Reimbursable Advisory Services Agreement on Modernizing the Disability Assessment System in Romania (P171157) Output 3. Proposed new working instruments for a modernized disability assessment Bucharest, August 2022 1 Disclaimer: This report is a product of the International Bank for Reconstruction and Development/the World Bank. The findings, interpretations, and conclusions expressed in this paper are entirely those of the authors and do not necessarily reflect the views of the World Bank, its Executive Directors, or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. This report does not necessarily represent the position of the European Union or the Romanian Government. Copyright statement: The materials in this publication are protected by copyright. Copying and/or transmitting certain sections of this document without the permission granted in this regard may constitute a violation of the legislation in force. 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). This report was delivered to the Ministry of Labor and Social Solidarity and the National Authority for the Protection of the Rights of Persons with Disabilities in August 2022 under the 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 This report corresponds to Output 3 of the mentioned above mentioned agreement: Proposed new working instruments for a modernized disability assessment. 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 Acknowledgements Output 3 under the Reimbursable Advisory Services Agreement on Modernizing the Disability Assessment System in Romania (P171157) was developed under the supervision of Mr. Cem Mete, Practice Manager for Social Protection and Labor Global Practice, Europe and Central Asia, with overall guidance from Mrs. Anna Akhalkatsi, World Bank Country Manager for Romania. The study, analysis and consultation activities of the relevant stakeholders, together with the drafting of the report, were coordinated by Mr. Victor Sulla, Mr. Manuel Salazar (Task Team Leaders) and Mrs. Manuela Sofia Stănculescu. Mr. Jerome Bickenbach provided invaluable guidance and contributions from a comparative international perspective. The Romanian team of experts was made up of social workers, sociologists, psychologists, doctors, architect, lawyer, human rights experts, disability experts and persons with disabilities. The following experts (in alphabetical order) contributed to data collection, analysis and report preparation: Florentina Bărbuţă, Marta-Iozefina Bencze, Mihai Berteanu, Georgiana Blaj, Diana Chiriacescu, Bogdan Corad, Dorica Dan, Luminiţa Daneș, Ionuț Dinu, Nicolae Grecu, Monica Marin, Georgiana Pascu, Cerasela Nicoleta Predescu, George Roman, Cristian Roșu, Atena Stoica, Daniela Tontsch, Clara Ursescu. On behalf of the World Bank, Andrei Zambor, Ramona Lipară and Oana Caraba offered constant support throughout the entire work. Aleksandra Posarac and Nenad Friedrich Ivan Kostanjsek, international experts from the World Bank and the World Health Organization, offered valuable advice to the team and participated in the consultation activities within the project. The World Bank would like to acknowledge the excellent cooperation, guidance and timely feedback provided by the ANPDPD counterpart, in particular by Mr. Mihai Tomescu (President), Monica Violeta Solomie, Liliana Toader, Crina Gîrleanu, Daniela Oana Ambara, Izabella Popa, Mirela Vasii, Maria Cotoi and Iolanda Dinu, as well as by Mrs. Ștefania Andreescu and Elena Șerban, on behalf of the Ministry of Labor and Social Solidarity. The World Bank is grateful to all the representatives of the relevant institutions who participated in the consultation process and offered helpful comments for completing this deliverable, in particular the current and former members of the Higher Commission, the chiefs and members of the Services for Comprehensive Assessment for Adults with Disabilities (from the General Directorates for Social Assistance and Child Protection), the Presidents, members and secretaries of the assessment committees (from the County and Local Councils). Also, the World Bank team thanks the representatives of the National College of Psychologists, the National College of Social Workers, the National Institute of Medical Expertise and Work Capacity Rehabilitation, Romanian Institute for Human Rights, the specialized commissions of the Ministry of Health, NGOs dedicated to persons with disabilities and all persons with disabilities who lent their support and shared their ideas and concerns with us during the consultation process carried out in April 2022. 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 bear in mind that sustainable development is the only way to meet human needs without undermining the integrity of natural systems and the future of humanity. 3 Content Introduction.................................................................................................................................................................................................. 8 1. Main elements for the modernization of the comprehensive disability assessment for adults .........................10 1.1. Theoretical framework: ICF and CRPD ...............................................................................................................................10 1.2. What we understand by modernizing the disability assessment system in relation to ICF and CRPD...13 1.3. Proposed general methodology for the comprehensive assessment of disability based on the ICF and CRPD ........................................................................................................................................................................................................13 1.4. Paradigm shift..............................................................................................................................................................................15 2. Overview of the new toolbox .........................................................................................................................................................16 2.1. Guiding principles for the development of new working tools (and the general methodology) .............17 2.2. Co-production: Consultations with stakeholders..........................................................................................................20 2.3. Pretesting and subsequent adjustment of the new work package .......................................................................21 3. Tools for participation in the pilot study ...................................................................................................................................22 3.1. Briefly about the pilot study ..................................................................................................................................................22 3.2. Tools for participation in the pilot study ..........................................................................................................................23 3.2.1. Instrument F00: Recruitment of participants .........................................................................................................24 3.2.2. Instrument F0: Registration of participants and informed consent ..............................................................24 4. Disability assessment instruments ...............................................................................................................................................24 4.1. Working tools for medical and psychological assessment .......................................................................................25 4.1.1. Standardization of the documents to be included in the application file .................................................25 4.1.2. Instrument F1: Medical and Psychological Assessment ....................................................................................27 4.2. Working tools for the functioning assessment ..............................................................................................................28 4.2.1. Instrument F2: Functioning Assessment WHODAS+RO ...................................................................................29 4.2.2. WHODAS+RO Guide........................................................................................................................................................32 5. Tools for assessing service and support needs.......................................................................................................................32 5.1. Social assessment: Annex for adults with disabilities to the social inquiry ........................................................33 5.2. Modules for the assessment of individual needs..........................................................................................................36 5.2.1. Instrument M0: First contact for the assessment of individual needs .........................................................37 5.2.2. Instrument M1: Support needs in education and work .....................................................................................39 5.2.3. Instrument M2: Personal assistance needs .............................................................................................................42 5.2.4. Instrument M3: Support needs for an independent life: home adaptation ..............................................46 5.2.5. Instrument M4: Needs to support decision-making on the management of economic resources 48 5.3. Individualized plan (PLIN) .......................................................................................................................................................52 5.3.1. Instrument M5: Inventory of needs not covered by services and support ................................................52 5.3.2. PLIN instrument: Individualized plan.........................................................................................................................53 References...................................................................................................................................................................................................54 4 Annex 1. Instruments for participation in the pilot study .......................................................................................................58 Annex 1.1_FORM 00: Recruitment for the pilot study .........................................................................................................59 Annex 1.2_FORM 0: Pilot study registration data ..................................................................................................................62 Annex 1.3_Informed consent .........................................................................................................................................................66 Annex 2. Instruments for disability assessment...........................................................................................................................68 Annex 2.1: Medical and psychological assessment ..............................................................................................................69 Green medical form......................................................................................................................................................................69 Minimum requirements for the psychological assessment report ...........................................................................71 FORM 1: Medical and psychological assessment ............................................................................................................81 ANNEX 2.2_FORM 2: Assessment of functioning and start of individual needs analysis......................................89 ANNEX 2.3_WHODAS Guideline................................................................................................................................................ 