2007.
Blake D. Chard
for Robin Arnold-Williams
Secretary
3788.7The Division of Developmental Disabilities (DDD) Assessment
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Definitions"AAIDD" means the American Association on Intellectual and Developmental Disabilities.
"Acuity Scale" refers to an assessment tool that is intended to provide a framework for documenting important assessment elements and for standardizing the key questions that should be asked as part of a professional assessment. The design helps provide consistency from client to client by minimizing subjective bias and assists in promoting objective assessment of a person's support needs.
"ADSA" means the aging and disability services administration (ADSA), an administration within the department of social and health services, which includes the following divisions: home and community services, residential care services, management services and division of developmental disabilities.
"ADSA contracted provider" means an individual or agency who is licensed, certified, and/or contracted by ADSA to provide services to DDD clients.
"Adult Family Home" or "AFH" means a residential home in which a person or persons provide personal care, special care, room and board to more than one but not more than six adults who are not related by blood or marriage to the person or persons providing the services (see RCW 70.12.010).
"Agency provider" means a licensed and/or ADSA certified business who is contracted with ADSA or a county to provide DDD services (e.g., personal care, respite care, residential services, therapy, nursing, employment, etc.).
"Algorithm" means a numerical formula used by the DDD Assessment for one or more of the following:
(1) Calculation of assessed information to identify a client's relative level of need;
(2) Determination regarding which assessment modules a client receives as part of his/her DDD assessment; and
(3) Assignment of a service level to support a client's assessed need.
"Authorization" means DDD approval of funding for a service as identified in the Individual Support Plan or evidence of payment for a service.
"CARE" refers to the Comprehensive Assessment Reporting Evaluation assessment per chapter 388-106 WAC.
"Client" means a person who has a developmental disability as defined in RCW 71A.10.020(3) who also has been determined eligible to receive services by the division under chapter 71A.16 RCW.
"Collateral contact" means a person or agency that is involved in the client's life (e.g., legal guardian, family member, care provider, friend, etc.).
"Companion home" is a DDD contracted residential service that provides twenty-four hour training, support, and supervision, to one adult living with a paid provider.
"DDD" means the division of developmental disabilities, a division with the aging and disability services administration (ADSA), department of social and health services (DSHS).
"Department" means the department of social and health services (DSHS).
"Group home" or "GH" means a ADSA licensed adult family home or boarding home contracted and certified by ADSA to provide residential services and support to adults with developmental disabilities.
"ICF/MR" means a facility certified as an intermediate care facility for the mentally retarded to provide habilitation services to DDD clients.
"ICF/MR Level of Care" is a standardized assessment of a client's need for ICF/MR Level of Care per 42 CFR 440 and 42 CFR 483. In addition, ICF/MR Level of Care refers to one of the standards used by DDD to determine whether a client meets minimum eligibility criteria for one of the DDD HCBS waivers.
"Individual Support Plan" or "ISP" is a document that authorizes and identifies the DDD paid services to meet a client's assessed needs.
"Legal Guardian" means a person/agency, appointed by a court, who is authorized to make some or all decisions for a person determined by the court to be incapacitated. In the absence of court intervention, parents remain the legal guardians for their child until the child reaches the age of eighteen.
"LOC score" means a score for answers to questions in the Support Needs Assessment for Children that are used in determining if a client meets eligibility requirements for ICF/MR Level of Care.
"Modules" refers to three sections of the DDD Assessment. They are: the Support Assessment, the Service Level Assessment, and the Individual Support Plan (ISP).
"Panel" refers to the visual user-interface in the DDD Assessment computer application where assessment questions are typically organized by topic and you and your respondents' answers are recorded.
"Plan of Care" or "POC" refers to the paper-based assessment and service plan for clients receiving services on one of the DDD HCBS waivers prior to June 1, 2007.
"Raw Score" means the numerical value when adding a person's "Frequency of Support," "Daily Support Time," and "Type of Support" scores for each activity in the support needs and supplemental protection and advocacy scales of the Supports Intensity Scale (SIS) Assessment.
"Residential Habilitation Center" or "RHC" is a state-operated facility certified to provide ICF/MR and/or nursing facility level of care for persons with developmental disabilities per chapter 71A.20 RCW.
"Respondent" means the adult client and/or another person familiar with the client who participates in the client's DDD Assessment by answering questions and providing information. Respondents may include ADSA contracted providers.
"SIS" means the Supports Intensity Scale developed by the American Association of Intellectual and Developmental Disabilities (AAIDD). The SIS is in the Support Assessment module of the DDD Assessment.
"Service Provider" refers to an ADSA contracted agency or person who provides services to DDD clients. Also refers to state operated living alternative programs (SOLA).
"SOLA" means a state operated living alternative program for adults that is operated by DDD.
"State supplementary payment" or "SSP" is the state paid cash assistance program for certain DDD eligible Social Security Income clients per chapter 388-827 WAC.
"Supported living" or "SL" refers to residential services provided by ADSA certified residential agencies to clients living in homes that are owned, rented, or leased by the clients or their legal representatives.
"Waiver personal care" means physical or verbal assistance with activities of daily living (ADL) and instrumental activities of daily living (IADL) due to your functional limitations per chapter 388-106 WAC to individuals who are authorized to receive services available in the Basic, Basic Plus, and Core waivers per chapter 388-845 WAC.
"Waiver respite care" means short-term intermittent relief for persons normally providing care to individuals who are authorized to receive services available in the Basic, Basic Plus, and Core waivers per chapter 388-845 WAC.
"You/Your" means the client.
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Division of Developmental Disabilities Assessment(2) The DDD Assessment has three modules:
(a) The Support Assessment (see WAC 388-828-2000 to WAC 388-828-6020);
(b) The Service Level Assessment (see WAC 388-828-7000 to WAC 388-828-7080); and
(c) The Individual Support Plan (ISP) (see WAC 388-828-8000 to 388-828-8060).
(3) The DDD Assessment is part of the Aging and Disability Services Administration's (ADSA) Comprehensive Assessment Reporting Evaluation system (CARE).
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(1) Collects a common set of assessment information for reporting purposes to the legislature and the department.
(2) Promotes consistency in evaluating client support needs for purposes of planning, budgeting, and resource management.
(3) Identifies a level of service and/or number of hours that is used to support the assessed needs of clients who have been authorized by DDD to receive:
(a) Medicaid personal care services or DDD HCBS Waiver Personal Care per chapter 388-106 WAC;
(b) Waiver respite care services per chapter 388-845 WAC;
(c) Services in the Voluntary Placement Program (VPP) per chapter 388-826 WAC.
(4) Records your service requests.
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(1) You are currently approved by DDD to receive a DDD paid service evidenced by meeting one of the conditions in WAC 388-828-1440;
(2) You request enrollment in one of the DDD HCBS waivers per chapter 388-845 WAC;
(3) You are age three or older and request a DDD Assessment;
(4) You have been determined eligible for categorically needy medical coverage per WAC 388-475-0100 and requested one of the following Medicaid state plan services:
(a) You have requested an assessment for Medicaid personal care services per chapter 388-106 WAC; or
(b) You have been approved to receive Private Duty Nursing services for clients seventeen years of age and younger per WAC 388-551-3000.
(5) You are receiving SSP in lieu of a DDD paid service per chapter 388-827 WAC;
(6) You request admission to a RHC per title 42 CFR 440, title 42 CFR 483, and title 71A RCW;
(7) You reside in a RHC or community ICF/MR and you are involved in discharge planning for community placement;
(8) You do not meet any of the conditions listed in WAC 388-828-1120.
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(1) You have not identified a person willing to receive notice or correspondence on your behalf regarding specific DDD decisions as required per RCW 71A.10.060 and DDD does not believe you are capable of understanding department decisions that may affect your care (See WAC 388-828-1140); or
(2) A respondent cannot be identified to participate in your DDD Assessment (See WAC 388-828-1540(c));
(3) You reside in a RHC and are not currently involved in discharge planning for community placement;
(4) You reside in a community ICF/MR and are not authorized by DDD to receive employment/community services paid through the counties; or
(5) You are under the age of three and do not meet any of the conditions in WAC 388-828-1100.
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(1) Consult with the Assistant Attorney General to determine if:
(a) You are able to represent yourself; or
(b) You require a legal representative/guardian.
(2) Continue current services until the issue is resolved per section (1) above.
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(2) Only clients receiving a DDD paid service, SSP in lieu of a DDD paid service, or who are approved for a DDD paid service will receive the Service Level Assessment and Individual Support Plan modules since these modules are required:
(a) Prior to the authorization/reauthorization of a DDD paid service or SSP; and
(b) To determine a service level and/or number of hours for a service; and
(c) To authorize the DDD approved paid service(s) per WAC 388-828-8000.
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(1) Provide information and referral for Non-DDD community-based supports; and
(2) Add your name to the waiver data base, if you have requested enrollment in a DDD HCBS waiver per chapter 388-845 WAC; and
(3) Authorize short-term emergency services as an exception-to-rule (ETR) per WAC 388-440-0001.
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(1) You are age seventeen or younger; and
(2) Your family has not made a request for your admission to a Residential Habilitation Center (RHC).
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(1) Ask if you would like referral information for ICF/MR services; and
(2) Continue to administer your DDD Assessment; and
(3) Continue to authorize the DDD paid services or SSP you are receiving at the time of your DDD Assessment if you continue to meet the eligibility requirements for those services.
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(1) Explain what happens if you refuse to allow DDD to administer the DDD Assessment to you, your respondents, and the person you have identified to receive notice on your behalf per RCW 71A.10.060.
(2) Consult with the Assistant Attorney General when you have not identified a person to receive notice on your behalf per RCW 71A.10.060 to determine if:
(a) You are able to represent yourself; or
(b) You require a legal representative/guardian.
(3) Terminate existing DDD paid services when they reach their authorized end date.
(4) Provide you notice and appeal rights for denied and/or terminated service(s) per WAC 388-825-100 and WAC 388-825-120.
(5) Provide you with information on how to contact DDD in case you later decide you want a DDD Assessment administered.
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(2) DDD will complete your DDD Assessment no later than thirty days from the date it was created in CARE.
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(1) You are approved to receive a DDD paid service; and
(2) You or your legal guardian has not identified an ADSA contracted provider.
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(1) An open social service payment system (SSPS) authorization within the past ninety days used for payment of a service or SSP; or
(2) A current county service authorization for one of the following services:
(a) Person to Person; or
(b) Individual Employment; or
(c) Group Supported Employment; or
(d) Pre-vocational/Specialized Industries; or
(e) Community Access; or
(f) Individual and Family Assistance.
(3) A current waiver POC or waiver ISP; or
(4) Residence in a State Operated Living Alternative (SOLA) program; or
(5) Authorization of Family Support services within the last twelve months per chapter 388-825 WAC; or
(6) Documentation of DDD approval of your absence from DDD paid services for more than ninety days with available funding for your planned return to services; or
(7) Evidence of approval for funding of a DDD service or enrollment in a DDD HCBS waiver; or
(8) Payment of services using Form A-19 State of Washington Invoice Voucher for receipt of:
(a) Dangerous Mentally Ill Offender funds
(b) Crisis stabilization services;
(c) Specialized psychiatric services; or
(d) Diversion bed services.
