Reimbursable Advisory Services Agreement on Modernizing the Disability Assessment System in Romania (P171157) Output 4. Report on the recommendation of a complex assessment procedure of persons with disabilities Bucharest, June 2023 1 Disclaimer: This report is a product of the staff of the World Bank. The findings, interpretations, and conclusions expressed in this document do not necessarily reflect the views of the Executive Directors of the World Bank or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this paper. It assumes no responsibility for any errors, omissions, or discrepancies in the information and no liability for the use or non-use of the information, methods, processes, or conclusions set forth. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any opinion on the part of the World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries. This report does not necessarily represent the position of the European Union or the Government of Romania. Copyright statement: The material in this publication is copyrighted. Copying and/or transmitting portions of this work without permission may be a violation of applicable laws. For permission to photocopy or reprint any section of this document, please send a request containing the complete instructions either (i) to the National Authority for the Protection of the Rights of Persons with Disabilities (Str. General Constantin Budișteanu nr. 28C, et. 1, Sector 1, Bucharest, Romania) or (ii) to the World Bank Group Romania (Str. Vasile Lascăr nr. 31, et. 6, Sector 2, Bucharest, Romania). Reimbursable Advisory Services Agreement on Modernizing the Disability Assessment System in Romania (P171157), signed between the Ministry of Labor and Social Solidarity and the International Bank for Reconstruction and Development on June 30, 2020. 1 The report corresponds to Output 4 and is a Report with recommendations on a comprehensive assessment procedure for people with disabilities. 1 The project, initially implemented by the National Authority for Persons with Disabilities, has taken over by the National Authority for the Rights of Persons with Disabilities, Children and Adoptions – institution established through the Government Emergency Ordinance no. 68 of 6 November 2019, by taking over the activities, attributions and structures of the National Authority for Persons with Disabilities (and of the National Authority for the Protection of Children Rights and Adoption), which was discontinued. Subsequently, the GD no. 234/2022 (in force since 18 February 2022) established by the current National Authority for the Protection of the Rights of Persons with Disabilities (ANPDPD). 2 Acknowledgments Output 4, produced under the Reimbursable Advisory Services Agreement on Modernizing the Disability Assessment System in Romania (P171157), was developed under the supervision of Cem Mete and Dhushyanth Raju, with the overall coordination of Ms. Anna Akhalkatsi. The study, analysis, and consultation of relevant stakeholders, together with the drafting of the report, were coordinated by Victor Sulla (team leader) and Manuela Sofia Stănculescu. The World Bank team was composed of the following international and local experts (in alphabetical order) - Florentina Bărbuță, Mihai Berteanu, Jerome Bickenbach, Georgiana Blaj, Bogdan Corad, Luminița Daneș, Mădălina Manea, Monica Marin, Mentor Shala, Atena Stoica, Daniela Tontsch and Clara Ursescu. On behalf of the World Bank, Andrei Zambor, Ramona Lipară, and Oana Caraba provided constant support throughout. The World Bank is grateful for the excellent cooperation, coordination, and attentive and prompt feedback provided by the partner institution ANPDPD, in particular by Mr. Mihai Tomescu (President), Monica Violeta Solomie, Liliana Toader, Crina Gîrleanu, Daniela Oana Ambara, Mirela Vasii, Maria Cotoi, Fevronia Scarlat, and Iolanda Dinu. The World Bank is grateful to all the representatives of relevant institutions who participated in the pilot study and contributed with valuable comments and observations to the completion of this Output, in particular to the chiefs and members of the comprehensive assessment services (within the General Directorates for Social Assistance and Child Protection), the chairs, members, and secretaries of the assessment commissions (within the county and local councils). The World Bank also thanks the National College of Social Workers of Romania (CNASR) for a valuable partnership in which, under the coordination of Diana Cristea (President of CNASR), the proposed new form of the Annex for Adults with Disabilities to the Social Inquiry (ASOC Annex) was rigorously tested. Equal opportunities and equity All project activities were designed and implemented for the equal benefit of boys and girls, men and women. The project team and experts received equal treatment regardless of gender, ethnic origin, or other characteristics. Sustainable development During project implementation, the World Bank team aimed for a wise and effective use of resources to protect the environment and ensure social cohesion. Every citizen and institution should remember that sustainable development is the only way to meet human needs without undermining the integrity of natural systems and the future of humanity. 3 CO-AUTHORS The project team would like to thank the professionals from the 16 county teams participating in the pilot study and the 66 social workers from 19 counties who tested the new Social Inquiry Annex for their effort, voluntary involvement and for their comments and ideas for improving the tools and the new methodology for assessing people with disabilities. Contributed to the development, piloting and validation of the proposed new disability assessment methodology (in alphabetical order of the county): Bejinariu Dumitru, Bădiță Giana Lodeta, Bacoș Ana Cristina, Deicean Simona Maria, Erdei Angelica, Lucea Maria Stela, Mechenici Tatiana Mihaela, Moti Monica, Rusu Daciana Alina, Ungur Daniela Magdalena, Nady Claudia Simona, Matei Adina (Arad), Dumitrascu Mihaela, Achivei Stela Maria Georgeta, Marin Corina Petronela, Pascal Liliana Gabriela, Raileanu Catalina Mihaela, Stoina Alexandra Elena, Tugui Valentin, Lazar Sorina (Bacău), Diditel Ecaterina, Gera Marilena, Popescu Daniela, Munteanu Aleodor, Mocanu Lucia (Bucharest Sector 1), Bălan Diana Mihaela, Cojocaru Dumitra, Davidescu Mona, Dima Carmen Mihaela, Ene Nina Doina, Geanta Florea, Gogu Elena, Ivan Mona Izabela, Licudis Paulina-Tereza, Man Ioana, Masala Florentina Cornelia, Mihăilescu Florența, Popescu Cristina-Mihaela, Stoian Daniela Natalia, Troznay Daniela, Tudor-Stefan Lidia Marilena, Corlan Daniela, Cristiana Huruiala, Nicoleta Szasz (Bucharest Sector 3), Voin Florin, Stanef Doina, Bistreanu Andreea, Chisalita Ovidiu, Valeanu Dana, Baias Cristina, Stefanut Mihaela (Caras Severin), Epure Marina, Bolos Sanda Mirela, Cristea Doina-Nastica, Bechis Elena Geanina, Marin Ana, Stasencu Alexandra, Iacov Lidia, Anton Violeta Neli, Bratasanu Elena, Dinu Iolanda (Constanța), Măciucă Claudia Daniela, Ilie Dana-Elena, Iovanescu Veronica Irina, Burtea Diana Nicoleta, Nicola Anisoara, Păceană Nicoleta Carmen, Tănasie Mădălina Maria, Ungureanu-Ceausescu Filofteia, Nicolae Elena Emanuela, Ciurea Aurora (Dolj), Corbu Cristina Mirela, Bobe Mariana Diana, Coscai Daniela, Lixandru Mariana, Nedelcu Nicoleta, Pasol Tudor, Otoiu Alina Adriana, Banca Gigi (Giurgiu), Bucnaru Stela, Antonescu Adina Nicoleta, Constantinescu Mariana, Genunchi Madi Mihaela, Radu Gladiola Nicoleta, Slipenchi Cornelia, Matcas Raluca Dorina (Ialomița), Căliman Janina Crina, Vaida Florina Elena, Trantea Sanda Dana, Vlad Semida Fabiola, Laszlo Csilla Timea, Coman Sinziana, Pascu Andreea Romina, Nagy Eva, Todoran Maria (Mures), Buzatu-Matei Mihaela-Ilona, Croitoru Ana, Dorobănțoiu Loredana, Pene Alexandru, Ralita Florentina, Vilcea Marian Bogdan, Bubulinca Maria, Costache Camelia (Olt), Basa Alexandru, Bolfos-Ciupe Diana, Faur Daniela, Gabor Harosa Vladimir Ștefan, Maxim Bianca, Ortan Marioara, Talos Bianca-Giorgiana, Podar Florina-Silvia, Viman Mariana (Sălaj), Popa Cosmin, Munteanu Dorian, Cismaș Mihaela, Todea Oana, Reche Marcela, Tica Eliada Despina, Trailovic Carla, Bratu Nicoleta Anca (Sibiu), Clapa Alina, Morărașu Monica, Filipescu Janita, Salomeia Cristian, Spiridon Lucian (Vaslui). Contributed to the development and pretesting of the tool ASOC Annex (in alphabetical order of county of residence): Scărlătescu Violeta, Tudorel Valeriu Ciubotaru, Botezatu Georgeta, Verdes Mirela, Bordei Simona, Ababei Nicoleta, Pintilie Alexandra, Dîlcu Anca, Ungureanu Elena, Huminiuc Liliana, Sofronia Mihaela Teodora, Cristea Florin, Crăciun Mirela, Crengăniș Maria Marcelina, Avram Luisa, Micle Alina-Maria, Daniela Bulcu, Duda Narcisa, Razoare Anamaria, Draghici Elisaveta, Roman Cristina Elena, Banucu Despina, Făinarea Alina, Bragau Mădălina, Muresanu Crina, Amatiesei Bogdan, Cojocaru Elena, Moise Mioara, Batariga Simona, Grigore Marinela, Felicia Militaru, Erika Dragan Keller, Badea Narcisa Florentina, Grigorie Maria, Rosioru Ana Maria, Costea Angelica, Bițan Nicoleta, Duna Elena, Galbinasu Valentina, Bujor Mihaela, Maria Krauciuc, Fabian Adina, Nastaca Anghel, Pop Florina, Buzatu Ana, Mircea Scridon, Gyorgy Reka, Pop Virginica, Iaciu Dorina, Mitroi Mirela Mihaela, Cornea Ramona, Romocea Iulia, Catinean Livia, Schlachter Anna Maria, Pop Cristina, Sescu Otilia, Veres Dorisz Maria, Cosariu Dalina, Savin Stefania, Drumea Oana, Gorgeta Iosup, Mirela Petcu, Marius Dohotaru, Bontea Oana-Elena, Irina Dumitrescu and Dutulescu Carmen. 4 Content Introduction ........................................................................................................................................................... 9 Activities related to the production of the report ................................................................................................................................................... 10 Content of the report ....................................................................................................................................................................................................... 10 1. Modernizing comprehensive disability assessment for adults in Romania ........................................... 11 Brief description of the new paradigm ...................................................................................................................... 11 Theoretical framework: ICF ............................................................................................................................................................................................. 11 Human rights dimension: UNCRPD ............................................................................................................................................................................. 13 The paradigm shift........................................................................................................................................................ 14 What we mean by modernizing the disability assessment system in relation to the ICF and UNCRPD ............................................... 14 The first step was a comprehensive diagnosis of the system .............................................................................................................................. 14 Proposed general methodology for comprehensive disability assessment based on ICF and UNCRPD ............................................. 15 Main elements of change ................................................................................................................................................................................................ 17 2. Map of the institutions involved and their proposed roles ..................................................................... 18 Government institutions responsible for disability assessment in Romania .................................................................................................. 18 The role of NGOs representing people with disabilities in the assessment process ................................................................................... 24 3. The new toolkit after piloting ...................................................................................................................... 25 Tools for assessing adults with disabilities ................................................................................................................................................................ 27 Proposed standard procedure for the use of the new toolkit ............................................................................................................................. 28 Administrative and information documents ............................................................................................................................................................. 34 4. Specialists involved and skills/professions required ................................................................................. 36 SECPAH specialists............................................................................................................................................................................................................. 36 CEPAH specialists ............................................................................................................................................................................................................... 40 SPAS specialists .................................................................................................................................................................................................................. 40 5. New draft pilot procedure for modernizing comprehensive disability assessment for adults in Romania ............................................................................................................................................................................... 41 5.1. The new procedure outline: Overview................................................................................................................ 41 5.2. Steps in the new procedure proposal that could not be piloted .................................................................... 44 5.3. New assessment procedure for adults with disabilities: Lessons from the pilot - county variations and performance .................................................................................................................................................................. 48 Annexes ................................................................................................................................................................ 49 Annex 1. Research tools for system and policy analysis of disability assessment............................................... 49 Annex 2. Scenarios for the selection of the NGO representative to the CEPAH, which may be subject to consultations with NGOs ............................................................................................................................................. 50 Scenario 1: Open vote ...................................................................................................................................................................................................... 50 Scenario 2: Election of CJ/CL .......................................................................................................................................................................................... 51 Annex 3. Instruments for medical and psychological assessment (version after piloting) ................................ 52 5 Annex 3a & b. Proposed Medical and Psychological Criteria ............................................................................................................................. 52 Annex 3c. Form 1 ............................................................................................................................................................................................................... 52 Annex 4. Performance evaluation tools (post-pilot version) ................................................................................. 63 Annex 4a. Form 2. WHODAS+RO ................................................................................................................................................................................. 63 Annex 4b. WHODAS cards .............................................................................................................................................................................................. 74 Annex 5. Documents related to disability certification ........................................................................................... 75 Annex 6. Social assessment tools (post-pilot version) ............................................................................................ 76 Annex 7. Individual needs assessment tools (post-pilot version) ........................................................................ 101 Annex 7a. Individual needs assessment.................................................................................................................................................................... 101 Annex 7b. Information sheet "What you need to know about individual needs assessment" ............................................................... 101 Annex 8. Model of County/Local Report on Unmet Needs of Adults with Disabilities .................................... 108 Annex 9. Fact sheet on the list of assistive devices and equipment found in Romania ................................... 109 Annex 10. County variations of the new draft standard assessment procedure for adults with disabilities 112 6 Acronyms and Abbreviations ADL Activities of daily living AJOFM County Agency for Employment ALOFM Local Employment Agency ANOFM National Employment Agency ANPDPD 2 National Authority for the Protection of the Rights of Persons with Disabilities APP Professional personal assistant ATU Administrative Territorial Unit CAbR Centre for habilitation and rehabilitation for adults with disabilities CEPAH Commission for the Assessment of Adults with Disabilities CES Special educational requirements CIA Care and support center for adults with disabilities CIM International Classification of Diseases CITO Centre for integration through occupational therapy CJRAE County Centre for Educational Resources and Assistance CMBRAE Bucharest Municipal Centre for Educational Resources and Assistance CNAS National Health Insurance House CNASR National College of Social Workers of Romania CPVI Centre for Independent Living CRRN/CRRNPH Neuropsychiatric Recovery and Rehabilitation Centre for Adults with Disabilities CSEPAH The Superior Commission for the Assessment of Adults with Disabilities DGASPC General Directorate of Social Assistance and Child Protection DSM Diagnostic and Statistical Classification of Mental Disorders Manual ECA Europe and Central Asia EIF Expression of interest form FSS Social service provider HG Government Decision IADL Instrumental activities of daily life ICF International Classification of Functioning, Disability, and Health ISJ County School Inspectorate M&E Monitoring and Evaluation MMSS Ministry of Labor and Social Solidarity MS Ministry of Health NGO Non-Governmental Organization NPDS National Strategy on the Rights of Persons with Disabilities 2021-2017 UN United Nations UNCRPD United Nations Convention on the Rights of Persons with Disabilities GEO Government Emergency Ordinance 2 The current National Authority for the Protection of the Rights of Persons with Disabilities (ANPDPD) was established by GD no. 234/2022 (in force from 18 February 2022). 7 PFA Authorized Person PIRIS Individual rehabilitation and social integration program PIS Individual Service Plan PLIN Individualized Plan PNRR National Recovery and Resilience Plan POIDS Operational Program Inclusion and Social Dignity SECC Comprehensive Assessment Service for Children SECPAH Comprehensive Assessment Service for Adults with Disabilities SNMD National Disability Management System SPAS Public Social Assistance Service 3 WB World Bank WHO World Health Organization WHODAS 2.0 WHO Disability Assessment Questionnaire 2.0 3 In this report, the acronym SPAS is used generically for all forms of organization of public social assistance services established in municipalities, towns, and communes in Romania (DAS - Directorate of Social Assistance, SPAS - Public Social Assistance Service or Compartment, according to Government Decision 797/2017). 8 Introduction The International Classification of Functioning, Disability, and Health (ICF) provides a framework for classifying and measuring disability, which considers disability a universal and multidimensional phenomenon. The application of the ICF provides an integrated bio-psycho-social approach to collecting and disseminating information and policy formulation. Under this Technical Assistance Agreement, the medico-psycho-social approach is ensured by using the ICF framework and by aligning with the principles of the UN Convention on the Rights of Persons with Disabilities (UNCRPD). The new vision and general methodology for the comprehensive disability assessment proposed in this project follows the recommendations of the UN Committee that: "the assessment should be based on a human rights approach to disability, focus on the needs of the person arising from barriers in society rather than on the disability itself, consider and take into account the wishes and preferences of the person, and ensure full involvement of persons with disabilities in decision-making". 4 There is a consensus among experts that Romania should change the procedure for assessing and classifying the degree and type of disability according to the ICF standards. Over the last ten years, there have been several attempts to do so, but largely without success. Currently, in Romania, the National Authority for the Protection of the Rights of Persons with Disabilities (ANPDPD) has initiated an extensive process of reform of the system, focusing on the application of the ICF framework in the assessment of disability for adults, in addition to the existing one for children. Through the current Reimbursable Advisory Services on the Modernization of the Romanian Disability Assessment System, the World Bank is assisting ANPDPD in improving the legislation governing the assessment of adults with disabilities in Romania. This Technical Assistance Agreement covers activities that will result in the development of seven analytical Outputs. The seven Outputs are: 1. Diagnosis report on the current disability assessment mechanism 2. Set of proposed medico-psycho-social criteria for disability assessment 3. Proposed working instruments for a modernized disability assessment 4. Report on the recommendation of a comprehensive assessment procedure of persons with disabilities 5. Mid-pilot report on recommendations on disability determination and needs assessment 6. Technical recommendations to facilitate specific expertise in disability assessment for court cases 7. Final report on recommendations on disability determination and needs assessment. In line with the terms of reference of the project, 5 the objective of this Output 4 is to recommend a new unitary procedure for the comprehensive assessment of people with disabilities based on the current situation diagnosis report (Output 1) and good practices from international examples, as well as considering the specificity of the tools developed (Outputs 2 and 3) and piloted within the project (Output 5). As a final note, the technical assistance provided under this Agreement is aimed at supporting the reform of the comprehensive disability assessment system. Therefore, it is not tackling the general reform of disability policies in Romania, which could include reform of benefits and services, identification of the extra cost of disability, development of case management for adults, accessibility and information, the transition from childhood to adulthood, unification of disability and invalidity systems, etc. However, it is imperative to support the alignment and coordination of the reform of the disability assessment system with all the reforms, projects, and significant changes in the legislative framework with an impact on disability that are taking place in parallel, such as the deinstitutionalization of adults with disabilities, the development of services for people with disabilities in the context of European funds (including PNRR and POIDS), changes to the Civil Code regarding guardianship, 4 UN Committee on the Rights of Persons with Disabilities, General Comment on Article 19. 5 Output 4 corresponds to activity A.1.4. Elaboration of the comprehensive assessment procedure in the classification of disability in the Application for Funding code 129751. 9 curatorship, and the implementation of the Decision no. 490/2022 for the approval of the Strategy on the Rights of Persons with Disabilities (SNDPD) "A fair Romania" 2022-2027. The primary audience for this report is ANPDPD specialists working with adults with disabilities and the hundreds of practitioners involved in disability assessment across Romania. Activities related to the production of the report The activities were organized in three stages. In the first stage, a draft procedure was created as part of the new methodological package for the disability assessment of adults. The draft procedure, together with criteria, methodologies, and tools (including rules for piloting them), was developed in a profoundly participatory way. A first draft was created by the World Bank's multidisciplinary team, which included doctors, psychologists, social workers, sociologists, disability rights and human rights representatives, ICF and WHODAS specialists, lawyers, and architects. This team worked closely with the ANPDPD validation experts, not only in refining the methodological package but also in consultation workshops to discuss the tools. 6 The draft procedure was discussed in 11 consultation workshops with SECPAH, CEPAH, and the Romanian National College of Social Workers (CNASR) representatives. In addition, a discussion was organized with representatives of the Romanian Institute for Human Rights. The WB team noted the suggestions, comments, and recommendations received and integrated them into the version that went into piloting. Then, the procedural steps selected for testing through the pilot study were included in the training package for the SECPAH/CEPAH teams involved in the piloting. In the second phase, the new unitary procedure was tested in the pilot study for 6 months (August 2022 - January 2023), as shown in Output 5 on the pilot study. Using the feedback collected systematically during the pilot, in January 2023, the WB team organized a workshop to validate the procedure. The workshop was organized online, with the participation of the ANPDPD project coordination team and the county teams involved in the pilot (more than 45 participants). Following the workshop, the procedure was modified according to the feedback obtained. The modified version was piloted for another 3 months (March-May 2023). In May 2023, the main changes proposed by the new procedure were one of the discussion topics with representatives of the ANPDPD and the Superior Commission. The World Bank in Bucharest organized this meeting with 10 participants. In the third stage, the procedure was finalized by incorporating the piloting results and all the comments and ideas received from the practitioners who tested the new methodological package. The final version of the proposed unitary procedure for modernizing disability assessment for adults is presented in this report. Content of the report Output 4 is organized into five chapters. Chapter 1 gives a brief description of the new disability paradigm and a review of the main elements proposed in the project to modernize the comprehensive disability assessment for adults in Romania. Chapter 2 presents the map of the institutions involved in the assessment and their proposed roles. Chapter 3 summarizes the proposed new toolkit for assessing adults with disabilities, including the other administrative documents recommended as part of the assessment approach. Chapter 4 is dedicated to assessment specialists and describes the types of skills/professions that specialists in each type of institution involved should have. Finally, Chapter 5 describes the flow of actions and documentation for classifying a disability and identifying the services and supports needed by people with disabilities. The annexes include tools already piloted and other materials developed to support the activities described in the previous chapters. 6 The consultation process involved a total of 15 workshops, held from 11-21 April 2022 and attended by around 300 professionals, including specialists from DGASPC, SECPAH and CEPAH, representatives of the Superior Commission for the Assessment of Adults with Disabilities (CSEPAH), local social workers, experts from various national institutions or professional associations relevant to the disability assessment system, international ICF experts, policy makers and disability rights activists. The consultation process took place online using the Zoom platform. English-Romanian and Romanian-English interpretation was provided for events with international participation. The consultation workshops were video, and audio recorded. 10 1. Modernizing comprehensive disability assessment for adults in Romania This chapter provides a brief description of the new disability paradigm and a review of the main elements proposed in the project for modernizing comprehensive disability assessment for adults in Romania. Brief description of the new paradigm This sub-chapter presents a selection of the key elements used to develop the new work package for comprehensive disability assessment proposed to modernize the current system in Romania. Theoretical framework: ICF Several countries in Europe and around the world have reformed or are in the process of reforming the way they carry out disability assessments for the provision of social cash and in-kind benefits to align with the World Health Organization's (WHO) International Classification of Functioning, Disability and Health (ICF). There are many reasons why governments have taken this step. Still, the stated motivation is invariably to modernize the assessment of disability, moving from a 'purely medical approach' to one based on the 'social model of disability' using 'medico-psycho-social' criteria for assessment, i.e., the ICF categories. 7 Romania is among the countries that have launched reforms for disability assessment aligned to the ICF and based on the "ICF principles". Officially endorsed by all 191 WHO Member States in May 2001, 8 WHO developed ICF to be the international standard for describing and measuring health, functioning, and impairment - i.e., disability. The ICF was designed to complement the International Classification of Diseases (ICD, now in its 11th revision) 9 as the global standard epidemiological tool for describing health status. ICF is not just about people with disabilities; in fact, ICF is about all people. This model tells us that functioning and disability are not neatly demarcated categories into which people should be integrated but are the extreme ends of a continuum on which we all find ourselves. On this continuum, our functioning can range from integrity in body functions, body structures, activities, and participation to impairments/deficiencies in functions or structures, activity limitations, or participation restrictions. In the ICF model, disability means some limitation or restriction in a person's functioning that is generated both by the person's intrinsic health capacity to perform actions (e.g., walking, dressing, housework, family, school, or work) and by the impact of the person's environment on the level of effective performance of those actions. Factors in a person's environment can be facilitators or barriers through their absence or presence. Factors that enhance functioning and reduce disability are considered facilitators, while factors that limit functioning and create disability are barriers. 10 The assessment of disability, therefore, requires an assessment of both the person's health-related capacity and their environment (barriers and facilitators), which in interaction determine their level of performance, i.e., the degree of disability they have. 7 In this document, ICF categories/descriptors/items/parameters are used interchangeably. 8 World Health Assembly Resolution WHA 54.21 of 22 May 2001. 9 https://www.who.int/news/item/11-02-2022-who-s-new-international-classification-of-diseases-(icd-11)-comes-into-effect 10 For example: for a wheelchair user, the steps at the entrance to a building are a barrier, while a ramp with the correct incline is an enabler. 