101 Annex 3. Instruments for assessment of services and support needs ............................................................................ 102 Annex 3.1. Annex to the social inquiry for adults with disabilities .............................................................................. 103 Annex 3.2. Modules for individual needs assessment ...................................................................................................... 127 Module 0: Socio-demographic data, what we already know about the applicant and organization ..... 127 Module 1: Support and service needs in education and work ................................................................................ 133 Module 2: Personal assistance needs ................................................................................................................................ 143 Module 3: Support for independent living: home adaptation ................................................................................ 166 Module 4: Decision-making support needs .................................................................................................................... 173 Annex 3.3. PLIN: Individualized plan ........................................................................................................................................ 186 5 Acronyms and Abbreviations ADL Activities of Daily Life AJOFM County Agency for Employment ALOFM Local Agency for Employment ANDPDCA National Authority for the Rights of Persons with Disabilities, Children and Adoptions ANPDPD National Authority for the Protection of the Rights of Persons with Disabilities ANPD National Authority for Persons with Disabilities 2 APP Professional personal assistant CabR Centre of habilitation and rehabilitation for adults with disabilities CEPAH Commission for Assessing Adults with Disabilities CES Special educational needs CIA Centre of care and assistance for adults with disabilities CITO Centre of integration through vocational therapy for adults with disabilities CJRAE County Center for Educational Resources and Assistance CMBRAE Bucharest Municipality Center for Educational Resources and Assistance CNAS National House of Health Insurance CNASR National College of Social Workers from Romania CPVI Center for independent life for adults with disabilities CRRN/CRRNPH Centre for rehabilitation and neuropsychiatric rehabilitation for adults with disabilities CSEPAH Higher Commission for Assessing Adults with Disabilities DGASPC General Directorate of Social Assistance and Child Protection DSM Diagnostic and Statistical Manual of Mental Disorders ECA Europe and Central Asia FEI Expression of interest form FSS Social Services Provider GD Government Decision IADL Instrumental activities of daily life ICD International Classification of Diseases 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 OUG Government Emergency Ordinance PFA Self-Employed Person PIRIS Individual program of rehabilitation and social integration PIS Individual Service Plan PLIN Individualized Plan PNRR National Recovery and Resilience Plan POIDS Operational Program Social Inclusion and Dignity SECC Comprehensive Assessment Service for Children SECPAH Service for Comprehensive Assessment of Adults with Disabilities SNDPD National Strategy on the Rights of Persons with Disabilities 2021-2017 2 The National Authority for the Rights of Persons with Disabilities, Children and Adoptions - an institution established by Government Emergency Ordinance No 68 of 6 November 2019, has taken over the activities, attributions and structures of the National Authority for Persons with Disabilities (a and of the National Authority for the Protection of Children Rights and Adoption). Subsequently, by GD no. 234/2022 (in force from 18 February 2022) the current National Authority for the Protection of the Rights of Persons with Disabilities (ANPDPD) was established. 6 SPAS Public Service of Social Assistance 3 UAT Administrative-Territorial Unit UN United Nations UNCRPD United Nations Convention on the Rights of Persons with Disabilities WB World Bank WHO World Health Organization WHODAS 2.0 WHO Disability Assessment Questionnaire 2.0 3 In this report, the acronym SPAS is generically used for all forms of organization of public social assistance services established in the municipalities, cities and communes of Romania (DAS - Directorate of Social Assistance, SPAS - Public Service of Social Assistance or Compartment, according to the Government Decision 797/2017). 7 Introduction The International Classification of Functioning, Disability and Health (ICF) provides a framework for classifying and measuring disability, that recognizes disability as a universal and multidimensional phenomenon. Use of the ICF leads to more integrated bio-psychosocial approach to gathering and sharing information and to policy making. Within the framework of this Advisory Services Agreement, the medical-psychosocial approach is ensured by using the ICF framework and aligning it with the principles of the UN Convention on the Rights of Persons with Disabilities (UNCRPD). The new vision and general methodology for the comprehensive assessment of disability proposed in this project complies with the recommendations of the UN Committee: "The assessment should be based on a human rights approach to disability, focus on the requirements of the person because of barriers within society rather than the impairment, take into account, and follow a person’s will and preferences, and ensure the full involvement of persons with disabilities in the decision-making process.” 