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(1) You are receiving a DDD paid service and your annual reassessment is due for continuation of the DDD paid service; or
(2) You are receiving a DDD paid service and a reassessment is needed due to a significant change that may affect your support needs; or
(3) You are receiving SSP in lieu of a DDD paid service and your eligibility for SSP needs to be re-determined per WAC 388-827-0120;
(4) You are approved for funding of a DDD paid service and an assessment must be performed prior to the authorization of services; or
(5) You make a request to have a DDD Assessment administered and meet the criteria in WAC 388-828-1100; or
(6) You are contacted by DDD and offered an opportunity to have a DDD Assessment.
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(1) Funding from the legislature that provides resources for services to be available by a certain date;
(2) The annual reallocation of dollars for Traditional Family Support in June 2007; or
(3) Emergency services as determined by DDD as critical to the client's health and safety.
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(1) On an annual basis if you are receiving a paid service or SSP; or
(2) When a significant change is reported that may affect your need for support. (e.g. changes in your medical condition, caregiver status, behavior, living situation, employment status).
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(2) DDD requires that at a minimum: you, one of your respondents, and your DDD case resource manager/social worker participate in your DDD Assessment interview. In addition:
(a) If you are under the age of eighteen, your parent(s) or legal guardian(s) must participate in your DDD Assessment interview.
(b) If you are age eighteen or older, your court appointed legal representative/guardian must be consulted if he/she does not attend your DDD Assessment interview.
(c) If you are age eighteen and older and have no legal representative/guardian, DDD will assist you to identify a respondent.
(d) DDD may require additional respondents to participate in your DDD Assessment interview, if needed, to obtain complete and accurate information.
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(1) The legislature has directed DDD to assess all eligible clients with a common, standardized assessment process that measures the support needs of individuals with developmental disabilities.
(2) The DDD Assessment algorithms in the Support Assessment module are designed to:
(a) Determine acuity scores and acuity levels for a variety client needs; and
(b) Provide a valid measure of each client's support needs relative to the support needs of other clients who have received the DDD Assessment.
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(1) Explain what happens if you refuse to answer a question on a mandatory panel to you, your respondents, and the person you have identified to receive notice on your behalf per RCW 71A.10.060.
(2) Consult with the Assistant Attorney General when you have not identified a person to receive notice on your behalf per RCW 71A.10.060 to determine if:
(a) You are able to represent yourself; or
(b) You require a legal representative/guardian.
(3) Terminate existing DDD paid services when they reach their authorized end date;
(4) Provide you notice and appeal rights for denied and/or terminated service(s) per WAC 388-825-100 and WAC 388-825-120; and
(5) Provide you with information on how to contact DDD in case you later decide you want a DDD Assessment administered.
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| If you are approved by DDD to receive: | Your client group is: |
| (1) DDD DCBS Waiver services per chapter 388-845 WAC; or (2) State-only residential services per chapter 388-825 WAC; or (3) ICF/MR services per 42 CFR 440 and 42 CFR 483. |
Waiver and State-Only Residential |
| (4) Medicaid personal care (MPC) per chapter 388-106 WAC; or (5) DDD HCBS Basic, Basic Plus, or Core Waiver services per chapter 388-845 WAC and Personal Care services per chapter 388-106 WAC; or (6) Medically Intensive Health Care Program services per chapter 388-551 WAC; or (7) Adult Day Health services per chapter 388-106 WAC; or (8) Private Duty Nursing services per chapter 388-106 WAC; or (9) Community Options Program Entry System (COPES) services per chapter 388-106 WAC; or (10) Medically Needy Residential waiver services per chapter 388-106 WAC; or (11) Medicaid Nursing Facility Care services per chapter 388-106 WAC. |
Other Medicaid Paid Services |
| (12) County Employment services per chapter 388-850 WAC. (13) Other DDD paid services per chapter 388-825 WAC, such as: (a) Family support services; or (b) Professional services. (14) Non-waiver voluntary placement program services per chapter 388-826 WAC; (15) SSP only per chapter 388-827 WAC; |
State-Only Paid Services |
| (16) You are not approved to receive any DDD paid services. | No Paid Services |
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(1) DDD "Assessment Main" and Client Details Information
| Client Group | ||||
| DDD Assessment Panel Name | No Paid Services | Waiver and State Only Residential | Other Medicaid Paid Services | State Only Paid Services |
| Assessment Main | X | X | X | X |
| Demographics | X | X | X | X |
| Overview | X | X | X | X |
| Addresses | X | X | X | X |
| Collateral Contacts | X | X | X | X |
| Financials | X | X | X | X |
| Client Group | ||||
| DDD Assessment Panel Name | No Paid Services | Waiver and State Only Residential | Other Medicaid Paid Services | State-Only Paid Services |
| Home Living | X | X | X | X |
| Community Living | X | X | X | X |
| Lifelong Learning | X | X | X | X |
| Employment | X | X | X | X |
| Health & Safety | X | X | X | X |
| Social Activities | X | X | X | X |
| Protection & Advocacy | X | X | X | X |
| Client Group | ||||
| DDD Assessment Panel Name | No Paid Services | Waiver and State Only Residential | Other Medicaid Paid Services | State-Only Paid Services |
| Activities of Daily Living | X | X | X | X |
| IADLs (Instrumental Activities of Daily Living) | X | X | X | X |
| Family Supports | X | X | X | X |
| Peer Relationships | X | X | X | X |
| Safety & Interactions | X | X | X | X |
| DDD Assessment Panel Name | No Paid Services | Waiver and State Only Residential | Other Medicaid Paid Services | State-Only Paid Services |
| Medical Supports | X | X | X | X |
| Behavioral Supports | X | X | X | X |
| Protective Supervision | X | X | X | X |
| DDD Caregiver Status* | X | X | X | X |
| Programs and Services | X | X | X | X |
| *Information on the DDD Caregiver Status panel is not mandatory for clients receiving paid services in an AFH, SL, GH, SOLA, or RHC. | ||||
| DDD Assessment Panel Name | No Paid Services | Waiver and State Only Residential | Other Medicaid Paid Services | State-Only Paid Services |
| Environment | X | X | O | |
| Medical Main | O | X | O | |
| Medications | X | X | X | |
| Diagnosis | X | X | X | |
| Seizures | X | X | X | |
| Medication Management | X | X | X | |
| Treatments/programs | X | X | X | |
| ADH (Adult Day Health) | O | O | O | |
| Pain | X | X | X | |
| Indicators-Main | O | X | O | |
| Allergies | X | X | X | |
| Indicators/Hospital | X | X | X | |
| Foot | X | X | O | |
| Skin | X | X | O | |
| Skin Observation | O | O | O | |
| Vitals/Preventative | X | X | O | |
| Comments | O | O | O | |
| Communication-Main | O | X | O | |
| Speech/Hearing | O | X | O | |
| Psych/Social | O | X | O | |
| MMSE (Mini-Mental Status Exam) | O | X | O | |
| Memory | O | X | O | |
| Behavior | O | X | O | |
| Depression | O | X | O | |
| Suicide | O | O | O | |
| Sleep | O | O | O | |
| Relationships & Interests | O | O | O | |
| Decision Making | O | X | O | |
| Goals | X | O | O | |
| Legal Issues | O | O | O | |
| Alcohol | O | O | O | |
| Substance Abuse | O | O | O | |
| Tobacco | O | X | O | |
| Mobility Main | O | X | O | |
| Locomotion In Room | O | X | O | |
| Locomotion Outside Room | O | X | O | |
| Walk in Room | O | X | O | |
| Bed Mobility | O | X | O | |
| Transfers | O | X | O | |
| Falls | O | O | O | |
| Toileting-Main | O | X | O | |
| Bladder/Bowel | O | X | O | |
| Toilet Use | O | X | O | |
| Eating-Main | O | X | O | |
| Nutritional/Oral | O | X | O | |
| Eating | O | X | O | |
| Meal Preparation | O | X | O | |
| Hygiene-Main | O | X | O | |
| Bathing | O | X | O | |
| Dressing | O | X | O | |
| Personal Hygiene | O | X | O | |
| Household Tasks | O | X | O | |
| Transportation | O | X | O | |
| Essential Shopping | O | X | O | |
| Wood Supply | O | X | O | |
| Housework | O | X | O | |
| Finances | O | O | O | |
| Pet Care | O | O | O | |
| Functional Status | O | O | O | |
| Employment Support* | X* | X* | X* | |
| Mental Health | X | X | X | |
| DDD Sleep* | X* | O | O | |
| *Indicates that: (a) The "Employment Support" panel is mandatory only for clients age twenty-one and older who are on or being considered for one of the county services listed in WAC 388-828-1440(2). (b) The "DDD Sleep" panel is mandatory only for clients who are age eighteen or older and who are receiving: (i) DDD HCBS Core or Community Protection waiver services; or (ii) State-Only residential services. |
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Support Assessment Module
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(1) Collect a common set of assessment information that is scored for all persons who are eligible to receive a DDD Assessment per WAC 388-828-1100;
(2) Promote a consistent process to evaluate client support needs;
(3) Determine whether a person meets the ICF/MR level of care standard for potential waiver eligibility; and
(4) Identify the persons receiving, or approved for, DDD paid services or SSP who will need the additional two assessment modules:
(a) The Service Level Assessment module; and
(b) The Individual Support Plan module.
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(1) The Support Assessment for Children;
(2) The Supports Intensity Scale (SIS)Assessment;
(3) DDD Protective Supervision Acuity Scale;
(4) DDD Caregiver Status Acuity Scale;
(5) DDD Activities of Daily Living (ADL) Acuity Scale;
(6) DDD Behavioral Acuity Scale;
(7) DDD Medical Acuity Scale;
(8) DDD Interpersonal Support Acuity Scale;
(9) DDD Mobility Acuity Scale;
(10) DDD Respite Assessment; and
(11) Programs and Services component.
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| Components contained in the Support Assessment module | Age (0-15) |
Age (16+) |
| The Support Assessment for Children | Yes | No |
| SIS Support Needs and Supplemental Protection and Advocacy Scales | No | Yes |
| SIS Exceptional Medical and Behavior Support Needs Scales | Yes | Yes |
| DDD Protective Supervision Acuity Scale | Yes | Yes |
| DDD Caregiver Status Acuity Scale | Yes | Yes |
| DDD Activities of Daily Living Acuity Scale | Yes | Yes |
| DDD Behavioral Acuity Scale | Yes | Yes |
| DDD Medical Acuity Scale | Yes | Yes |
| DDD Interpersonal Support Acuity Scale | Yes | Yes |
| DDD Mobility Scale | Yes | Yes |
| Current Programs and Services component | Yes | Yes |
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The Support Assessment for Children
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(1) Your ICF/MR Level of Care score for DDD HCBS waiver eligibility;
(2) The health and welfare needs that must be addressed in your individual support plan if you are enrolled in a DDD HCBS waiver; and
(3) Your support need levels for:
(a) The DDD Activities of Daily Living Acuity Scale;
(b) The DDD Interpersonal Support Acuity Scale; and
(c) The DDD Mobility Acuity Scale.