11 The ICF does not define disability but, more relevantly, models disability to describe and measure it. The ICF model of disability aligns, on the one hand, with the accepted view among academics and scientists and, on the other hand, with the recognized understanding of disability in international human rights law. The UN Convention on the Rights of Persons with Disabilities (UNCRPD) characterizes disability as reflecting the experiences of persons "who have enduring physical, mental, intellectual or sensory impairments which, in interaction with various barriers, may hinder their full and effective participation in society on an equal basis with others." As a conceptualization of the experience of living with a condition in a person's everyday environment, ICF describes activities and participation in nine life areas (domains) using a multitude of descriptors, such as the examples provided in Table 1. Table 1: ICF domains and descriptors ICF field ICF descriptors (selection) 1 Learning and applying Watching, listening, copying, focusing attention, learning to read, learning knowledge to write, learning to calculate, learning to make decisions 2 General tasks and demands Accomplishing a single task or several tasks, fulfilling daily routines, managing stress and other psychological challenges 3 Communication Reception, production of non-verbal messages, conversation, and use of communication devices and techniques 4 Mobility Changing and maintaining body position, carrying, moving, and handling objects, walking, and moving, using means of transport 5 Self-care Washing, taking care of body parts, using the toilet, dressing, eating, drinking, taking care of yourself 6 Self-care Purchasing goods and services, preparing meals, doing housework 7 Interactions and interpersonal Show respect and warmth in relationships and respond to them, relationships appreciation, tolerance, physical contact, regulate behavior in interactions such as impulses and aggression, interact according to social rules, establish, and maintain informal social relationships 8 Major areas of life a. Education: informal education/training, preschool education, school education b. Work and employment: getting, keeping, and ending a job; paid employment c. Economic life: using money to buy food, saving money, keeping a bank account 9 Community, social and civil a. Community life, recreation/leisure, religion/spirituality: participate in life games and sports, visit museums, cinemas, or theatres b. Human rights, political life, citizenship: enjoys nationally and internationally recognized rights, exercises the right to vote, has legal status as a citizen Source: https://icd.who.int/dev11/l-icf/en/http%3a%2f%2fid.who.int%2ficd%2fentity%2f993742687 Early adopters of the ICF in disability assessment reform - such as Taiwan, France, Germany, and the United States - have appreciated that the ICF provides a scientific framework for disability assessment that is both valid (in the sense that it assesses the phenomenon of disability itself, not a proxy for disability such as medical condition) and reliable for all assessors. But soon after the adoption of the reform, they discovered that there were two fundamental problems with using the ICF, namely: i. ICF is not an evaluation tool 12 Although the ICF is a scientifically sound international standard that provides an understanding of disability that aligns with people's actual experience, it is not an assessment tool. ICF is an international standard classification that conceptualizes disability based on functioning. In all the contexts where ICF is currently used - clinical, research, health information, management, and finance - ICF-based tools have been developed - clinical assessment tests, questionnaires and standard data sets, e-health models, and so on. ii. Disability assessment benefits from additional medical information In ICF, disability is determined both by medical factors (impairments, symptoms, signs) that clinically determine the level of intrinsic health capacity associated with a particular disability and by environmental determinants. Although disability is not a medical phenomenon, it is shaped by medical issues. In addition, to assess disability, it is crucial to know whether the applicant's health condition is temporary or permanent, progressive or curable, stable or variable. These aspects will influence the experience of disability. Therefore, for the ICF to be implemented for disability assessment, assessment tools and procedures aligned with the ICF must be developed and used. The WHO was very aware of this problem and, in response, developed the WHODAS questionnaire. For assessment purposes, the ICF considers two levels or dimensions of functioning/disability, namely: - the specific disability that is a limitation in a particular ICF area; and - disability of the whole person (also called global or synthetic disability) which refers to multiple limitations in different areas. In the integrative biopsychosocial model, the person's disability as a whole is a general description of the degree of disability a person experiences in their life and requires evidence of actual limitations to the person's activity in daily life caused by impairments and other restrictions associated with the underlying health condition in interaction with the person's real environment. In other words, the person's disability as a whole is the result of the medical condition's impact on the level of effective activity performance and participation in all areas of a person's life. The person's disability as a whole is measured using a synthetic index constructed statistically by aggregating limitations in different domains of life. Therefore, the assessment of disability must be carried out using sound psychometric tools - to ensure valid and reliable data collection - and detailed statistical analysis, in particular item-response theory and Rasch modeling. The WHODAS questionnaire meets these requirements. Human rights dimension: UNCRPD The ICF conceptualization of disability is represented in the UNCRPD as a human right, a legal and moral principle. Article 3 of the UNCRPD sets out the normative requirements of the assessment process: it must be conducted in a manner that respects the human dignity, individual autonomy, and independence of persons; it must be non- discriminatory, accessible, and accepting of human diversity; and it must contribute to the full and effective participation and inclusion of persons with disabilities in society. These normative constraints, given the rationale and role of disability assessment, argue for two fundamental principles of disability assessment: 1. The disability assessment should validly, reliably, and comprehensively assess the degree of disability the person experiences in everyday life; 2. The disability assessment process should respect the dignity and autonomy of the individual and be accessible and, in particular, should not be burdensome or discriminatory. The disability assessment process must therefore be not only accurate and comprehensive but also quick and respectful. Requiring an applicant to go through several stages of a disability assessment - for example, having to return several times to an assessment center, incurring travel and other costs - or asking for documents that 13 are not easy to obtain or require personal expense, violates human rights principles. An assessment process that uses invalid or unreliable tools subject to bias or arbitrariness also violates the human rights principles of respect for the dignity, autonomy, and independence of those being assessed. The paradigm shift What we mean by modernizing the disability assessment system in relation to the ICF and UNCRPD The overall objective of this project is to propose a modern approach to disability assessment, following the ICF framework and aligning with the principles of the UNCRPD. Accordingly, the modernization of the disability assessment system requires the incorporation of ICF and UNCRPD principles, both in the determination of disability and in the assessment of needs. • In terms of determining the degree of disability, the project involves: o (1) revision of the current medico-psychosocial criteria and o (2) selection of a set of ICF criteria in line with international best practice, representing a scientifically robust and meaningful integration of functional information into the assessment process alongside medical information. • Regarding the activities and services that the adult with disabilities needs for social integration, a set of ICF criteria is selected corresponding to a range of services, among those available in Romania, identified in a participatory manner. The first step was a comprehensive diagnosis of the system To inform the new methodological package (of criteria, tools, and procedures) for modernizing the disability assessment system, the project's first activity was to carry out an in-depth analysis of the disability assessment system and policies. Output 1 11 presented the results of this analysis in detail. The system and policy analysis was evidence-based and supported by an extensive data collection process. First, the research was structured according to the analytical framework for social protection delivery systems, as defined in the World Bank's Sourcebook on the Foundations of the Social Protection Delivery Systems. 12 That is, the analysis covered all the main steps in the process of obtaining a disability classification certificate in Romania, namely (1) information, (2) preparation, submission, and registration of the file, (3) assessment for disability classification, (4) classification, (5) individual intervention plans (or identification of needs and establishment of the package of benefits and services) and (6) submission of complaints and appeals against the certificate. Second, the research covered all key actors - governmental and non-governmental individuals and institutions - involved in the disability assessment and classification system across the country. Third, the research covered all counties of the country (plus sectors in Bucharest municipality) plus a sample of 71 local communities. The research methodology combined quantitative and qualitative techniques, including institutional studies, opinion surveys, interviews, and focus group discussions. 13 Following the literature review and analysis of existing 11 World Bank (2021) Romania: Diagnosis report of the current disability assessment system. 12 Lindert et al. (eds.) (2020) Sourcebook on the Foundations of the Social Protection Delivery Systems. 13 The field research had the following components: - SPAS survey (Q1); - institutional survey (Q2A), opinion survey (Q2B) and focus groups through which factual data and opinions were collected from specialists working in the Comprehensive Assessment of Adults with Disabilities (SECPAH) and Comprehensive Assessment of Children with Disabilities (SECC) services; 14 legislation, the World Bank team developed a set of research tools. The tools were extensively discussed with the ANPDPD team and other specialists from the county and local institutions and pretested at the level of public social welfare services (SPAS) in the communities. The feedback from all stakeholders has been integrated into the final version of the instruments, which is available in Output 4_Annex1, attached to this report. The research instruments allowed the analysis of the current system of assessment and classification of disability by providing the following information: (i) a description of the current institutional structure (including inter- institutional relationships), operational processes, assessment approach (including current tools 14 and equipment used for assessment and grading and type of disability) and focus on the beneficiary (the person with disabilities); (ii) a profile of the human resources involved in assessment, their work in multidisciplinary teams, workload, job descriptions/roles, staff training needs at local and county level, etc.; (iii) a description of the information system, data analysis processes and proactive information of people with disabilities; (iv) the package of benefits and services recommended (under the individual intervention plan) and available to people with disabilities at the end of the assessment and classification process; (v) the current institutional procedures for challenging the disability classification certificate in court. A total of 741 professionals participated in the data collection activities; 570 responded to institutional surveys and questionnaires, and about 170 participated in interviews and focus groups. The World Bank team collected the data closely cooperating with the ANPDPD during January-March 2021. Proposed general methodology for comprehensive disability assessment based on ICF and UNCRPD The general methodology described at length in Output 2 uses the international terminology that follows from the theoretical framework briefly described in section 1.1. In practice, the new model developed for the comprehensive disability assessment in Romania is a process that includes the following four steps: 1. Medical and psychological assessment Disability Disability 2. ICF-based performance assessment determination assessment Comprehensive disability 3. Disability certification assessment Needs 4. Assessing the service and support needs assessment of people with disabilities - Institutional survey (Q3A), opinion survey (Q3B) and focus groups collecting factual data and opinions from members of the Adult Disability Assessment Committees (ADACs), their secretariat and the Child Protection Committees (CPCs) assessing children with disabilities. The views of SECC and CPC specialists focused on the transition from child to adult with disabilities, specifically 16-17 year olds; - two factual data questionnaires completed by the CEPAH Secretariat (within the DGASPC) on: (Q3C) outcome indicators of the disability classification process and (Q3D) the mechanism for lodging appeals and complaints and appeals against the disability classification certificate; - 7 interviews with judges and lawyers in relation to appeals and complaints; - 20 in-depth interviews with NGOs that represent people with disabilities in Romania and are actively and directly involved in the protection, representation and community integration of people with disabilities; - A total of 61 semi-structured interviews with people with disabilities, of which (a) 35 interviews focused on the perceptions of adults with disabilities about their direct experience of each stage of the assessment process, including suggestions for improvement, using a person-centred approach, (b) 20 structured interviews that focused on the interaction between the person and key institutional actors within the disability assessment system and (c) 6 interviews that focused on the experiences of people with disabilities as complainants in the disability certificate challenge process. 14 The current tools have also been assessed in terms of their alignment with the terminology and conceptual model of functioning and disability in the ICF. 15 Procedurally, a disability determination is an authoritative, usually legally regulated, administrative process - which may involve several steps and official actors - that provides some form of support, service, or assistance to people based on eligibility criteria and a disability assessment procedure that identifies the type, degree, or level of disability of the person as a whole that the applicant suffers. Disability evaluation is the initial administrative examination process for determining disability. This first stage assesses the person's level of disability as a whole (expressed in percentages, grades, or levels). This decision forms the basis for another administrative action, called disability certification, where further decisions are made - whether the applicant qualifies for any, some, or all of the benefits, services, and supports available under the various regulatory legislations. A disability assessment is a brief description and measure of a person's overall level of Working performance of everyday behaviors and actions, ranging from simple to complex, in their definition actual or usual environment, depending on the person's health status. Individual Needs Assessment is an administrative process that identifies the needs and requirements of people with disabilities based on evidence of their functional problems. By their nature, needs assessments are individualized and focus on specific actions a person has difficulty performing due to health conditions or environmental barriers they face in everyday life (e.g., sensitivity to air pollution or barriers to mobility). The diagnosis report 15 showed that one of the main challenges in the modernization of the disability system in Romania is that the disability assessment and the needs assessment are merged into the single process of "comprehensive disability assessment", according to Law 448/2006 on the protection and promotion of the rights of persons with disabilities. The merging of the two assessments is ineffective because: i. The needs assessment must be done through direct interaction with the person and by considering in detail all types of support needs of the person (i.e., clinical, granular, and individualized). Done correctly, the needs assessment will involve multiple professionals and different specialized tools to identify the exact difficulty level regarding sensory issues, mobility issues, cognition or emotional issues, independent living issues, and so on. ii. Not all applicants need this level of scrutiny. Some claimants may not have a level of disability that qualifies them for any existing benefit or service. Conducting a comprehensive needs assessment for these individuals wastes time and money. iii. Most applicants will have disability-related issues in one or two areas. While an appropriate disability assessment tool can easily highlight these issues, accurate needs identification requires a separate process. iv. The disability assessment, if carried out with a sufficiently scientifically rigorous tool, can be carried out by qualified specialists quickly and efficiently without placing an undue burden on the applicant. Individual needs assessment potentially requires different qualified professionals (doctors, vocational specialists, psychologists, educational specialists) and, to be effective, may take longer and require more than one assessment session. As a solution, the proposed general methodology in Output 2 introduces a clear distinction between disability assessment and needs assessment. In line with international best practice, the needs assessment is independent of and subsequent to the disability assessment. In short, both scientifically and administratively, disability assessment and individual needs assessment differ fundamentally in terms of methodology and outcomes. For this reason, it is neither practical nor efficient to carry out these different forms of assessment simultaneously. 15 World Bank (2021) Deliverable 1. 16 Main elements of change According to the legislation in force in Romania, the comprehensive assessment for disability classification is a two-step process. In the first stage, the Service for the Assessment of Adults with Disabilities (SECPAH) 16 carries out the assessment, 17 the results of which are recorded in the Comprehensive Assessment Report and draws up an Individual Rehabilitation and Social Integration Program (PIRIS) and an Individual Service Plan (PIS) which include the services/actions that SECPAH recommends for the applicant. In the second stage, the applicant's file, together with the comprehensive assessment report and the PIRIS, is forwarded to the Commission for the Assessment of Adults with Disabilities (CEPAH), which makes the final decision on (i) classification or non- classification in a disability grade; (ii) the vocational guidance certificate, upon request; and (iii) the services/actions recommended in the PIRIS, including protective measures such as the provision of a personal assistant or admission to an institution or day center. Infographic 1: The new four-step process of comprehensive disability assessment and the corresponding methodological package developed in the project Current 2-step process New 4-step process The major change that the new overall methodology proposes is the restructuring of the comprehensive disability assessment from a two-step process to a four-step process, as outlined in the previous section. This restructuring was based on the recommendations in „Output 1 18 and was carried out using good international practice. In addition, for each of the four steps, a work package was developed within the project, including a methodological framework - ICF criteria/categories (Output 2), working tools for SECPAH and SPAS (Output 3) and the standard procedure described in this output. Overall, the new general methodology is aligned with the ICF principles and is based on a set of ICF categories (medico-psychosocial criteria) presented in Output 2. According to the new general methodology, assessing the degree of disability is the aggregated result of two distinct steps: the medical and psychological assessment (step 1) and the assessment of functioning based on a sound psychometric instrument (step 2). In contrast to the current situation, the certification of disability (step 3) will be done automatically by aggregating the medical and 16 In Romania, there are 47 comprehensive assessment services for the classification of adult disability. DGASPC provides these services in all 41 counties and 6 districts of Bucharest. 17 In accordance with the Joint Order of the Minister of Labor, Family and Equal Opportunities and the Minister of Public Health no. 762/1.992/2007 approving the medical-psycho-social criteria on the basis of which the classification in degree of disability is determined, with subsequent amendments and additions and with the assessment procedure defined in GD no. 430/2008 and Order no. 2298/2012 approving the Framework Procedure for the assessment of adults for classification in degree and type of disability. 18 The three main recommendations to align the assessment process with the ICF principles, as well as those of the UNCRPD, include: the need to integrate functioning into the disability assessment, to update the medical criteria, and to redesign the approach so that needs assessment and disability assessment are clearly separated. 17 psychological assessment score with the functioning assessment score based on an algorithm to be determined in the pilot study (Output 7). Finally, the individual needs assessment (step 4) is differentiated and strengthened by developing a specific methodology and appropriate assessment tools. Thus, the whole process of comprehensive disability assessment is aligned with the UNCRPD and the ICF and covers all mandatory areas of assessment foreseen in the current legislation. 19 2. Map of the institutions involved and their proposed roles This sub-chapter describes the map of government institutions responsible for assessing adults with disabilities and outlines their proposed roles under the new unified procedure. The second section briefly discusses the role of NGOs representing people with disabilities. Government institutions responsible for disability assessment in Romania The current disability assessment system in Romania involves several institutions at different levels, as shown in the following scheme. Scheme 1: Key institutional actors involved in Romania's disability assessment system Source: Authors' elaboration. Note: In this report, the acronym SPAS is used generically for all forms of organization of public social assistance structures set up at the level of municipalities, towns, and communes (DAS, SPAS, or social assistance department, following GD no. 797/2017). 19 The six mandatory areas of assessment are: social, medical, psychological, professional, or vocational aptitudes, level of education and skills and level of social integration (GD no. 268/2007, art. 48, respectively Order no. 2298/2012. art. 4). 18 First, at the local level, social workers or social work departments are responsible for conducting a social inquiry, a mandatory step in the disability assessment process. At the county level, the SECPAH, part of the DGASPC, are responsible for checking and analyzing the file of someone applying for disability assessment, conducting the assessment, and making recommendations about the person's type and degree of deficiency, as well as their individual intervention plan (PIRIS and PIS). CEPAH is the specialized body of County Councils 20 that makes the final decision regarding the type and degree of disability. The Superior Commission (CSEPAH) ensures the methodological coordination and monitoring of disability assessment and determination. The ANDPPD elaborates, implements, and monitors the disability assessment system. The following table compares the attributions of the institutions under the current regulations and the changes proposed by the new procedure. CURRENT PROCEDURE NEW UNIFIED PROCEDURE (proposal) (according to the law) At local level SPAS: On the submission of the file Following the current regulations, the - No change SPAS at the community level is the central On the social inquiry institution responsible both at the beginning and the end of the delivery It will also be carried out by social workers from SPAS, but: chain. Thus, in compliance with GD no. (1) According to the new model ASOC Annex (see Annex 6) 430/2008 (Art. 6, para. 6, letter a), the applicant submits the file for certifying the (2) Only for people with a valid disability certificate who various degrees of disability or legal have opted for one or more needs assessment modules representative thereof to the registering (and not for all applicants for disability assessment as at office of the municipality in the present). domicile/residence town or with the On monitoring and case management registering office of DGASPC. SPAS will continue to monitor cases and provide case The social workers from SPAS complete management for adults with disabilities living in the the social inquiry necessary to apply for a family/community. In addition, disability certificate. (1) The SPAS (together with the beneficiaries) will receive Also, after a person receives the disability from SECPAH the Individualized Plans (PLIN) whose certificate, SPAS oversees the provision of fulfillment it will have to monitor. Thus, when the person many benefits and services and ensures comes to renew the assessment (in 1-2 years), the SPAS will the case management of those with an send to SECPAH the ASOC Annex and a PLIN monitoring individualized intervention plan under sheet. implementation. (2) At the community level, SPAS will be required to request/analyze the Local Unmet Needs Report of adults with disabilities in the locality (extracted by SECPAH from the data management information system completed with a module similar to the e-PLIN ICT application developed for the pilot study). SPAS will communicate the results of the analysis at a City Council meeting. The County/Local Report template is available in Annex 8. 20 As well as for the Local Councils for the districts of Bucharest. 19 CURRENT PROCEDURE NEW UNIFIED PROCEDURE (proposal) (according to the law) At county level SECPAH: On disability assessment As per Law no. 448/2006 (Art. 88) and Law SECPAH will have the role of conducting the disability no. 292/2011 (Art. 85, para. 1), the Service assessment with the following tasks: for Comprehensive Assessment for Adults - medical and psychological assessment with Disabilities is established at the DGASPC level in each (41) county and (6) - functioning evaluation through the application of district of Bucharest. The SECPAH's role is WHODAS+RO to conduct the medico-psychosocial - entering the data into the computerized data evaluation of adults for assignment into a management system and extracting the overall disability deficiency degree category and determine score of the person as a whole with the corresponding needs related to personal care. According degree of disability to GD no. 268/2007 (Art. 49), the SECPAH has the following main responsibilities: (i) On individual needs assessment conducts the comprehensive evaluation/ SECPAH will have the role of conducting an individual reevaluation of adults applying for a (new) needs assessment with the following tasks: disability certificate, at their own offices or at the person's residence; (ii) drafts the - informing applicants about the existence of the needs comprehensive evaluation report for each assessment, the assessment modules available, how it is evaluated person; (iii) makes a carried out, and with what results recommendation for the assignment of a - record in the Expression of Interest Form (see Annex 7) person into a disability category and type the applicant's options (or rejects the application), and for the PIRIS; (iv) endorses the PIS of the person - upon arrival of the ASOC Annex from SPAS, takes over with a disability certificate, which is drafted the case and ensures completion of all assessment by the case manager; (v) evaluates whether modules requested by the individual. the necessary conditions are met for - at the end of the needs assessment, completes the certification as a professional personal Individualized Plan (PLIN) together with the person and the assistant, drafts the comprehensive family/carer. evaluation report, and makes recommendations to the CEPAH; and (vi) - where appropriate, refers the person to other DGASPC recommends protection measures for the services (e.g., supported employment, social services, etc.) person with a disability certificate, which are recommended and agreed upon by the person according to the law. within the PLIN. CEPAH: Relationship between CEPAH and SECPAH According to the provisions of Article 85, According to the Diagnosis Report, 22 currently, the CEPAH para. 4 of Law no. 448/2006, the decision is essentially the same as the SECPAH Assessment Commission is a specialized recommendations based on the comprehensive body of the county council, if applicable, of assessment. The redundancy refers not only to the the local council of the Bucharest classification/non-classification of disability but also to the municipality, responsible for determining Individual Program for Rehabilitation and Social Integration both disability and the benefit-service (PIRIS), which recommends the activities and services that package for persons with disabilities. the adult with disabilities needs in the social integration process. The role and responsibilities of CEPAH in relation 22 World Bank (2021) Deliverable 1. 20 CURRENT PROCEDURE NEW UNIFIED PROCEDURE (proposal) (according to the law) to SECPAH in the disability classification process should be CEPAH assigns adults a deficiency degree clarified and standardized at the county level. A general category and promotes the rights of review of the role and responsibilities of CEPAH and persons with disabilities. CEPAH's key SECPAH is needed, considering the need for assessment responsibilities include: 21 (i) assigning and classification to be carried out by a single institutional adults to deficiency degree categories and structure and, as far as possible, using standardized tools the certificate's period of validity, as and procedures at the level of all Romanian counties. The applicable; the date of disability onset; review should aim to add value to CEPAH and avoid establishing the professional orientation of overlap or redundancy with SECPAH. adults with disabilities, based on the comprehensive assessment report On disability certification prepared by SECPAH; (ii) establishing the Given the new methodology that establishes the overall measures for protecting adults with disability score based on an algorithm, the CEPAH is no disabilities, as provided by law; (iii) longer responsible for determining the degree and type of repealing or replacing the protection disability. measure established, subject to law, if the circumstances under which the measure The certificate's validity period will also be determined by was decided have changed; (iv) releasing the SECPAH physician-psychologist team based on the professional personal assistant certificates; revised medical and psychological criteria (see Appendix 3). (v) informing the person with disabilities or The degree of disability will be determined by the chief of their legal representative about the SECPAH with computer assistance. The certificate will be protection measures established and generated on the computer by a secretariat (the current obligations incumbent upon them; and (vi) CEPAH secretariat) and will be signed by the DGASPC promoting the rights of persons with director. disabilities in all their activities. On individual needs assessment Vocational guidance for adults with disabilities is carried out as part of the M1 needs assessment module (see Annex 7) by SECPAH specialists. Determining protective measures in a residential service for adults with disabilities can only be the result of a comprehensive needs assessment (covering all modules M1, M2, M3, and M4) - i.e., people who, in addition to their disability, are experiencing difficulties such as a lack of support network, insufficient income to care for themselves, difficulties in decision-making, loss of autonomy, homelessness or inadequate housing for the person's needs. Therefore, the determination of protection measures will be carried out by the SECPAH team. On complaints, appeals, redress mechanism The diagnosis report has already shown that the whole process of comprehensive assessment for disability classification is not participatory; the interaction of SECPAH and CEPAH with applicants is very limited or non-existent and does not include a feedback mechanism, which 21 Law no. 448/2006, Art. 87, para.1. 