4 There is broad recognition among experts that Romania should reform its disability assessment and determination process, and align it with the ICF standards. The country has attempted to do so several times over the past decade, though largely without success. Currently, in Romania, the National Authority for Protecting the Rights of Persons with Disabilities (ANPDPD) has initiated an extensive reform of the system, focused on the application of the ICF framework in disability assessment for adults, in addition to the existing one for children. Through the current Reimbursable Advisory Services (RAS) Agreement on Modernizing the Disability Assessment System in Romania, the World Bank provides assistance to the ANPDPD in order to improve the legislation governing the country’s disability assessment system for adult persons. The present Advisory Services Agreement includes activities aimed to contribute to drafting seven analytical outputs. The seven outputs include: 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. Output 3 is the third product in the project and corresponds to Component 1 of the Reimbursable Advisory Services Agreement. In accordance with the terms of reference of the project, the objective of this activity is to develop the main working tools that allow the SECPAH and CEPAH experts to provide qualifiers for the ICF descriptors already selected in Output 2, as well as the medical-psychosocial criteria proposed for disability assessment (set of relevant categories in ICF covering all disease codes in the international classification of diseases – ICD 10). These working tools refer both to the determination of disability and to the assessment of the needs for services and support, in accordance with the general methodology for the modernization of the comprehensive disability assessment process for adults. 5 6 Accordingly, the current Output 3 includes: (i) working tools for completing the descriptors identified in the 'medico-psycho-social criteria' prepared for each SECPAH/CEPAH expert who must specifically fill in specific information either for the disability assessment or for the assessment of needs; and (ii) detailed instructions on the assignment of qualifiers for each of the ICF used descriptors. The working tools for determining disability and assessing the needs that this report proposes will be pretested as part of Output 4 and subsequently tested for one year through the pilot study planned in Output 5. 4 UN Committee on the Rights of Persons with Disabilities, General Commentary on Art. 19. 5 In this document, ICF descriptors/items/categories/parameters are used interchangeably. 6 WHO International Statistical Classification of Diseases and Related Health Issues, 10th revision (ICD-10, version: 2016). 8 The research team developed the new working tools taking into account: (a) basic principles and scientific conclusions from the literature, (b) good practices from international examples, along with (c) the conclusions and recommendations of the Diagnosis Report of the Current Disability Assessment System (Output 1). As a final note, the general methodology together with the new set of criteria (Output 2) and working tools (Output 3) presented in this report refer only to the technical assistance provided for the reform of the comprehensive disability assessment system and not to the general reform of disability policies in Romania, which could include the reform of benefits and services, the identification of the extra cost of disability, development of case management for adults, accessibility and information, transition from childhood to adult, unification of disability and invalidity systems, etc. However, it is crucial to align and coordinate the reform of the disability assessment system with all the reforms, projects and major changes in the legislative framework with impact on disability that are taking place in parallel, such as the deinstitutionalization of adults with disabilities, the development of services for persons with disabilities in the context of European funds (including PNRR and POIDS), the changes made to the Civil Code on guardianship, curatorship, as well as the implementation of the Decision No 490/2022 approving the National Strategy on the Rights of Persons with Disabilities "A Fair Romania" 2022-2027. The main audience of this report is represented by the ANPDPD specialists who work with adults with disabilities, as well as by the hundreds of practitioners involved in disability assessment in Romania. Structure of the report Output 3 is organized in five sections. First chapter makes a short synthesis of the key elements suggested in Output 2 for modernizing the comprehensive assessment of disability for adults in Romania, including a short introduction of the theoretical framework from ICF and UNCRPD, what we mean by modernizing the assessment process related to ICF and UNCRPD and what we mean by the paradigm shift. Section 2 includes an overall picture on the new set of working instruments, with a focus on the principles guiding their drafting and the way they have been developed. Sections 3-5 presents each of the working instruments developed for different stages of comprehensive assessment of disability. Hence, the third section includes the general guiding lines of the pilot study and the instruments for participation in this study. The fourth section presents the instruments for disability assessment, namely the medical and psychological assessment and assessment of functioning, whereas the fifth section considers the instruments developed for needs assessment. Annexes include the standard models for the new instruments. 9 1. Main elements for the modernization of the comprehensive disability assessment for adults This chapter is a summary of the main elements proposed in Output 2 for the modernization of the comprehensive disability assessment for adults in Romania. 1.1. Theoretical framework: ICF and CRPD Several countries in Europe and around the world have reformed or started to reform the way they carry out disability assessment for the provision of social benefits in cash or in-kind, so as to align them with the International Classification of Functioning, Disability and Health (ICF) of the World Health Organization (WHO). There are many reasons why governments have taken this step, but invariably the stated motivation is to modernize the assessment of disability, moving from a "purely medical approach" to one that is based on the "social model of disability" using "medico-psycho-social" assessment criteria, that is, ICF categories. 