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(1) Dress and groom self: What support does the child need to dress and groom self as expected of others of same age?
| Answers | Definitions | LOC Score | Acuity Score |
| Physical Assistance | Needs major support in the form of total physical assistance, intensive training and/or therapy for dressing and grooming. | 1 | 4 |
| Training | Needs moderate support in the form of some physical assistance and/or training and/or therapies to dress and groom self. | 0 | 3 |
| Reminders/Prompts | Needs reminders or prompts to dress and groom self appropriately. | 0 | 2 |
| No support needed or at age level | At age level (may have physical supports) in dressing and grooming. | 0 | 0 |
| Answers | Definitions | LOC Score | Acuity Score |
| Total physical support | Needs major support in the form of total physical support. Intensive training intervention and/or daily therapy to toilet self. | 1 | 4 |
| Partial physical assistance, training | Needs moderate support in the form of some physical assistance, standard training and/or regular therapy. | 0 | 3 |
| Reminders/prompts | Needs reminders or prompts. | 0 | 2 |
| No support needed or at age level | Toilets self or has physical support in place to toilet self. | 0 | 0 |
| Answers | Definitions | LOC Score | Acuity Score |
| Total physical support | Needs major support in the form of total physical assistance, intensive training and/or daily therapy. | 1 | 4 |
| Partial physical assistance, training | Needs moderate support in the form of some physical assistance, standard training, and/or regular therapy. | 1 | 3 |
| Reminders/prompts | Needs help with manners and appearance when eating, in the form of reminders and prompts. | 0 | 2 |
| No support needed or at age level | At age level (may have physical supports) in eating. | 0 | 0 |
| Answers | Definitions | LOC Score | Acuity Score |
| Total physical support | Needs major intervention in the form of total physical support to move around, intensive training and/or daily therapy. | 1 | 4 |
| Partial physical assistance, training | Needs moderate support such as someone's help to move around or may use or learn to use adaptive device or may require standard training. | 1 | 3 |
| Reminders/prompts | Needs mild intervention in the form of training and physical prompting for scooting/crawling/walking behaviors. | 0 | 2 |
| No support needed or at age level | No supports needed - child is scooting/crawling/walking at age level | 0 | 0 |
| Answers | Definitions | LOC Score | Acuity Score |
| Total physical support | Currently someone else must always determine and communicate child's needs. | 1 | 4 |
| Training/therapy | With intensive training or therapy support, child may learn sufficient verbal and/or signing skills to make self easily understandable to others. May include partial physical support. | 1 | 3 |
| Adaptive device/interpreter | With physical support (adaptive device, interpreter), child is always able to communicate. | 0 | 2 |
| No support needed or at age level | No supports needed and/or at age level. | 0 | 0 |
| Answers | Definitions | LOC Score | Acuity Score |
| Total physical support | Child is not old enough to know about money. | 0 | 4 |
| Partial physical assistance, training | Family must devise special opportunities for child to earn/or spend money. | 0 | 3 |
| Create opportunities, reminders/prompts | Needs to learn about earning and/or spending money in typical age-level ways. | 0 | 2 |
| No support needed or at age level | Needs no support. Independently uses opportunities typical to his/her age group to earn and/or spend money. | 0 | 0 |
| Answers | Definitions | LOC Score | Acuity Score |
| Total physical support | Needs major support in the form of special and/or technical help to and from family/teachers to create opportunities for making choices and taking responsibility. | 1 | 4 |
| Partial physical assistance, training | Needs moderate support in the form of family/teachers creating and explaining a variety of opportunities for making choices and taking responsibility. | 1 | 3 |
| Create opportunities, reminders/prompts | Needs some support in the form of explanation of available options for making choices and taking responsibility. | 1 | 2 |
| No support needed or at age level | Needs no support. Readily uses a variety of opportunities to indicate choices (activity, food, etc.) and take responsibility for tasks, self, etc. | 0 | 0 |
| Answers | Definitions | LOC Score | Acuity Score |
| Total physical support | Needs major support in the form of specialized technical help to and from family/teachers to create ways which support/encourage child to explore and reach out. | 1 | 4 |
| Partial physical assistance, training | Needs moderate support in the form of some training/physical help to and from family and teachers to create ways and opportunities for child to explore environment and reach out. | 1 | 3 |
| Reminders/prompts | Needs some support in the form of verbal encouragement or presence of someone child trusts to explore environment and reach out. | 0 | 2 |
| No support needed or at age level | Needs no support and/or is at age level. Readily explores environment (may have adaptive device) and reaches out in ways typical to child's age group. | 0 | 0 |
| Answers | Definitions | LOC Score | Acuity Score |
| Daily intervention by professionals | Child requires medical/health intervention or monitoring by professionals at least daily. | 1 | 4 |
| Monitoring by health professionals | Child needs regular (weekly, monthly) monitoring by health professionals. | 1 | 3 |
| Monitoring by trained others | Child needs daily support and/or monitoring by training others. | 1 | 2 |
| Community health system | Needs regular on-going therapy and/or monitoring of health needs through typical community health systems. | 0 | 1 |
| No support needed or at age level | No specialized supports or ongoing therapies necessary. | 0 | 0 |
| Answers | Definitions | LOC Score | Acuity Score |
| Urgent extensive support | Substantial significant supports to child and parents needed. Child in, or at risk of, out-of-home placement at this time. | 1 | 4 |
| Substantial support/referrals needed | Substantial support needed/requested; (e.g., requests for more than two days per month respite, referral to homemakers, homebuilders; request for long term behavior management training, need extensive and/or expensive environmental modification or equipment; request frequent contact with case manager.) | 1 | 3 |
| Moderate support | Moderate external support needed/requested; (e.g., requests for regular respite, intensive but short-term behavior management, referral for parent training help, referral to day care services; and/or request for regular contact with case manager.) | 0 | 2 |
| Minimal support | Minimal external support needed/requested; (e.g., requests for occasional respite, referrals to parent support group, and/or case manager helps obtain adaptive equipment.) | 0 | 1 |
| No support needed or at age level | No external supports are necessary. Family has obtained any necessary adaptive equipment. | 0 | 0 |
| Answers | Definitions | LOC Score | Acuity Score |
| Total physical support | Opportunities for contributing to family life totally dependent on others to maintain, interpret child's role to other family members. | 0 | 4 |
| Partial physical assistance, training | Requires major support in the form of daily/weekly creation of opportunities to be seen as a contributing member and assume typical family responsibilities. | 0 | 3 |
| Reminders/prompts | Requires moderate support in the form of adaptive device, training and/or reminders to be seen as contributing member and assume typical family responsibilities. | 0 | 2 |
| No support needed or at age level | Needs no support to form positive family relationship. | 0 | 0 |
| Answers | Definitions | LOC Score | Acuity Score |
| Total physical support | Family needs major support (perhaps respite) to continue to provide child total physical support to use typical resources. | 0 | 4 |
| Partial physical assistance, training | Moderate support is needed - family must create ways for child to use these resources in ways typical to child's age group. | 0 | 3 |
| Reminders/prompts | Minimal support needed - family may wish suggestions or some support on ways to enable child's regular use of typical resources. | 0 | 2 |
| No support needed or at age level | Needs no support and/or at age level. Uses these resources regularly. | 0 | 0 |
| Answers | Definitions | LOC Score | Acuity Score |
| Total physical support | Major support needed by others to help child play. Parents may request special adaptive equipment and training to foster child's playing skills. | 0 | 4 |
| Partial physical assistance training | Moderate support needed in the form of a verbal and/or some physical intervention to help child play. Parents may be requesting suggestions instruction in ways to help child develop playing skills. | 0 | 3 |
| Reminders/prompts | Minimal support needed. | 0 | 2 |
| No support needed or at age level | No supports needed and/or at age level. Child's playing skills developing at age level. | 0 | 0 |
| Answers | Definitions | LOC Score | Acuity Score |
| Total physical support | Substantial system support (e.g., system must set up "programs" that allow for interaction with typically developing children and the "programs".) | 0 | 4 |
| Partial physical assistance, training | Moderate supports (e.g., parents have to create opportunities for contacts). Parents may ask for instruction in how to facilitate such contacts. System may need to provide structural supports (e.g., transportation, barrier-free public play environments, etc). | 0 | 3 |
| Reminders/prompts | Minimal support (e.g., some monitoring). Parents may request help on how to broaden child's range of contacts or to increase the age appropriateness of contacts. | 0 | 2 |
| No support needed or at age level | No support needed. | 0 | 0 |
| Answers | Definitions | LOC Score | Acuity Score |
| Total physical support | Needs total physical support to respond to emergencies. | 1 | 4 |
| Always needs help to identify and respond | Needs help all of the time to identify emergencies and to respond. | 1 | 3 |
| Sometimes needs help to identify and respond | Needs help some of the time to identify emergencies and to respond. | 1 | 2 |
| Can identify, needs help to respond | Independently identifies emergencies; needs help from others to respond. | 1 | 1 |
| No help needed or at age level | Needs no help from others in emergencies. | 0 | 0 |
| Answers | Definitions | LOC Score | Acuity Score |
| Total physical support | Needs total physical support for safety measures in daily activities and routines. | 1 | 4 |
| Partial physical assistance, training | Does not recognize own safety needs and requires help in most safety areas. | 1 | 3 |
| Reminders/prompts | Knows importance of safety measures. Needs training and/or physical support in many areas. | 1 | 2 |
| No support needed or at age level | Needs no support in providing for own safety. | 0 | 0 |
| Answers | Definitions | LOC Score | Acuity Score |
| Total physical support | Needs physical support by others in the form of interpretation of self to others to interact with peers. | 1 | 4 |
| Partial physical assistance, training | Needs physical intervention in the form of modeling to enable child to reach out to peers to give and take support. | 1 | 3 |
| Reminders/prompts | Needs much encouragement, supervision and guidance in how to give and ask for support and interact with peers. | 0 | 2 |
| No support needed or at age level | Without support, child relates to others as a valued member of work/learning unit. | 0 | 0 |
| Answers | Definitions | LOC Score | Acuity Score |
| Continuous behavioral interventions | Needs major tolerance and control. Could include being dangerous to self and/or others. | 1 | 4 |
| Major behavior modifications | Needs major behavior modifications to be perceived as typical. Child's behaviors are extremely disagreeable to others. | 1 | 3 |
| Modeling, reminders, prompts | Needs participation in typical settings with typically developing others to model desirable behaviors. Child's behaviors cause him/her to be easily recognized as different from others. | 0 | 2 |
| Minor support | Needs interactions with typically developing others. Child's behaviors are different from others in minor ways and the child may not immediately be perceived as different. | 0 | 1 |
| No support needed or at age level | Needs no support. Behaviors are similar to others in general community of same age and culture. | 0 | 0 |
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(1) You are age birth through five years old and the total of your LOC scores is five or more; or
(2) You are age six through fifteen years old and the total of your LOC scores is seven or more.
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The Supports Intensity Scale Assessment
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(1) Your ICF/MR Level of Care score for DDD HCBS waiver eligibility;
(2) The health and welfare needs that must be addressed in your individual support plan if you are enrolled in a DDD HCBS waiver;
(3) Your DDD behavioral and medical acuity levels regardless of your age; and
(4) Your support need acuity levels specific to the:
(a) DDD Activities of Daily Living Acuity Scale;
(b) DDD Interpersonal Support Acuity Scale; and
(c) DDD Mobility Acuity Scale.
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(1) The Support Needs scale;
(2) The Supplemental Protection and Advocacy scale;
(3) Exceptional Medical Support Needs scale; and
(4) Exceptional Behavioral Support Needs scale.
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(1) Home living activities;
(2) Community living activities;
(3) Lifelong learning activities;
(4) Employment activities;
(5) Health and safety activities; and
(6) Social activities.
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(1) Type of support;
(2) Frequency of support; and
(3) Daily support time.