21 CURRENT PROCEDURE NEW UNIFIED PROCEDURE (proposal) (according to the law) violates the principle of "nothing for us without us". In general, in Romania, the whole disability assessment system lacks a complaints mechanism that complements (rather than replaces) formal legal channels for handling complaints, such as the judicial system or the organizational audit mechanism. Given the large number of national appeals to be resolved by the Superior Commission, we consider it essential to develop a redress mechanism. County CEPAHs could play a central role in setting up this mechanism. In this way, all persons dissatisfied with the assessment process or its results (degree of disability, validity of the certificate, decisions on access to services associated with the needs assessment) could appeal to the CEPAH before going to court. Also, in cases that go to court, CEPAH could provide expert opinions to judges. This approach would usefully utilize the existing expertise of CEPAHs and relieve SECPAHs of the burden of justifying to the courts. Thus, among the tasks currently provided for by law, CEPAH would retain the following: (iii) revoke or replace the protection measure established, under the law, if the circumstances that led to its establishment have changed; (iv) resolve applications for the issuance of the professional personal assistant certificate; (v) inform the adult with disabilities or their legal representative about the protection measures established and the obligations incumbent on them; (vi) promote the rights of persons with disabilities in all the activities it undertakes. DGASPC: The diagnosis report 23 highlighted the significant differences in practices and operational models established According to Article 1, para. 2 of Order no. and adopted at the county level for assessing adults for 2298/2012 approving the Framework disability classification and the type and ensuring the Procedure for assessing adults, the transition from child to adult for 16-26-year-olds. DGASPC "shall develop its own detailed internal procedures for assessing adults to Ensuring uniform tools and procedures across counties is establish their level and type of disability ". practically necessary from a human rights perspective: it is fair and equitable that people in similar situations and with similar levels of disability are assessed similarly across the country. Any other approach is unfair and discriminatory. In conclusion, Romania needs to adopt a single procedure and a methodological package to be applied uniformly throughout the country. 23 World Bank (2021) Deliverable 1. 22 CURRENT PROCEDURE NEW UNIFIED PROCEDURE (proposal) (according to the law) DGASPC/ CEPAH secretariat: The Secretariat largely retains its current tasks. However, it will no longer be just the CEPAH Secretariat but the It has the following main tasks: i) receives Disability Assessment Secretariat. Its main tasks will include: and registers the files of adults evaluated by the SECPAH; (ii) prepares and - disability certification participates in CEPAH meetings, with no - forwarding the documents resulting from the disability role in the decision; (iii) draws up minutes assessment to the person or the SPAS and keeps records of CEPAH meetings; (iv) drafts the certificates that classify the - sending the ASOC Annex request to the SPAS and degree/type of disability and certificates of receiving the completed ones from the SPAS professional orientation, within a maximum - forwarding the documents resulting from the needs of three working days from the date the assessment to the person or the SPAS CEPAH meeting took place; (v) manages the registry of appeals; (vi) notifies - a focal point for the new recovery mechanism, acting as applicants of the results and sends the the CEPAH secretariat disability certificate, with all the other documents approved by the CEPAH (certificate of professional orientation, individual rehabilitation, and social integration program—PIRIS, PIS, etc.); and (vii) fulfills any other attributions established, under the conditions provided by law, by the chief of DGASPC. 24 At national level CSEPAH: On complaints, appeals, redress mechanism Being part of the ANPDPD, the Superior We have justified above the need to create a mechanism Commission for the Assessment of Adults for redressing the system with the support of the county- with Disabilities was initially established (by level CEPAHs. The CSEPAH should be the coordinator of Order No. 1261/2016) as a body this new mechanism and not deal directly with complaints responsible, at the national level, for and appeals at the national level. resolving grievance and appeal cases. The latest regulation (ANPDPD Order No 1066 of May Although Order No 1261/2016 has not 2023) returns the system to the pre-2017 state, which has been revised, the provisions relating to the already been proven not to be functional. Moreover, the mechanism for dealing with grievances and main problem of the absence of feedback is not solved. appeals were amended by GEO No The county CEPAHs retain their current role (redundant in 51/2017, under which the disability 90% of cases with that of SECPAH), while the CSEPAH will classification certificate can only be be required to resolve an estimated 26,000 complaints appealed to the administrative courts. As a annually. result, the powers of the CSEPAH at the level of the grievances and appeals mechanism were canceled. Subsequently, the Order of the President of the ANDPDCA No 136/2020 specifies that the 24 GD no. 430/2008, Art. 15. 23 CURRENT PROCEDURE NEW UNIFIED PROCEDURE (proposal) (according to the law) CSEPAH ensures the methodological coordination and monitors the evaluation and classification by degree/type of deficiency at the national level, and it fulfills the duties provided by Law no. 448/2006 on the protection and promotion of the rights of persons with disabilities. Most recently, on May 9, 2023, by ANPDPD Order No. 1066 on the Regulation on the organization and functioning of the Superior Commission for the Assessment of Adults with Disabilities, the CSEPAH became the main structure for resolving grievances and appeals at the national level. MMSS, MS, ANPDPD We are not proposing changes in the roles of these institutions. The role of NGOs representing people with disabilities in the assessment process In addition to government institutions, NGOs 25 play an active role in the disability assessment process. According to the regulations, 26 any CEPAH must include an NGO representative appointed by the county council or the local council of each sector of Bucharest. Concerning the role of NGOs, the new unified procedure for disability assessment proposes two measures, building on the main findings of the Diagnosis Report, namely: • In all the counties studied, CEPAH includes a representative of NGOs as a member. They are social workers or have other specializations (such as law, military studies, or high school graduates) and have been CEPAH members for more than nine years on average. According to CEPAH presidents, the NGO representative "is simply appointed by the County Council" and has "the same responsibilities as any other member". However, the study found that in some counties, applicants with disabilities other than visual or hearing impairments do not have representation on CEPAH. • Most of the NGOs interviewed stressed that the mechanism for appointing the NGO representative to the CEPAH is not transparent. Some of them do not even know who the NGO representative is in their county. In their opinion, NGO representatives in CEPAH "tend to confuse their role and forget that they should first and foremost monitor and guarantee respect for the rights of people with disabilities and ensure that their voices are heard." 27 There has never been a case in which the NGO representative in 25 The disability movement in Romania includes organizations representing people with different types of disabilities (physical disabilities, visual impairments, hearing impairments, intellectual disabilities, rare diseases, chronic diseases, HIV/AIDS, etc.), organizations coordinated by parents of people with disabilities and organizations providing social or rehabilitation services for people with disabilities. The main role of these organizations is to promote and protect the rights of people with disabilities and to remove barriers to access to education, health, the labor market, and social participation. 26 In accordance with Law no. 448/2006, Chapter VII, and the Methodological Norms of 14 March 2007 for the application of the provisions of Law no. 448/2006 on the protection and promotion of the rights of persons with disabilities, Art. 54^1, 54^2 and 55. 27 Interview with a national NGO. 24 CEPAH reported a rights violation in the disability assessment process and for which other NGOs have been involved in resolving or remedying the situation, according to the answers of all CEPAH presidents. 28 This means either the decision-making process is working perfectly or the representation mechanism through an NGO representative is not working at all. The two measures proposed in the new unified procedure are: (1) Inclusion of an NGO representative in the composition of the Superior Commission (2) Establish a transparent procedure for the selection of the NGO representative in CEPAH. It is recommended that the selection procedure be decided through a participatory process to which as many disability NGOs as possible in the country should be invited. In preparation for this participatory process, the WB team has prepared two possible scenarios for NGO consultation. These are available in Annex 2. 3. The new toolkit after piloting Chapter 3 summarizes the proposed new toolkit for assessing adults with disabilities, the final versions after piloting, including the other administrative documents recommended to be part of the assessment process. Infographic 2: A proposed new toolkit for the ICF and UNCRPD-based comprehensive disability assessment The new toolkit (together with the general methodology, criteria, and standard procedure) was developed in its first version by the World Bank team. It was then discussed and agreed upon with ANPDPD experts and underwent an extensive consultation process with relevant stakeholders. 29 The county teams piloted the resulting 28 In the institutional study Q3A. 29 The new toolkit was discussed in 13 workshops, held from 11-21 April 2022, attended by over 250 professionals, including SECPAH and CEPAH specialists, local social workers, representatives of the College of Psychologists and the National College of Social Workers in Romania, together with people with disabilities and NGOs active in the field of disability. 25 version (presented in Output 3) between August 2022 and May 2023. During the pilot study, 30 the WB team collected feedback systematically. The final version of the new toolkit is significantly improved over previous versions and is available in Annexes 3-8. The new methodological package includes 13 working tools, as shown in Infographic 2. Tools F00 and F0 were developed to recruit and register participants in the pilot study and are, therefore, not part of the final package prepared for legislation. The other 11 working instruments correspond to the assessment steps foreseen in the new standard procedure for the assessment of disability in adults, as follows: Step in the new unitary SECPAH working tools and administrative They are procedure and information documents found in ... Stage 1. Medical and psychological Revised medical and psychological criteria Annex 3 assessment F1 form Information sheet "How to get a disability Output 7 certificate" Stage 2. Functioning assessment Form F2 - WHODAS+RO Annex 4 Stage 3. Disability certification Disability certificate model Annex 5 Guide on "How to challenge a disability Output 6 certificate" Stage 4. Needs assessment ASOC Annex for social inquiry Annex 6 Factsheet "What you need to know about Annex 7 individual needs assessment" F2 - Expression of Interest Form (EIF) Annex 7 Needs assessment modules M0, M1, M2, M3, Annex 7 M4 and PLIN (including M5) County/Local Report on Unmet Needs of Adults Annex 8 with Disabilities (format) Information sheet on the list of assistive devices Annex 9 and equipment found in Romania Note: Administrative and information documents recommended to be part of the evaluation process are marked in italics. Please note that the ASOC Annex presented in Annex 6 is a maximum version corresponding to a complete needs assessment, i.e., for a case where the applicant has expressed interest in all the assessment modules. The new working tools have been built based on the tools provided in the current regulations, which have been modified considering international best practices and adapted to the Romanian context based on the results of the Diagnosis Report. 31 30 The pilot study is extensively covered in Deliverable 5. The sample includes ten DGASPCs - Sector 3 of Bucharest municipality and nine counties in all regions of the country, namely: Arad, Bacău, Constanța, Dolj, Giurgiu, Ialomița, Olt, Sălaj and Sibiu. Subsequently, six other DGASPCs requested to participate in the pilot study, namely: Sectors 1 and 2 in Bucharest, Argeș, Caraș-Severin, Mureș and Vaslui. 31 The diagnosis report (Deliverable 1) shows that in Romania: (i) there is no unified approach to comprehensive disability assessment at national level; (ii) the assessment procedure and tools used by SECPAH are not aligned with the ICF model; (iii) there are no specific tools or methodologies for data analysis and no clear rules on which data should be used/analyzed for each of the six mandatory assessment domains. Although the comprehensive assessment is a multi-criteria evaluation, there are no specific weights or rules that clearly establish the contribution of each domain to the final outcome of the evaluation. As a result, data are used and analyzed differently from county to county and sometimes from specialist to specialist, especially as many SECPAHs have not developed specific working procedures for this purpose. 26 Tools for assessing adults with disabilities The toolkit is aligned with the ICF The new tools are designed from a performance (rather than capacity) perspective 32 and are structured according to the ICF's dimensions, domains (life areas), descriptors, and qualifiers. For both the disability assessment and the needs assessment, the tools use a unique set of ICF descriptors (Output 2), however: - for the assessment of disability, the DEGREE OF DIFFICULTY in performing the activities is measured, and - for the needs assessment, the NEED FOR SUPPORT to carry out the activities is measured. The toolkit is aligned with the UNCRPD In line with UNCRPD principles, to maximize the chances of standardized and uniform use across counties, the WB team has designed the new tools to ensure that the qualifying elements for the activity/participation and environmental factors dimensions are completed appropriately. To this end, the tools include detailed instructions on assigning qualifiers for each descriptor listed in the medical/psychosocial criteria set. Where the assignment of the qualifier may involve a higher level of subjectivity, examples are provided for the use of future assessors. For applicants with psychiatric disorders with psychotic symptoms or intellectual disabilities, the participation of the legal representative/carer/family member in the interview is allowed, as in these cases, the person's answers may not accurately reflect reality. In addition, for these cases, the WHODAS+RO questionnaire is accompanied by cards in easy-to-understand language to facilitate the active participation of applicants in the interview. The toolkit is built in cascade The new working tools are developed as a coherent package to reduce the burden on applicants (obtaining documents) and SECPAH specialists (verifying and analyzing information). The tools are built in a cascade system, as shown in Infographic 2, so that (1) unnecessary repetition is eliminated (i.e., the person being assessed does not have to provide the same information several times) and (2) information other than that strictly necessary for the assessment is not collected. Cascade construction means that each tool takes from the information collected in the previous steps and records only the information newly collected through the interview with the applicant. The information retrieval from the tools completed in the earlier steps has to be done automatically in an online application based on the e-PLIN model developed specifically for the pilot study. Concerning the new information, a parsimonious set 33 of descriptors was selected for each tool to keep the tool as short and user-friendly as possible. Thus, the set of descriptors selected for the applicant interview corresponding to each tool is designed to take no more than 30 minutes. The toolkit is designed to be variable, tailored to the needs, conditions, and preferences of the person with disabilities The existence of an IT infrastructure for the application of the new work package is also essential because the package is designed to be variable, depending on the specific needs, conditions, and preferences of the applicant. The disability assessment tools apply to all applicants (i.e., F1 and F2-WHODAS+RO), but the needs assessment is modular and voluntary according to the new procedure. Therefore, only the Expression of Interest Form (EIF) is applied to all. 32 Performance is a true description of what happens in a person's life in the context of all the environmental barriers and facilitators they face. In contrast, capacity information is usually the result of an inference or clinical judgement based on medical information about a person's expected ability to perform in relation to their health condition and impairments/disabilities. 33 A parsimonious model is a model that achieves the desired level of explanation or prediction with as few predictor variables as possible. Source: https://stats.stackexchange.com/questions/17565/choosing-the-best-model-from-among-different-best- models. 27 The ASOC Annex is to be completed for all individuals who wish to have their needs assessed. Still, the content of the ASOC Annex will vary depending on the assessment modules for which the individual has opted. Thus, if a person expresses an interest in, for example, M1-education and work and M2-personal assistance, then the content of the ASOC should only include the general indicators plus the appropriate ones for M1, M2, and PLIN (e.g., the sections on housing affordability or assisted decision-making will not apply). 34 SECPAH will then only have to carry out the assessment modules for which the person has opted (M1 and M2 in our example), plus PLIN. The ability to variably apply the toolkit, tailored to the needs, conditions, and preferences of the person with a disability, is significantly reduced if the tools are in paper format and have the potential to hamper the work of SECPAH seriously. Adoption of the new toolkit However, the pilot study demonstrated that to ensure standardized and uniform use at the national level, the adoption of the toolkit in legislation must be accompanied by the following measures: • Organize appropriate training for all SECPAH/CEPAH teams in counties that were not part of the pilot study • Organize training sessions for social workers from the SPASs, in cooperation with the National College of Social Workers in Romania (CNASR). • Provision, for at least one year, of a support team at the ANPDPD level to provide ongoing support to the county teams and organize joint working and monitoring sessions based on the model developed by the WB team in the pilot study. • Use a software application to help implementation and ensure information management, as was e- PLIN in the pilot study. Proposed standard procedure for the use of the new toolkit The new procedure for using the toolkit is based on the Pomodoro technique Given that the new toolkit can vary from person to person, with a significant number of files to be assessed (250 thousand files assessed over a year at the national level), time management is essential to ensure a good workflow while allowing for adaptations to the specific conditions and demands of applicants. A sound system satisfies both beneficiaries and staff involved in disability assessment. To this end, the World Bank team has modeled the unified comprehensive assessment unit procedure using a simple and effective time management method to "be a little happier and do a little more" or "work smarter, faster, and better". 35 This is the Pomodoro technique to reduce the impact of internal and external interruptions on concentration and flow. According to this technique, work (complex tasks) is divided into indivisible work units (simple tasks called Pomodoro), separated by short breaks (3-5 minutes). Traditionally, a work unit lasts 20-25 minutes. Work units are recorded at completion, which adds a sense of achievement and provides raw data for self-observation and further improvement. Four units of work form a set. Longer breaks of 15-30 minutes separate two consecutive sets. Infographic 3 shows how the new toolkit is distributed across Pomodoro-like working time intervals. 34 Please note that the ASOC Annex presented in Annex 6 represents a maximum variant corresponding to a full needs assessment, i.e., for a case where the applicant has expressed an interest in all assessment modules. 35 Pash and Trapani (2013). 28 Infographic 3: The new toolkit translated into Pomodoro (working time estimation) Note: The estimate of applicants for individual needs assessment (about 40% of applicants) is based on statistical data collected in Output 1 on the proportion of adults with severe disabilities and personal assistants and the proportion of vocational assessment recipients. However, needs assessment is modular and voluntary, implying that only some people will be eligible/opt for one or more modules, with a small number of applicants benefiting from all assessment modules. According to preliminary data from the pilot study, the interest expressed by people with disabilities in the needs assessment modules is as follows: M1-education and work - 12%, mainly young people; M2-personal care - 39%, particularly seniors aged 65 and over; M3-home adaptation - 9%; M4-assisted decision making - 9%. In total, 66% of people with a disability certificate apply for a needs assessment module (of which less than 5% apply for more than one module) and obtain a PLIN. By design, the new methodological package increases the working time per complete evaluation by introducing several evaluation steps, each with a specific tool and rules (Infographic 3). But without this effort, the assessment will remain unstructured, unfair, and somewhat arbitrary. The average time for SECPAH to assess a case is currently 30-35 minutes 36 and 76 minutes in the pilot, with the note that this includes an average of 20 minutes spent completing the social inquiry on the ASOC Annex model, a task which in current practice is not the responsibility of SECPAH but of SPAS. 37 From the point of view of SECPAH specialists, about 17% of the cases evaluated take the same amount of time as the current average (up to 35 minutes). Another 30% of cases last up to one hour, 41% last between 60 and 120 minutes, and the remaining 12% last more than two hours. The time per full assessment was shorter for the pilot participants 36 According to Output 1, at present, nationally, direct interaction between an applicant and the SECPAH team takes, on average, 15-20 minutes, regardless of where the assessment is carried out, at SECPAH headquarters or at the applicant's home. To this is added 10-15 minutes for completing documents and managing the file. 37 Average time that does not consider the average round trip time for home assessment cases. Output 1 shows that, nationally, for home assessments, the average round trip time is approximately 107 minutes, with considerable variation from a minimum of 7 minutes to a maximum of 300 minutes. On average, home visits in urban areas, especially in large cities, take longer than in rural areas. 29 because some steps in the procedure do not require direct interaction between the assessor and the assessed person. 87% of those assessed spent a maximum of 80 minutes in the assessment process under the new package. The threshold of 2 hours was exceeded for 6.4% of the persons assessed. Table 2: Actual working times observed in the implementation of the pilot in the first five months by evaluation tools (minutes) F1 F2_ F2_EIF ASOC M1 M2 M3 M4 PLIN WHODAS+RO Annex The actual time taken to implement 17 18 5* 23** 17 22 17 18 18 Source: World Bank, MODDiz Pilot, e-PLIN data. Note: Data for August 5 to December 31, 2022, N=2,110 cases evaluated, total sample. * Underestimated time because, in the pilot, information on needs assessment was limited, with the focus on needs and not on access to services, with special instruction not to create a waiting horizon that may lead to misunderstanding and disappointment on the part of the person assessed. ** Underestimated time because, in the pilot, the completion of the ASOC Annex included home visits only in some cases and not in all cases, as required by the rules on social worker practice developed and approved by the CNASR. However, in most cases, the feedback from the evaluators was positive because they perceived the evaluation as focused on issues of interest in their lives and not just a formal/administrative exercise. Feedback from SECPAH specialists involved in the piloting was predominantly positive as well. Rules for applying the new instruments The administration rules for the instruments used in the pilot study have been described in detail in Output 5. Based on the results of the pilot, the final proposed rules for applying the new toolkit for assessing adults with disabilities are presented below. Tools for assessing disability COD NEW PROCEDURE F1 Objective: Medical and psychological assessment Evaluator: A team including at least the specialist doctor and a SECPAH/CEPAH psychologist. The decision on the team's composition is taken by the chief of SECPAH, depending on the case's characteristics and the specialists' availability. Respondent: For all applicants. Method: Based on the documents in the file and the information obtained during an interview with the applicant, following the regulations. F2 Objective: Assessment of functioning based on ICF WHODAS Evaluator: A SECPAH/CEPAH practitioner, thoroughly trained to use WHODAS+RO, who may +RO be a physician, psychologist, educational psychologist, social worker, physical therapist, education instructor, rehabilitation educator, or career counselor. Respondent: For all applicants. Method: Face-to-face or online interviews conducted, based on prior planning, either at the SECPAH office or at the applicants' home for persons that cannot be moved. Tools for needs assessment COD NEW PROCEDURE F2 Objective: Initiate needs assessment through the Expression of Interest Form (EIF) EIF Evaluator: SECPAH/CEPAH practitioner who also administered WHODAS+RO. Respondent: For all participants in the pilot study. 30 COD NEW PROCEDURE - The EIF must be completed for each person, even if they declare no interest in any needs assessment. - Each person can express an interest in one or more assessment modules. M1 and M4 need assessment modules can also be initiated at the request of persons or organizations/institutions other than the person being assessed, but only with the consent of the person being assessed. At the first contact with the case manager (in M0), the person may change their mind and options. At this point, the interview plan for the needs assessment is decided. Method: Face-to-face or online interviews conducted after the completion of WHODAS+RO. ASoc Objective: Social assessment Information required for the needs assessment modules (M1-M5) from the person's natural living environment, contributing to the analysis of personal and environmental factors, as well as information from the Activities and Participation domain, according to the ICF criteria. Evaluator: The social worker from SPAS, after prior training in using the new tool. Respondent: All people with a disability certificate who express an interest (within the EIF from F2) in one or more of the needs assessment modules. Method: The information requested in the ASOC Annex comes from existing administrative data, direct interaction with the applicant and their family, including a home visit, and other local sources such as other professionals in the community (doctor, AMC, mediator, teachers, police, priest, etc.). The ASOC Annex must be completed and submitted to SECPAH within a maximum of 15 working days of receipt of the request from SECPAH/Secretariat. M0 Objective: Once the SPAS submits the ASOC Annex, the chief of SECPAH appoints a case manager who schedules the interviews. The appointments are communicated to the person (via SPAS), and the needs assessment is started with the first contact between the applicant and the case manager. The M0 form is the tool for the first contact. Evaluator: - Respondent: For all people with a disability certificate who have expressed an interest in one or more assessment modules (M1-M5). Method: The case manager is the coordinator of the applicant's individual needs assessment and contact person. He/she ensures that the options in the F2-EIF remain valid, makes the necessary changes if the applicant has decided otherwise, ensures that all required assessment modules are completed, uses various sources of information, and participates in face-to-face/online interviews with the applicant. The face-to-face interview can be conducted either at SECPAH's premises or at the applicants' homes for persons who cannot move. M1 Objective: Assessment of support needs in education and work, with the aim of increasing access and interest of adults with disabilities to/for the active labor market and educational services. This is even more challenging in a national context marked by a weak presence of supported employment opportunities, sheltered units, occupational rehabilitation services, and, more generally, active labor market services for vulnerable groups. Evaluator: Preferably, a multidisciplinary team of SECPAH specialists which, in addition to the case manager, may include educational psychologists, educational instructors, remedial educators, psychologists specializing in work and organizational psychology or other specializations, career counselors, supported employment specialists (COR 263507) or 31 COD NEW PROCEDURE vocational assessment specialists (COR 263506). If this is not possible, the case manager may also conduct the interview alone. Respondent: For all people with a disability certificate who have expressed an interest in the M1 module on employment and education needs. M1 is strongly recommended for 18-35- year-olds. Method: Face-to-face interview, held at SECPAH headquarters or online. M2 Objective: Personal assistance needs assessment aims to ensure equitable access for adults with disabilities to existing or to be developed personal assistance services. In essence, the M2 module has been designed to facilitate the transition from almost exclusively family-based personal assistance (as it is at present) to the gradual development of a network of non-family personal assistants, employed on a contract basis, who provide a number of hours of care in the person's home, according to their specific needs. For people recommended for care by a professional personal assistant, information is collected on the preferences of the person with disabilities that can support the matching process. Evaluator: Preferably a multidisciplinary team of SECPAH specialists under the coordination of the case manager. The assessment team may include social workers, psychologists, educational psychologists, doctors, or physiotherapists. It would be preferable for the person's legal representative/carer/family to participate in this interview. Respondent: For all persons with a certificate of severe or marked degree of disability who have expressed an interest in the M2 module on personal assistance needs. People with a mild or moderate degree of disability are not eligible for personal assistance and, therefore, cannot opt for the M2 module. Method: Face-to-face or online interview. The face-to-face interview can be held, subject to prior planning, either at SECPAH's premises or at the applicant's home, for persons who cannot move. M3 Objective: Assessment of housing adaptation support needs, with the aim of shifting the focus from investing in assisted housing (in APP, center, or sheltered housing) to allocating resources to support families caring for an adult with a disability to adapt their housing. 