Checklists

Washington’s automated, comprehensive, person centered assessment and planning tool measures the personal care needs of anyone receiving services at home or in a residential setting and develops a care plan. The tool contains 60 different screens, some relate to risk. Participant selects a service setting and then the program computes eligibility, need and a service plan that crosses settings. The package contains: CARES Training Manual, CARES Assessment, Eligibility & Rates for LTC Services.

Developed by Oregon’s Office of Home & Community these tools include consideration of 43 areas of risk and illustrates the state’s risk tracking documentation in Q&A format. They also provide instruction to staff with loops back to participant preference and guidance to protocols to address identified risks. Forms included: ISP Addendum, Financial & Individual Support Plan, Personal Focus Worksheet, Risk Training, Protocol for Aspiration, Constipation, Dehydration, Seizure and Signature Sheet.

This quality tool product was developed by the state of Arizona, Department of Economic Security. The Prevention and Risk Assessment form identifies risk in a variety of dimensions, including home, work, and the community. The tool identifies risk prevention and mitigation strategies, as well as needed supports and the individuals who can/will provide these supports.

This handbook, drafted by Jane Schiele and edited and revised by Laura Hershey (HCPF Systems Change Section), is designed to help other advocates or agencies to inform many more individuals about their right to live in the community, and to assist those who desire a transition back to their community. The report defines transition and offers the nuts and bolts of the program and lastly overs tips for moving day and beyond.

The Indiana Waiver Services is a new unit created in Jan ‘04, to consolidate the management and operation of Indiana’s eight HCBS Waivers. Attached are documents that provide a program overview. The Services Unit Summary describes the program; the Priority Diversion Guidelines details the individual criteria for priority diversion; the Waiver Services Organizational Chart provides a pictorial overview; and the Hoosiers at Home Press Release announces the programs goals.

This document provides information on elements to include in the ADRC evaluation plan. This resource will provide guidance on what to include, and will serve as an example of how to organize the elements into a matrix, but this format can be tailored by each grantee. Elements to incorporate into the ADRC evaluation plan include: Project Objectives; Tasks; Indicators; Data Sources; Data Collection Methods; Timeline/Interval; Responsible Entity; and Instruments.

New Hampshire received an ADRC Grant in 2003. The following materials provide information on grant activities in relation to Hospital Discharges. The SLRC Referral Check-off Form for Hospital Discharge Planners is a check-off form for the use of hospital discharge planners in determining whether an individual should be referred to the Resource Center. The other draft protocol documents provide procedures for receiving and sending referrals between hospital and Resource Center staff.

The South Carolina ADRC also known as South Carolina Access Plus has developed a number of checklists and surveys to evaluate a variety of program outcomes. The Access Training is an introduction to the program. The Customer Service Training assesses staff opinion on customer service training sessions. The Level Outcome Checklist assesses staff opinion on how well the program is achieving systems-level outcomes. The Progress Checklist assesses staff opinion on collaborating with stakeholders.

Moving out on your own is a big decision. There are so many issues to decide. Where to live? Who to live with? How to spend your money? In order to consent to living in a place of their own, it may be helpful for consumers to know about safety. This paper helps to create a safety plan after completing the safety checklist

This is an example of a personal support and safety plan. This document can be used with clients to determine what they hope to accomplish, design a people map and outline important and positive characteristics about themselves. The plan then focuses on support and what others need to know to provide assistance. Lastly, the plan address what is happening in life (ups and downs) and forms an action plan.