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| Type of Support: What kind of support is needed for the assessed activity? | |
| Answer | Score |
| None | 0 |
| Monitoring | 1 |
| Verbal/gestural prompting | 2 |
| Partial physical assistance | 3 |
| Full physical assistance | 4 |
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| Frequency: How frequently is support needed for the assessed activity? | |
| Answer | Score |
| None or less than monthly | 0 |
| At least once a month, but not once a week | 1 |
| At least once a week, but not once a day | 2 |
| At least once a day, but not once an hour | 3 |
| Hourly or more frequently | 4 |
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| Daily Support Time: On a typical day when support in this area is needed, how much time should be devoted? | |
| Answer | Score |
| None | 0 |
| Less than 30 minutes | 1 |
| 30 minutes to less than 2 hours | 2 |
| 2 hours to less than 4 hours | 3 |
| 4 hours or more | 4 |
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[]
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| # | Home Living Activities | Type of Support | Frequency of Support | Daily Support Time | Raw Score | ||||||||||||
| A1 | Using the toilet | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | |
| A2 | Taking care of clothes (includes laundering) | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | |
| A3 | Preparing food | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | * | 0 | 1 | 2 | 3 | 4 | |
| A4 | Eating food | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | |
| A5 | Housekeeping and cleaning | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | * | * | |
| A6 | Dressing | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | |
| A7 | Bathing and taking care of personal hygiene and grooming needs | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | * | 0 | 1 | 2 | 3 | 4 | |
| A8 | Operating home appliances | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | |
| A9 | Using currently prescribed equipment or treatment | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | |
| Total Raw Score for Home Living Activities: | |||||||||||||||||
| * = Score is not an option per AAIDD. Note: Question A9 is a question added by DDD. It is for information purposes only and is not used to calculate scores or levels for service determination. |
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| # | Community Living Activities | Type of Support | Frequency of Support | Daily Support Time | Raw Score | ||||||||||||
| B1 | Getting from place to place throughout the community (transportation) | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | * | 0 | 1 | 2 | 3 | 4 | |
| B2 | Participating in recreation/leisure activities in community settings | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | * | 0 | 1 | 2 | 3 | 4 | |
| B3 | Using public services in the community | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | * | 0 | 1 | 2 | 3 | 4 | |
| B4 | Going to visit friends and family | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | * | 0 | 1 | 2 | 3 | 4 | |
| B5 | Participating in preferred community activities (church, volunteer, etc.) | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | * | 0 | 1 | 2 | 3 | 4 | |
| B6 | Shopping and purchasing goods and services | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | |
| B7 | Interacting with community members | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | |
| B8 | Accessing public buildings and settings | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | |
| Total Raw Score for Community Living Activities: | |||||||||||||||||
| * = Score is not an option per AAIDD. | |||||||||||||||||
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| # | Lifelong Learning Activities | Type of Support | Frequency of Support | Daily Support Time | Raw Score | ||||||||||||
| C1 | Interacting with others in learning activities | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | * | 0 | 1 | 2 | 3 | 4 | |
| C2 | Participating in training/educational decisions | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | * | 0 | 1 | 2 | 3 | * | |
| C3 | Learning and using problem-solving strategies | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | |
| C4 | Using technology for learning | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | |
| C5 | Accessing training/educational settings | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | |
| C6 | Learning functional academics (reading signs, counting change, etc.) | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | |
| C7 | Learning health and physical education skills | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | |
| C8 | Learning self-determination skills | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | |
| C9 | Learning self-management strategies | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | * | 0 | 1 | 2 | 3 | 4 | |
| Total Raw Score for Lifelong Learning Activities: | |||||||||||||||||
| *= Score is not an option per AAIDD. | |||||||||||||||||
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| # | Employment Activities | Type of Support | Frequency of Support | Daily Support Time | Raw Score | ||||||||||||
| D1 | Accessing/receiving/job/tasks accommodations | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | * | 0 | 1 | 2 | 3 | 4 | |
| D2 | Learning and using specific job skills | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | * | 0 | 1 | 2 | 3 | 4 | |
| D3 | Interacting with co-workers | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | * | 0 | 1 | 2 | 3 | 4 | |
| D4 | Interacting with supervisors and/or coaches | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | * | 0 | 1 | 2 | 3 | 4 | |
| D5 | Completing work-related tasks with acceptable speed | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | * | 0 | 1 | 2 | 3 | 4 | |
| D6 | Completing work-related tasks with acceptable quality | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | * | 0 | 1 | 2 | 3 | 4 | |
| D7 | Changing job assignments | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | * | * | 0 | 1 | 2 | 3 | 4 | |
| D8 | Seeking information and assistance from an employer | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | * | 0 | 1 | 2 | 3 | 4 | |
| Total Raw Score for Employment Activities: | |||||||||||||||||
| * = Score is not an option per AAIDD. | |||||||||||||||||
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| # | Health and Safety Activities | Type of Support | Frequency of Support | Daily Support Time | Raw Score | ||||||||||||
| E1 | Taking medications | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | |
| E2 | Avoiding health and safety hazards | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | |
| E3 | Obtaining health care services | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | * | * | |
| E4 | Ambulating and moving about | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | |
| E5 | Learning how to access emergency services | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | |
| E6 | Maintaining a nutritious diet | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | |
| E7 | Maintaining physical health and fitness | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | |
| E8 | Maintaining emotional well-being | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | |
| Total Raw Score for Health and Safety Activities: | |||||||||||||||||
| * = Score is not an option per AAIDD. | |||||||||||||||||
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| # | Social Activities | Type of Support | Frequency of Support | Daily Support Time | Raw Score | ||||||||||||
| F1 | Socializing within the household | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | * | 0 | 1 | 2 | 3 | 4 | |
| F2 | Participating in recreation and/or leisure activities with others | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | * | 0 | 1 | 2 | 3 | 4 | |
| F3 | Socializing outside the household | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | |
| F4 | Making and keeping friends | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | * | 0 | 1 | 2 | 3 | 4 | |
| F5 | Communicating with others about personal needs | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | |
| F6 | Using appropriate social skills | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | |
| F7 | Engaging in loving and intimate relationships | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | |
| F8 | Engaging in volunteer work | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | |
| Total Raw Score for Social Activities: | |||||||||||||||||
| * = Score is not an option per AAIDD. | |||||||||||||||||
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| # | Protection and Advocacy Activities | Type of Support | Frequency of Support | Daily Support Time | Raw Score | ||||||||||||
| G1 | Advocating for self | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | * | 0 | 1 | 2 | 3 | 4 | |
| G2 | Managing money and personal finances | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | |
| G3 | Protecting self from exploitation | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | |
| G4 | Exercising legal responsibilities | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | |
| G5 | Belonging to and participating in self-advocacy/support organizations | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | |
| G6 | Obtaining legal services | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | |
| G7 | Making choices and decisions | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | 4 | |
| G8 | Advocating for others | 0 | 1 | 2 | 3 | 4 | 0 | 1 | 2 | 3 | * | 0 | 1 | 2 | 3 | 4 | |
| Total Raw Score for Protection and Advocacy Activities: | |||||||||||||||||
| * = Score is not an option for AAIDD. | |||||||||||||||||
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| Answer | Score |
| No support needed | 0 |
| Some support needed | 1 |
| Extensive support needed | 2 |
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| # | Medical Supports Needed | No Support Needed | Some Support Needed | Extensive Support Needed |
| 1. | Inhalation or oxygen therapy | 0 | 1 | 2 |
| 2. | Postural drainage | 0 | 1 | 2 |
| 3. | Chest PT | 0 | 1 | 2 |
| 4. | Suctioning | 0 | 1 | 2 |
| 5. | Oral stimulation or jaw positioning | 0 | 1 | 2 |
| 6. | Tube feeding (e.g., nasogastric) | 0 | 1 | 2 |
| 7. | Parenteral feeding (e.g., IV) | 0 | 1 | 2 |
| 8. | Turning or positioning | 0 | 1 | 2 |
| 9. | Dressing of open wound(s) | 0 | 1 | 2 |
| 10. | Protection from infectious diseases due to immune system impairment | 0 | 1 | 2 |
| 11. | Seizure management | 0 | 1 | 2 |
| 12. | Dialysis | 0 | 1 | 2 |
| 13. | Ostomy care | 0 | 1 | 2 |
| 14. | Lifting and/or transferring | 0 | 1 | 2 |
| 15. | Therapy services | 0 | 1 | 2 |
| 16. | Diabetes Management* | 0 | 1 | 2 |
| 17. | Other(s) - Specify: | 0 | 1 | 2 |
| Sub-total Scores of 1s and 2s: | ||||
| Add Sub-totals scores for 1's and 2's for total exceptional Medical Support Needs Score: | ||||
| * #16 is a question added by DDD. It is used as part of the DDD Medical Acuity Scale and is not used to calculate SIS percentiles. | ||||
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| # | Behavioral Supports Needed | No Support Needed | Some Support Needed | Extensive Support Needed |
| 1. | Prevention of assaults or injuries to others | 0 | 1 | 2 |
| 2. | Prevention of property destruction (e.g., fire setting, breaking furniture) | 0 | 1 | 2 |
| 3. | Prevention of stealing | 0 | 1 | 2 |
| 4. | Prevention of self-injury | 0 | 1 | 2 |
| 5. | Prevention of PICA (ingestion of inedible substances) | 0 | 1 | 2 |
| 6. | Prevention of suicide attempts | 0 | 1 | 2 |
| 7. | Prevention of sexual aggression | 0 | 1 | 2 |
| 8. | Prevention of non-aggressive but inappropriate behavior (e.g., exposes self in public, exhibitionism, inappropriate touching or gesturing) | 0 | 1 | 2 |
| 9. | Prevention of tantrums or emotional outbursts | 0 | 1 | 2 |
| 10. | Prevention of wandering | 0 | 1 | 2 |
| 11. | Prevention of substance abuse | 0 | 1 | 2 |
| 12. | Maintenance of mental health treatments | 0 | 1 | 2 |
| 13. | Managing attention-seeking behavior* | 0 | 1 | 2 |
| 14. | Managing uncooperative behavior* | 0 | 1 | 2 |
| 15. | Managing agitated/over reactive behavior* | 0 | 1 | 2 |
| 16. | Managing obsessive/repetitive behavior* | 0 | 1 | 2 |
| 17. | Prevention of other serious behavior problem(s) - Specify: | 0 | 1 | 2 |
| Sub-total Scores of 1s and 2s: | ||||
| Add sub-totals scores for 1s and 2s for total exceptional Behavioral Support Needs Scores: | ||||
| *#13-16 are questions added by DDD. They are used as part of the DDD Behavior Acuity Scale and are not used to calculate SIS percentiles. | ||||
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(1) You have a percentile rank that is over nine percent for three or more of the six subscales in the SIS Support Needs Scale;
(2) You have a percentile rank that is over twenty-five percent for two or more of the six subscales in the SIS Support Needs Scale;
(3) You have a percentile rank that is over fifty percent in at least one of the six subscales in the SIS Support Needs Scale;
(4) You have a support score of one or two for any of the questions listed in the SIS Exceptional Medical Support Needs Scale;
(5) You have a support score of one or two for at least one of the following items in the SIS Exceptional Behavior Support Needs Scale:
(a) Prevention of assaults or injuries to others;
(b) Prevention of property destruction (e.g., fire setting, breaking furniture);
(c) Prevention of self-injury;
(d) Prevention of PICA (ingestion of inedible substances);
(e) Prevention of suicide attempts;
(f) Prevention of sexual aggression; or
(g) Prevention of wandering.