38 In addition, the M3 module ends with a Home Accessibility Profile, which could also be used to certify professional personal assistants who have to provide care for person with disabilities in their own home. Evaluator: Preferably a multidisciplinary team of SECPAH specialists under the coordination of the case manager, which may include social workers, psychologists, doctors, or physiotherapists. If this is not possible, the case manager can also conduct the interview alone. The person's legal representative/carer/family should preferably participate in the interview. Respondent: For all people with a disability certificate who have expressed an interest in the M3 module on home adaptation needs. Method: Face-to-face or online interview. The face-to-face interview can be held, subject to prior planning, either at SECPAH's premises or at the applicant's home, for persons who cannot move. 38 Operational plan for the implementation of the NDPS, Annex 2. Target 5 = Measures to reduce the number of people with disabilities who are vulnerable because they would not be able to evacuate their homes in the event of disasters and other risk situations and humanitarian emergencies; Target 15 = Access technologies and assistive devices paid for through external non-reimbursable funding sources; Target 20 = Social housing or housing benefit for people with disabilities. 32 COD NEW PROCEDURE M4 Objective: Assessment of needs for decision support in managing economic resources, with the aim of increasing access of adults with disabilities to supported decision-making services to be developed. 39 This assessment may be helpful to courts in cases where judicial advice or special guardianship is required. Evaluator: Preferably a multidisciplinary team of SECPAH specialists, under the coordination of the case manager, which may include social workers, psychologists, psycho-pedagogues, doctors, or physiotherapists. The person's legal representative/carer/family should preferably participate in this interview. Respondent: For all people with a disability certificate who have expressed an interest in the M4 module on assisted decision-making needs. M4 is strongly recommended for people with severe degrees of disability, especially those with intellectual and psychosocial disabilities (as assessed by the disability assessment). Method: Face-to-face or online interview. The face-to-face interview can be held, subject to prior planning, either at SECPAH's premises or at the applicant's home, for persons who cannot move. M5 Objective: Inventory of unmet needs for services and support. 40 It does not have a separate instrument but a section within the Individualized Plan (PLIN). By aggregating data from the M5 module at the administrative-territorial unit, county, and national level, it is possible to quantify the specific service and benefit needs of adults with disabilities. This can be used to develop evidence-based service development plans. Evaluator: The specialist designated in charge of the case by the chief of SECPAH. Respondent: For all recipients of a Comprehensive Disability Assessment, regardless of how many and which needs assessment modules have been completed. It would be preferable for the person's legal representative/carer/family to attend this interview. Method: Face-to-face or online interview. The face-to-face interview can be held, subject to prior planning, either at SECPAH's premises or at the applicant's home, for persons who cannot move. PLIN Objective: Individualized Plan (PLIN) containing the conclusions of the assessment and the list of services and benefits that the person needs in the social integration process: (i) which are recommended by SECPAH specialists, (ii) which he/she has benefited from in the last 12 months and (iii) which he/she wants (and assumes) for the next 12 months. PLIN, which was designed to replace the current PIRIS and PIS. Evaluator: The specialist designated in charge of the case by the chief of SECPAH. Respondent: For all beneficiaries with a comprehensive disability assessment for whom a needs assessment has been completed, regardless of how many and which assessment modules have been completed. It would be preferable for the person's legal representative/carer/family to attend this interview. 39 Operational plan for the implementation of the NDPS, Annex 2. Target 6 = By 2027, at least 17,000 people with disabilities benefit from assistance and decision support services in a pilot programme. 40 The services and benefits considered under the M5 tool refer to: (i) necessary services as identified by the doctor and psychologist following the medical-psychological assessment; (ii) personal assistance; (iii) services that support independent living recommended by SECPAH specialists based on the results of the M1-M4 needs assessment modules; (iv) free benefits, subsidies and exemptions as required by law; (v) social benefits addressing disability; and (vi) social benefits addressing poverty. 33 COD NEW PROCEDURE Method: Face-to-face or online interview. The face-to-face interview can be held, subject to prior planning, either at SECPAH's premises or at the applicant's home, for persons who cannot move. Administrative and information documents Information sheet "How to get a disability certificate" To complement the new procedure, the WB team will propose a model information sheet, "How to obtain a disability certificate", in an accessible format. This will be developed at the end of the pretesting activities of the proposed standardized forms to complete the documentation on file - the "green form" for doctors and the list of minimum requirements for assessment reports prepared by clinical psychologists (see also subchapter 5.2). It will be part of Output 7, together with the two 'green forms.' According to the procedure, health facilities should hand out this information sheet to all persons who receive the "green form" completed by the doctor or clinical psychologist, as they are potential applicants for a disability certificate. Such a leaflet could contribute to the achievement of target 2 set out in the Operational Plan for the implementation of the NDPS - National Strategy on the Rights of Persons with Disabilities: "A Fair Romania", 2022-2027, according to which, in 2027, at least 70% of people with limitations in their daily activities due to their health condition declare that they have no problems accessing the information environment (forms, websites, and intermediation) of public institutions. Guide on "How to challenge a disability certificate" The WB team will also develop a draft guide on "How to challenge a disability certificate" in relation to Output 6 activities. The guide will contain essential information, including how to access free legal assistance. This guide aims to improve the predictability of challenging the assessment results (disability certificate, decision to access services related to the needs assessment modules). The ANPDPD should distribute this guide to all DGASPCs in the country, making it available to all certificate applicants, either directly by SECPAH specialists or sent by the secretariat with the certificate. Developing and disseminating this guide is part of the activities needed to create a redress mechanism. At the same time, it could contribute to the achievement of target 7 set in the Operational Plan for the implementation of the NDPS - National Strategy on the Rights of Persons with Disabilities: "A Fair Romania", 2022-2027, according to which, by 2027, at least 4,000 persons with disabilities will benefit from free legal assistance in cases of suspected violation of the rights deriving from the status of a person with disabilities. Information sheet "What you need to know about individual needs assessment" In relation to the needs assessment, the concern of NGOs and people with disabilities expressed in the consultation workshops is that SECPAH specialists will only carry out the information formally without ensuring that the person understands. That is, there would be a considerable risk that many people would fill in and sign an EIF with "no" to all the modules, and in this way, many people's right to assessment would be violated. To prevent this risk, the new procedure provides: (1) thorough training of SECPAH specialists (2) the development of an information sheet, "What you need to know about the individual needs assessment" (using content from in Annex 7), to support SECPAH specialists and to be given to the person (3) permission for interest in the needs assessment to be expressed independent of the disability assessment/certification. That is, the person can go home, consult with, or learn from others (or from the information sheet) more information that will make them change their mind and realize that they want one or more of the needs assessment modules. (4) developing a grievance and complaints redress mechanism in which CEPAH can play a crucial role. County/Local Report on Unmet Needs of Adults with Disabilities 34 In any country, the disability assessment authority may accompany the disability assessment with a service/benefit needs assessment. Only the disability assessment authority can recommend and not provide access to the necessary services/benefits. Ideally, the needs assessment along with recommendations are shared electronically with relevant benefit/service providers as input to the eligibility testing process to increase access to disability support programs. The legal framework in Romania is designed precisely for this purpose. However, in practice, the current integration plans (both PIRIS and PIS) seem to rely more on what exists than what is needed. Instead, they are tools limited to identifying available supply (unevenly distributed across the territory), but identifying and managing unavailable supply is not foreseen. This management task of what services are needed and what adjustments need to be made to available services is not established or carried out. It is for this reason that the new procedure replaces the PIRIS and PIS with the Individualized Plan (PLIN), which contains not only the conclusions and recommendations taken from each of the assessment modules M1-M4 but also the M5 module, which makes an inventory of the services and benefits that the person has benefited from in the last 12 months and intends/wants to benefit from in the next 12 months.41 By aggregating the data from the M5 module at the level of the administrative-territorial unit, county, and national level, it is possible to quantify the specific service and benefit needs of adults with disabilities, both covered and uncovered needs. These can be used to develop evidence-based plans for developing services for people with disabilities. To this end, the proposed unitary procedure proposes to produce a County Report every 12 months, presenting the outcome of the aggregated analyses, to be distributed by the DGASPC to the County Council and the county municipalities. To increase the institutional capacity of SECPAH/DGASPC/CJ, the WB team has developed a model county/local report on the service needs of adults with disabilities, which can be found in Annex 8. Ideally, the ICT application for assessing adults with disabilities will also have a facility to automatically aggregate data and generate these annual reports at the county and locality level, at least for larger municipalities (with a sufficiently large number of cases). 42 Thus, the chief of SECPAH should generate these reports at the end of each year, check them, and inform the DGASPC management about the main findings at the county level (relevant to the development plans of new services for adults with disabilities). The secretariat should also forward these annual reports to the county council and relevant local councils. In the future, the services linked to the needs assessment approach can be extended by developing the referral system, particularly relevant national programs implemented by the Ministry of Health. The ANPDPD should also explore the possibility of introducing new support measures, such as subsidy programs for adapting housing or cars, to meet the individual needs of people with disabilities. 43 Also, the development of ICF-based rehabilitation services, both medical and vocational, is a top priority for reforming the disability support system and achieving effective individualized plans. However, improving access of people with disabilities to existing services is as important as developing new rehabilitation services. More efforts should be made at the county level to establish partnerships, communication, and collaboration between DGASPC/SECPAH and other service providers (public and private) to create a functioning network instead of existing clusters of isolated services. "Information sheet on the list of assistive devices and equipment found in Romania" For the assessment approach to contribute to increasing access to support and services, it is also proposed to distribute information material - "Information sheet on the list of assistive devices and equipment available in Romania" (organized according to the 16 types of activities included in the assessment) - at the needs assessment stage. This is available in Annex 9. 41 The services and benefits considered under the M5 tool refer to: (i) necessary services as identified by the doctor and psychologist following the medical-psychological assessment; (ii) personal assistance; (iii) services that support independent living recommended by SECPAH specialists based on the results of the M1-M4 needs assessment modules; (iv) free benefits, subsidies and exemptions as required by law; (v) social benefits addressing disability; and (vi) social benefits addressing poverty. 42 It is possible that for some municipalities or small towns, the number of cases (persons assessed annually) may be too small to be relevant for reporting at locality level. 43 Grigoraș at al. (coord.), World Bank (2020: 122-123). 35 4. Specialists involved and skills/professions required Chapter 4 is dedicated to evaluation specialists and describes the types of skills/professions that specialists in each type of institution involved should have. SECPAH specialists In line with the proposed final rules for implementing the new assessment toolkit for adults with disabilities (outlined above), SECPAH specialists should have the following types of competencies/professions. Tools for assessing disability COD NEW PROCEDURE: The assessor must be ... F1 A team comprising at least the specialist doctor and a SECPAH/CEPAH psychologist. The decision on the team's composition is taken by the chief of SECPAH, depending on the case's characteristics and the specialists' availability. F2_WHODAS+RO A SECPAH/CEPAH practitioner, thoroughly trained to use WHODAS+RO, who may be a physician, psychologist, educational psychologist, social worker, physical therapist, education instructor, rehabilitation educator, or career counselor. Tools for needs assessment COD NEW PROCEDURE: The assessor must be ... F2_FEI SECPAH/CEPAH practitioner who also administered WHODAS+RO. ASOC Annex The social worker from SPAS, after prior training in using the new tool. M0 Case manager - any specialist designated by the chief of SECPAH M1 Preferably, a multidisciplinary team of SECPAH specialists which, in addition to the case manager, may include educational psychologists, educational instructors, remedial educators, psychologists specializing in work and organizational psychology or other specializations, career counselors, supported employment specialists (COR 263507) or vocational assessment specialists (COR 263506). If this is not possible, the case manager may also conduct the interview alone. M2 Preferably a multidisciplinary team of SECPAH specialists under the coordination of the case manager. The assessment team may include social workers, psychologists, educational psychologists, doctors, or physiotherapists. It would be preferable for the person's legal representative/carer/family to participate in this interview. M3 Preferably a multidisciplinary team of SECPAH specialists under the coordination of the case manager, which may include social workers, psychologists, doctors, or physiotherapists. If this is not possible, the case manager can also conduct the interview alone. The person's legal representative/carer/family should preferably participate in the interview. M4 Preferably a multidisciplinary team of SECPAH specialists, under the coordination of the case manager, which may include social workers, psychologists, psycho-pedagogues, doctors, or physiotherapists. The person's legal representative/carer/family should preferably participate in this interview. 36 COD NEW PROCEDURE: The assessor must be ... M5 Case manager - any specialist designated by the chief of SECPAH PLIN Case manager - any specialist designated by the chief of SECPAH In conclusion, to apply the new package of tools in good conditions, SECPAH should include doctors, psychologists, social workers, psycho-pedagogues, physiotherapists, and other specialists such as education instructors, rehabilitation pedagogues, physiotherapists, or rehabilitation therapists. However, some additional observations need to be considered, which are discussed below. 1. Certain types of specialists could carry out the assessment but are not essential for SECPAH performance. This is the case for career guidance counselors, supported employment specialists (COR 263507), or vocational assessment specialists (COR 263506). These specialists can carry out the M1 needs assessment module in education and work. However, they are not essential for the performance of SECPAH if we take into account that: (1) only about 9% of the persons assessed are expected to opt for the M1 module; (2) the instrument corresponding to the M1 module is neither a vocational profile matching a person to a specific job, nor a profile in preparation for a specific intervention, nor vocational counseling, nor a work ability test. 44 According to the legislation, vocational assessment and counseling are the AJOFM's responsibility, the institution that holds the employment situation and carries out job mediation. In addition, supported employment (in the few places where it exists) are separate services (public or private) to which SECPAH should refer and not take over their tasks. At present, 45 only a few SECPAHs comply with HG no. 268/2007 (art. 49) regarding staff specializations. Specialists such as educational psychologists, physiotherapists, educational instructors, and rehabilitation therapists represent very few of the total SECPAH staff and are found in a small number of counties. 2. SECPAH should consist of 9+ specialists to ensure effective implementation of the new methodological package (criteria, tools, and standard procedure) The pilot study demonstrated that the new methodological package is feasible and can be successfully implemented if SECPAH comprises 9+ specialists, with at least one specialist doctor. 46 The number of specialists in SECPAH is not in itself a good indicator of performance. For example, the Olt team, with only eight specialists and the highest workload in the country, performed better in the pilot than other counties with teams with more specialists and a workload less than half that of Olt. The difference is due to the coordination of the SECPAH team, teamwork, the support received from the DGASPC management, the cooperation between SECPAH and CEPAH at the county level, and the willingness to participate and contribute to the modernization of the system. This result is even more relevant as the county teams piloted the new work package as additional work to the current service tasks against an already significant workload. Moreover, this additional work was unpaid, although it involved extra effort and a substantial change in thinking and approach to cases compared to the daily routine. 44 The M1 tool has been created to serve as (i) an opportunity to encourage and reflect on the potential and abilities of the person with a disability; (ii) an opportunity to inform people with disabilities about the sphere of work and education; (iii) a summary of a package of information that can be useful for any of the types of tools mentioned in the text and for any type of employment - formal, supported or voluntary (full or part-time). Module M1 ends with a Vocational Potential Profile which is proposed to replace the current vocational guidance certificate which does not provide any information that could be useful to the person with disabilities in accessing active employment or educational services. 45 World Bank (2021) Output 1. 46 The teams from Dolj, Sălaj and Constanța performed excellently in the pilot study. 37 However, the estimated staffing needs based on actual assessment times, the new procedure, and the new tools (Infographic 4) indicate that for a county with about 400 people assessed monthly, SECPAH would need 9+ specialists to ensure an optimal workflow. Infographic 4: SECPAH staffing needs, estimate based on preliminary data for the first five months of piloting Source: World Bank, MODDiz Pilot, e-PLIN data. Note: Data for 5 August to 31 December 2022, N=2,110 cases evaluated, total sample. Currently, 47 the number of specialists employed per SECPAH varies considerably between counties (from 5 to 22) but is generally insufficient. Therefore, the first step in adopting the new methodological package should be to update the analysis of staffing needs and to complement the SECPAHs by hiring specialists where the number is too low. 3. The composition of SECPAH should consider the skewed distribution of workload according to members' specializations The diagnosis report 48 has already shown that, in view of a paradigm shift from a medical to a holistic approach, the current mix of technical expertise is not aligned with the ICF, neither at CEPAH nor at the SECPAH level. Family doctors and general practitioners predominate, while specialists in work capacity medical expertise and physical and rehabilitation medicine doctors are very few. A more significant presence of these specialists would be beneficial for improving the use of new comprehensive assessment tools and for recommending optimal services/benefits for people with disabilities. Increasing the number of doctors at the SECPAH level is even more necessary, considering that in most counties, SECPAH includes only one specialist doctor. As a result, the workload per doctor is very high, practically equal to the county's total number of assessed cases. 49 It is therefore recommended that SECPAH should have 9+ specialists, including at least two physicians, a physical and rehabilitation medicine physician, and a 47 World Bank (2021) Output 1. 48 Ibid. 49 For example, there are counties with 7,200 assessed cases per year. This means about 600 files assessed each month, i.e., about 30 files per working day and 3.75 files per working hour, which allows about 16 minutes per file assessed under continuous working conditions. 38 second physician with another specialization, who would not only provide medical assessment but also participate in ICF-based functioning assessment and needs assessment (especially M2 and M4 modules). This would also correct the skewed distribution of workload between team members. SECPAH's performance could also be improved by including at least one specialist trained in case management for adults with disabilities. 4. However, all SECPAH, CEPAH, and SPAS specialists need training both in the ICF and UNCRPD and in the new methodological package Staff training is generally minimal at all levels, SPAS, SECPAH, and CEPAH. 50 Training on ICF is also extremely limited. SECPAH and CEPAH staff knowledge of ICF is too limited to fully understand the systemic transformations that would come with the paradigm shift from medical to holistic. Therefore, awareness raising and training of SECPAH and CEPAH specialists is critical, as it could equally well advance reform or lead to its failure or reversal. However, the performance of the county teams in the pilot study proves that the new methodological package can be applied in all counties in the country if the SECPAH/CEPAH teams are given the appropriate training and support. The need for training was also highlighted by social workers participating in the pre-testing of the new format of the annex for people with disabilities to the social inquiry (see also subchapter 5.2). 5. To function appropriately, SECPAH should have a secretariat, i.e., 1-2 additional support staff According to the Diagnosis Report and the information collected from the pilot study, SECPAH specialists also carry out many other activities besides assessment - from receiving and registering files to handling files, archiving them, entering data into the computer, etc. Precisely in this sense, the SECPAH chiefs, when mentioning the need for additional staff, refer not only to specialists but also to professional archivists, social services specialists, secretaries, public administration or communication specialists, and data operators. At the SECPAH/CEPAH level, no IT, data management, data analysis specialist, or data operators are foreseen. Without these human resources and under high workload conditions, poor data management, low data quality, and low data utilization are predictable results. 6. For the SECPAH specialists to carry out their tasks properly, SECPAH should have adequate premises, appropriate equipment, and an adequate computerized information management system. For SECPAH specialists to implement the new procedure, they need adequate space, including for interviews, team meetings, or document storage, as well as functional equipment (including printers, scanners, mobile phones, tablets, or laptops). At the same time, as already mentioned, the new methodological package can only be effectively applied with the support of a dedicated ICT application for evaluation. At present, process automation is minimal (if it exists at all). Most of the activities related to disability assessment are paper-based. To address this shortcoming, the ANPDPD is currently implementing an EU-funded project to develop a National Disability Management System (SNMD). 51 However, the SNMD does not contain a dedicated assessment module or facilities. Therefore, developing an ICT application based on the e-PLIN model (which can be integrated with the SNMD) remains one of the issues to be resolved before adopting the new methodological package. 50 World Bank (2021) Output 1. 51 The overall objective of the project is to develop and implement a centralized national platform for collecting, storing, and distributing information on people with disabilities (adults and children) to central and local public authorities, individual beneficiaries and institutional partners. More details at: http://anpd.gov.ro/web/wp-content/uploads/2019/10/ANUNT-WEB- final-ANPD-v2.pdf 39 CEPAH specialists The current legal regulations in force 52 provide for a commission composed of seven members, namely: - a president who is a doctor employed by the DGASPC, - a vice president who is a doctor, employed by the DGASPC, and - five members with different professions, namely: a doctor appointed by the county/local DSP, a social worker, a psychologist, a representative of the non-governmental sector in the county/sector, and a lawyer. Such a composition mirrors that recommended for SECPAH and corresponds to the role of the proposed CEPAH in the new procedure, as described in Chapter 2. SPAS specialists In Romania, only about one-third of local authorities currently have a public social assistance service (SPAS) at the local level, accredited by law. In urban SPAS, the number of staff involved in social assistance activities is higher, with 1-10 employees in small towns and 3-59 employees in large cities, while in rural SPAS, the staffing drops to one or two people. The indicative staff structure of SPAS, according to GD 797/2017 (art. 4, para. 2), is only partially implemented. The most significant deficit is registered in terms of persons responsible for providing social services and case managers/case responsible for children and adults with disabilities living in families. Many SPASs, especially in rural areas, employ only persons with social work attribution and not social workers. The ASOC Annex, like the social inquiry, must be carried out by a social worker or social technician under the supervision of a social worker. Although the ASOC Annex is an improvement on the current regulated framework model, 53 the quality of the data provided by the social inquiry may not increase, given the shortage of social workers at the local level. However, the MMSS is currently implementing a project funded from the PNRR to develop integrated services in marginalized communities, whereby community teams (including social workers) are to be employed in 2000 localities. This project can potentially address the lack of social workers in most of the country's communes. 52 According to Law No 96/2023, amending and supplementing Law No 448/2006. 53 The mandatory social inquiry for the assessment of adults for disability classification carried out by the SPAS should follow a standard framework model, according to GD 430/2008, Annex 6. 40 5. New draft pilot procedure for modernizing comprehensive disability assessment for adults in Romania This chapter describes the flow of actions and paperwork for disability classification and identification of services and support needs of people with disabilities. 5.1. The new procedure outline: Overview 1 FILE 1.1. Preparation of the file and its contents TBD 54 Introduction of standardized forms for specialist doctors and clinical psychologists, paid for by CNAS The medical unit hands out the information sheet "How to obtain a disability certificate" to potential applicants for a disability certificate 2 REGISTRATION 2.1 Application files can be sent by email, submitted to SPAS, or DGASPC/SECPAH 2.2 Scheduling the assessment interview 3 DISABILITY ASSESSMENT The interview can be conducted face-to-face (at SECPAH headquarters), online (with video), or at the applicant's home for persons who cannot move. 3.1 F1 = medical and psychological assessment The doctor and a SECPAH psychologist assess based on the medical documents on file and an interview, using the revised criteria, and complete the F1 form (includes SCOR MP) in the dedicated IT application. 3.2 F2_WHODAS+RO = assessment of functioning based on ICF Any SECPAH specialist trained in the application of WHODAS. The answers to the 45 questions are entered into the dedicated IT application. 3.3 Determining the degree of disability The chief of SECPAH ensures that the procedure is followed by the specialists and, in the results module of the dedicated IT application, initiates the automatic calculation for: - SCOR WHODAS+RO - the person's total disability score (from 0 to 100, with associated grade thresholds) After that, press the key CASE FINISHED TBD Are the current 4 degrees maintained? 54 TBD = To be decided/developed. 41 Obtaining disability automatically triggers payment of disability allowance, free medical insurance, free parking, and free transport. What else? 3.4 Issue and transmission of the certificate Secretariat: - take over completed cases from the system, - automatically generates the CERTIFICATE - forward the package of certificates for signature to the Director of the DGASPC - send the person the certificate and the guide "How to contest the certificate". 