7 Romania is among the countries that have launched reforms for disability assessment aligned with ICF and based on the "ICF principles". Officially endorsed by all 191 WHO member states in May 2001, 8 ICF was developed by WHO to be the international standard for describing and measuring health, functioning and functioning problems - that is, disability. The ICF has been designed to complement the International Classification of Diseases (ICD, currently in its 11th review) 9 as a standard global epidemiological tool for describing health status. From the WHO perspective, in short, ICF is essentially an epidemiological classification of health conditions for collecting clinical and population data - a standard language. As such, the ICF is made up of separate classifications of body functions and structures, activities and participation, and environmental factors. Each category and operating area within the ICF is represented as a continuum from no functioning (or total absence) to full functioning. ICF does not only refer to disabled persons; in fact, ICF refers to everyone. It tells us that functioning and disability are not only clearly delineated categories in which to integrate individuals, but are the extreme limits of a continuum on which we all exist. Throughout this continuum, our functioning can vary from integrity in body’s functions, structures, activity and participation through limitations/ impairments of functions and structures, activity limitations or participation restrictions. In the ICF model, disability means a certain limitation or restriction of a person's functioning, which is generated both by the intrinsic health capacity of the person to perform actions (e.g. walking, dressing, household, family, school or job) and by the impact of the person's environment on the level of actual performance of these actions. Factors in a person's environment can be facilitators or barriers, through their absence or presence. Factors that improve functioning and reduce disability are considered facilitators, while factors that limit functioning and create disabilities are barriers. 10 Therefore, disability assessment involves an 7 In this document, categories/descriptors/items/ ICF parameters are used interchangeably. 8 Resolution WHA 54.21 of the World Health Assembly 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 represent a barrier, while a ramp with a correct inclination is a facilitator. 10 assessment of both the person's capacity in terms of health and their environment, which, in interaction, determine the performance level, that is, the degree of disability that the person has. The principle underlying the ICF model is simple: throughout our lives, each of us will face a certain degree of restriction in one or more areas of activity, due to a limitation of health (a disease, trauma, congenital problem, a disorder or just deterioration of the state of health caused by aging), and the impact of the general context in which we live. Understanding disability means accurately describing what the individual is actually experiencing in his/her life due to a health condition. In order to accurately describe disability - the real lived experience of disability - it is necessary to describe both the impact of the health condition (the states of illness and the deficiencies that the person experiences) and the impact of the physical environment (for example, air pollution or uneven terrain for walking), the environment built by people (for example, narrow walkways, the lack of an elevator), the attitudinal environment (for example, stigma, positive or negative attitudes of people) and the complex social environment (the way in which work is organized or social services are provided). ICF does not define disability but, more relevantly, shapes disability in order to describe it and measure it. The ICF model of disability aligns, on the one hand, with the accepted vision among academics and scientists and, on the other hand, with the recognized acceptance 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 people "who have long-term physical, mental, intellectual or sensory impairments which, in interaction with various barriers, may hinder their full and effective participation of individuals in society on an equal basis with others." For the purposes of the assessment, the ICF takes into consideration two levels or dimensions of functioning, similar to disability: i. There are discrete and specific areas of functioning (e.g., bodily functions, specific activities such as walking, reading, cleaning the home, and complex areas of participation such as work and participation in social and political activities). A limitation in one of these areas is a specific disability. ii. ICF also anticipates statistically constructed overall functioning, as synthetic or aggregated measures of a person's overall functioning – and thus disability degrees of the person as a whole. The ICF itself does not specify how the performance and disability measures are statistically constructed at the level of the whole person. In the integrative biopsychosocial model, the disability of the person as a whole is a general description of the degree of disability that a person feels in his/her life and requires evidence of real limitations of the person's activity in everyday life, caused by deficiencies and other restrictions associated with the underlying health condition in interaction with the real environment of the person. In other words, the disability of the person as a whole is the result of the impact that the medical condition has on the level of effective performance of activities and participation in all areas of a person's life. This overall or synthetic assessment of the person can only be carried out by means of solid psychometric tools - to ensure