(6) You have a support score of two for any of the questions listed in the SIS Exceptional Behavior Support Needs Scale; or
(7) You meet or exceed any of the qualifying scores for one or more of the following SIS questions:
| Question # of SIS Support Needs Scale | Text of Question | Your score for "Type of Support" is: |
And your score for "Frequency of Support" is: |
| A1 | Using the toilet | 2 or more | 4 |
| 3 or more | 2 | ||
| A2 | Taking care of clothes | 2 or more | 2 or more |
| 3 or more | 1 | ||
| A3 | Preparing food | 2 or more | 4 |
| 3 or more | 2 | ||
| A4 | Eating food | 2 or more | 4 |
| 3 or more | 2 | ||
| A5 | Housekeeping and cleaning | 2 or more | 2 or more |
| 3 or more | 1 | ||
| A6 | Dressing | 2 or more | 4 |
| 3 or more | 2 | ||
| A7 | Bathing and taking care of personal hygiene and grooming needs | 2 or more | 4 |
| 3 or more | 2 | ||
| C3 | Learning and using problem-solving strategies | 2 or more | 3 or more |
| 3 or more | 2 | ||
| C9 | Learning self-management strategies | 2 or more | 3 or more |
| 3 or more | 2 | ||
| B6 | Shopping and purchasing goods and services | 2 or more | 2 or more |
| 3 or more | 1 | ||
| E1 | Taking medication | 2 or more | 4 |
| 3 or more | 2 | ||
| E2 | Avoiding health and safety hazards | 2 or more | 3 or more |
| 3 or more | 2 | ||
| E4 | Ambulating and moving about | 2 or more | 4 |
| 3 or more | 2 | ||
| E6 | Maintaining a nutritious diet | 2 or more | 2 or more |
| 3 or more | 1 | ||
| E8 | Maintaining emotional well-being | 2 or more | 3 or more |
| 3 or more | 2 | ||
| F6 | Using appropriate social skills | 2 or more | 3 or more |
| 3 or more | 2 | ||
| G2 | Managing money and personal finances | 2 or more | 2 or more |
| 3 or more | 1 |
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| If your raw score for the following SIS subscale is: | ||||||
| Home Living | Community Living | Lifelong Learning | Employment Support | Health and Safety | Social Activities | Then your percentile rank for the SIS subscale is: |
| >99 | ||||||
| >88 | >94 | >99 | ||||
| 87-88 | 93-94 | >99 | ||||
| 85-86 | 91-92 | >97 | 99 | |||
| 81-84 | 88-90 | >96 | >95 | 92-97 | >97 | 98 |
| 77-80 | 84-87 | 92-96 | 91-95 | 86-91 | 91-97 | 95 |
| 73-76 | 79-83 | 86-91 | 85-90 | 79-85 | 84-90 | 91 |
| 68-72 | 74-78 | 79-85 | 78-84 | 72-78 | 76-83 | 84 |
| 62-67 | 69-73 | 72-78 | 70-77 | 65-71 | 68-75 | 75 |
| 55-61 | 63-68 | 64-71 | 61-69 | 57-64 | 58-67 | 63 |
| 48-54 | 56-62 | 55-63 | 52-60 | 49-56 | 48-57 | 50 |
| 40-47 | 49-55 | 46-54 | 42-51 | 42-48 | 38-47 | 37 |
| 32-39 | 41-48 | 36-45 | 32-41 | 34-41 | 28-37 | 25 |
| 25-31 | 33-40 | 27-35 | 23-31 | 27-33 | 19-27 | 16 |
| 18-24 | 25-32 | 18-26 | 15-22 | 20-26 | 10-18 | 9 |
| 11-17 | 16-24 | 9-17 | 7-14 | 13-19 | 3-9 | 5 |
| 3-10 | 6-15 | <9 | <7 | 7-12 | <3 | 2 |
| <3 | <6 | 1-6 | 1 | |||
| <1 | <1 | |||||
| <1 | ||||||
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DDD Protective Supervision Acuity Scale
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(2) The Protective Supervision Acuity Scale is not used when determining your Medicaid personal care or waiver personal care; and
(3) The information is used for reporting purposes to the legislature and the department.
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(1) What level of monitoring does the client typically require during awake hours?
| Answers | Definitions | Score |
| Independent | Can be left unattended. Might occasionally show poor judgement, but does not require routine access to a support person. | 0 |
| Remote (e.g., a week or more) | Can be left unattended for extended periods of time, but requires access to a support person either via phone or someone who visits the person weekly or so. | 1 |
| Periodic (e.g., every couple of days) | Can be left unattended for a couple of days, but requires access to a support person who checks in every few days via telephone or in person. | 2 |
| Monitoring (e.g., half day, unstructured) | Can be left unattended for several hours at a time (2-4 hours) to engage in independent activities, but needs access to a support person daily for guidance or assistance. | 3 |
| Close Proximity (e.g., 1-2 hours, structured) | Can be left unattended for short periods of time (1-2 hours), provided that the environment is strictly structured and that a support person can respond quickly in an emergency situation. | 4 |
| Onsite (e.g., on property) | Cannot be left unattended. Requires a support person on the property at all times, at least during awake hours. | 5 |
| Line of Sight/Earshot (e.g., close observation) | Cannot be left unattended. Requires a support person within the room or within earshot of the client's location at all times during awake hours. | 6 |
| Answers | Definitions |
| Can resolve independently | The client can generally handle unfamiliar or unexpected situations. The client shows generally good judgment and awareness of personal safety. |
| Can resolve with remote assistance | The client can handle unfamiliar or unexpected situations by calling or contacting someone remotely for assistance (e.g., by telephone or email). The support person does not need to be physically present. |
| Needs someone physically present to assist | When unfamiliar or unexpected situations occur, generally someone must be present or come to the client to help the client resolve the issue. |
| Needs full physical assistance | The client cannot generally participate in resolving such situations; someone else must resolve them. |
| Answers | Definitions |
| Can call someone on telephone | Client can discern when help is needed and contact someone via telephone or other electronic means. This includes dialing 911, using speed dial to contact someone, email, radio, or dialing a phone number. |
| Can seek help outside the house, nearby | Client can discern when help is needed and can summon a remote caregiver, neighbor, or other person outside the house or nearby to assist when necessary. |
| Can seek help inside house | Client can discern when help is needed and can summon a caregiver or roommate within the house to assist when necessary. |
| Cannot summon help | Client is unable to summon help or discern a dangerous situation that would require help. |
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| If you are: | Then your age-based score adjustment is: |
| 18 years or older | Score is equal to your level of monitoring score |
| 16-17 years of age | Subtract 1 from your level of monitoring score |
| 12-15 years of age | Subtract 2 from your level of monitoring score |
| 8-11 years of age | Subtract 3 from your level of monitoring score |
| 5-7 years of age | Subtract 4 from your level of monitoring score |
| 0-4 years of age | Subtract 5 from your level of monitoring score |
| If your adjusted level of monitoring score is a negative number, your adjusted protective supervision acuity score is zero. | |
[]
| If your Adjusted Protective Supervision score is: | Then your Protective Supervision Support Level is: |
| 5-6 | High |
| 3-4 | Medium |
| 1-2 | Low |
| 0 | None |
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DDD Caregiver Status Acuity Scale
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(2) The DDD Caregiver Status Acuity Scale does not affect service determination for the Medicaid personal care or waiver personal care assessment; and
(3) The information is used for reporting purposes to the legislature and the department.
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[]
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(1) He or she has been identified as an informal caregiver; and
(2) He or she is available to provide assistance as an informal caregiver when other caregivers are unavailable.
[]
[]
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(1) Overall, how stressed do you feel in caring for the client?
| Answers | Score |
| Not stressed | 0 |
| Somewhat stressed | 4 |
| Very stressed | 9 |
| Answers | Score |
| Client is the only person who requires direct care | 0 |
| Part-time responsibility for one or more additional persons | 1 |
| Full-time responsibility for one additional person | 2 |
| Full-time responsibility for two or more additional persons | 4 |
(3) Factors that make it hard to be a caregiver for client?
| Answers | Score |
| Decline in physical health | 1 |
| Decline in emotional health | 1 |
| Negative impact on employment | 1 |
| Getting less than 5 hours of uninterrupted sleep because of care giving | 1 |
| Health or safety impact | 1 |
| Other issues than impact care giving | 1 |
| Answers | Score |
| Little or no impact | 0 |
| Possible impact, no concrete evidence | 1 |
| Concrete evidence of reduced care | 4 |
| Unable | 9 |
| Answers | Score |
| Stable and healthy | 0 |
| Clearly identifiable signs of stress | 4 |
| Serious risk of failure | 9 |
| Answers | Score |
| 2 or more years | 0 |
| 6 months to 2 years | 0 |
| 1 to 6 months | 4 |
| Less than 1 month | 9 |
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| If the following criteria are met: | Then your caregiver risk factor (s) are: |
| (1) You have a score of "less than 1 month" for question 6 ("How long do you expect to continue providing care?") in WAC 388-828-5260. | Immediate risk of loss of caregiver |
| (2) You have not identified any collateral contacts in the CARE
system as having a contact role of "informal caregiver;" and (3) You have not identified any collateral contacts in the CARE system as having a contact role of "formal caregiver;" and (4) You have not identified any collateral contacts in the CARE system as having a contact role of "backup caregiver;" and (5) You do not have a paid provider, authorized by DDD, to provide supports for a DDD paid service; and (6) You have an adjusted protective supervision score of 3 or more in WAC 388-828-5080. |
No caregiver, and needs one |
| (7) You have identified one of your collateral contacts in the
CARE system as having a contact role of primary caregiver; and (8) Your primary caregiver is 70 years of age or older; and (9) Your primary caregiver lives with you in the same residence. |
Aging caregiver |
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| Your scores for the following questions in | Your Caregiver Risk Level | ||
| Your score for question 4 | Your score for question 5 | Your score for question 6 | |
| 0 | 0 | 0 | None |
| 0 | 0 | 4 | Medium |
| 0 | 0 | 9 | Immediate |
| 0 | 4 | 0 | Medium |
| 0 | 4 | 4 | Medium |
| 0 | 4 | 9 | Immediate |
| 0 | 9 | 0 | High |
| 0 | 9 | 4 | High |
| 0 | 9 | 9 | Immediate |
| 1 | 0 | 0 | Low |
| 1 | 0 | 4 | Medium |
| 1 | 0 | 9 | Immediate |
| 1 | 4 | 0 | Medium |
| 1 | 4 | 4 | Medium |
| 1 | 4 | 9 | Immediate |
| 1 | 9 | 0 | High |
| 1 | 9 | 4 | High |
| 1 | 9 | 9 | Immediate |
| 4 | 0 | 0 | Medium |
| 4 | 0 | 4 | Medium |
| 4 | 0 | 9 | Immediate |
| 4 | 4 | 0 | Medium |
| 4 | 4 | 4 | Medium |
| 4 | 4 | 9 | Immediate |
| 4 | 9 | 0 | High |
| 4 | 9 | 4 | High |
| 4 | 9 | 9 | Immediate |
| 9 | 0 | 0 | High |
| 9 | 0 | 4 | High |
| 9 | 0 | 9 | Immediate |
| 9 | 4 | 0 | High |
| 9 | 4 | 4 | High |
| 9 | 4 | 9 | Immediate |
| 9 | 9 | 0 | High |
| 9 | 9 | 4 | High |
| 9 | 9 | 9 | Immediate |
(3) If your caregiver risk factor is "No caregiver, and needs one" in WAC 388-828-5280, your caregiver risk level is immediate regardless of your scores for questions four, five, and six.