3.5 F2_EIF The person is informed about the needs assessment (purpose, how it is carried out, etc.), and the option for one or more modules is registered. The person also receives the "What you need to know about individual needs assessment" information sheet. Needs assessment is voluntary and modular. Only people with an acute or severe degree can opt for the M2 module. The other modules are open to people with a certificate, regardless of the degree of disability. NO 3.6.A. EIF option The person can (re)consider the needs assessment. If he/she wishes, he/she can then make a request for one or more assessment modules, which he/she can submit to the SPAS or directly to the DGASPC/SECPAH and go to 3.6.B. YES 3.6.B. ASOC Annex The secretariat sends a request (by email) to the SPAS to complete the Annex to the Social Inquiry for Adults with Disabilities (ASOC Annex) for the people who meet the conditions (obtain a certificate with a degree of disability, have expressed interest in F2_FEI. For the M2 module eligibility is checked - severe or severe degree). 3.7 SPAS has 15 working days to prepare and submit the ASOC Annex to SECPAH. 4 NEEDS ASSESSMENT 4.1 Upon receipt of the ASOC Annex, the interview is scheduled, and the chief of SECPAH appoints a specialist (case manager) to accompany the person during the needs assessment. IT YES 4.2.A. application The dedicated IT application allows the ASOC Annex to be introduced by the SPAS. NO 42 4.2.B. In preparation for the interview, the designated specialist takes the ASOC Annex, requests additional information from the SPAS (if necessary) and enters the data into the IT application. 4.3 Conducting the needs assessment The interview can be conducted face-to-face (at SECPAH headquarters) or online (with video) 4.3.A. M1 = Education and work Referral to DGASPC service/ sheltered workshops 4.3.B. M2 = Personal assistance Access to service decision signed by the DGASPC director sent to the mayoralty 4.3.C. M3 = Adaptation of Referral to DGASPC/ assistive equipment service housing 4.3.D. M4 = Assisted Decision Referral to DGASPC service 4.3.E. M5 = Unmet needs County Annual Report Annual reports to municipalities Reports are generated automatically. 4.3.F. PLIN The Individualized Plan is sent to the SECPAH Chief, who verifies and presses the FINALIZED CASE key. Needs assessment results 4.4 At the end of the year (in December), the chief of SECPAH automatically generates (and verifies) the following: - Annual report of unmet needs at the county level - Annual reports for municipalities 4.5 The Secretariat takes the completed cases from the system and transmits: - PLIN and, where applicable, the decision on access to personal assistance to the person, as well as the guide "How to contest the certificate", which also has a section on contesting the decision on personal assistance. - Personal assistance decision to the DGASPC service for APP - PLIN and, where applicable, the decision on access to personal assistance to the SPAS (for employment of the personal assistance or payment of the allowance) At the end of the year (in December): - Annual report of unmet needs to the CJ - Annual reports to municipalities YES The person is satisfied with the results of the disability assessment/needs Person assessment. satisfaction He will be back: - To renew the certificate - For extending access to personal assistance NO - The possible appearance of new additional modules relating to services of interest. 43 5 REDRESS AND APPEALS 5.1 Options The person expresses dissatisfaction/disagreement. The Secretariat informs the person of the options: A) Complaint to CEPAH B) Complaint to the courts Option A) can be followed by option B) if the person is unsatisfied. 5.2.A. For complaints to CEPAH, The Secretariat prepares the file with the F1, F2 forms and needs assessment modules completed by SECPAH at the assessment time. CEPAH: - checks that the procedure has been followed - reviews that no errors have occurred in the process (checks scores) - may request that SPAS redraft the ASOC Annex - decide how to proceed further and - provides clarification to the dissatisfied person. The county CEPAHs operate under the coordination of the Superior Commission. TBD Organize consultations with NGOs to decide on a transparent procedure for selecting the NGO representative in CEPAH. TBD What if the CEPAH analysis reveals an error that leads to a grade change (e.g., SCOR MP is wrong because some information in the file was not considered)? 5.2.B. If the person files a lawsuit, CEPAH provides expert opinions (justifications) to judges/courts. TBD The register of experts (to be drawn up by the ANPDPD in relation with Output 6) will include the members of the county CEPAHs. 5.2. Steps in the new procedure proposal that could not be piloted As mentioned, the new draft procedure is organized according to the four stages of the evaluation process. The flow of activities followed in the pilot for each stage is described in Output 5. However, at the level of each stage, some steps in the procedure could not be piloted. These steps are the focus of this sub-chapter. STAGE 1. Medical and psychological assessment The new draft unitary procedure proposes to supplement the documentation on file required by law with a "green form" for doctors and a list of minimum requirements for assessment reports by clinical psychologists. These forms are intended to be filled in by any doctor or psychologist once they establish a medical diagnosis mentioned in the medical and psychological criteria for disability classification. They are intended to limit the possibilities of obtaining/supplying medical documents prone to fraud and, at the same time, to improve initial information for all categories of the population. Details of these standardized forms can be found in Output 3. These two standardized forms were not part of the pilot study, as they were addressed to specialists outside SECPAH. Instead, the World Bank team organized an extensive pre-testing of these instruments in collaboration with a team of physicians from Elias Emergency University Hospital (under the coordination of Dr. Mihai Berteanu) and the National College of Psychologists (Clinical Psychology Section). 44 This pre-testing is still ongoing and aims at (1) identifying the medical and psychological data gap in the current files for disability classification (on 460 files collected by ANPDPD from SECPAHs in all counties of the country) and (2) adjusting the standardized forms after actual application by a batch of medical specialists, i.e., clinical psychologists (from outside SECPAH). The work is planned to be completed in June 2023, and the results will be included in Output 7. STAGE 1. Assessment of operation based on ICF All steps in the procedure have been piloted. STAGE 3. Certification of disability Once the disability assessment phase is completed, the degree of disability is determined based on an algorithm (applied automatically) that combines the medical-psychological score with the WHODAS+RO score. The disability certification stage leads to the person's disability status and disability certificate, making them eligible for certain immediate entitlements (e.g., free healthcare). The steps in the procedure that could not be piloted were as follows: (i) Upon completion of Phase 1, the team submits the completed F1 form to the chief of SECPAH. Similarly, at the end of Phase 2, the evaluator sends the completed F2 form to the Chief of SECPAH. First, the SECPAH Chief reviews the documents submitted by the evaluators, approves them, or sends them back for review. After review and any corrections, the chief of SECPAH determines the person's disability score and the appropriate degree of disability using the dedicated software. (ii) The disability score of the person as a whole is automatically generated by software that incorporates both (i) the combination algorithm for determining the functioning score based on the specific WHODAS+RO scores and (ii) the combination algorithm for calculating the overall score based on the medical-psychological and functioning scores. Based on the global score, the software also indicates the appropriate degree of disability to be assigned to the person. In this way, the level of disability is no longer determined based on a subjective or discretionary decision. Instead, the decision is scientifically sound (valid and reliable) and non-discriminatory, in addition to being based both on the individual's health status and on-point assessments of specific activities. These steps will be tested on the data collected through the pilot study, and the results will be included in Output 7. STAGE 4. Assessment of individual needs for services and support The individual needs assessment is initiated at the end of the performance assessment phase. The needs assessment is voluntary to ensure freedom of choice and control for people with disabilities over their own lives, including the support they receive, in line with the UNCRPD. So, the applicant for a certificate should be well informed as early as possible. Only in this way is the applicant aware of the required actions, time, and opportunities available. Therefore, the F2 form is designed so that after the WHODAS+RO application (functional assessment) is completed, the needs assessment is initiated by applying the Expression of Interest Form (EIF). The unified procedure proposed (Output 4) provides several steps, only some of which have entered piloting. Thus, according to the procedure, the SECPAH specialist must do the following actions: (i) inform the applicant of the existence of the needs assessment after the certification stage, accessible to all beneficiaries of a certificate (with legal status as a person with disabilities). 55 (ii) strongly recommend module M1 - assessment of support needs and services in education and work for people with disabilities aged 18-35 and module M4 - assessment of decision support needs for all people with severe disabilities. 56 55 Partially applied step - The condition of having a certificate could not be applied, e.g., for people in their first lifetime assessment (who do not yet have a certificate). 56 Step piloted as such. 45 (iii) assist the applicant in completing the Expression of Interest Form (EIF) for participation in the needs assessment, with the possibility of opting for one or more services and the corresponding assessment modules. 57 (IV) explain to the applicant the possible benefits of the individual needs assessment (potential professional profile, housing accessibility profile, assisted decision-making recommendation, and access to personal assistance service) and that it ends with an Individualized Plan (PLIN) which will be communicated to the SPAS who will be responsible for supporting and monitoring them over the next 12 months. After completing the F2 form (after the EIF), the SECPAH specialist hands the applicant the guide on "How to challenge the certificate". 58 STAGE 4A. Social assessment The social assessment is the first step in the needs assessment and provides the necessary information for the assessment modules (M1-M5) from the person's natural living environment. It, therefore, only applies to people who express an interest in the EIF (from F2) for one or more of the needs assessment modules. At present, the social inquiry is a document required on file for all adults applying for disability classification. It must be carried out according to the framework model provided in GD no. 430/2008, Annex 6. Following these provisions, all applicants for disability classification have a social inquiry on file. However, according to the new methodological package, the social assessment must be based on a new tool ASOC Annex - Annex to the social inquiry for adults with disabilities, designed to replace the current framework model. In contrast to the existing provisions, according to which the person must apply to the SPAS to obtain the compulsory social inquiry on file, the new unified outline procedure proposes a significant change involving the following: (i) the social inquiry report is no longer compulsory for all applicants but only for those who express an interest in the needs assessment. 59 (ii) SECPAH/DGASPC sends the request for the Social Inquiry Annex via a standard email once the person has completed the disability assessment stage and has expressed an interest in one or more of the services covered by the needs assessment modules within the EIF. 60 (iii) SPAS has 15 working days to complete the ASOC Annex and return it to SECPAH (by post or email). 61 (IV) the application for the social inquiry on the model ASOC Annex can also be submitted after the assessment by persons with a valid disability certificate directly to the SPAS, which will inform SECPAH/DGASPC and obtain an appointment for the individual needs assessment. 62 The Adult with Disabilities Annex to the Social Inquiry (ASOC Annex) has not been systematically piloted with SECPAH teams but has only been used for some cases (where it could be done). Instead, the ASOC Annex was rigorously pre-tested by the WB team in collaboration with the National College of Social Workers in Romania (CNASR). With the help of the CNASR, social workers were selected to volunteer to test the new ASOC Annex form. People with disabilities assessed were selected either by social workers from among their clients or in collaboration with SECPAH county teams. 66 social workers from 19 counties (8 counties and one sector of Bucharest municipality, part of the pilot study, plus 10 counties outside the pilot) participated in this testing activity. They assessed 539 people with disabilities (of which 175 were also registered in the e-PLIN application). 57 Partially implemented step - In the pilot, the assessor explicitly stated that the needs assessment would in no way affect the rights (services and benefits) that the person receives under the assessment by law. The particular instruction was not to create a waiting horizon that could lead to misunderstanding and disappointment. 58 Step that could not be piloted. 59 Step piloted as such. 60 Step that could not be piloted. 61 Step that could not be piloted. 62 Step that could not be piloted. 46 The main outcomes of this work were: (1) valuable observations on questions whose content needs to be improved/changed; (2) the need for a modular application of the ASOC Annex tailored to the needs, conditions, and preferences of the person assessed (and their choices for particular needs assessment modules); (3) the need to introduce a specific social disability assessment competency for social workers at the CNASR level. To this end, the CNASR will develop a specific Guide for the intervention of the social worker in the field of persons with disabilities that will include, among other things, instructions for the use and application of the ASOC Annex together with specific references for the social worker's practice. Comments and ideas collected at the final event with volunteer social workers have been incorporated into the final version of the tool and procedure included in this report. 63 STAGE 4B. Individual needs assessment modules Based on the principles of the UNCRPD, the needs assessment is not only voluntary but also modular, as there is no one-size-fits-all solution/measure. Thus, the needs assessment comprises four distinct modules (M1, M2, M3, and M4) that subsume the concept of independent living, understood as choice and control in everyday life for people with disabilities, on an equal basis with the general population. To these, two additional modules (M0 and M5) are added. The proposed unified procedure provides for the following steps, which have been modified for piloting purposes: (i) after the SPAS submits the ASOC Annex, the chief of SECPAH designates a case manager who schedules the interviews. The date is communicated to the SPAS, which forwards it to the applicant. If possible, the Mayoralty/SPAS can support the person with access to a computer connected to the Internet (if the person does not have one) so that the interviews can be organized online. 64 (ii) the needs assessment is initiated with the first contact between the applicant and the case manager. The M0 form is the tool for the first contact. 65 (iii) the case manager is the individual needs assessment coordinator and contact person for the applicant. The case manager ensures that all required assessment modules are completed by drawing on various sources of information and participating in face-to-face or online interviews with the applicant. The person also receives an Information Sheet on the list of assistive devices and equipment available in Romania, organized according to the 16 types of activities included in the assessment. 66 (iv) the assessment is concluded by the case manager completing the PLIN with the person and his/her representative/family. 67 GENERAL. Other provisions of the proposed unified procedure not applicable in the pilot study The procedure requires that any instrument (F1, F2, M1, PLIN, etc.) be signed by the assessed person/ his/her representative, and the evaluation team. This rule has not been applied in the pilot for simplicity and to avoid giving the approach too formal an appearance, which could have created false expectations or misunderstandings among the persons assessed. All the provisions in the procedure relating to SPAS were not applied because the implementation teams did not include SPAS representatives. 63 The final event was organized online using the ZOOM platform on 31 May 2023. The workshop was attended by 46 social workers, the WB team, and representatives of the ANPDPD. A total of 32 social workers also submitted written feedback detailing the various problems encountered and ideas for improving the tool or application procedure. 64 This step was not piloted because the disability assessment and needs assessment were carried out in one meeting with the person and not on two separate days as required by the procedure. 65 Step that was not piloted. In the study, any SECPAH specialist who recruited a person became the default case manager for that case during the piloting period. 66 This step was not piloted because, in the study, the needs assessment could be stopped at any time if the person no longer wanted to continue or was tired. 67 Step piloted as such. 47 The steps relating to the future grievance and redress mechanism, which the procedure proposes to be part of the CEPAHs' sphere of responsibility, have not been tested. These steps will be addressed through the methodology to be developed in Output 6. 5.3. New assessment procedure for adults with disabilities: Lessons from the pilot - county variations and performance The pilot study provided important information for the eventual adoption of the new methodological package at the national level. Concerning the adoption of the new proposed unified assessment procedure, the first relevant result is that each county team applied it with specific variations. Examples of county variations in using the new procedure are presented in Annex 10. 68 Firstly, the county variations were determined by the human and material resources (premises, equipment) available at the county level. For example, some teams do not have a doctor, others have poor management, and others work in a corridor without other premises. The fact is that county teams with insufficient or incomplete human resources in terms of specialization generally performed worse than other teams. 69 However, the pilot proved that solutions can be found with satisfactory results if there is a willingness to participate in such situations. Secondly, the county variations result from the fact that the new procedure does not apply in a vacuum, nor can it be applied on top of, but only in conjunction with existing practices. Each team already has some entrenched practices created over time based on how they have interpreted/understood existing law. 70 The diagnosis report 71 clearly showed that existing practices are only formalized in institutional procedures to a small extent. And whether formalized in procedures or not, existing practices differ significantly between counties. Under these circumstances, in the pilot study, the new unitary procedure was combined with elements of existing practices, i.e., the teams did not completely "forget" how they do things in the "normal way". 72 This is how county variations resulted from how teams combined the new piloted procedure with the grounded practices. The fact is that county teams with current practices conflicting with those in the newly piloted package performed considerably worse than other counties. Primarily, counties that make disability rating assessments solely based on records, in the absence of direct interaction with the person, for most cases assessed. These county teams had severe difficulties applying the new unitary procedure, as they could not recruit participants or apply the working tools involving an interview with the person being assessed. Therefore, the adoption of the new package (criteria, tools, uniform procedure) can only be successfully achieved if the human and material resources necessary for good functioning are ensured, and the county teams are provided not only with training but also with assistance and joint working sessions (exchange of experience) to help them in becoming aware of the differences, the reasons for them and possible alternatives or other ways to solve problems and do things in an effective way. 68 These presentations were made by the county teams during weekly working sessions. In this way, differences between counties became visible and were discussed at the entire team participating in the pilot. 69 Performance was defined as the number of cases evaluated per month on the new methodology package. 70 According to Article 1, para. 2 of Order no. 2298/2012 approving the Framework Procedure for the assessment of adults for disability classification, the DGASPC "shall develop its own detailed procedures for the assessment of adults for disability classification". 71 World Bank (2021) Output 1. 72 For example, doctors reinterpreted the revised criteria from the perspective of the current routine, assessment teams were formed according to existing practices and not according to the new procedure, instruments were completed on paper and only then entered in e-PLIN because some members were not computer literate, etc. 48 Annexes Annex 1. Research tools for system and policy analysis of disability assessment See separate document Output 4_Annex1. Output 4_Annex1 includes the following list of research tools: • Questionnaire 1. Disability assessment and access to benefits and services for persons with a certificate acknowledging disability degrees and types • Questionnaire 2A. Determination of disability degrees in Romania - FACTS AND FIGURES • Questionnaire 2B. Determination of disability degrees in Romania - PRACTICES AND EXPERIENCES • Questionnaire 3A. Determination of disability degrees in Romania - FACTS AND FIGURES • Questionnaire 3B. Determining disability degrees in Romania - PRACTICES AND EXPERIENCES • Questionnaire 3C. Determination of disability degrees in Romania - THE CEPAH SECRETARIAT AND THE RESULT INDICATORS OF THE PROCESS PERFORMED TO DETERMINE DISABILITY (STATISTICAL DATA) • Questionnaire 3D. Determination of disability degrees in Romania- ON APPEALING THE TYPE AND DEGREE OF DISABILITY • Interview guide for lawyers - APPEALS AGAINST CERTIFICATES FOR DETERMINATION OF A DISABILITY DEGREE • Interview guide for judges - APPEALS AGAINST CERTIFICATES FOR DETERMINATION OF A DISABILITY DEGREE AND A DISABILITY TYPE • Interview Guide for non-governmental organizations - CIVIL VOICE AND PROTECTION OF THE RIGHTS OF PERSONS WITH DISABILITIES IN THE COMMUNITY • Interview guides for adults who have requested the assessment for determination of a degree and type of disability - THE PERSON'S JOURNEY THROUGH THE DISABILITY ASSESSMENT SYSTEM • Interview guides for adults who have requested the assessment for determination of a disability degree and type - INTERACTION BETWEEN INDIVIDUALS AND INSTITUTIONS • Interview guides for adults who have requested the assessment for determination of a degree and type of disability - APPEALS AGAINST CERTIFICATES FOR DETERMINATION OF A DISABILITY DEGREE AND TYPE • Interview guide for the representatives of the public social assistance services at local level (SPAS) - THE SOCIAL INQUIRY FOR DETERMINATION OF A DISABILITY DEGREE AND TYPE AND THE ACCESS OF PERSONS WITH A DISABILITY CERTIFICATE TO BENEFITS AND SERVICES • Group discussion guide for discussions with CEPAH specialists • Group discussion guide for discussions with SECPAH and SEC Child specialists 49 Annex 2. Scenarios for the selection of the NGO representative to the CEPAH, which may be subject to consultations with NGOs Scenario 1: Open vote Regulation for the appointment of a civil society member to the Commission for the Assessment of Adults with Disabilities: 1. Criteria for NGO representation and independence in the Commission for the Assessment of Persons with Disabilities (CEPAH) a. Members of the Commission must meet the same criteria of professional and personal integrity. b. The nominated NGO must be legally registered and active in the county they are running. c. Professional training in the field of disability rights. d. Representativeness at sector level on disability rights. e. Independence from the authority they will work and evidence of proper moral conduct. f. The designated persons and non-governmental organizations must not be in employment relationships or contracts for funding or contracting services with the CJ or DGASPC - of the county in which they will participate in the work of CEPAH. 2. Procedure for appointing the NGO member to the CEPAH a. At a specific time of the year, the procedure is launched at the national level on an online platform based on an agreed document concluded with the ANPDPD, DGASPCs, and VotONGs (e.g., https://votong.ro/ro/ platform). b. NGOs can nominate their candidates for participation in the CEPAH according to established criteria. c. The competition will be conducted publicly online - by submitting applications with documents agreed upon by civil society representatives in the rights of adults with disabilities and ANPDPD. d. The public vote will be conducted via the online platform. Candidates' applications and CVs will be public. e. The evaluation committee will comprise NGO representatives and benefit from observers from the ANPDPD and DGASPCs. f. The nominee and the organization he/she represents shall provide evidence that they meet the criteria of integrity, professional training, independence, representativeness, and professional and institutional activities that do not contravene the provisions of the UNCRPD. g. If no non-governmental organization nominates at least one representative to the CEPAH, applications may be accepted from NGOs operating in neighboring counties, following a specific selection and nomination procedure. 3. Term of office and quarterly reporting a. The duration of a mandate in the CEPAH will be three years, with the possibility to be renewed once (a maximum of 6 years). Before the expiry of the mandate, the NGO that nominated a member will be notified and may propose the same person or another candidate to take his/her place in the Commission. b. Quarterly, non-governmental organizations that have appointed their members to the CEPAH will publish a report on their work, challenges, and opportunities encountered within the Commission. The report will be available on the organization's website and sent to the ANPDPD and DGASPCs for inclusion in the Commission's quarterly reports to the ANPDPD's Superior Commission. 50 4. Challenge to the mandate of the designated person and/or NGO a. The procedure for appealing the decision to designate a professional or the organization in which he/she works will be set out in the document agreed upon and concluded with the ANPDPD, DGASPCs, and VotONGs (on behalf of civil society) and will include information on the deadlines, modalities, and place for lodging appeals. b. If a nominee no longer meets the criteria of integrity, professional training, independence, or representativeness, the nominating organization shall be obliged to propose another candidate to take his/her place. 5. Voting procedure in CEPAH Members of the Commission will be entitled to separate opinions, and decisions will be taken by majority vote. In a tie, the President of the Commission will have the casting vote. 6. Organization of meetings and participation of the designated NGO representative Commission meetings can also be organized in a hybrid system, combining physical attendance with online participation. If a member of the Commission cannot be physically present at the meeting, he or she may participate by videoconference or other means of remote communication. Scenario 2: Election of CJ/CL Selection of the NGO representative in CEPAH The current legal regulations in force 73 provide for a commission composed of seven members, namely: - a president who is a doctor employed by the DGASPC, - a vice president who is a doctor, employed by the DGASPC and - 5 members with different professions, i.e., a doctor appointed by the county/local DSP, a social worker, a psychologist, a representative of the non-governmental sector of the county/sector, and a lawyer. The selection criteria must be applied uniformly to all commission members based on their professionalism, willingness to participate, and specific professional skills. In addition, for some members (not for psychologists, social workers, and lawyers), conditions of institutional membership (DGASPC, DSP, etc.) and residence in the county/sector concerned are mentioned. The selection criteria must also be proportionate to the more limited responsibilities of the committee, whose main role is to re-evaluate the appeals submitted by people with disabilities who are dissatisfied with the score obtained following the evaluation by SECPAH specialists. Criteria for the selection and analysis of the NGO representative 1. The NGO they represent must be legally registered, accredited, with demonstrable activity in disability rights protection - it can be an NGO providing social services, an NGO with advocacy activities, an NGO part of a known network working to benefit people with disabilities, etc. 2. The organization to operate in the county/area where CEPAH operates. 3. The willingness of the NGO member to actively participate in the committee's work as a representative of the NGO sector for the entire 4-year term (affidavit). 74 4. Not to hold more than two consecutive mandates to represent the NGO sector. 5. If there is no NGO in the county/sector in question, NGOs in the vicinity of the committee (other county, sector) can be used. 73 According to Law No 96/2023, amending and supplementing Law No 448/2006. 74 Similar to the mandate of the members of the Superior Commission. 51 6. Demonstrate at least three years of experience in the disability field (CV, recommendations, references, similar experience, etc.). 7. Demonstrate involvement in improving the quality of life and/or promoting the rights of people with disabilities (CV and/or recommendations). 8. The designated person must know about the regulation of the disability sector, the protection measures, and services for people with disabilities. 9. Maintain an active and transparent liaison with non-governmental organizations promoting the rights of people with disabilities in the county/sector. 10. The person appointed by the NGO to be part of the CEPAH must not be employed by the DGASPC and/or CJ/CL. Procedure for appointing the NGO member to the CEPAH 1. DGASPC publishes on its website the start of the selection procedure for the NGO representative: application period, required documents and their submission, the committee for the evaluation of applications, selection criteria, and the points awarded. 2. The evaluation committee consists of 3-5 members and comprises representatives of the DGASPC. 3. The DGASPC submits the proposed members of the CEPAH to the CJ/CL, including the NGO representative. 4. The county/local council decides, based on a proposal from the DGASPC, on the composition of the CEPAH for a 4-year term. Annex 3. Instruments for medical and psychological assessment (version after piloting) Annex 3a & b. Proposed Medical and Psychological Criteria The proposed revised Medical and Psychological Criteria can be found in the separate Word document Output 4_Annex3a and the database format summary in Output 4_Annex3b. Annex 3c. Form 1 52 FORM 1. The results of the medical and psychological assessment, based on the revised medical and psychological criteria JUD County/sector: . Assessment team: OMSM1 SECPAH physician CodeS. CodeS Mark 0 (zero) if there was no physician present when filling in F1. DATLOG1 Date of filling F1 by |_z_|_z_|: |_l_|_l_|: |_a_|_a_|_a_|_a_| Automatically the physician generated SECPAH psychologist OMSM2 CodeS. CodeS Mark 0 (zero) if there was no psychologist present when filling in F1. DATLOG2 Date of filling F1 by |_z_|_z_|: |_l_|_l_|: |_a_|_a_|_a_|_a_| Automatically the psychologist generated OMSMalt For filling in F1 has 1. Yes 0. No other SECPAH representative participated (other than the physician and psychologist)? If OMSMalt=1, OMSM3 Other SECPAH CodeS. specialist CodeS The code of the specialist who is actually filling in the form. DATLOG3 Date of filling in F1 |_z_|_z_|: |_l_|_l_|: |_a_|_a_|_a_|_a_| Automatically by other SECPAH generated representative * Informații confidențiale care nu vor fi exportate în setul de date anonimizat pentru analiză. 