the collection of valid and reliable data - and statistical analysis, especially item-response theory and Rasch modeling. As a conceptualization of the experience of living with a condition in a person's daily environment, ICF describes activities and participation in nine areas of life (fields) by using a multitude of descriptors, such as the examples provided in Table 1. Table 1: ICF domains and descriptors ICF domain ICF descriptors (selection) 1 Learning and applying To watch, to listen, to copy, to focus attention, to learn to read, to learn to knowledge write, to learn how to compute, to make decisions 2 General tasks and Completing a single task or several tasks, completing the daily routine, requirements managing stress and other psychological challenges 11 ICF domain ICF descriptors (selection) 3 Communication Reception, production of non-verbal messages, conversation and use of communication devices and techniques 4 Mobility Changing and maintaining the position of the body, transporting, moving and handling objects, walking and moving, using means of transport 5 Self-care Washing, caring for body parts, using the toilet, dressing, eating, drinking, taking care of your own health 6 Self-management Purchase of goods and services, preparation of meals, carrying out household chores 7 Interpersonal interactions They show respect and warmth in relationships and react to them, and relationships appreciation, tolerance, physical contact, regulation of behavior within interactions such as impulses and aggressions, interact according to social rules, establish and maintain informal social relationships 8 Major areas of life a. Education: informal education/training, pre-school education, school education b. Work and employment: getting, keeping and stopping a job; paid employment c. Economic life: using money to buy food, saving money, maintaining 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 theaters b. Human rights, political life, citizenship: enjoys nationally and internationally recognized rights, exercises their 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 The logic of ICF is that the functioning is described by a combination of ICF descriptors and qualifiers. In order to record a person's functioning and disability, the appropriate descriptor must be selected for each category and then the figures or qualifiers specifying the degree of functioning or disability in that category or the extent to which an environmental factor is a facilitator or a barrier must be added. 11 To be meaningful, an ICF descriptor requires at least one qualifier. Qualifiers give a full description of a person's level of function or disability. 12 There is no defined and objective methodology for assigning ICF qualifiers to the different situations in which persons with disabilities find themselves. With regard to the way in which the elements of the assessment instruments are translated into ICF categories and ratings, the ICF handbook mentions the following: (i) it is not always possible to match one to one ICF category; (ii) the scoring system of the assessment tool may not correspond to the ICF rating scale; and (iii) the environment in which the assessment was carried out may overlap with several environmental factors, in particular when compiling assessments from different sources, media or assessors. 13 Bickenbach et al. further stresses that there are no uniform recommendations available and that it would not be the role of the WHO, as an international agency, to specify the thresholds; instead, a designated state authority must judge on the basis of tradition, common sense, employment policy or a political decision. 14 The best option therefore remains to organize country-specific meetings with experts in the field who are qualified and who can agree on each descriptor and its significance. 11 WHO (2013: 9). 12 Bickenbach et al. (2015: 37). 13 WHO (2013: 63). 14 Bickenbach et al. (2015: 36-37). 12 1.2. What we understand by modernizing the disability assessment system in relation to ICF and CRPD The overall objective of this project is to propose a modern approach to disability assessment, following the ICF framework and aligning it with the principles of the UNCRPD. Consequently, the modernization of the disability assessment system requires incorporating the principles of the ICF and the UNCRPD into both disability determination and needs assessment. • As regards the determination of the degree of disability, the project involves: o (1) reviewing the current medical-psychosocial criteria, and o (2) the selection of a set of ICF criteria in line with international best practices, as a significant and scientifically robust integration of information on functioning in 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 corresponding to a range of services is selected, from those available in Romania, identified in a participatory manner. 1.3. Proposed general methodology for the comprehensive assessment of disability based on the ICF and CRPD The general methodology described in detail in Output 2 uses international terminology based on the theoretical framework briefly described in section 1.1. Basically, the new model developed for the comprehensive assessment of disability in Romania is a process that includes the following four steps: 1. Medical and psychological assessment Determination Disability 2. ICF-based assessment of operation of disability assessment Comprehensive assessment of 3. Disability Certification disability Needs 4. Assessment of the service and support assessment needs of persons with disabilities From a procedural point of view, the determination of disability is an authoritative, legally sanctioned, administrative process - which may involve several stages and official actors - that provides some form of support, service or assistance to individuals on the basis of eligibility criteria and a disability assessment procedure that identifies the type, degree or level of disability a person experiences. Disability assessment is the administrative process of initial examination to determine disability. This first stage assesses the level of disability of the person as a whole (expressed in percentages, degrees or levels). This decision forms the basis of another administrative action, called disability certification, in which other decisions are made - whether the applicant qualifies for any, part or all of the benefits, services and support available under different regulatory legislations. 