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(1) Under what conditions are other caregivers available?
| Answers available for selection | Score |
| Routinely provides care | 0 |
| Upon request | 2 |
| Emergency only | 4 |
| No other caregiver available | 9 |
[]
[]
| If the availability of your back caregiver is: | Then your risk level score is: |
| (1) Your backup caregivers are available routinely or upon request as
evidenced by a score of 0 to 2 for question 1 of the backup caregiver subscale;
and (2) You have a person identified as a backup caregiver that does not live with you evidenced by the "Lives with client" checkbox not being selected as contact details information for him or her. |
1 (Not at risk) |
| (3) Your backup caregivers are available upon an emergency only basis
evidenced by a score of 4 for question 1 of the backup caregiver subscale; and (4) "Lives with client" has been selected for all of the persons you have identified as your backup caregivers. |
2 (Some risk) |
| (5) You have no other caregiver available evidenced by a score of 9 for question 1 of the backup caregiver subscale. | 3 (High risk) |
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DDD Activities of Daily Living (ADL) Acuity Scale(1) The DDD Activities of Daily Living Acuity Scale does not affect service determination for the Medicaid personal care or waiver personal care assessments; and
(2) The information is used for reporting purposes to the legislature and the department.
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(1) Your ADL support needs level from the Support Assessment for Children if you are age birth through fifteen years old; or
(2) Your ADL support needs level from the SIS Assessment if you are age sixteen or older.
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| ADL questions from the Support Assessment for Children in WAC 388-828-3040 | |
| Question # | Text of ADL Questions: |
| 1 | Dress and Groom self |
| 2 | Toilet self |
| 3 | Eat at age level |
| 4 | Move around |
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| If your ADL support needs score is: | Then your ADL support need level is: | Value |
| 11 to 16 | High | 3 |
| 7 to 10 | Medium | 2 |
| 2 to 6 | Low | 1 |
| 0 or 1 | None | 0 |
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| ADL questions from the SIS assessment in WAC 388-828-4200 and WAC 388-828-4280 | |
| Question # | Text of ADL questions: |
| A1 | Using the toilet |
| A4 | Eating food |
| A6 | Dressing |
| A7 | Bathing and taking care of personal hygiene and grooming needs |
| E1 | Taking medications |
| E4 | Ambulating and moving about |
(3) If your "Frequency of Support" score for a SIS ADL support question is two, three, or four, no adjustment is needed to your "Type of Support" score.
Example:
| SIS ADL Questions | Text of SIS ADL Questions | If your "Frequency of Support" score is: | And your "Type of Support" score is: |
Then your adjusted "Type of Support" score is: |
| A1 | Using the toilet | 3 | 3 | 3 |
| A4 | Eating food | 1 | 2 | 0 |
| A6 | Dressing | 3 | 3 | 3 |
| A7 | Bathing and taking care of personal hygiene and grooming needs | 1 | 2 | 0 |
| E1 | Taking medications | 3 | 2 | 2 |
| E4 | Ambulating and moving about | 0 | 0 | 0 |
| Your SIS ADL support needs score: | 8 | |||
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| If the sum of your adjusted ADL support needs score for the SIS is: | Then your ADL support needs level for the SIS is: | Value |
| 16 to 24 | High | 3 |
| 10 to 15 | Medium | 2 |
| 2 to 9 | Low | 1 |
| 0 or 1 | None | 0 |
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DDD Behavioral Acuity Scale
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(2) The DDD Behavioral Acuity Scale does not affect service determination for the Medicaid personal care or waiver personal care assessment.
(3) The information is used for reporting purposes to the legislature and the department.
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[]
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| If the frequency of occurrence of your most prominent behavior is: | Then your score for frequency is: |
| Less than once per month | Rare |
| 1 to 3 times per month | Occasional |
| 1 to 4 times per week | Occasional |
| 1 to 3 times daily | Frequent |
| 4 or more times daily | Frequent |
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| If the characteristics of your most prominent behavior are: | Then your score for severity is: |
| Your behavior may be uncooperative, inconvenient, repetitive, and/or require time intensive support. However, your behavior is not considered aggressive or self-injurious. | Minor incidents |
| Your behavior, if allowed to continue over time, may result in life-threatening harm for yourself and/or others. | Potentially dangerous |
| Your behavior without immediate intervention will result in life-threatening harm for yourself and/or others. | Life threatening |
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| If the caregiver assistance provided to support your most prominent behavior is: | Then your score for caregiver assistance is: |
| Your respondent reports that you do not require any assistance to keep your most prominent behavior under control. | No supervision, Oversight |
| Your respondent reports that you may at times require supervision and verbal redirection to keep your most prominent behavior under control. | Verbal redirection |
| Your respondent reports that you require occasional physical guidance of limbs and/or caregiver intervention to keep your most prominent behavior under control. | Occasional physical guiding or intervention |
| Your respondent reports that you require in-sight supervision at all times and may require 1 to 2 person physical restraint or removal from the area to keep your most prominent behavior under control. | In-Sight Supervision -Physical restraint |
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| If your score for frequency is: | And your score for severity is: | And your score for caregiver assistance is: | Then your behavioral acuity level is: |
Rare |
Minor |
None | Low |
| Verbal redirection | Low | ||
| Physical guiding or selection | Low | ||
| Physical restraint | Low | ||
Potentially Dangerous |
None | Low | |
| Verbal redirection | Low | ||
| Physical guiding or selection | Medium | ||
| Physical restraint | High | ||
Life-Threatening |
None | Medium | |
| Verbal redirection | Medium | ||
| Physical guiding or selection | High | ||
| Physical restraint | High | ||
Occasional |
Minor |
None | Low |
| Verbal redirection | Low | ||
| Physical guiding or selection | Low | ||
| Physical restraint | Medium | ||
Potentially Dangerous |
None | Medium | |
| Verbal redirection | Medium | ||
| Physical guiding or selection | Medium | ||
| Physical restraint | High | ||
Life Threatening |
None | Medium | |
| Verbal redirection | Medium | ||
| Physical guiding or selection | High | ||
| Physical restraint | High | ||
Frequent |
Minor |
None | Low |
| Verbal redirection | Low | ||
| Physical guiding or selection | Medium | ||
| Physical restraint | Medium | ||
Potentially Dangerous |
None | Medium | |
| Verbal redirection | Medium | ||
| Physical guiding or selection | High | ||
| Physical restraint | High | ||
Life-Threatening |
None | High | |
| Verbal redirection | High | ||
| Physical guiding or selection | High | ||
| Physical restraint | High |
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DDD Medical Acuity Scale(1) The DDD Medical Acuity Scale does not affect service determination for the Medicaid personal care or waiver personal care assessments; and
(2) The information is used for reporting purposes to the legislature and the department.
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| If you meet the following criteria: | Then your medical acuity level is: | Value |
| (1) If you have a score of 2 on questions 1, 4, and 7; | High | 3 |
| (2) If you have a score of 2 on any two of the following questions: 2, 3, 5, 6, 8, 9, 10, 11, 12, 13, 14, 16, or 17; | High | 3 |
| (3) If your total exceptional medical support needs score is 8 or higher; | High | 3 |
| (4) If you have a score of 2 on any of the following questions: 2, 3, 5, 6, 8, 9, 10, 11, 12, 13, 14, 16, or 17 and do not meet the criteria for a high medical acuity level; | Medium | 2 |
| (5) If your total exceptional medical support needs score is 6 or 7 and you do not meet the criteria for a high medical acuity level; | Medium | 2 |
| (6) If your total exceptional medical support needs score is 5 or less, but greater than zero, and you do not have a score of 2 on any questions excluding number 15; | Low | 1 |
| (7) If your total exceptional medical support needs score equals zero. | None | 0 |
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DDD Interpersonal Support Acuity Scale(1) The DDD Interpersonal Support Acuity Scale does not affect service determination for the Medicaid personal care or waiver Personal Care assessments; and
(2) The information is used for reporting purposes to the legislature and the department.
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(1) Your interpersonal support acuity level from the Support Assessment for Children if you are age birth through fifteen; or
(2) Your interpersonal support acuity level from the SIS Assessment if you are age sixteen or older.
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| Interpersonal support needs questions from the Support Assessment for Children in WAC 388-828-3040 | |
| Question # | Text of Questions: |
| 5 | Communicate: What support does the child need to communicate with others of same age? |
| 11 | Have relationships with family members: What support does the child need to make the kind of relationships with family members expected of non disabled children of the same age? |
| 13 | Play with others: What supports are needed for the child to develop age-level skills in playing with others? |
| 17 | Effectively relate to other students/peers: What support does the person need to most effectively relate to fellow students and/or peers? |
| 18 | Have behaviors which promote being included: What support is needed for this person to have behaviors which promote being included? |
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| If your interpersonal support needs score is: | Then your interpersonal support needs level is: | Value |
| (1) Your interpersonal support needs score is 10 or more. | High | 3 |
| (2) Your interpersonal support
needs score is a 4, 5, 6, 7, 8, or
9; or (3) You have an acuity score of 3 or 4 for one of the interpersonal support needs questions listed in WAC 388-828-3040. |
Medium | 2 |
| (4) Your interpersonal support
needs score is 1, 2, or 3; and (5) You do not have an acuity score of 3 or 4 for one of the interpersonal support needs questions listed in WAC 388-828-3040. |
Low | 1 |
| (6) Your interpersonal support needs score is zero. | None | 0 |
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| Interpersonal support needs questions from the SIS assessment | |
| Question # | Text of interpersonal support needs questions: |
| B7 | Interacting with community members |
| C1 | Interacting with others in learning activities |
| D3 | Interacting with co-workers |
| D4 | Interacting with supervisors/coaches |
| D8 | Seeking information and assistance from an employer |
| F1 | Socializing within the household |
| F3 | Socializing outside the household |
| F5 | Communicating with others about personal needs |
| F6 | Using appropriate social skills |
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| If your interpersonal support needs score is: | Then your interpersonal support needs level is: | Value |
| (1) 56 or more | High | 3 |
| (2) At least 20; and (3) Less than 56 |
Medium | 2 |
| (4) 3 or 4 for both "Type of Support" and "Frequency of Support" for one of the interpersonal support needs questions | Medium | 2 |
| (5) At least 1; and (6) Less than 20; and (7) You do not have a score of 3 or 4 for both "Type of Support" and "Frequency of Support" for one of the interpersonal support needs questions |
Low | 1 |
| (8) Zero | None | 0 |
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DDD Mobility Acuity Scale(1) The DDD Mobility Acuity Scale does not affect service determination for the Medicaid personal care or waiver personal care assessments; and
(2) The information is used for reporting purposes to the legislature and the department.
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(1) Your mobility acuity level from the Support Assessment for Children if you are age birth through fifteen; or
(2) Your mobility acuity level from the SIS Assessment if you are age sixteen or older.
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| If your acuity score for question 4 is: | Then your mobility acuity level is: |
| 4 | High |
| 3 | Medium |
| 1 or 2 | Low |
| 0 | None |
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| If you score for "Frequency of Support" is: | And your score for "Type of Support" is: | Then your Mobility Acuity Level is: | Value |
| 3 or 4 | 4 | High | 3 |
| 3 or 4 | 3 | Medium | 2 |
| If your raw score for question E4 or 5 or more and you do not meet the criteria for a high or medium mobility acuity level | Low | 1 | |
| If your raw score for question E4 is 4 or less | None | 0 | |
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Respite Assessment
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(1) Voluntary Placement Program services per chapter 388-826 WAC; or
(2) Companion home services per chapter 388-821 WAC.