1. AUTOMATICALLY PRE-FILLED DATA THAT THE ASSESSMENT TEAM File CAN CONSULT BEFORE THE INTERVIEW 53 File 1.1. Socio-demographic data DATA AUTOMATICALLY RETRIEVED FROM O#3_F0. REGISTRATION FORM NUMEP Assessed person a. Name:* Automatically retrieved from IDENTIFICATION DATA b. First name 1:* c. First name 2:* ID Unique Identification Automatically generated Code ADR Home address 1. UAT name: 1a. SIRUTA drop down 2. Village/district name: 2a. SIRUTA 3. Residential area: 1. Urban 0. Rural SEX Gender 1. M 2. F DN Date of birth* |_z_| _z_|: |_l_|_l_|: |_a_|_a_|_a_|_a_| AGE Age (in years of age) |__|__| automatically generated years. TAKEN FROM F00. SCIV Marital status 1. Legally married | 2. Cohabitation | 3. Widowed | 4. Divorced 5. Separated in fact | 6. Never married AFAM The person lives ... 1. In a family (APP included) 5. Another situation, namely ... 2. In a public or private residential service (GD no. 867/2015) 3. In detention 4. Temporary treatment abroad/country PASIST2 The person has... APP or personal assistant 1. Yes 0. No IF PASIST=1 OR 2 THEN PASIST2=1 Automatically generated PTUT The person is... 1. Under the guardianship of a 1. Yes 0. No family member 2. Under the guardianship of local 1. Yes 0. No authorities 3. Under curatorship 1. Yes 0. No PRLEG Does the person have a legal 1. Yes 0. No representative? If YES 1. Gender: 1. M 2. F 2. Age in years of age: |__|__| Years 54 1. | spouse 2. son/daughter | 3. mother/father | 4. another 3. Relationship: relative, ... 5. another person (non-relatives), namely ... ECD 1.2. Disability certification DATA AUTOMATICALLY RETRIEVED FROM O#3_F0. REGISTRATION FORM ECD1 Type of assessment 1. First Assessment for determining the degree of disability, during the lifespan One answer 2. Assessment for renewing an existing certificate 3. Assessment because of a change of situation or of a health condition, or upon request, including the provisions of art. 58 or 59 of the Law 263/2010 on the public pension system ECD2 If ECD1=1 The person does not have a valid certificate = > GO TO Other information If ECD1=2 OR 3 The person has a valid certificate and data below are filled in. ECD2 Disability certificate We refer to the previous certificate with which the person came to the assessment for determining the degree of disability a. Degree 0. Rejection/not with a determined degree of disability CERTIFICATE 2020-21 with which he/she 1. Minor 2. Medium 3. Marked 4.Severe 5. Severe with personal assistant came at the assessment b. Type 1. physical disability | 2. somatic disability | 3. hearing disability| 4. eyesight disability CERTIFICATE 2020-21 | 5. mental disability | 6. psychiatric disability | 7. associated disability | 8. HIV/AIDS with which he/she disability | 9. rare diseases disability | 10. deafblind disability came at the assessment c. Validity 1= 12 months | 2 = 24 months | 3= Permanent CERTIFICATE 2020-21 ATTENTION! If in the revised criteria, there is a recommendation of 6 months, then you fill with which he/she in code 1=12 months. came at the assessment Ediz 2. MEDICAL AND PSYCHOLOGICAL ASSESSMENT THE ASSESSMENT MAY BE CARRIED OUT BY ANALYSIS OF THE MEDICAL AND PSYCHOLOGICAL DOCUMENTS IN THE FILE AND, WHERE APPROPRIATE, BY DIRECT INTERACTION (INTERVIEW) WITH THE APPLICANT 55 INTM 2.1. About the interview FACE-TO-FACE OR ONLINE INTERVIEW. INTM1 Where does the 1. SECPAH headquarters interaction take 2. Applicant's home (for bedridden persons) place? 3. Online 4. Another situation, namely: ... INTM3 Language of the 1. 2. 3. Romani 4. German 5. another, namely: interview Romanian Hungarian ... INTM2 Participants a. Person to be assessed/ The applicant 1. Yes 0. No b. Designated case responsible 1. Yes 0. No c. Legal representative / attendant / family* 1. Yes 0. No is. Other people who are not SECPAH specialists 1. Yes 0. No If YES e1. Namely: ... * For applicants with psychiatric disorders with psychotic symptoms or intellectual disabilities, the participation of the legal representative / attendant / family in the interview is allowed, because in these cases the person's answers may not correctly mirror the reality. EVM 2.2. Results of the medical and psychological assessment MEDICAL SCORE AND RECOMMENDATIONS EVM1 PRIMARY DIAGNOSIS 1a. Name: 1b. CODE ICD-10/DSM5: 2. Known duration of pathology: 1. less than 1 2. between 1 3. more than 2 -1. NS year and 2 years years 3. Character of the impairments 1. Continuous 0. Fluctuating -1. NS EVM2 SECONDARY DIAGNOSIS(S) Are there any secondary diagnoses? 1. Yes 0. No If YES 1a. Name: 1b. CODE ICD-10/DSM5: 2a. Name: 2b. CODE ICD-10/DSM5: 3a. Name: 3b. CODE ICD-10/DSM5: 56 SCOR FINAL MEDICAL SCORE* indicating M an impairment of the functions and body structures ...: 1. Mild 2. Moderate 3. Severe 4. Complete Established in the base of O#2_MED1. Revised medical and psychological criteria FINDINGS OF THE DOCTOR AND PSYCHOLOGIST REGARDING THE NEEDS OF THE ASSESSED PERSON EVM3 Validity of the certificate: ATTENTION! If in the revised criteria, there is 1= 12 months 2= 24 months 3= permanent a recommendation of 6 months, then you fill in code 1=12 months. EVM3 Type of disability mentioned in the 1. physical disability | 2. somatic disability | 3. hearing disability| 4. 0 eyesight disability | 5. mental disability | 6. psychiatric disability | 7. revised criteria: associated disability | 8. HIV/AIDS disability | 9. rare diseases disability | 10. deafblind disability Services: EVM4 1. Specialized medical services 1. Yes 0. No -1. I can't assess it 2. Current drug treatment 1. Yes 0. No -1. I can't assess it 3. Medical rehabilitation (recovery), 1. Yes 0. No -1. I can't assess it including spa resort 4. Medical home care services (funded 1. Yes 0. No -1. I can't assess it by CNAS) 5. Medical devices, technologies and 1. Yes 0. No -1. I can't assess it assistive devices intended to rehabilitate organic or functional deficiencies in outpatient settings If YES a. Select from the list below Annex 38 of the PROCEDURE of 1 April 2019, MMJS, MS and CNAS, from the Official Gazette no. 258 of April 3, 2019 drop down A. BASIC PACKAGE 1. Prosthetic devices in the field of O.R.L. 2. Devices for stoma prosthesis 3. Devices for urinary retention and/or incontinence 4. Prostheses for the lower limb 5. Prostheses for the upper limb 6. Orthotics 6.1 for the spine 6.2. for the upper limb 6.3. for the lower limb 7. Orthopedic footwear 8. Devices for eyesight impairments 9. Equipment for oxygen therapy and non-invasive ventilation 10. Devices for aerosol therapy 11a. Walking devices - Crutches, stick; Crutches with subaxillary/elbow support; Tricycle; Walking frames; 11b. Walking devices - Scratch rolling for active user; Wheelchair, manual; Wheelchair, manual, with postural support; Wheelchair, electric 57 12. External breast prosthesis B. Package of services for patients from the Member States of the European Union (...) based on Regulation (EC) No. 883/2004 of the European Parliament and of the Council and for patients from states with which Romania has concluded agreements, agreements, conventions or international protocols with provisions in the field of health. 6. Other assistive technologies and 1. Yes 0. No -1. I can't assess it devices and access technologies For example, those targeted by subsidies in the form of a voucher for persons with disabilities to facilitate insertion into the labor market (MySMIS code 130164) that are granted through DGASPC's. 7. Psychological counseling 1. Yes 0. No -1. I can't assess it 8. Individual or group psychotherapy 1. Yes 0. No -1. I can't assess it 80. Other psychological services/ 1. Yes 0. No -1. I can't assess it therapies (speech therapy, occupational therapy, music etc.) 9. Current mental health medication 1. Yes 0. No -1. I can't assess it treatment In the framework of assistance from physical medicine and rehabilitation: 10. Free individual spa treatment 1. Yes 0. No -1. I can't assess it ticket 11. Free spa treatment ticket with 1. Yes 0. No -1. I can't assess it personal assistant / attendant EVM5 Any kind of health problem recorded in the medical documents that could constitute barriers to employment / workplace, among the following: 1. Epilepsy 1. Yes 0. No 7. Eyesight problems 1. Yes 0. No 2. Asthma 1. Yes 0. No 8. Diabetes 1. Yes 0. No 3. Bronchitis 1. Yes 0. No 9. Eczema 1. Yes 0. No 4. Dermatitis 1. Yes 0. No 10. Heart disease 1. Yes 0. No 5. Lack of hearing 1. Yes 0. No 11. Speech deficiencies 1. Yes 0. No 6. 1. Yes 0. No 12. Asperger's syndrome/ 1. Yes 0. No Hepatitis B autism spectrum disorders 13. Rare diseases 1. Yes 0. No EVM 2.3. Necessary support for special needs THIS INFORMATION WILL BE USED IN THE INDIVIDUAL NEEDS ASSESSMENT TO DETERMINE THE RIGHT TO PERSONAL ASSISTANCE 58 EVM6 Does the person have special medical 1. Yes  FILL IN THE TABLE BELOW needs, any of those in the table below? 0. No  SWITCH TO EVM7 -1. NŞ/NR EVM6 Special medical needs: Does not Need for Need for need occasional intensive support support support Airway care 1. Inhalation or oxygen therapy 0 1 2 2. Postural drainage 0 1 2 3. Thoracic PT 0 1 2 4. Suction 0 1 2 Assistance for feeding 5. Oral stimulation or positioning of the jaw 0 1 2 6. Tube feeding (for example, nasogastric) 0 1 2 7. Parenteral feeding (for example, IV) 0 1 2 Skin care 8. Turning or positioning 0 1 2 9. Dressing of open wounds 0 1 2 Other exceptional medical care 10. Protection against infectious diseases due to damage 0 1 2 to the immune system 11. Seizure management 0 1 2 12. Dialysis 0 1 2 13. Care of the stoma 0 1 2 14. Collection and/or transfer 0 1 2 15. Supervision or night care 0 1 2 16. Special diet 0 1 2 16. Other, namely: ... EVM7 Does the person have special behavioral 1. Yes  FILL IN THE TABLE BELOW needs, any of the ones in the table 0. No  STOP below? -1. NŞ/NR 59 EVM7 Special behavioral needs: Does not Need for Need for need occasional intensive support support support Destructiveness directed outwards 1. Preventing attacks or injuries from others 0 1 2 2. Preventing the destruction of property (for example, 0 1 2 lighting a fire, breaking furniture) 3. Theft prevention 0 1 2 Self-directed destructiveness 4. Prevention of self-harm 0 1 2 5. Prevention of ingestion of inedible substances 0 1 2 6. Prevention of suicide attempts 0 1 2 Other behaviors that require special care 9. Prevention of anger crises or emotional outbursts 0 1 2 10. Preventing wandering 0 1 2 11. Prevention of substance abuse 0 1 2 12. Maintaining mental health treatments 0 1 2 13. Poses physical resistance to care 0 1 2 14. Other serious behavioral problems, namely: 3. QUALITY OF THE INFORMATION IN THE MEDICAL AND EVMC PSYCHOLOGICAL DOCUMENTS FROM THE APPLICANT’S FILE EVALUATION OF THE SECPAH TEAM THAT CARRIED OUT THE MEDICAL AND PSYCHOLOGICAL ASSESSMENTS. According to the assessment team, ... P. M. Medical Psychological documents documents Yes No Yes No C0 Did the file contain a psychological assessment in addition to the other medical documents? x x 1 0 If there were no psychological documents on the file, then, just fill in the column M. Medical documents to the questions below. C1 Were the documents on file sufficient? 1 0 1 0 C0bis Was it requested to complete the file with paraclinical 1 0 1 0 investigations or additional documents (of any type)? 60 According to the assessment team, ... P. M. Medical Psychological documents documents Yes No Yes No C2 Did the documents have any vague or unclear 1 0 1 0 conclusions/diagnoses? C3 Did the documents have incomplete conclusions/diagnoses? 1 0 1 0 C4 Did the documents have contradictory 1 0 1 0 conclusions/diagnoses? C5 Were there any suspicions about the correctness of the 1 0 1 0 documents? Overall, on a scale of 1-very weak to 10-very good, ... P. M. Medical Psychological documents documents C6 ... what was the quality of the data in the documents on file? C7 ... to what extent do you consider that the medical and psychological score you have given (according to the revised criteria) reflects the real status of the person? IF THE GRADE AWARDED IS LESS THAN 9 C8 Explain what problems or difficulties were encountered? 0. No problem For preparing the following interviews, the assessed person has ... EVN01 Eyesight impairments 1. Yes 0. No If YES a. Is there a need to use the cards adapted for interviews? 1. Yes 0. No EVN02 Hearing impairments 1. Yes 0. No * Dacă DA a. Is there a need for a sign language interpreter during th 1. Yes 0. No interviews? EVN03 Understanding The person has psychatric impairments with psychotic 1. Yes 0. No impairments ** symptoms or intellectual disabilities, as a primary or associated diagnostic? Note: * For deaf persons, there is a need to have a sign language interpreter during the interview. ** For applicants with psychiatric impairments with psychotic symptoms or intellectual disabilities, participation during the interview of a legal representative/ assistant/ family is allowed. 61 Estimat Other information TIMEF1 a. How many minutes did it take to review the documents on the file and |__|__| minutes interviewing the assessed person, to complete sections 2 and 3 of this form? 62 Annex 4. Performance evaluation tools (post-pilot version) Annex 4a. Form 2. WHODAS+RO FORM 2. WHODAS+RO JUD County/sector: DATA Date of filling in F2: |_z_|_z_|: |_l_|_l_|: |_a_|_a_|_a_|_a_| Automatically generated OMSF SECPAH Assessor: CodS. The code of the specialist who fills in the form. OMSFalt At the interview, in 1. Yes 0. No addition to the assessor, are there any other SECPAH members with other specializations? ** OMSF 1. Member 1_F2 CodS. Select 0 (zero) if for filling in F2 there was no other specialist taking part in the assessment. 2. Member 2_F2 CodS. Select 0 (zero) if for filling in F2 there was no other specialist taking part in the assessment. * Confidential information that will not be exported to the anonymized dataset for analysis. 1. AUTOMATICALLY PREFILLED DATA THAT THE ASSESSOR File CAN CONSULT BEFORE THE INTERVIEW DATA RETRIEVED FROM O#3_F0. REGISTRATION FORM ALSO FROM O#3_F1. MEDICAL ASSESSMENT File 1.1. Socio-demographic data DATA AUTOMATICALLY RETRIEVED FROM O#3_F0. REGISTRATION FORM NUMEP Assessed person a. Name:* Automatically retrieved from IDENTIFICATION DATA 63 b. First name 1:* c. First name 2:* ID Unique Identification Automatically generated Code ADR Home address 1. UAT name: 1a. SIRUTA drop down 2. Village/district name: 2a. SIRUTA 3. Residential area: 1. Urban 0. Rural SEX Gender 1. M 2. F DN Date of birth* |_z_| _z_|: |_l_|_l_|: |_a_|_a_|_a_|_a_| AGE Age (in years of age) |__|__| automatically generated years. TAKEN FROM F00. SCIV Marital status 1. Legally married | 2. Cohabitation | 3. Widowed | 4. Divorced 5. Separated in fact | 6. Never married AFAM The person lives ... 1. In a family (APP included) 5. Another situation, namely ... 2. In a public or private residential service (GD no. 867/2015) 3. In detention 4. Temporary treatment abroad/country PASIST2 The person has... APP or personal assistant 1. Yes 0. No IF PASIST=1 OR 2 THEN PASIST2=1 Automatically generated PTUT The person is... 1. Under the guardianship of a 1. Yes 0. No family member 2. Under the guardianship of local 1. Yes 0. No authorities 3. Under curatorship 1. Yes 0. No PRLEG Does the person have a legal 1. Yes 0. No representative? If YES 1. Gender: 1. M 2. F 2. Age in years of age: |__|__| Years 1. | spouse 2. son/daughter | 3. mother/father | 4. another 3. Relationship: relative, ... 5. another person (non-relatives), namely ... 64 ECD 1.2. Disability certification DATA AUTOMATICALLY RETRIEVED FROM O#3_F0. REGISTRATION FORM ECD1 Type of assessment 1. First Assessment for determining the degree of disability, during the One answer lifespan 2. Assessment for renewing an existing certificate 3. Assessment because of a change of situation or of a health condition, or upon request, including the provisions of art. 58 or 59 of the Law 263/2010 on the public pension system ECD2 If ECD1=1 The person does not have a valid certificate = > GO TO Other information If ECD1=2 OR 3 The person has a valid certificate and data below are filled in. ECD2 Disability certificate We refer to the previous certificate with which the person came to the assessment for determining the degree of disability a. Degree 0. Rejection/not with a determined degree of disability CERTIFICATE 2020-21 with which he/she 1. Minor 2. Medium 3. Marked 4.Severe 5. Severe with personal assistant came at the assessment b. Type 1. physical disability | 2. somatic disability | 3. hearing disability| 4. eyesight disability CERTIFICATE 2020-21 | 5. mental disability | 6. psychiatric disability | 7. associated disability | 8. HIV/AIDS with which he/she disability | 9. rare diseases disability | 10. deafblind disability came at the assessment c. Validity 1= 12 months | 2 = 24 months | 3= Permanent CERTIFICATE 2020-21 ATTENTION! If in the revised criteria, there is a recommendation of 6 months, then you fill with which he/she in code 1=12 months. came at the assessment EVM 1.3. Medical and psychological assessment results DATA AUTOMATICALLY RETRIEVED FROM O#3_F1. MEDICAL AND PSYCHOLOGICAL EVALUATION EVM1 PRIMARY DIAGNOSIS 1a. Name: 1b. CIM-10/DSM5 code: 2. Known duration of pathology: 1. less than 1 2. between 1 3. more than 2 -1. NS year and 2 years years 3. Character of impairments 1. continuous 0. Fluctuating -1. NS EVM2 SECONDARY DIAGNOSIS(S) Are there secondary diagnoses? 1. Yes 0. No If YES 65 1a. Name: 1b. CIM-10/DSM5 code: 2nd. Name: 2b. CIM-10/DSM5 code: 3rd. Name: 3b. CIM-10/DSM5 code: SCORM MEDICAL SCORE* indicating an impairment of body functions and structures ...: 1. Light 2. Moderate 3. Severe 4. Complete * Based on O#2_MED1. Revised medical and psychological criteria FINDINGS OF THE DOCTOR AND PSYCHOLOGIST REGARDING THE NEEDS OF THE EVALUATED PERSON EVM3 Validity of the certificate: ATTENTION! If there is a 6-month 1= 12 months 2= 24 months 3= permanent recommendation in the revised criteria, the code 1=12 months will be recorded EVM30 Type of disability mentioned in the 1. Physical disability 6. Mental disability revised criteria: 2. Somatic disability 7. Associated disability 3. Hearing disability 8. HIV/AIDS disability 4. Visual disability 9. Rare disease disability 5. Mental disability 10. Deafblindness disability Services: EVM4 1. Specialized medical services 1. Yes 0. No -1. I can't appreciate it 2. Current drug treatment 1. Yes 0. No -1. I can't appreciate it 3. Medical rehabilitation (recovery), 1. Yes 0. No -1. I can't appreciate it including in the spa resort Ediz 2. ASSESSMENT OF FUNCTIONING THE ASSESSMENT IS CARRIED OUT THROUGH FACE-TO-FACE INTERVIEW OR ONLINE WITH THE APPLICANT. DATA ABOUT THE INTERVIEW FILLED IN BY THE ASSESSOR AT THE BEGINNING OF THE INTERVIEW, WHEN THERE IS AN INTRODUCTION OF THE PARTICIPANTS. According to the new general methodology for assessing disability for adult persons, disability assessment includes two separate phases, namely: 1. Medical and psychological assessment and 2. Assessment of functioning through applying WHODAS+RO instrument. INTW1 Where does the 1. SECPAH headquarters interaction take 2. Applicant's home (for bedridden persons) place? 3. Online 4. Another situation, namely: ... 66 INTW3 Language of the 1. 2. 3. Romani 4. German 5. another, namely: interview Romanian Hungarian ... INTW2 Participants a. Person to be assessed 1. Yes 0. No b. Designated case responsible 1. Yes 0. No c. Legal representative / attendant / family* 1. Yes 0. No is. Other people who are not SECPAH specialists 1. Yes 0. No If YES e1. Namely: ... * For applicants with psychiatric disorders with psychotic symptoms or intellectual disabilities, the participation of the legal representative/attendant/family in the interview is allowed, as in these cases the person's answers to the WHODAS questions may not correctly reflect the reality. INTW 3. WHODAS+RO 45 ITEMS WHODAS 2.0 made by WHO and adapted for Romania. Dom.0 3.1. Preamble THE BLUE TEXT SHALL BE COMMUNICATED TO THE ASSESSED PERSON. THE GREY TEXT IS FOR THE ASSESSOR, IT IS NOT TO BE READ. Tell the respondent: The interview is about the difficulties that people face due to health problems. Hand the respondent the card no. 1 and say: Explain that "difficulty with an activity" means: By health condition I mean diseases or conditions, or other - increased effort health problems that can be short or long-lasting; injuries; - discomfort or pain mental or emotional problems; and problems with alcohol or drugs. - slowness Don't forget to keep all your health issues in mind while - changes in the way you do the activity answering questions. When I ask you about the difficulties in carrying out an activity, think about: Tell the respondent: Remember: When you answer, I would like you to think about the last 30 If in the last 30 days there have been good days days. I would also like you to answer these questions by and bad days, the answer represents the thinking about how many difficulties you have had, on average between them, as the respondent average, in the last 30 days, while doing the activity as you does. usually do. Hand the respondent the card no. 2 and say: Read the scale aloud: Use this scale when responding: 1= None, 2=Mild, 3= Moderate, 4= Severe, 5= Extreme or cannot do. 67 0= N/A - Not applicable Make sure that the respondent can easily see the no cards. 1 and no. 2 throughout the interview. For applicants with psychiatric disorders with psychotic symptoms or intellectual disabilities, use easy-to-understand language cards to facilitate the active participation of applicants in the interview. Remember! 1. As the respondent usually does the The recorded responses reflect The questions refer to the activity the point of view of the degree of difficulty 2. Considering all the help/ all the assessed person! encountered by the technical and personal assistance they applicant: receive. Dom.1 3.2. Domain 1 — Understanding and communication THE BLUE TEXT SHALL BE COMMUNICATED TO THE ASSESSED PERSON. THE GREY TEXT IS FOR THE ASSESSOR, IT IS NOT TO BE READ. Show cards no. 1 and no. 2 to the respondent I am going to ask you a series of questions regarding understanding and communication. Extreme or In the past 30 days, how much difficulty did cannot you have in... None Mild Moderate Severe do N/A D1.1 Concentrating on doing something for 10 1 2 3 4 5 0 minutes? D1.2 Remembering do important everyday 1 2 3 4 5 0 things? D1.3 Analyzing and finding solutions to 1 2 3 4 5 0 problems in day-to-day life? D1.4 Learning to do something new, for 1 2 3 4 5 0 example, how to get to an unfamiliar place? D1.5 Generally understanding what people say? 1 2 3 4 5 0 D1.6 Starting and maintaining a conversation? 1 2 3 4 5 0 DRO1.7 Managing the stress caused by a task that demands responsibilities, for example, the 1 2 3 4 5 0 lighting of the fire in the furnace? DRO1.8 Staying calm/ take a breather when you get 1 2 3 4 5 0 angry? DRO1.9 Using your phone? 1 2 3 4 5 0 68 Dom.2 3.3. Domain 2 – Mobility/ Activities in the nearby environment THE BLUE TEXT SHALL BE COMMUNICATED TO THE ASSESSED PERSON. THE GREY TEXT IS FOR THE ASSESSOR, IT IS NOT TO BE READ. Show cards no. 1 and no. 2 to the respondent I am going to ask you a series of questions regarding the difficulties of traveling. Extreme or In the past 30 days, how much difficulty did cannot you have in... None Mild Moderate Severe do N/A D2.1 Standing for long periods such as 30 1 2 3 4 5 0 minutes? D2.2 Standing up from sitting down? 1 2 3 4 5 0 D2.3. Moving around inside your home? 1 2 3 4 5 0 D2.4 Getting out of your home? 1 2 3 4 5 0 D2.5 Walking a long distance such as a 1 2 3 4 5 0 kilometer? DRO2.6 Picking up an object or move an object from one place to another, such as a mug or 1 2 3 4 5 0 a box? DRO2.7 Using your hand and fingers to manipulate 1 2 3 4 5 0 or let go of a small object such as a coin? DRO2.8 Using public transport? 1 2 3 4 5 0 Dom.3 3.4. Domain 3 – Personal Autonomy/ Self-Care THE BLUE TEXT SHALL BE COMMUNICATED TO THE ASSESSED PERSON. THE GREY TEXT IS FOR THE ASSESSOR, IT IS NOT TO BE READ. Show cards no. 1 and no. 2 to the respondent I am going to ask you a series of questions about the difficulties you encounter in taking care of yourself. Extreme In the past 30 days, how much difficulty did or cannot you have in... None Mild Moderate Severe do N/A D3.1 Washing your whole body? 1 2 3 4 5 0 D3.2 Getting dressed? 1 2 3 4 5 0 D3.3 Eating? 1 2 3 4 5 0 D3.4 Staying by yourself for a few days? 1 2 3 4 5 0 DRO3.5 Washing your face and teeth? 1 2 3 4 5 0 69 DRO3.6 Taking care of your own health, such as a balanced diet or performing some physical 1 2 3 4 5 0 exercise? Dom.4 3.5. Domain 4 — Interpersonal relationships THE BLUE TEXT SHALL BE COMMUNICATED TO THE ASSESSED PERSON. THE GREY TEXT IS FOR THE ASSESSOR, IT IS NOT TO BE READ. Show cards no. 1 and no. 2 to the respondent I am going to ask you a series of questions about the difficulties of getting along with people. Please note that I ask you only about the difficulties caused by health conditions. I am referring here to diseases or illnesses, injuries, mental or emotional problems and problems with alcohol or drugs. Extreme or In the past 30 days, how much difficulty did cannot you have in... None Mild Moderate Severe do N/A D4.1 Dealing with people you do not know? 1 2 3 4 5 0 D4.2 Maintaining a friendship? 1 2 3 4 5 0 D4.3 Getting along with people who are close to 1 2 3 4 5 0 you? D4.4 Making new friends? 1 2 3 4 5 0 D4.5 Having intimate relations? 1 2 3 4 5 0 Dom.51 3.6. Domain 5 — Day-to-day activities: 5(1) Household activities THE BLUE TEXT SHALL BE COMMUNICATED TO THE ASSESSED PERSON. THE GREY TEXT IS FOR THE ASSESSOR, IT IS NOT TO BE READ. Show cards no. 1 and no. 2 to the respondent I am going to ask you a series of questions about the activities involved in the maintenance of your household and in the care of the people with whom you live or are close. These activities include cooking, cleaning, shopping, caring for others and caring for your belongings. Activities from own yard/ garden are considered household activities. Extreme or In the past 30 days, how much difficulty did cannot you have in... None Mild Moderate Severe do N/A D5.1 Taking care of your household 1 2 3 4 5 0 responsibilities? Doing your most important household D5.2 1 2 3 4 5 0 tasks well? D5.3 Getting all the household work done 1 2 3 4 5 0 70 that you needed to do? Getting your household work done as D5.4 1 2 3 4 5 0 quickly as needed? IF ANY OF THE RESPONSES FROM D5.1 TO D5.4 IS GREATER THAN 1=NONE AT ALL In the past 30 days, on how many days did you reduce or completely miss household work D5.01 |__|__| days because of your health condition? Does the person currently carry out any form  FILL IN SECTION 3.7. DOMAIN 5(2) 1. Yes of paid or non-paid work (even for a few hours NEXT OCED a week) or attends any form of education or training (of any kind)? 0. No  JUMP TO SECTION 3.8. DOMAIN 6 3.7. Domain 5 — Day-to-day activities: 5(2) Professional or school Dom.52 activities THE BLUE TEXT SHALL BE COMMUNICATED TO THE ASSESSED PERSON. THE GREY TEXT IS FOR THE ASSESSOR, IT IS NOT TO BE READ. Show cards no. 1 and no. 2 to the respondent I am going to ask you a series of questions about professional or school activities. Extreme or In the past 30 days, how much difficulty did cannot you have in... None Mild Moderate Severe do N/A D5.5 Your day-to-day work/school activity? 1 2 3 4 5 0 Doing your most important work/school D5.6 1 2 3 4 5 0 tasks well? Getting all the work done that you need D5.7 1 2 3 4 5 0 to do? Getting your work done as quickly as D5.8 1 2 3 4 5 0 needed? IF ANY OF THE RESPONSES FROM D5.5-D5.8 ARE GREATER THAN 1=NONE In the past 30 days, on how many days did you D5.02 miss work for half a day or more because of |__|__| days your health condition? D5.9. Have you had to work at a lower level than 1. Yes 0. No your training because of a health condition? 71 D5.10 Did you earn less money as the result of a 1. Yes 0. No health condition? Dom.6 3.8. Domain 6 — Social participation THE BLUE TEXT SHALL BE COMMUNICATED TO THE ASSESSED PERSON. THE GREY TEXT IS FOR THE ASSESSOR, IT IS NOT TO BE READ. Show cards no. 1 and no. 2 to the respondent I am going to ask you a series of questions about your participation in society and the impact of your health problems on you and your family. Some of these questions may involve issues that go beyond the past 30 days, however in answering, please focus on the past 30 days. Again, I remind you to answer these questions while thinking about health problems: physical, mental or emotional, alcohol or drug related. Extreme or In the past 30 days,... cannot None Mild Moderate Severe do N/A How difficult was it for you to participate in social activities (e.g. festivities, religious or D6.1 1 2 3 4 5 0 other activities), in the same way as anyone else can? How difficult was it for you (in general) D6.2 because of the barriers or hindrances around 1 2 3 4 5 0 you? How difficult was it for you to live with D6.3 dignity, because of the attitudes and actions 1 2 3 4 5 0 of others? How much time did you spend on your health D6.4 1 2 3 4 5 0 condition or its consequences? How much have you been emotionally D6.5 1 2 3 4 5 0 affected by your health condition? How much has your health been a drain on D6.6. 1 2 3 4 5 0 the financial resources of you or your family? How difficult was it for your family because of D6.7 1 2 3 4 5 0 your health problems? How difficult was it for you doing D6.8 1 2 3 4 5 0 things/activities for relaxation or pleasure? How difficult has it been for you to enjoy your rights as a citizen, such as the right to DRO6.9 1 2 3 4 5 0 religion, the right to a lawyer or legal rights and protection against discrimination? 72 FBK 3.9. Feedback THE BLUE TEXT SHALL BE COMMUNICATED TO THE ASSESSED PERSON. THE GREY TEXT IS FOR THE ASSESSOR, IT IS NOT TO BE READ. Feedback of the assessed person FBOM1 On a scale of 1 to 10 (as in school), how relevant do you think |__|__|-1. NŞ/NR the questions were for your situation? FBOM2 On a scale of 1 to 10 (as in school), what grade do you award |__|__|-1. NŞ/NR for how respectfully the interview was conducted? Assessor's feedback To be completed after the applicant leaves. FBEV1 On a scale of 1 to 10 (as in school), how difficult was it to |__|__| apply WHODAS+RO? FBEV2 Have you had difficulty assigning qualifiers? 1. Yes 0. No If YES a. Write down item codes... D1.1 to DRO6.9 codes drop down FBEV3 On a scale of 1 to 10, what grade do you award for the |__|__| accuracy of the information provided by the applicant? Attention! Note your assessment regarding the extent in which the answers offered by the assessed person have correctly mirrored the reality. Code 1= You consider that answers mirrored the reality to a little extent, as they have been strategically altered. Code 10= You consider that the answers received fully mirrorred the reality. Given all the data in the application file, an interviewer may not always agree with the respondent's response. FBEV4 On a scale from 1 to 10, to what extent did you feel such |__|__| discomfort during the application of WHODAS+RO? FBEV5 And when you felt discomfort, did you record the answer 1. Yes, I made some changes given by the requester or did you change it to make the 0. No, I have filled in the exact answer information more accurate (to correctly mirror reality)? given by the respondent -7. Not applicable, there was no discomfort Other information TIMEF2 a. How many minutes did it take to apply WHODAS+RO (including the |__|__| Minutes feedback section)? Estimated time 10 + 20(30) + 10 = 73 Annex 4b. WHODAS cards 74 Annex 5. Documents related to disability certification Disability certificate model 75 Annex 6. Social assessment tools (post-pilot version) ASOC Annex Please note that the ASOC Annex presented in Annex 6 represents a maximum version corresponding to a full needs assessment, i.e., for a case where the applicant has expressed interest in all the assessment modules. SOCIAL INQUIRY Annex for adults with disabilities requesting disability assessment or individual needs assessment ASOCYES Is the social inquiry filled 0. No, the social inquiry is not filled in e-PLIN in ...? 