13 Working Disability assessment is a summary measure of a person's performance in regard to daily behaviors and actions, simple to complex, in their actual environment, in light of Definition the person's state of health. The assessment of individual needs is an administrative process by which the needs and requirements of people experiencing a disability are identified, based on evidence of their functioning problems. Needs assessments are by their nature individualized and focus on specific actions that a person has difficulty in carrying out due to health conditions or environmental barriers faced in everyday life (e.g. sensitivity to air pollution or obstacles to mobility). The diagnosis report showed 15 that one of the main challenges in modernizing the disability system in Romania is the fact that disability assessment and needs assessment are merged into the unique process of "comprehensive disability assessment", in accordance with Law no. 448/2006 on the protection and promotion of the rights of persons with disabilities. The merged use of the two assessments is inefficient, because: i. 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). Properly carried out, the needs assessment will involve several professionals and different specialized tools to identify the exact level of difficulty in terms of sensory problems, mobility problems, knowledge or emotional problems, problems related to independent living and so on. ii. Not all applicants need this level of thorough examination. Some applicants may not have a disability degree that qualifies them for any existing benefit or service. Conducting a comprehensive needs assessment for these people is a waste of time and money. iii. Most applicants will have disability-related issues in one or two areas, and while a suitable disability assessment tool can easily highlight these issues, precise identification of needs requires a separate process. iv. The disability assessment, if carried out with a scientifically sound enough instrument, can be carried out by qualified specialists, quickly and efficiently, without posing an undue burden to the applicant. The assessment of individual needs potentially requires various qualified professionals (doctors, vocational specialists, psychologists, education specialists) and, to be effective, it can take more time and require more than one assessment session. As a solution, the newly proposed general methodology in Output 2 introduces a clear distinction between disability assessment and needs assessment. According to international best practices, the needs assessment is independent of and subsequent to disability assessment. In short, both from a scientific and administrative point of view, disability assessment and individual needs assessment differ fundamentally in methodology and results. For this reason, it is neither practical, nor effective to carry out these different forms of assessment at the same time. An important consequence of the new approach is that the current legal terminology 'classification in degree and type of handicap' is no longer appropriate. The new ICF-based methodology measures the degree of disability of the person as a whole and not handicap, deficiency or impairment. Therefore, the appropriate terminology would be 'classification in a level of disability' – determination of a disability degree. Likewise, the certificate is no longer a 'handicap certificate' but a 'disability certificate'. 15 World Bank (2021) Output 1 presented an analysis of the current system for assessing and determining disability in Romania and evaluated it, among other things, from the point of view of its alignment with the terminology and conceptual ICF model of functioning and disability. 14 1.4. Paradigm shift According to the legislation in force, in Romania, the comprehensive assessment in order to determine the degree of disability is a two-stage process. In the first stage, the Service for Comprehensive Assessment of Adults with Disabilities (SECPAH) 16 carries out the evaluation, 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) that include the services/actions recommended by SECPAH for the applicant. In the second stage, the applicant's file, together with the comprehensive assessment report and PIRIS, is submitted to the Commission for Assessing Adults with Disabilities (CEPAH) which takes the final decision on (i) the classification or non-classification in a degree of disability; (ii) the certificate of vocational guidance, upon request; and (iii) services/actions recommended in PIRIS, including protective measures such as the provision of a personal assistant or admission to an institution or day care center. Building on the recommendations of Output 1 18 and using international best practices, the research team developed the general methodology (and all elements included) presented in this report. The major change that the new methodology proposes is the restructuring of the comprehensive assessment of disability from a two-step process to a four-step process, as illustrated in Infographic 1. For each of the four stages, a package is developed within the project that includes a methodological framework (ICF criteria/categories), working tools for SECPAH and SPAS (the current Output 3) and procedures (part of Output 4). Infographic 1: The new four-stage process of the comprehensive assessment of disability and the corresponding methodological package developed within the project 16 In Romania, there are 47 comprehensive assessment services for determination of degree and type of disability for adults. DGASPC provides these services in all 41 counties and 6 sectors of Bucharest. 