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(1) The Protective Supervision Acuity Scale;
(2) The DDD Caregiver Status Acuity Scale; and
(3) The DDD Behavioral Acuity Scale.
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| If your Protective Supervision Support Level is: | And your primary caregiver risk level is: | And your backup caregiver risk score is: | And your behavioral acuity level is: | Then your respite assessment level is: |
| 0 | None | 1 | None | 1 |
| 0 | None | 1 | Low | 1 |
| 0 | None | 1 | Medium | 1 |
| 0 | None | 1 | High | 2 |
| 0 | None | 2 or 3 | None | 1 |
| 0 | None | 2 or 3 | Low | 1 |
| 0 | None | 2 or 3 | Medium | 2 |
| 0 | None | 2 or 3 | High | 2 |
| 0 | Low | 1 | None | 1 |
| 0 | Low | 1 | Low | 1 |
| 0 | Low | 1 | Medium | 1 |
| 0 | Low | 1 | High | 2 |
| 0 | Low | 2 or 3 | None | 1 |
| 0 | Low | 2 or 3 | Low | 1 |
| 0 | Low | 2 or 3 | Medium | 2 |
| 0 | Low | 2 or 3 | High | 2 |
| 0 | Medium | 1 | None | 1 |
| 0 | Medium | 1 | Low | 1 |
| 0 | Medium | 1 | Medium | 1 |
| 0 | Medium | 1 | High | 2 |
| 0 | Medium | 2 or 3 | None | 1 |
| 0 | Medium | 2 or 3 | Low | 1 |
| 0 | Medium | 2 or 3 | Medium | 2 |
| 0 | Medium | 2 or 3 | High | 2 |
| 0 | High | 1 | None | 1 |
| 0 | High | 1 | Low | 1 |
| 0 | High | 1 | Medium | 2 |
| 0 | High | 1 | High | 2 |
| 0 | High | 2 or 3 | None | 2 |
| 0 | High | 2 or 3 | Low | 2 |
| 0 | High | 2 or 3 | Medium | 2 |
| 0 | High | 2 or 3 | High | 3 |
| 0 | Immediate | 1 | None | 1 |
| 0 | Immediate | 1 | Low | 1 |
| 0 | Immediate | 1 | Medium | 2 |
| 0 | Immediate | 1 | High | 2 |
| 0 | Immediate | 2 or 3 | None | 2 |
| 0 | Immediate | 2 or 3 | Low | 2 |
| 0 | Immediate | 2 or 3 | Medium | 2 |
| 0 | Immediate | 2 or 3 | High | 3 |
| 1 | None | 1 | None | 1 |
| 1 | None | 1 | Low | 1 |
| 1 | None | 1 | Medium | 1 |
| 1 | None | 1 | High | 2 |
| 1 | None | 2 or 3 | None | 1 |
| 1 | None | 2 or 3 | Low | 1 |
| 1 | None | 2 or 3 | Medium | 2 |
| 1 | None | 2 or 3 | High | 3 |
| 1 | Low | 1 | None | 1 |
| 1 | Low | 1 | Low | 1 |
| 1 | Low | 1 | Medium | 1 |
| 1 | Low | 1 | High | 2 |
| 1 | Low | 2 or 3 | None | 1 |
| 1 | Low | 2 or 3 | Low | 1 |
| 1 | Low | 2 or 3 | Medium | 2 |
| 1 | Low | 2 or 3 | High | 3 |
| 1 | Medium | 1 | None | 1 |
| 1 | Medium | 1 | Low | 1 |
| 1 | Medium | 1 | Medium | 2 |
| 1 | Medium | 1 | High | 3 |
| 1 | Medium | 2 or 3 | None | 1 |
| 1 | Medium | 2 or 3 | Low | 2 |
| 1 | Medium | 2 or 3 | Medium | 2 |
| 1 | Medium | 2 or 3 | High | 3 |
| 1 | High | 1 | None | 2 |
| 1 | High | 1 | Low | 2 |
| 1 | High | 1 | Medium | 2 |
| 1 | High | 1 | High | 3 |
| 1 | High | 2 or 3 | None | 2 |
| 1 | High | 2 or 3 | Low | 2 |
| 1 | High | 2 or 3 | Medium | 3 |
| 1 | High | 2 or 3 | High | 4 |
| 1 | Immediate | 1 | None | 2 |
| 1 | Immediate | 1 | Low | 2 |
| 1 | Immediate | 1 | Medium | 2 |
| 1 | Immediate | 1 | High | 3 |
| 1 | Immediate | 2 or 3 | None | 2 |
| 1 | Immediate | 2 or 3 | Low | 2 |
| 1 | Immediate | 2 or 3 | Medium | 3 |
| 1 | Immediate | 2 or 3 | High | 4 |
| 2 or 3 | None | 1 | None | 1 |
| 2 or 3 | None | 1 | Low | 1 |
| 2 or 3 | None | 1 | Medium | 2 |
| 2 or 3 | None | 1 | High | 3 |
| 2 or 3 | None | 2 or 3 | None | 2 |
| 2 or 3 | None | 2 or 3 | Low | 2 |
| 2 or 3 | None | 2 or 3 | Medium | 2 |
| 2 or 3 | None | 2 or 3 | High | 4 |
| 2 or 3 | Low | 1 | None | 1 |
| 2 or 3 | Low | 1 | Low | 1 |
| 2 or 3 | Low | 1 | Medium | 2 |
| 2 or 3 | Low | 1 | High | 3 |
| 2 or 3 | Low | 2 or 3 | None | 2 |
| 2 or 3 | Low | 2 or 3 | Low | 2 |
| 2 or 3 | Low | 2 or 3 | Medium | 2 |
| 2 or 3 | Low | 2 or 3 | High | 4 |
| 2 or 3 | Medium | 1 | None | 2 |
| 2 or 3 | Medium | 1 | Low | 2 |
| 2 or 3 | Medium | 1 | Medium | 2 |
| 2 or 3 | Medium | 1 | High | 3 |
| 2 or 3 | Medium | 2 or 3 | None | 2 |
| 2 or 3 | Medium | 2 or 3 | Low | 2 |
| 2 or 3 | Medium | 2 or 3 | Medium | 3 |
| 2 or 3 | Medium | 2 or 3 | High | 4 |
| 2 or 3 | High | 1 | None | 2 |
| 2 or 3 | High | 1 | Low | 2 |
| 2 or 3 | High | 1 | Medium | 2 |
| 2 or 3 | High | 1 | High | 3 |
| 2 or 3 | High | 2 or 3 | None | 2 |
| 2 or 3 | High | 2 or 3 | Low | 2 |
| 2 or 3 | High | 2 or 3 | Medium | 3 |
| 2 or 3 | High | 2 or 3 | High | 4 |
| 2 or 3 | Immediate | 1 | None | 2 |
| 2 or 3 | Immediate | 1 | Low | 2 |
| 2 or 3 | Immediate | 1 | Medium | 2 |
| 2 or 3 | Immediate | 1 | High | 3 |
| 2 or 3 | Immediate | 2 or 3 | None | 2 |
| 2 or 3 | Immediate | 2 or 3 | Low | 2 |
| 2 or 3 | Immediate | 2 or 3 | Medium | 3 |
| 2 or 3 | Immediate | 2 or 3 | High | 4 |
| 4 | None | 1 | None | 2 |
| 4 | None | 1 | Low | 2 |
| 4 | None | 1 | Medium | 2 |
| 4 | None | 1 | High | 3 |
| 4 | None | 2 or 3 | None | 2 |
| 4 | None | 2 or 3 | Low | 2 |
| 4 | None | 2 or 3 | Medium | 3 |
| 4 | None | 2 or 3 | High | 4 |
| 4 | Low | 1 | None | 2 |
| 4 | Low | 1 | Low | 2 |
| 4 | Low | 1 | Medium | 2 |
| 4 | Low | 1 | High | 3 |
| 4 | Low | 2 or 3 | None | 2 |
| 4 | Low | 2 or 3 | Low | 2 |
| 4 | Low | 2 or 3 | Medium | 3 |
| 4 | Low | 2 or 3 | High | 4 |
| 4 | Medium | 1 | None | 2 |
| 4 | Medium | 1 | Low | 2 |
| 4 | Medium | 1 | Medium | 3 |
| 4 | Medium | 1 | High | 3 |
| 4 | Medium | 2 or 3 | None | 2 |
| 4 | Medium | 2 or 3 | Low | 3 |
| 4 | Medium | 2 or 3 | Medium | 3 |
| 4 | Medium | 2 or 3 | High | 4 |
| 4 | High | 1 | None | 2 |
| 4 | High | 1 | Low | 2 |
| 4 | High | 1 | Medium | 3 |
| 4 | High | 1 | High | 3 |
| 4 | High | 2 or 3 | None | 2 |
| 4 | High | 2 or 3 | Low | 3 |
| 4 | High | 2 or 3 | Medium | 4 |
| 4 | High | 2 or 3 | High | 4 |
| 4 | Immediate | 1 | None | 2 |
| 4 | Immediate | 1 | Low | 2 |
| 4 | Immediate | 1 | Medium | 3 |
| 4 | Immediate | 1 | High | 3 |
| 4 | Immediate | 2 or 3 | None | 2 |
| 4 | Immediate | 2 or 3 | Low | 3 |
| 4 | Immediate | 2 or 3 | Medium | 4 |
| 4 | Immediate | 2 or 3 | High | 4 |
| 5 | None | 1 | None | 2 |
| 5 | None | 1 | Low | 2 |
| 5 | None | 1 | Medium | 3 |
| 5 | None | 1 | High | 4 |
| 5 | None | 2 or 3 | None | 3 |
| 5 | None | 2 or 3 | Low | 3 |
| 5 | None | 2 or 3 | Medium | 4 |
| 5 | None | 2 or 3 | High | 5 |
| 5 | Low | 1 | None | 2 |
| 5 | Low | 1 | Low | 2 |
| 5 | Low | 1 | Medium | 3 |
| 5 | Low | 1 | High | 4 |
| 5 | Low | 2 or 3 | None | 3 |
| 5 | Low | 2 or 3 | Low | 3 |
| 5 | Low | 2 or 3 | Medium | 4 |
| 5 | Low | 2 or 3 | High | 5 |
| 5 | Medium | 1 | None | 2 |
| 5 | Medium | 1 | Low | 2 |
| 5 | Medium | 1 | Medium | 3 |
| 5 | Medium | 1 | High | 4 |
| 5 | Medium | 2 or 3 | None | 3 |
| 5 | Medium | 2 or 3 | Low | 3 |
| 5 | Medium | 2 or 3 | Medium | 4 |
| 5 | Medium | 2 or 3 | High | 5 |
| 5 | High | 1 | None | 2 |
| 5 | High | 1 | Low | 2 |
| 5 | High | 1 | Medium | 3 |
| 5 | High | 1 | High | 4 |
| 5 | High | 2 or 3 | None | 3 |
| 5 | High | 2 or 3 | Low | 3 |
| 5 | High | 2 or 3 | Medium | 4 |
| 5 | High | 2 or 3 | High | 5 |
| 5 | Immediate | 1 | None | 2 |
| 5 | Immediate | 1 | Low | 2 |
| 5 | Immediate | 1 | Medium | 3 |
| 5 | Immediate | 1 | High | 4 |
| 5 | Immediate | 2 or 3 | None | 3 |
| 5 | Immediate | 2 or 3 | Low | 3 |
| 5 | Immediate | 2 or 3 | Medium | 4 |
| 5 | Immediate | 2 or 3 | High | 5 |
| 6 | None | 1 | None | 2 |
| 6 | None | 1 | Low | 3 |
| 6 | None | 1 | Medium | 3 |
| 6 | None | 1 | High | 4 |
| 6 | None | 2 or 3 | None | 3 |
| 6 | None | 2 or 3 | Low | 3 |
| 6 | None | 2 or 3 | Medium | 4 |
| 6 | None | 2 or 3 | High | 5 |
| 6 | Low | 1 | None | 2 |
| 6 | Low | 1 | Low | 3 |
| 6 | Low | 1 | Medium | 3 |
| 6 | Low | 1 | High | 4 |
| 6 | Low | 2 or 3 | None | 3 |
| 6 | Low | 2 or 3 | Low | 3 |
| 6 | Low | 2 or 3 | Medium | 4 |
| 6 | Low | 2 or 3 | High | 5 |
| 6 | Medium | 1 | None | 3 |
| 6 | Medium | 1 | Low | 3 |
| 6 | Medium | 1 | Medium | 3 |
| 6 | Medium | 1 | High | 4 |
| 6 | Medium | 2 or 3 | None | 3 |
| 6 | Medium | 2 or 3 | Low | 4 |
| 6 | Medium | 2 or 3 | Medium | 4 |
| 6 | Medium | 2 or 3 | High | 5 |
| 6 | High | 1 | None | 3 |
| 6 | High | 1 | Low | 3 |
| 6 | High | 1 | Medium | 4 |
| 6 | High | 1 | High | 4 |
| 6 | High | 2 or 3 | None | 4 |
| 6 | High | 2 or 3 | Low | 4 |
| 6 | High | 2 or 3 | Medium | 5 |
| 6 | High | 2 or 3 | High | 5 |
| 6 | Immediate | 1 | None | 3 |
| 6 | Immediate | 1 | Low | 3 |
| 6 | Immediate | 1 | Medium | 4 |
| 6 | Immediate | 1 | High | 4 |
| 6 | Immediate | 2 or 3 | None | 4 |
| 6 | Immediate | 2 or 3 | Low | 4 |
| 6 | Immediate | 2 or 3 | Medium | 5 |
| 6 | Immediate | 2 or 3 | High | 5 |
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| If your respite assessment level is: | Then the maximum number of hours you may receive for respite care each year is: |
| 1 | 240 |
| 2 | 240 |
| 3 | 336 |
| 4 | 432 |
| 5 | 528 |
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Programs and Services Component(1) DDD services you are currently receiving;
(2) DDD services you have been approved to receive; and
(3) If you currently meet the ICF/MR Level of Care requirements for continued DDD HCBS waiver eligibility or for potential DDD HCBS waiver services if resources become available.