1. The social inquiry is filled in solely based on the information from the file (grounded on the framework model) 2. The social inquiry is filled in based on the model from the pilot study and afterwards introduced in e-PLIN JUD County/sector: DATASS Date of introducing the |_z_| _z_|: |_l_|_l_|: |_a_|_a_|_a_|_a_| form in e-plin OMSS SECPAH specialist who CodS. ... enters data from the Fill in the code of the specialist who fills in the form. social inquiry which is attached to the file DATAS Date of conducting the |_z_|_z_|: |_l_|_l_|: |_a_|_a_|_a_|_a_| social inquiry in the field OMSL Social worker/ SPAS Name and surname:* Cods. representative who Profession: conducted the social inquiry NUMEP Assessed person a. Name:* b. First name 1:* c. First name 2:* ID Unique Identification Submitted by SECPAH to SPAS Code 1a. SIRUTA ADR Home address 1. UAT name: Automatically generated 2a. SIRUTA drop down 2. Village/sector name: Automatically generated 3. Residential area: 1. Urban 0. Rural Automatically generated 76 * Confidential information that will not be exported to the anonymized dataset for analysis. Asoc 1. SOCIO-DEMOGRAPHIC DATA DATA ABOUT THE PERSON WITH DISABILITIES ACTID Identity document a. CNP:* b. C.N./C.P./B.I./C.I.: Series* c. No.* d. issued by:* e. on:* dd/mm/yyy f. validity:* dd/mm/yyy ADRAS Home address in social Str..... No. ..., bl. , sc. ap. ... inquiry:* Postcode... ADRCO1 Mailing address* 1. From the identity document (ADRBI) 3. Address in the social inquiry 2. De facto, from registration (ADRDF) CONT1AS Contact info 1. Phone:* Mark 0 (zero) if the person does NOT have a phone contact number 2. Email:* Mark 0 (zero) if the person does NOT have an email contact address CONT2AS How he/she prefers to be 1. Post Office 2. Telephone 3. E-mail 4. SPAS contacted* 1. Romanian | 2. Hungarian | 3. Romani | 4. German | 5. another | 0. LMAT Native language Undeclared LMAT5 Another, namely ... RELG Religion 1. Orthodox | 2. Catholic | 3. Protestant | 4. Other | 5. | Atheist 0. Undeclared RELG4 Another, namely ... AFAMAS The person lives ... 1. In a family (APP included) 5. Other situation, namely: 2. In a public or private residential/center service (according to GD no. 867/2015) 3. In detention 4. Temporary treatment abroad/country If in the family AFAM=1 Section 2. HOUSEHOLD GRID refers to the household in which the person lives (this includes people who live alone, in the community) If AFAMAS>1 and the person Section 2 refers to the household to which the person belongs, where has a family he/she will return/could be reintegrated after leaving the institution. 77 If AFAMAS>1 and the person Section 2 considers the assessed person to be a one-person household, has no family so the person = household. AGO The composition of the household: Note zero in adults/children if the Respondent =1 + |__|__| + |__|__| person lives alone A. adults (18+ K. children (0-17 years) years) NPERS Total number of members in the household: |__|__| members in the household Automatically generated COMPUTE NPERS = 1+AGO_A+AGO_K Asoc 2. HOUSEHOLD GRID THE HOUSEHOLD IN WHICH THE PERSON WITH ASSESSED DISABILITIES LIVES. SEE THE DIRECTIONS ABOVE. THE NUMBER OF COLUMNS (PEOPLE) MUST BE EQUAL TO NPERS. People in the household P0 = Person PERSON'S CODE with p1 p2 p3 p4 p5 p6 disabilities SEX Gender 1.M | 2. F DN Date of birth day month aaaa year AGE Age in years old Automatically generated. COMPUTE AGE=1 August 2022 – DN. NAT Ethnicity 1. Romanian | 2. Hungarian | 3. Romani | 4. German 5. another | 0. Undeclared | SCIVA Marital status S 1. Married | 2. Cohabitation | 3. Divorced | 4. Separated| 5. Never married | 6. Widowed | LEVEL The highest graduated educational level 1. no graduate school 6. high school (9-12 grades) 2. Primary (1- 4 classes) 7. post-secondary specialized or technical foremen 3. Gymnasium (5-8 classes) 8. Short-term university/college 4. professional, apprentice or complementary 9. Long-term university (including master's degree) 5. first stage of high school (grades 9-10) 10. PhD OCUP Main employment status in the last 12 months 78 People in the household P0 = Person PERSON'S CODE with p1 p2 p3 p4 p5 p6 disabilities 1. employed person, including women on 8. unemployed person who is not registered (no longer maternity leave receiving unemployment benefit/support allowance and is 2. other status of employed person (day workers, looking for work) informal worker, etc.) 9. old-age pensioner 3. employer with employees 10. other type of pensioner 4. self-employed person in non-agricultural 11. pupil, student (Attention! Include children who go to activities (PFA, AF, self-employed, etc.) kindergarten) 5. self-employed person in agriculture 12. Housewife 6. Family help 13. person with work disability 7. registered unemployed person 14. other inactive status (preschool child who does not go to kindergarten, dependent person) P0 = Person PERSON'S CODE (TO BE KEPT) with p1 p2 p3 p4 p5 p6 disabilities KID Child under 18 years of age who is dependent on 1. Yes | 0. No the person with disabilities DEPD Person 18+ years old who A has no income of his/her own and depends 1. Yes | 0. No economically on the assessed person APIS Personal assistant 1. Yes | 0. No PASISTAS Does the person have a personal 1. Yes 0. No assistant? If PASISTAS=1 OR 2, data about AP/APP 1. Gender: 11. M 2. F 2. Age in years of age: |__|__| Years 1. | spouse 2. son/daughter | 3. mother/father | 4. another 3. Relationship: relative, ... 5. another person (non-relatives), namely ... 4. Does the AP/APP live with the 1. Yes 0. No person? SIM Does the family benefit from 1. Medical home care services (paid for by CNAS) home care services? 2. Social (socio-medical) home care services (paid by MMPS) 3. Other home care services (regardless of funding/provider) 0. No 79 SIM2 Does the family benefit from 1. Yes 0. No Automatically generated. IF SIM>0 THEN SIM2=1 home care services? Asoc 3. EDUCATION AND WORK 3.1. Participation of the person with disabilities in education and training FOR THE PERSONS UNDER 65 YEARS OLD WHICH DO NOT HOLD AN INVALIDITY PENSION FOR THE FIRST OR SECOND DEGREE (AGE<65 & PDZ20<2) OUTSC Which of the 0. Never been enrolled in a form of education => JUMP TO following situations SCH1 1. Went to school, but dropped out or left school early is valid for the (before completing compulsory education of 10 person being classes) assessed? 2. Complemented compulsory education or a higher level of education 7. It is still in an educational form (formal) If ever been to school OUTSC>0 TIPSC What type of school did he/she attend? 1. Mainstream school 4. Homeschooling Multiple response 2. Special school 5. Training courses 3. Second chance 6. other situations, namely: ... CES By the time you turned 18, did you have a Certificate of 1. Yes 0. No Special Educational Needs (CES)? If YES Do you currently still have a valid school orientation 0. No and would not even need CES1 certificate (for CES)? 1. No, although it would need 2. Yes SFATE Does the person/family remember ever having received 1. Yes 0. No school or professional counselling or guidance? If he/she has dropped out or left school early OUTSC=1 ABN1 What was the 1. He/She couldn't cope, it was too difficult (e.g. failing classes, repetition, reason for dropping etc.) out? 2. He/She did not like it, could not integrate/understand with colleagues, on the grounds of violence, bullying, theft, destruction of goods, stigmatization, etc. 3. The family made the decision because they could not help, they did not have money, they needed help at work, they were ashamed, etc. 80 4. Another reason, namely: ... Irrespective if the person has ever been to school SCH1 Throughout his/her life, has the person followed any form of 1. Yes 0. No professional training completed with a qualification or a certificate? If YES SCH2 Is the person currently undergoing any form of professional training? 1. Yes 0. No (of any type and level, formal or informal, etc.) If OUTSC=7 (IS IN EDUCATION) OR SCH2=1 (IS IN TRAINING) EDNOW Is the person currently undergoing any form of education or training? 1. Yes 0. No (Automatically generated) IF OUTSC=7 OR SCH2=1 THEN EDNOW=1 If YES EDHO Is the person studying at home? 1. Yes 0. No 3.2. The connection of the person with disabilities with the labor Asoc market OUTLM Which of the following situations is 0. Never had paid work throughout his/her life valid for the person being assessed? 1. Had (sometimes or from time to time), but now Paid work = any type of work that brings income, no longer carries out any paid activity formally (on contract) or informal, continuous, seasonal or occasional, full-time or part-time, in 2. He/she is currently doing paid work private, state, sheltered units or households. However, regardless of the main 0. No, no form of work employment status, has the person, in 1. Unpaid work in the household (household work) the last 12 months, even occasionally, OCUP1 carried out some form of work (any 2. Unpaid work for other people/organisations (e.g. form, including domestic work), for at practice, apprenticeship, volunteering, etc.) least one hour/week? 3. Paid work OCNOW Currently, did the person carry out some form of work 1. Yes 0. No (Automatically (of any type) for the past 12 months? generated) IF (OCUP P0 = 1, 2, 3, 4, 5 OR 6 OR OCUP1>0) THEN OCNOW=1 For all persons who in the last 12 months have carried out any form of work (paid or unpaid, formal or informal, full-time or part-time, continuous or occasional, etc.) Specifically, what has the person been working on 0. They have not carried out any form OCUP2 most recently (last job/last activity)? of work in the last 12 months 1. The work consisted of ... (Write down clearly) 81 OCHO Does the person work (from) home? ATTENTION! We want to find out whether the work is conducted from home (irrespective whether he/she works 1. Yes 0. No remotely or he/she has a workshop/ working space at home). The question does not refer to housekeeping activities. Only for people who have ever/currently had paid work OCUP4 Overall, throughout life, what work experience has the |__|__| Years person accumulated? Asoc 4. SUPPORT NEEDS OF THE PERSON WITH DISABILITIES DATA ON THE INTENSITY OF SUPPORT REQUIRED IN DIFFERENT AREAS OF LIFE. Observation! For the persons with disabilities living in a residential center (according to GD no. 867/2015), this section is filled in by a specialist of the corresponding service. ATTENTION! In this section "lethargy/ vegetative status” = extended lesions of brain spheres, alongside a fair degree of functioning of the brainstem. D155 Indications He/she can remember and carry out a sequence of directions (a shopping list, 0 etc.) He/she can remember the directions and conduct them later (a message from 1 work) 2 Can follow simple instructions that can be carried out at once He/she does not respond when spoken to him/her, except when he/she is called 3 by name D160 Ability to He/she has no difficulty concentrating on the same activity for a long period of 0 concentrate time He/she must periodically take (every 15 minutes or more) short breaks from the 1 task on which he/she focuses 2 Can focus on the same task for about 5 minutes He/she is always on the move and unable to focus on a single activity without 3 constant support or if he/she is in a lethargy/ vegetative status D177 Decision making 0 Independently, the person can make decisions that are generally in line with related to the his/her lifestyle, values and goals management of 1 The person can make safe decisions in familiar/routine situations, but requires economic help in making decisions when faced with new tasks or situations resources 2 The person needs help in remembering, planning or executing routine activities, even when it’s about routine situations 3 The person requires help from someone else most of the time or all the time D230 Carrying out the Able to plan, organize, and complete tasks such as time management and 0 planning distinct tasks throughout the day usual daily schedule 1 He/she doesn't always cope 2 Most of the time he/she does not cope 3 He/she is not able to cope 82 D2304 Coping with 0 Has no difficulty in adapting to unfamiliar or new situations changing 1 Becomes anxious when familiar routines are changed, but can cope with them circumstances with support and assurances 2 He/she can become visibly stressed or aggressive when routines are changed, but he/she can adapt with intensive support 3 He/she is particularly inflexible and finds that any change in well-known routines is unbearable or if he/she is in a lethargy/ vegetative status D240 Coping with 0 Uses the right social methods to respond to stressful situations stressful 1 He/she adopted socially acceptable, yet atypical behaviors to deal with anxiety situations 2 He/she is often prone to irrational outbursts of anxiety in the absence of clear external stimuli and needs intensive support to deal with the situation 3 He/she has an anxiety or obsessive-compulsive behavior, clinically diagnosed, that must be controlled -7 He/she is in a lethargy/ vegetative status D330 Communication He/she speaks well and intelligibly, using a language that can be understood; 0 can provide accurate information He/she has certain speech difficulties; lack of clarity and fluency (he/she tends to 1 stutter), but uses a language that can be understood Speech problems; he/she is understood only by people who know him/her very 2 well He/she doesn't speak; uses gestures when he/she wants to communicate or 3 he/she is in a lethargy/ vegetative status D410_ Changing and 0 The person can change or maintain the position of the body without any 15 problem. maintaining the position of the 1 He/she can change or maintain the position of the body, but he/she has body difficulties in some situations, for example the squatting position, getting out of bed or maintaining the position on the knees. 2 He/she requires help in carrying out certain actions that he/she cannot carry out. 3 He/she cannot change or maintain the position without the support of another person. D420a Toilet use and He/she can sit down and get up from the toilet bowl, he/she can wrap up and transfer unbutton clothes, he/she can avoid getting dirty with clothes, and he/she can 0 use toilet paper without help. If necessary, he/she can use a bed pan, a chair with a toilet or a urinal at night, he/she can empty and clean these devices. Requires supervision for the safe use of the usual toilet. He/she can use a chair 1 with a toilet at night, but needs support to empty and clean it or on clothing, transfer and hand washing. 2 He/she requires partial help in all aspects, constantly. 3 Totally dependent. D420b Transfer to bed 0 Independent in all phases of the transfer. He/she can safely approach the bed in or wheelchair (to a wheelchair, lock the brakes, lift the footrests, safely climb into bed, lie down, sit be completed also in on the edge of the bed, change the position of the wheelchair, sit back on it the case of safely. bedridden persons) 1 The presence of another person is necessary either to give confidence, for safety reasons, or for certain aspects of the transfer. 2 He/she can participate, but needs full assistance from another person in all aspects of the transfer. 83 3 He/she is not able to participate in the transfer. Two people are needed to transfer the person with disabilities, with or without a mechanical device. D4551 Use of stairs 0 He/she can climb and descend the stairs safely, without help or supervision. He/she can use railings, sticks or crutches when needed and can carry these devices when climbing or descending stairs. 1 Sometimes he/she does not need assistance and supervision for safety reasons (for example, due to morning joint stiffness, dyspnea, etc.) or to carry assistive devices for walking. 2 He/she needs help in all aspects of climbing stairs (including assistive devices for walking). 3 He/she cannot go up and down stairs or he/she is bedridden. D450_ Walking, moving 0 He/she can move independently, without problems 60_65 1 Only with help (cane, supported unilaterally) 2 Only with help (frame, wheelchair, supported bilaterally), for short distances 3 Can't do the work or he/she is bedridden. D4708 Finding the way 0 He/she has no difficulty finding his/her way into a new area in the local 1 He/she must be trained in the use of public transport and suggested certain community routes to use 2 Can learn to follow a certain route after a long-term training 3 He/she needs to be accompanied every time in the community or he/she is bedridden. D510_ Personal care He/she can take care of herself completely and independently – personal 0 20_40 hygiene, using the bathroom, dressing and choosing the right clothes (bathroom, shower, hygiene, personal He/she can take care of himself, but needs to be checked and reminded of 1 toilet, dressing) certain things He/she needs help, for example with transferring to the shower/ bathtub, 2 washing or drying, with certain stages of the personal hygiene process, handling buttons, zippers, bras, laces, etc. 3 Depends on other people for personal care D530 Intimate hygiene 0 No problems (intense and bladder 1 Occasional incontinent or needs occasional help control) 2 Incontinent, he/she needs partial, constant help 3 Incontinent or permanent catheter, he/she is not able to perform the activity D550 Feeding 0 He/she can feed herself and organize all his/her dining activities without any problem 1 He/she can feed itself and organize most of the activities related to feeding, but he/she requires support and guidance, for example with cutting meat, opening milk boxes, removing lids from jars, etc. 2 He/she can feed under supervision. He/she requires help in carrying out certain actions, such as adding milk/sugar to tea, using salt and pepper, spreading butter, handling plates or other activities related to laying the table. 3 He/she needs someone's help to feed himself/herself, or, if left alone he/she gets dirty. He/she can use cutlery, usually a spoon, but needs someone's help during a meal or is completely dependent. 84 D570 Health care and 0 The person can take care of his/her own health, does not expose himself/ herself medication to health risks, follows the advice of the doctor and knows how to prevent administration worsening of his/her health condition 1 In general, the person takes care of his/her health, but requires monitoring or to be reminded of some rules or the hours for taking the medicines. 2 He/she can take care of his/her health under supervision. He/she requires help in carrying out certain actions and must be supervised to avoid health risks (injuries, communicable diseases, etc.), and the risk of abuse of medicines and alcohol. 3 He/she needs constant supervision and help from another person. D620 Shopping Can shop alone, without problems in the selection, payment, transport or storage 0 of products and services necessary for everyday life 1 Mostly alone, with occasional help, for example with the payment of utility bills 2 With partial help, constantly 3 Depends on other people for the purchase of goods and services D630 Meal 0 He/she can prepare his/her own meal and prepare different dishes without preparation supervision 1 He/she can prepare simple (warm) dishes without supervision – he/she can fry eggs and cook a packed soup 2 He/she can prepare dishes that do not require the use of the stove or that he/she is used to – cereals, teas, sandwiches. He/she needs supervision when preparing simple dishes. 3 He/she needs the support of another person to prepare his/her food. -7 He/she does not do this activity due to health reasons D640 Domestic work 0 He/she can perform all the household activities without supervision – he/she can make his/her bed, he/she can wash and dry the dishes, he/she can clean the floor, etc. 1 He/she can do simple and reiterative tasks – laying the table, wiping dishes in the kitchen, and for some household activities he/she needs supervision and help to complete them properly. 2 He/she tries to execute simple and reiterative tasks, but cannot finish them properly. 3 He/she cannot perform any household work. -7 He/she does not do this activity due to health reasons D710 Social relations 0 He/she has no difficulty in making friends and being sociable Needs to be encouraged and supported to engage on a personal level with 1 others Considers group situations as uncomfortable and needs support in one-on-one 2 situations He/she is isolated – relates only with the family, he/she finds it very difficult to 3 manage one-on-one social and group situations and he/she is in a lethargy/vegetative status D720 Control of 0 Has no difficulty controlling depressive experiences, anxiety or anger feelings Becomes depressed or upset visibly and inappropriately, but can be easily 1 calmed down 85 He/she can become anxious, depressed or angry in the absence of any obvious 2 external stimulus, but in the end he/she can be calmed down He/she is unable of controlling his/her feelings and emotions in an appropriate 3 manner and can become a danger for himself or others and he/she is in a lethargy/vegetative status D860 Use of money 0 He/she can use the money responsibly – he/she has no difficulties with monetary transactions for daily activities; can give an exact amount and can check the rest 1 He/she can give the correct amount depending on the price of the product, but he/she has trouble estimating the things he/she can buy with a certain amount of money 2 Can only sort money by value 3 He/she doesn't understand what money is D865_ Management of Without problems he/she can save money, keep a bank account, manage 70 0 properties and other personal economic resources, to ensure economic security economic resources/ for present and future needs Economic 1 Mostly alone, with occasional help independence 2 With partial help, constantly 3 Totally dependent concerning the management of economic resources Asoc 4.1. Special behavioral needs Observation! For persons with disabilities living in a residential center (according to GD no. 867/2015), this section is filled in by a specialist from this service. NX1 Does the person have cognitive impairments, 0. Doesn't go out on the streets and does it happen/have a practice to leave 1. He/she goes out on the streets during the day, home/the immediate area without informing but sleeps during night time other people? 2. He/she goes out on the streets day and night NX2 Does the person have a self-harm behavior? 0. No, not at all Examples include: physical abuse of oneself (hitting, biting, 1. Yes, some behaviors, require weekly hitting the head against various objects, etc.), swallowing interventions or less often inedible objects and intoxication with water (polydipsia). 2. Yes, various behaviors and require interventions once or several times a day NX3 Does the person have offensive or violent 0. No, not at all behaviors towards other people? 1. Yes, some behaviors, require weekly Behaviors that cause pain or inconvenience to other people interventions or less often and that affect other people's activities. This includes sexual assault and inappropriate behavior, such as exhibitionism, 2. Yes, various behaviors and require touching or inappropriate gesticulation. interventions once or several times a day NX4 Is the person at risk of alcohol abuse? 0. I can not appreciate, I do not know 1. There are some signs and information that suggest the possibility of alcohol abuse 2. In the last year, the person has had problems with the police or received treatment/has been diagnosed with a problem of abuse 86 NX5 Risk factors of abuse and neglect of the person 0. I can not appreciate, I do not know with disabilities by family members, neighbors, 1. There are some signs and information that colleagues or other people in the community? suggest the possibility of abuse and neglect of the assessed person NX6 The support network of the assessed person is 2. Adequate both now and for the next 12 ...? months (until reassessment) Observation! It is not applicable for persons with disabilities 1. Currently adequate, but can be fragile in the living in a residential center (according to GD no. 867/2015). next 3-4 months, with the risk of giving up the care of the assessed person 0. It is fragile and is already looking for or discussing the transfer of the person to a social service Asoc 5. HOUSING 5.1. General data about the dwelling Observation! This section is about the household where the assessed person actually lives. For persons with disabilities living in a residential center (according to GD no. 867/2015), this section refers to the household to which the person belongs to, where he or she can be reintegrated after leaving the institution. LOCYES Does the person 1. Yes  FILL IN NEXT (or his/her 0. No, the person lives in a center, LP,  GO TO SECTION 6 family) have a hospital, asylum, where he/she grabs or home? on the streets If YES LOCTIP Housing type Single-family dwellings (houses in which 5. Semi-collective dwellings (residential only one family lives), namely: buildings divided into several apartments, According to NP the division being made either by levels or 057/2002 – 1. isolated (buildings/houses detached by building bodies, each with individual Regulatory from all sides of the plot/land) access from a common courtyard) framework (standard) on designing 2. coupled (buildings/houses coupled two 6. Collective housing (residential residential buildings by two on one side) buildings, blocks where several families live, access to them through a common 3. stock (buildings/houses glued on two space / hallway) sides to other buildings and occupying the entire width of the creek/land) 7. Makeshift shelter / space that is not intended for habitation – storerooms, 4. carpet (buildings/houses glued on two water houses, sewerage elements, or 3 sides to other buildings) constructions in advanced state of degradation, grottoes, shanties, etc. LOCAN The year the 1. before 1960 building was 2. between 1960 and 1990 built? 3. after 1990 ETJ On which floor is the 0. Ground floor dwelling located (within -1. Basement At floor number |__|__| the building)? 87 ETJL Number of floors in the |__|__| Floors Fill in zero if there are no floors inside the dwelling. dwelling? ETJD Within the dwelling, on what floor, is the bedroom of At floor number -1. Basement 0. Ground floor 99. Mezzanine the person with disabilities |__|__| located? ETJB Within the dwelling, on what floor, is the bathroom of At floor number -1. Basement 0. Ground floor 99. Mezzanine the person with disabilities |__|__| located? 100. There is no bathroom inside the dwelling USAS From the roadway/street to the interior of the home, are there curbs, culverts, stairs 1. Yes 0. No or other types of thresholds? USA The entrance to the At floor number dwelling is at: -1. Basement 0. Ground floor 99. Mezzanine |__|__| USAA Access to the entrance is: 1. Flat surface 2. Ramp 3. Stairs LIFT The building is equipped 1. Ladder lift 2. Elevator in 3. Elevator in 0. It is not with: which a trolley which a trolley equipped with platform fits does not fit anything 5. Ramp that is not usable (with a 4. Usable ramp slope above 8% or which does not have a maneuvering area of 1.50x1.50m in front) GEOL Person with disabilities 1. Person with mobility disabilities who lives upstairs in an area at risk of particularly vulnerable in earthquake case of emergency 2. Bedridden person living on the ground floor in a floodplain Multiple response 3. Person living on a street that is difficult to access by emergency transport services 4. Other problematic situations in relation to assistance in the event of natural disasters or emergencies 0. No vulnerabilities in case of emergency NPERS Total number of persons in |__|__| persons in the Automatically the household household generated MP/ Total living area: ...... ....... Automatically MPOM generated ...... ....... m2 m2/person COMPUTE MPOM=MP/NPERS CAM Number of rooms in the |__|__| rooms, apart from the kitchen, hallways, bathroom and other dwelling: outbuildings CAMN Does the family believe that the number of rooms in the 1. Yes 0. No dwelling meets its specific needs? 88 RISCH Does the home have any of the following problems: leaks through the roof, damp walls, rotten/ damaged 1. Yes 0. No windows/floorboards? OBSL Is the dwelling well-maintained, is hygiene ensured? Attention! This is subjective assessment based on direct observation 1. Yes 0. No from the field visit, the household is not asked. UTILL The dwelling is connected 1. Electricity to: 2. Sewerage 5. Cable TV network Multiple response 3. Gas 6. Internet 4. Running water DTRI Does the family have debts to pay utilities (electricity, 1. Yes 0. No water, gas, etc.) and/or rent (if applicable)? APA Does the family have access to an uncontaminated 1. Yes 0. No water source? BUC Does the house have specially designed space for 1. Yes 0. No preparing and storing food? ARGZ Does the dwelling have the necessary equipment (stove, 1. Yes 0. No hob, refrigerator) for preparing and storing food? PAT In the past 6 months did it happen for a member of the household to sleep somewhere else (on the floor, on a 1. Yes 0. No lavatory, in the stable, etc.) because there was not enough place in a bed? PATC Is each bed equipped with all the necessary equipment 1. Yes 0. No (sheets, blankets, pillows, etc.)? LIZ Is the dwelling in an isolated, hard-to-reach area? 1. Yes 0. No GEOZM The dwelling is located in a marginalized area (which concentrates poor population, with a low level of 1. Yes 0. No education and employment, and living in inadequate housing conditions) WC The toilet is located: 1. inside the dwelling 2. in the yard HEAT Home heating is: 1. Central heating 3. Own gas plant 2. Wood/coal stoves 4. Liquid fuel 0. without heating PROPL Ownership of 1. Family property, the person with disabilities is the owner or co-owner the dwelling in 2. Family property, the person with disabilities is not owner / co-owner which the family 3. Rented to private (the family pays rent) lives 4. Rented to state (e.g. social housing) or with zero rent (from the employer, NGO, etc.) 5. Occupied dwelling without the consent of the owner or without legal rights If PROPL=1 or 2 the dwelling is owned by the family HACT Does the family hold papers on the house? 1. Yes 0. No TACT Does the family hold papers on the land on which the dwelling 1. Yes 0. No is built? 89 LOCB1 Does the family benefit from the exemption from the 1. Yes 0. No land/housing tax? If PROPL=4 the dwelling is with subsidized rent LOCB2 Does the family benefit from exemption from paying rent in 1. Yes 0. No-7. Not applicable social housing? 1. The respective If YES Asoc 5.2. Home equipment system/device is 2. The person with available in the home disabilities or his/her main carer uses the respective system/device Yes No Yes No DL1 Lifting/moving systems for the person with disabilities, 1 0 1 0 including elevator system Mechanical systems for windows, doors, blinds or other 1 0 1 0 DL2 home automation systems Systems for individuals to control the environment in which they live (scanners, remote control systems, voice 1 0 1 0 e11511 control systems, timer switches) Systems for facilitating the accommodation/ carrying out of household activities (support bars especially in hallways and bathrooms, surfaces textures that allow 1 0 1 0 their tactile reading as well as avoidance of injury, lack e11512 of thresholds /interior level differences) Induction cooker, refrigerator, furniture adapted to the 1 0 1 0 e11513 needs of persons with disabilities Communication and IT devices DCIT1 Mobile phone 1 0 1 0 DCIT2 Smartphone 1 0 1 0 DCIT3 Tablet 1 0 1 0 DCIT4 Computer or laptop 1 0 1 0 DCIT55 Smart TV 1 0 1 0 DCIT6 Radio, TV 1 0 1 0 90 5.3. Accessibility issues inside the 1. The person with If YES Asoc home disabilities uses 2. Accessibility (autonomously or issue that makes it Observation! This section is about the household where the assisted) or would like difficult or hinders assessed person actually lives. For persons with disabilities living to use the space the performance of in a residential center (according to GD no. 867/2015), this 1. Yes the activity section refers to the household to which the person belongs to, where he or she can be reintegrated after leaving the institution. 0. No 1. Yes Accessibility issues concern both the person with disabilities and -7. Not applicable 0. No their assistants. That is, it is possible that a space that is not used (space does not exist in by the person with disabilities still represents an accessibility issue the dwelling) for the family. PA1 Access in the dwelling/departure from the dwelling A. Access way in the entrance to the dwelling 1 0 1 0 B. Entry into the dwelling/exit from the dwelling 1 0 1 0 PA2 Moving into the home A. Moving between the different levels of the house 1 0 -7 1 0 B. Moving between different spaces (at the same level) 1 0 -7 1 0 If PA2A2 or PA2B2=1. Accessibility issue a. What makes it difficult to move? ... For example, the sills at narrow doors, doors or hallways. Access and use of the outdoor spaces of the dwelling PA3 (balconies, terraces, gardens, courtyards) A. Access way to the outdoor spaces of the dwelling 1 0 -7 1 0 B. Moving in the outdoor spaces of the dwelling 1 0 -7 1 0 PA4 Feeding Access to the table/dining area 1 0 -7 1 0 PA5 Meal preparation A. Using the sink in the kitchen 1 0 -7 1 0 B. Using the stove 1 0 -7 1 0 C. Using the oven 1 0 -7 1 0 D. Using the refrigerator 1 0 -7 1 0 Is. Using the kitchen furniture 1 0 -7 1 0 PA6 Meeting physiological needs A. Access way to the toilet if it is in the yard 1 0 -7 1 0 B. Sitting on the toilet 1 0 -7 1 0 C. Use of the toilet 1 0 -7 1 0 PA7 Achieving personal hygiene A. Using the sink in the bathroom 1 0 -7 1 0 91 5.3. Accessibility issues inside the 1. The person with If YES Asoc home disabilities uses 2. Accessibility (autonomously or issue that makes it Observation! This section is about the household where the assisted) or would like difficult or hinders assessed person actually lives. For persons with disabilities living to use the space the performance of in a residential center (according to GD no. 867/2015), this 1. Yes the activity section refers to the household to which the person belongs to, where he or she can be reintegrated after leaving the institution. 