Home and Community Based Services Manual


4.00 Appendix 10 Instructions for Self-Direction Assessment Questions Instructions

The Self-Direction Assessment Questions shall be used to help staff and/or their designee to determine the current or potential participant’s ability to self-direct their Consumer-Directed Services (CDS).

The Self-Direction Assessment Questions shall not be used exclusively to deny CDS services. If there are further questions about the participant’s ability to self-direct their own care, staff shall complete further evaluation using the Saint Louis University Mental Status (SLUMS) exam, Healthcare Professional Inquiry, and/or collateral contacts.

Number of Copies

At least one copy shall be completed when necessary.

Instructions for Completion

Name: Enter the participant’s name

DCN: Enter the participant’s Departmental Client Number (DCN)

Date: Enter the date questionnaire is completed

Questions

Questions should be posed to the participant. If another individual responds on behalf of the current or potential participant, this must be documented in the Case Notes. Allow the participant enough time to answer all questions. As space allows, note the answer given next to the question. Further clarification can be given to the participant to ensure understanding of the question, particularly if the participant has never received CDS. Staff should use sound judgment if the participant is unable to appropriately answer questions to determine if further action should be taken by staff to determine the participant’s ability to self-direct their own care. If the participant has difficulty answering questions #1 and #2, the participant is able to use whatever materials they may have available to them to locate the answer (i.e. calendar, cell phone, etc.). Questions #14 through #17 shall only be asked if the participant is currently authorized for CDS or has been a CDS participant in the past.

Distribution

The Self-Direction Assessment Questions shall be uploaded to the participant’s electronic case record.

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