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Service Level Assessment Module
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(1) The CARE Assessment for Medicaid or waiver personal care services, as defined in chapter 388-106 WAC; and
(2) The DDD Seizure Acuity Scale as defined in WAC 388-828-7040 through WAC 388-828-7080.
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DDD Seizure Acuity Scale(2) The DDD Seizure Acuity Scale does not affect service determination for the Medicaid personal care or waiver personal care assessments.
(3) The information is used for reporting purposes to the legislature and the department.
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| If you meet the following criteria: | Then your seizure acuity level is: |
| (1) You received medical attention for
your seizures, on two or more occasions. (2) Medical attention includes: (a) Visits to a primary care physician; (b) Visits to an emergency room; (c) Calls to 911 that result in paramedics having to provide care, treatment, or stabilization services. |
High |
| (3) You have convulsive seizures
(Tonic-clonic or atonic) and meed the
following conditions: (a) You have a seizure at least once every three months; and (b) Your seizures last at least five minutes. |
High |
| (4) You have convulsive seizures
(Tonic-clonic or atonic) and meet the
following conditions: (a) You have a seizure at least once every three months; and (b) Your seizures last less than five minutes. |
Medium |
| (5) You report a history of having seizures and you do not meet the requirements for a high or medium seizure acuity level. | Low |
| (6) You report that you do not have a history of seizures. | None |
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Individual Support Plan Module(1) Your acuity scores generated from the Support Assessment;
(2) Referral information;
(3) The SSP, if any, you are approved to receive in lieu of a DDD paid service; and
(4) DDD paid services you are authorized to receive:
(a) If you are enrolled in a DDD waiver, the ISP must address all the health and welfare needs identified in your ICF/MR Level of Care assessment and the supports used to meet your assessed needs; or
(b) If you are not enrolled in a DDD waiver, DDD is only required to address the DDD paid services you are approved to receive.
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(1) Activities from the Support Needs Assessment for Children:
| # | Questions in the Support Needs Assessment for Children: | DDD must address in your ISP if you have an acuity score of: | Health and Welfare Category |
| 1 | Dress and groom self | 2 or more | Home Living |
| 2 | Toilet self | 2 or more | Home Living |
| 3 | Eat at age level | 3 or more | Home Living |
| 4 | Move around | 3 or more | Home Living |
| 5 | Communicate | 2 or more | Home Living |
| 7 | Make choices and take responsibility | 2 or more | Protection and Advocacy |
| 8 | Explore environment | 3 or more | Community Living |
| 9 | Meet therapy health needs | 1 or more | Medical Supports |
| 10 | Help family continue to meet child's needs | 1 or more | Protection and Advocacy |
| 15 | Identify and respond safely to emergencies | 1 or more | Health and Safety |
| 16 | Practice age-level safety measures | 2 or more | Protection and Advocacy |
| 17 | Effectively relate to other students/peers | 3 or more | Employment |
| 18 | Have behaviors which promote being included | 3 or more | Behavior Supports |
| # | Questions in the Exceptional Medical Support Needs Scale | DDD must address in your ISP if you have an acuity score of: | Health and Welfare Category |
| 1 | Inhalation or oxygen therapy | 1 or more | Medical Supports |
| 2 | Postural drainage | 1 or more | Medical Supports |
| 3 | Chest PT | 1 or more | Medical Supports |
| 4 | Suctioning | 1 or more | Medical Supports |
| 5 | Oral Stimulation or Jaw Repositioning | 1 or more | Medical Supports |
| 6 | Tube feeding (e.g., nasogastric) | 1 or more | Medical Supports |
| 7 | Parenteral feeding (e.g., IV) | 1 or more | Medical Supports |
| 8 | Turning or positioning | 1 or more | Medical Supports |
| 9 | Dressing of open wound(s) | 1 or more | Medical Supports |
| 10 | Protection from infectious diseases due to immune system impairment | 1 or more | Medical Supports |
| 11 | Seizure management | 1 or more | Medical Supports |
| 12 | Dialysis | 1 or more | Medical Supports |
| 13 | Ostomy care | 1 or more | Medical Supports |
| 14 | Lifting and/or transferring | 1 or more | Medical Supports |
| 15 | Therapy services | 1 or more | Medical Supports |
| 16 | Diabetes management | 1 or more | Medical Supports |
| 17 | Other(s) | 1 or more | Medical Supports |
| # | Questions in the Exceptional Behavior Support Needs Scale: | DDD must address in your ISP if you have an acuity score of: | Health and Welfare Category |
| 1 | Prevention of assaults or injuries to others | 1 or more | Behavioral Supports |
| 2 | Prevention of property destruction (e.g., fire setting, breaking furniture) | 1 or more | Behavioral Supports |
| 3 | Prevention of stealing | 1 or more | Behavioral Supports |
| 4 | Prevention of self-injury | 1 or more | Behavioral Supports |
| 5 | Prevention of pica (ingestion of inedible substances) | 1 or more | Behavioral Supports |
| 6 | Prevention of suicide attempts | 1 or more | Behavioral Supports |
| 7 | Prevention of sexual aggression | 1 or more | Behavioral Supports |
| 8 | Prevention of non-aggressive but inappropriate behavior (e.g., exposes self in public, exhibitionism, inappropriate touching or gesturing) | 1 or more | Behavioral Supports |
| 9 | Prevention of tantrums or emotional outbursts | 1 or more | Behavioral Supports |
| 10 | Prevention of wandering | 1 or more | Behavioral Supports |
| 11 | Prevention of substance abuse | 1 or more | Behavioral Supports |
| 12 | Maintenance of mental health treatments | 1 or more | Behavioral Supports |
| 13 | Managing attention-seeking behavior | 1 or more | Behavioral Supports |
| 14 | Managing uncooperative behavior | 1 or more | Behavioral Supports |
| 15 | Managing agitated/over-reactive behavior | 1 or more | Behavioral Supports |
| 16 | Managing obsessive/repetitive behavior | 1 or more | Behavioral Supports |
| 17 | Prevention of other serious behavior problem(s) | 1 or more | Behavioral Supports |
| # | Question in the DDD Caregiver Status Acuity Scale: | DDD must address in your ISP if you have a score: | Health and Welfare Category |
| 6 | How long do you think you expect to continue providing care? | 1 to 6 months or less than 1 month | DDD Caregiver Status |
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| # | SIS Activity | DDD must address in the ISP if your Type of Support score is: | Health and Welfare Category |
| A1 | Using the toilet | 3 or more | |
| A2 | Taking care of clothes (includes laundering) | 3 or more | |
| A3 | Preparing food | 3 or more | |
| A4 | Eating food | 3 or more | |
| A5 | Housekeeping and cleaning | 3 or more | Home Living |
| A6 | Dressing | 3 or more | |
| A7 | Bathing and taking care of personal hygiene and grooming needs | 3 or more | |
| A8 | Operating home appliances | 3 or more | |
| A9 | Using currently prescribed equipment or treatment | 3 or more | |
| B1 | Getting from place to place throughout the community (transportation) | 2 or more | |
| B2 | Participating in recreation/leisure activities in the community settings | 2 or more | |
| B3 | Using public services in the community | 2 or more | Community Living |
| B4 | Going to visit friends and family | 4 | |
| B6 | Shopping and purchasing goods and services | 2 or more | |
| B7 | Interacting with community members | 4 | |
| B8 | Accessing public buildings and settings | 2 or more | |
| D3 | Interacting with co-workers | 3 or more | |
| D4 | Interacting with supervisors and or coaches | 3 or more | Employment |
| E1 | Taking medications | 2 or more | |
| E2 | Avoiding health and safety hazards | 3 or more | |
| E3 | Obtaining health care services | 3 or more | |
| E4 | Ambulating and moving about | 3 or more | Health and Safety |
| E6 | Maintaining a nutritious diet | 3 or more | |
| E7 | Maintaining physical health and fitness | 3 or more | |
| F2 | Participating in recreation/leisure activities with others | 2 or more | |
| F4 | Making and keeping friends | 4 | Social Activities |
| F6 | Using appropriate social skills | 4 | |
| G2 | Managing money and personal finances | 2 or more | |
| G3 | Protecting self from exploitation | 2 or more | Protection and Advocacy |
| G7 | Making choices and decisions | 2 or more |
(3) If you have a support score of one or more for any of the questions in the SIS Exceptional Behavior Support Needs Scale, DDD must address your support need using the behavior supports category.
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