0. No 1. Yes Accessibility issues concern both the person with disabilities and -7. Not applicable 0. No their assistants. That is, it is possible that a space that is not used (space does not exist in by the person with disabilities still represents an accessibility issue the dwelling) for the family. B. Transfer to bidet/bathtub/shower 1 0 -7 1 0 C. Using the bidet - toilet bowl or toilet seat 1 0 -7 1 0 D. Using the bathtub/shower 1 0 -7 1 0 PA8 Sleep/rest A. Transfer to bed and other equipment for rest 1 0 -7 1 0 B. Sleep/rest 1 0 -7 1 0 PA9 Dressing Taking/replacing clothes in/in cabinets, wardrobe, 1 0 -7 1 0 commode or other storage spaces PA10 Control of environmental factors A. Open/close windows 1 0 -7 1 0 B. Opening of the gates/doors from the inside 1 0 -7 1 0 C. Communication with visitors on the outside 1 0 -7 1 0 Opening/closing sunscreen systems such as drapes, 1 0 -7 1 0 D. screens, blinds, etc. Control and regulation of heating and cooling systems of 1 0 -7 1 0 Is. the dwelling (including stoves) PA11 Recreational activities Caring for pet animals and gardens (including potted 1 0 -7 1 0 plants, flower garden or vegetable garden) PA12 Others, namely ... Asoc 6. MOVING OUTSIDE THE HOUSE/ THE RESIDENTIAL CENTER TRA1 How close does the 0. Get on foot without difficulty person live to a 1. Walk pretty much bus/minibus stop, train 2. There is no public transport station, although the person would need 92 station or other means of -7. The person does not need it, goes by car, bicycle, taxi, etc. or he/she transport? does not walk, he/she is bedridden TRA2 Usually how does the 0. On his/her own, without accompanying person move? 1. Occasionally with attendant 2. Only with attendant -7. He/she is not able to move, he/she is bedridden D470_ And, usually, what means 1. Walk 2. The bicycle 75 does the person use? 3. Drives the car by himself/herself 4. With a car driven by someone else/Taxi 5. Train 6. Bus/minibus 7. Metro 8. Special transport for persons with disabilities -7. He/she is not able to move, he/she is bedridden OUTH Usually, how often does 0. Never or less often than once a month the person leave the 1. At least once a month, but less often than once a week house? 2. At least once a week, but not daily 3. Once a day 4. Several times a day OUTH1 Most recently, when did 0. Today, on the day of the interview/interaction with the person/family the person leave the 1. In the last 3 days house? 2. In the last week, but not in the last 3 days 3. In the last month, but not in the last week 4. More than a month ago OUTT1 1. Yes 0. No Does the person benefit from free of charge urban surface -7. The person is not eligible or transport and subway, for people with severe and marked he/she does not live in the urban disabilities? area OUTT2 Does the person benefit from the free of charge interurban transport, at their choice, by any type of train, within the limit of the cost of a ticket to interregio IR train with reservation 1. Yes 0. No regime in second class, by buses or by river transport vessels, for -7. The person is not eligible 12 round trips per calendar year (severe handicap) and 6 trips (marked disability)? RAB1 Did the person benefit of tickets for theatre performance, 1. Yes 0. No museums, artistic events, in the past 12 months? Asoc 7. FAMILY INCOME AND EXPENSES Observation! This section is about the household in which the assessed person llives. For persons with disabilities living in a residential center (according to GD no. 867/2015), this section is about the household in which the person belongs to, where he or she can be reintegrated after leaving the institution. SAL In the past month, the total amount of money obtained ............................. Lei from salaries, pensions, allowances, benefits, sales, day 93 work, etc. by all household members (including the person with disabilities), was about ... SALDZ In the past month, the total amount of money obtained by the assessed person with disabilities, from any sources, ............................. Lei was ... NPERS Total number of persons in the household |__|__| persons in the household Automatically generated VPP Total income recorded last month per family member ............................. lei/person Automatically generated COMPUTE VPP=SAL/NPERS RISC1a 1. Yes 0. No Family at risk of monetary poverty Automatically generated If the total income recorded per family member is below the ISR = 525.5 lei (VPP<525.5 lei). IF VPP<525.5 lei THEN RISC1A=1 FRG Last winter, the family could not afford to heat the dwelling 1. Yes 0. No at least a couple of times a month and slept in the cold (includes daily, weekly)? HNGR In the last 6 months, the family has not had enough food for 1. Yes 0. No all members and some members did not succeed to eat, at least a few times a month (includes daily, weekly)? RISC1b Family at risk of extreme poverty 1. Yes 0. No Automatically generated If FRG=1 or HNGR=1. IF FRG=1 OR HNGR=1 THEN RISC1B=1 In the last 12 months, the family has benefited from ...? VMG ... social aid (minimum income guarantee) 1. Yes 0. No ASF ... family support allowance 1. Yes 0. No URG ... emergency support 1. Yes 0. No LMN ... support for heating the house (heating subsidy, wood) 1. Yes 0. No ALUE ... received food from the city hall (EU) 1. Yes 0. No MEAL ... the services of a social canteen, hot meal, meal on wheels 1. Yes 0. No RISC1c Low-income family not receiving poverty benefits for 1. Yes 0. No various reasons Automatically generated If the total income recorded per family member is below the RSI = 525.5 lei IF VPP<525.5 lei AND (VPPs<525.5 lei) and the family did not benefit from support (VMG and VMG=ASF=URG=LMN=ALUE=MEAL=0 ASF and URG and LMN and ALUE and MEAL=0). THEN RISC1C=1 In the last 12 months, the family has benefited from ...? BDZ1 Monthly allowance for persons with disabilities 1. Yes 0. No BDZ2 Complementary personal budget for persons with disabilities 1. Yes 0. No BDZ3 Salary of personal assistant 1. Yes 0. No BDZ4 Monthly allowance (in place of the personal assistant - AP) for 1. Yes 0. No the degree of severe disability with AP, other than the blind BDZ5 Carer's allowance for adults with a severe eyesight disability 1. Yes 0. No 94 PDZ1 Pension for determined degree of disability 1. Yes 0. No PDZ2 Invalidity pension 1. Yes 0. No BBDZ Social integration incentive offered by the Bucharest City Hall 1. Yes 0. No -7. Not from Bucharest SAL In the past month, the total amount of money spent by all household members (including the person with disabilities), on food, payment of utilities, health services/medicines, any other goods and services (of any ............................. Lei kind, including tobacco and alcohol), was about ... Bank rates, debts or expenses for large goods such as a house, car, land, etc. are not included. SALDZ In the past month, the total amount of money spent specifically on the health care and functioning of the person with disabilities assessed was about... ............................. Lei It does not include food costs or any common expenses with those of other family members, but only those directly related to the costs of disability. SDZ Income tax exemption for persons with severe or marked 1. Yes 0. No disabilities, for income from self-employment, salaries, -7. The assessed person is not pensions, income from agricultural activities, forestry and eligible or does not have the tax- fisheries? exempt income CARD Does the person with disabilities have a card/bank 1. Yes 0. No account? DEPDZ Are there adult family members who do not have their 1. Yes 0. No own income and are economically dependent on the Automatically generated person with disabilities? IF SUM (DEPDA_P1+DEPDA_P2 + ... FROM TABLE 2)>0 THEN DEPDZ=1 NKID The number of children under 18 that the person has in |__|__| children their care? Automatically generated COMPUTE NKID=SUM (KID_P1+KID_P2 + ... FROM TABLE 2) CRED1 Does the family have to pay mortgage installments for 1. Yes 0. No the home? CRED11 Did the family take a loan for people with severe or marked 1. Yes 0. No disabilities, for the adaptation of the home (of max. 10,000 euros, with subsidized interest paid by DGASPC)? CRED2 What about bank rates other than real estate loan? 1. Yes 0. No DTRIOM Does the family have debts other than the ones related to utilities/ rent and bank rates (for instance, debts to relatives, 1. Yes 0. No friends, neighbours, money-lenders etc.)? ECON 1. Yes 0. No Does the family have savings? If YES 1. Approximately, how much is saved? ............................. Lei 95 PROP Does the family have properties such as other houses, 1. Yes 0. No businesses, shares, land, vineyards, forests, herds of animals, agricultural machinery, etc.? If YES 1. Is the person with the assessed disability the owner or co- 1. Yes 0. No owner of one or more of the family properties? CAR Does the family own one or more cars? 1. Yes 0. No If YES 1. Is the person with the assessed disability the owner or co- 1. Yes 0. No owner of the car? 2. Is the family car (or one of them) adapted? 1. Yes 0. No 3. Does the family benefit from the car tax exemption? 1. Yes 0. No 4. Does the family benefit from the parking card for people 1. Yes 0. No with disabilities? LTG Are there disputes, conflicts, contrary interests between 1. Yes 0. No the person with disabilities and the family with whom -1. There is no information or clues, they live? I cannot appreciate 8. ENVIRONMENTAL FACTORS: BARRIERS AND Asoc FACILITATORS Observation! This section is about the community in which the assessed person llives. For persons with disabilities living in a residential center (according to GD no. 867/2015) for which deinstitutionalization is envisaged, this section is about the community where the person can return/ be reintegrated after leaving the institution. Example addition for E1301. Education: -1. Barrier => The person attends the courses in the community, but they are not accessible and adapted for people with disabilities 0. It does not => The person attends classes in a different location, not in the community influence 1. Facilitator => The person attends the courses in the community, and they are accessible and adapted for people with disabilities -7. Not applicable => Fill in in this code if the person is not in a form of education 96 -1. Rather barrier -7. Not applicable (not valid for the 0. It does not influence person’s status or the performance of the does not exist in the person's daily activities community) 1. Rather facilitator - 9. I don't know if it affects the person's life Education and work e130 a. Educational services, of any level and type -1 0 1 -7 -9 b. Non-formal education services or activities (regardless -1 0 1 -7 -9 of who provides them) e135 a. Career counselling and guidance services and support -1 0 1 -7 -9 for activation on the labor market b. Opportunities for paid work (of any kind) -1 0 1 -7 -9 c. Opportunities for unpaid work (volunteering) -1 0 1 -7 -9 Support and relationships People or animals that provide practical physical or emotional support, development, protection, assistance in their relationships with others, in their homes, at work, at school or at play, or in other sequences of their daily activities. e310 Closest family environment (people who live with the -1 0 1 -7 -9 person) e340 Accompanying persons and personal assistants Services provided either from state or private funds, or otherwise, on a voluntary basis, for example, household support providers, personal -1 0 1 -7 -9 attendants, transport support persons, paid aid, nannies and other individuals providing primary care. e315 Extended family -1 0 1 -7 -9 e320a Friends -1 0 1 -7 -9 e320b Acquaintances, colleagues, neighbors and community -1 0 1 -7 -9 members e355 Healthcare professionals -1 0 1 -7 -9 e360 Other professionals -1 0 1 -7 -9 If e360=-1. Barrier or e360=1. Facilitator a. Namely what kind of professionals? ... e350 Domestic animals providing physical, emotional or psychological support -1 0 1 -7 -9 For example, pets (dogs, cats, birds, fish, etc.) and animals that help move or transport people. If e350=-1. Barrier or e350=1. Facilitator a. Namely what kind of domestic animals?... Assistive/supportive products or technologies 97 -1. Rather barrier -7. Not applicable (not valid for the 0. It does not influence person’s status or the performance of the does not exist in the person's daily activities community) 1. Rather facilitator - 9. I don't know if it affects the person's life Any products, tools, equipment or technologies adapted or specifically designed to improve/maximize the potential of people with disabilities e1201 Assistive devices and technologies for mobility and personal transport inside and out Walking devices, cars and special vans, vehicle adaptations, -1 0 1 -7 -9 wheelchairs, scooters and devices that help people change their seat/position. If e1201=-1. Barrier or e1201=1. Facilitator a. Namely what kind of assistive devices?... e540 Public transport (schedule of flights, stations, frequency of flights, routes, etc.) -1 0 1 -7 -9 Facilitator = The person can use without difficulties or constraints, even if they are not adapted e1251 Assistive devices and technologies for communication For example, specialized sight devices, electro-optical devices, specialized writing, drawing or handwriting devices, signaling systems -1 0 1 -7 -9 and special software and hardware, hearing implants, hearing aids, frequency modulation hearing adapters, voice prostheses, communication tablets, glasses and contact lenses. If e1251=-1. Barrier or e1251=1. Facilitator a. Namely what kind of assistive devices and technologies for communication ... e535 Mobile telephone and Internet services -1 0 1 -7 -9 Facilitator = The person can use it without difficulties or constraints Attitudes towards participation in education and work of the person with disabilities, which influence the individual behavior and the social life For example, individual or societal attitudes about the person's credibility and value, that can trigger positive practices or negative and discriminatory practices (e.g., stigmatization, stereotyping and marginalization or neglect of a person). e410 Attitudes of closest family members -1 0 1 -7 -9 e420 Attitudes of friends -1 0 1 -7 -9 e430 Attitudes of people in management positions (including teachers, supervisors, employers, local councillors, mayor, -1 0 1 -7 -9 etc.) e440 Attitudes of companions and personal assistants -1 0 1 -7 -9 Products for personal use in everyday life 98 -1. Rather barrier -7. Not applicable (not valid for the 0. It does not influence person’s status or the performance of the does not exist in the person's daily activities community) 1. Rather facilitator - 9. I don't know if it affects the person's life e1151 Equipment, products and technologies, adapted or specially designed to help people in everyday life, e.g. prosthetic and orthopedic devices, neural prostheses (e.g. -1 0 1 -7 -9 functional stimulation devices that control the bladder, intestines, heart rate and respiratory rate) Services e5500 Legal services For example, court houses and other agencies for hearing and settling civil disputes and criminal proceedings, representation by lawyers, -1 0 1 -7 -9 notary services, mediation, arbitration and correctional or criminal facilities, including those who provide these services e5650 Financial services Including banks, insurance services, mutual aid houses, cash machine, -1 0 1 -7 -9 etc. e540 Public transport services -1 0 1 -7 -9 e5750 a. Home care services (regardless of funding and provider) -1 0 1 -7 -9 b. Day care centers for adults and older persons -1 0 1 -7 -9 c. Other social services for adults with disabilities -1 0 1 -7 -9 e580 Health services -1 0 1 -7 -9 e5800 Rehabilitation services -1 0 1 -7 -9 Physical environment e150 Physical accessibility of buildings for public use (including hospital, dispensary, town hall, school, cultural or sports -1 0 1 -7 -9 spaces, shops, etc.) e155 Physical accessibility of buildings where relatives and friends of the assessed person live (whom he/she likes or -1 0 1 -7 -9 would like to visit) e160 a. Accessibility of streets and sidewalks For example, cuts in kerbs, ramps, signage through billboards and -1 0 1 -7 -9 street lighting. b. Uneven terrain (hills, slopes) and the type of the land -1 0 1 -7 -9 surface (grass, gravel, sand, mud, etc.) c. Location of your residence (depending on the distance -1 0 1 -7 -9 from the services) 99 Other information TIMEAS a. How many minutes did it take to fill in the data already in the office? |__|__| Minutes b. How many minutes did the round trip to the person's home take? If the social inquiry was filled in at SECPAH headquarters or if no home visit has been paid, |__|__| Minutes mark 0 (zero). c. How many minutes did the visit/discussion with the assessed person and his/her family last? |__|__| Minutes If the social inquiry was filled in at SECPAH headquarters or if no home visit has been paid, mark 0 (zero). Estimated time = 10+30+30 100 Annex 7. Individual needs assessment tools (post-pilot version) Annex 7a. Individual needs assessment See separate document Output 4_Annex7a. Annex 7b. Information sheet "What you need to know about individual needs assessment" The individual needs assessment information sheet will be written in easy-to-understand language and include illustrations relevant to the information provided. The content (text) for each module is reproduced below. M1. EDUCATION AND WORK This information is for people with disabilities. If you want to continue your education or work, you have the right to ask for an assessment of your situation. A team of specialists does the assessment through an interview. The team of specialists is part of an institution called the Comprehensive Assessment Service for Adults with Disabilities. If you agree, your request for evaluation can be sent by: • your representative • a relative • a friend • a neighbor • a person from a social or medical service, or • the representative of the company employing you. After you apply, you will attend an interview. At the interview, we advise you and your carer to attend. The interview can last more than 30 minutes. The interview can take place in one of the following ways: 1. at the evaluating institution 2. if you can't move around, at home 3. online, i.e., using your laptop, tablet, or phone. The questions you will receive will be about the following: • what you want to learn in the future • what help do you need to learn new things • why you want to work and what you would like to work on • what you know and what you like to do After the interview, you will receive the "Professional Potential Profile" document. Your professional profile will show everyone your level of education or training. Your professional profile is valid for two years. After two years, you can resubmit a request for a new profile. 101 Your professional profile can help you in the following ways: • you will find out your education level and how you can continue your education. • you'll find out how prepared you are for a job and how you can get a better professional qualification. • you'll be able to show what level of professional training you have when you want to get a job. • you will find out what you need for your education or training, such as: - a special chair - special computer equipment - a social phone - a special office - person to help you learn how to work - a sign language interpreter - a special work schedule - transport You will be guided to the right institutions if you want a better education or training. Who can you contact to find out more about your rights? National Authority for the Protection of the Rights of Persons with Disabilities Address: 28C General Constantin Budișteanu Street, 1st floor, sector 1, Bucharest, PO Box 010773, anpd.gov.ro Phone: 0314338090, Key 1 Email: registratura@anpd.gov.ro If you need emergency help, call 112. M2. PERSONAL ASSISTANCE This information is for people with disabilities. If you have a certificate of severe disability, you are entitled to personal assistance. You are also entitled to receive personal assistance if you have a certificate of severe disability and do not have a home. People with moderate or mild disabilities are not entitled to personal assistance. Personal assistance is the daily help you can get from someone called a personal assistant. A personal assistant is a person who cares for a child or adult with a severe disability. The person caring for an adult with a disability may be a relative or a professional personal assistant. If you are visually impaired, you can benefit from personal assistance by getting a guide dog. The guide dog is a trained dog that provides independence of movement and security for the visually impaired person. A team of specialists assesses your personal assistance needs. The team of specialists is part of an institution called the Comprehensive Assessment Service for Adults with Disabilities. If you agree, the request can be sent to: • your representative, • your companion, • a family member. 102 After you apply, you will attend an interview. At the interview, we advise you and your carer to attend. The interview can take up to 1 hour. The interview can take place in one of the following ways: 1. at the institution making the assessment, 2. if you can't travel, at your home or 3. online, i.e., via a laptop, tablet, or phone. The questions you will receive will be: • about your daily schedule • about how you take care of yourself • about the personal assistance you receive • about your care needs (sleep, personal hygiene, food preparation, medical care, house cleaning, caring for your children, other family members, or pets) • about how you communicate with people inside and outside the family • about your professional activities • about your education • about your out-of-home travel needs • about your free time and relationships with your relatives or friends After the interview, you will receive a decision about your need for personal assistance. The decision will also have a recommendation on the most appropriate personal assistance for you: • at home • through a professional personal assistant or • by receiving a guide dog Deciding whether or not to have a personal assistant will depend on a total score of your personal needs and help in your home or in your social activities. The decision will contain the number of hours of care through the personal assistant and the time of day they will help you. Depending on your needs, the decision will show whether the professional personal assistant will care for you for 2, 4, or more hours. If your needs are special and you need to be cared for 24 hours a day, up to 3 personal assistants can be appointed. Personal assistance is valid for two years. After two years, the right to a personal assistant can be granted again. Who can you contact to find out more about your rights? National Authority for the Protection of the Rights of Persons with Disabilities Address: 28C General Constantin Budișteanu Street, 1st floor, sector 1, Bucharest, PO Box 010773, anpd.gov.ro Phone: 0314338090, Key 1 Email: registratura@anpd.gov.ro If you need emergency help, call 112. 103 M3. HOUSING ADAPTATION This information is for people with disabilities. Home adaptation means the changes you make to your home because of your disability. You can request changes to your home once or when you move into a new home. A team of specialists assesses your home adaptation needs. The team of specialists is part of an institution called the Comprehensive Assessment Service for Adults with Disabilities. If you agree, the request can be sent to: • your representative, • a relative • a friend • a neighbor • a person from a social or medical service. After you apply, you will attend an interview. At the interview, we advise you and your carer to attend. The interview can take up to half an hour. Changes in your home help you manage yourself and make your life better. For example, • when you have problems entering your house or apartment block • when you need to use the stairs, bathroom, toilet, kitchen, or other parts of your house or yard. So, changes for the better in your home and desired by you are called home adaptations. The law can help you make the changes you need in your home. But not just any change! For example: • if you live in a block of flats, the changes must be known to the block manager and the tenants' association. • if you rent privately, your landlord may refuse some changes. • if you are renting from the state, the housing manager must be informed of changes in your home. Unless there are serious reasons to refuse, landlords and managers should agree to changes in your home. It's easier to get: • small changes in your home that are cheaper • mobile equipment, i.e., things that fit in your home and that you can move if necessary. For significant changes in your home, you need special help. You can get this help from your local council or organizations that help people with disabilities. Some modifications to your home are free. For others, you need special help from the municipality. Here are the changes that can be made to your home with help from the city! If you use a wheelchair, you can be helped into the house with the following: 104 • ramp in your home or at the entrance to the block where you live, • stair lift, • an elevator that fits the stroller. Some ramps are permanent and are usually used at building entrances. Other ramps are mobile and can be moved to other entrances whenever needed. Inside your home, you can be helped with the following: • Modification of the doors by widening them so that the wheelchair can enter. • Replacing doors with sliding doors. • Change the windows to a height that suits you. • Modify your bed, wardrobes, tables, and handles to a height that suits you. • Move sockets and switches to a height that suits you. • A bed that can be adjusted, i.e., lowered or raised. • Adding a trapeze or support handles to the bed. • Removal of thresholds between rooms. • Modifying the floor with non-slip materials. • Fitting support bars in different places in your home. In the bathroom, you can be helped with the following: • Fitting grab rails on the wall and next to the sink, bath, shower, or toilet. • Fit the sink and toilet seat to a height that suits you. • Fitting a shower or shower cubicle at floor level. • Fitting a bathtub with the right height for you. • Application of non-slip surfaces on floors. A dog that helps you get around and groom and other things your dog needs. In the kitchen, you can be helped with the following: • Fitting an electric induction cooker. • Modify tables, cupboards, and fridge for easier use. What do you need to do to adapt your home? You or your carer can ask for an assessment of where you live. A team of specialists will assess your home. The team of specialists is part of an institution called the Comprehensive Assessment Service for Adults with Disabilities. We advise you and your carer to attend the assessment. Assessment is face-to-face or online in the form of an interview. The interview can take place in one of the following ways: 1. at the institution making the assessment, 2. if you can't travel, at your home or 3. online, i.e., via a laptop, tablet, or phone. The interview may take half an hour. The institution is obliged to make a document called a Housing Affordability Profile. After the assessment, the institution sends you its conclusions about the help you will receive to adapt your home. The evaluation is valid for 2 years. After this period, you can ask for a new home valuation. 105 How is a home valuation done? What help can you get for adapting your home? To adapt your home, you can get a loan of not more than €10,000 without any interest. If you leave a residential facility, you can get the following: • a cash benefit called a transition benefit. • special housing for your needs, called Inclusive Housing. Who can you contact to find out more about your rights? National Authority for the Protection of the Rights of Persons with Disabilities Address: 28C General Constantin Budișteanu Street, 1st floor, sector 1, Bucharest, PO Box 010773, anpd.gov.ro Phone: 0314338090, Key 1 Email: registratura@anpd.gov.ro If you need emergency help, call 112. M4. ASSISTED DECISION-MAKING FOR YOUR FINANCIAL RESOURCES This information is for people with disabilities. Assisted Decision Making means you can decide certain things about your financial resources with other people who agree to help you. You can ask for this help once a year. After you apply, you will attend an interview. Your financial resources are concerned: • to your money that you need to know how to use, like the money in the bank, the money you get each month; • to your property, such as your home, land, or other valuable possessions; • to your purchases and the debts that you have to pay; • to protect you from people who offer you different things about your money and property and who might cheat you; • to your plans, such as buying a house, land, or car or borrowing money. There are three ways you can be helped to make important decisions about your rights: 1. Appointment of an assistant 2. Judicial advice 3. Special protection Solution 1 - Your decision assistant Appointing an assistant is the best solution. To have an assistant, you have to ask a notary. The notary is a specialist in the production of legal documents. The assistant is the person who helps you make decisions about your financial resources. For the help they give you, the assistant doesn't get any money from you or anyone else. He has to defend you, be honest, and explain all the decisions you make with him. 106 Assisted decision-making If an assistant has not been appointed, you can ask for an assessment of your need for assisted decision-making. Your application is sent to an institution called the Comprehensive Assessment Service for Adults with Disabilities. If the application has been sent by someone else on your behalf, you must also agree in writing. Your legal representative, companion, or family should be at the assessment. A team of specialists does the assessment. We advise you and your carer to attend the assessment. Assessment is face-to-face or online in the form of an interview. The interview can take up to half an hour. The interview can take place in one of the following ways: 1. at the evaluating institution, 2. if you can't travel, at your home or 3. online, i.e., via a laptop, tablet, or phone. After the assessment, the specialists will let you know if you need help with your decisions and activities. A judge will use this decision for the other two ways to help with your decisions: judicial advice and special guardianship. These two ways of helping you are explained below. Solution 2 - Judicial advice If an assistant cannot be appointed, a judge may decide to give you legal advice. Legal advice means that you will only get help with some important decisions about your financial resources. Judicial counseling lasts a maximum of 3 years. Solution 3 - Special guardianship If an assistant cannot be appointed and legal advice cannot be decided, a judge will decide on special guardianship. Special guardianship means that all decisions for you will be made by a person called a guardian. The guardian can be a stranger, your spouse, a relative, a friend, or the person you live with. The special guardianship lasts a maximum of 5 years. Who can you contact to find out more about your rights? National Authority for the Protection of the Rights of Persons with Disabilities Address: 28C General Constantin Budișteanu Street, 1st floor, sector 1, Bucharest, PO Box 010773, anpd.gov.ro Phone: 0314338090, Key 1 Email: registratura@anpd.gov.ro If you need emergency help, call 112. 107 Annex 8. Model of County/Local Report on Unmet Needs of Adults with Disabilities See separate document Output 4_Annex8. 108 Annex 9. Fact sheet on the list of assistive devices and equipment found in Romania 109 110 111 Annex 10. County variations of the new draft standard assessment procedure for adults with disabilities See separate document Output 4_Annex10. 112