Score 0 Unsatisfactory Major revision recommended 1 Standard Does not meet all required / lasting standards - Moderate revision recommended 2 Satisfactory Meets current / lasting standards ACCEPTABLE PRACTICE 3 Excellent Exceeds current standards BEST PRACTICE Requirement 0 Points 1 Point 2 Points 3 Points Score IISP includes the individual’s first & last name, legal representative, date of the ISP, date of the IISP (must be reviewed at least every 6 months) and the preparer’s printed name and date Score at this level if missing 2 or more of required components OR Required items may be in another plan, but it was not submitted Score at this level if missing 1 of required components (aside from those in blue font) Score at this level if required components can be found in plan Score at this level if all required components AND are included in plan in a clear, easy-to find manner Mark all that apply: The individual’s first and last name is listed The name of the legal representative (guardian) is listed or it is indicated person does not have guardian The ISP date is listed The preparer’s printed name is listed The date the IISP was developed or revised is listed The date the IISP is no older than 6 months Requirement 0 Points 1 Point 2 Points 3 Points Score IISP includes a list of individuals that participated in the IISP development, and written agreement of individual/legal rep Score at this level if the plan does not include references to participation or signatures of individual or guardian. Score at this level if the plan is missing reference to participation of individual and guardian, OR missing the individual’s / legal representative’s signature (if applicable) Score at this level if there is evidence that the person participated and the plan is individualized to their preferences; AND the plan includes signature of individual and their legal representative (if applicable) Score at this level if the IISP includes evidence of the individual’s participation and involvement (or notes of attempt to involve) guardian (if applicable) and non-agency staff AND includes signatures of individual /legal rep Evidence could include a list, or notes on who contributed AND a plan individualized to the person’s preferences
Requirement 0 Points 1 Point 2 Points 3 Points Score Habilitation Goals . Score at this level when the required number of goals are not included, OR when any goal meets 3 or fewer of the requirements OR when requirements are met for less than ½ of the required goals Score at this level if at least 4 of the 5 requirements are met for all goals, or if all requirements are met for at least ½ of required goals Score at this level when all requirements are met for the required number of goals at this level when all requirements are met for the required number of goals AND the reader can clearly “see” the individual in the goal, why it is important to them, the goal shows evidence of recent revision, and/or components are detailed Mark all that apply: The minimum number of goals identified are included Minimum of two (2) habilitation support goals for individuals who are assessed at Support Levels1 and 2 Minimum of three (3) habilitation goals for individuals who are assessed at Support Levels 3A, 3B, 4, 5, and 6 The goal is specific and measurable Goal includes measurement criteria and timeline Goal includes specific active role staff take to support goal Goal includes documentation instructions Requirement 0 Points 1 Point 2 Points 3 Points Score Evidence of Habilitation Goal Implementation (Documentation) Score at this level when there is no documentation provided to support that goals have been implemented OR Documentation provided shows that goals were not supported Score at this level when there is documentation provided that goals have been implemented, but there is no indication of progress or revision of goals OR Documentation provided only supports some of the required goals at this level when documentation provided shows that the goals have been implemented as described in plan (within 15% margin) and there is some indication of progress for at least some of the goals Score at this level when the documentation provided shows clear evidence that the goals have been implemented AND progress is being made toward goal OR when data includes visual representation (graph, chart) of progress For purposes of data analysis only: Number of days out of specified 7 day period individual left their home: Is plan written on DDA Template? Yes No Has plan writer completed DDA’s IISP Training? Yes No