17 According to Joint Order of the Minister of Labor, Family and Equal Opportunities and of the Minister of Public Health No. Order of the Minister of Public Health no. 762/1.992/2007 on the approval of the medical-psychosocial criteria on the basis of which determination of the degree of disability is established, with subsequent amendments and completions and with the assessment procedure defined in GD No. 430/2008 and Order no. 2298/2012 on the approval of the Framework Procedure for the assessment of adults on determination of degree and type of disability. 18 The three main recommendations to align the assessment process with the principles of the ICF, as well as those of the UNCRPD, include: the need to integrate the functioning into the disability assessment, to update the medical criteria and to redesign the approach so that the assessment of needs and the assessment of the disability are clearly separate. 15 Overall, the general methodology is aligned with the ICF principles and is based on a set of categories from the ICF (medical-psychosocial criteria) presented in Output 2. According to the new general methodology, the assessment of the degree of disability is the aggregate result of two distinct steps, namely the medical and psychological assessment (step 1), together with the assessment of the functioning based on a solid psychometric instrument (step 2). Unlike the current situation, disability determination (stage 3) will be done automatically, by aggregating the score from the medical and psychological assessment with the score from the assessment of functioning, based on an algorithm to be determined in the pilot study. Finally, assessment of individual needs (step 4) is differentiated and strengthened by the development of a specific methodology and appropriate assessment tools. Thus, the entire process of comprehensive disability assessment is aligned with the UNCRPD and the ICF and covers all mandatory areas of assessment provided for in the current legislation. 19 2. Overview of the new toolbox The new package includes 13 working tools corresponding to the four stages of the comprehensive disability assessment process, plus the pilot study (Outputs 5 and 7). Of these, two tools are useful for recruiting and registering participants in the pilot study, three tools are created for medical and psychological assessment, another one is used to assess functioning, six tools refer to individual needs assessment modules, and the last tool is the Individualized Plan (PLIN) that completes the process. The new instruments are extensively presented in the sections that follow. Infographic 2: New working toolkit proposed for comprehensive disability assessment based on ICF and CRPD Assessment instruments F00 Recruitment are built as a fall F0 Registration M1 F1 Education & work Med & Psi F2 M0 M2 PLIN Personal Assistance WHODAS+RO Needs Assessment Green Forms” for doctors Ẁ M3 Home Adaptation and psychologists ANNEX M5 Social Inquiry Unmet need M4 Assisted decision - making 19 The six mandatory areas of assessment are: social, medical, psychological, professional or vocational skills, the level of education and skills, and the level of social integration. (GD no. 268/2007, art. 48, respectively Order no. 2298/2012. art. 4). 16 2.1. Guiding principles for the development of new working tools (and the general methodology) Alignment with ICF principles The newly proposed working tools (as well as the general methodology and procedures) are based on ICF theoretical framework. Accordingly, newly developed instruments are structured according to the ICF dimensions, fields (areas of life), descriptors and qualifiers as presented in Section 1.1. For both disability and needs assessment, the working tools use a unique set of ICF descriptors (Output 2), but: - for the disability assessment, the DEGREE OF DIFFICULTY in carrying out the activities is measured, and - for the assessment of needs, the NEED FOR SUPPORT for carrying out the activities is measured. According to ICF, 'disability' is any level of problem or difficulty encountered in functioning in a given area from a performance perspective, although capacity is a determining factor in performance. Correspondingly, the new working tools are designed from the perspective of performance and not of capacity. Performance is a real description of what happens in a person's life, in the context of all the environmental barriers and facilitators to be faced. In contrast, capacity information is usually the results of a clinical inference or judgment based on medical information on a person's expected ability to carry out activities according to their health condition and deficiencies/impairments. Alignment with CRPD principles Ensuring uniform tools and procedures at national level is a necessity from a human rights perspective: it is fair and equitable that persons in similar situations and with similar disability degrees are assessed similarly throughout the country. Any other approach is unfair and discriminatory. This is provisioned in all human rights treaties and the UN Convention on the Rights of Persons with Disabilities (UNCRPD). From the perspective of human rights, the UNCRPD lays down, in Article 3, the regulatory requirements of the assessment process: it must be carried out in a way that respects human dignity, individual autonomy and the independence of individuals; it must be non-discriminatory, accessible and accept human diversity; and must contribute to the full and effective participation and inclusion of persons with disabilities in society. To this end, the toolkit (as well as the new procedures proposed in Output 4) was designed taking into account the two basic principles of disability assessment: • Disability assessment should assess in a valid, reliable and comprehensive way the degree of disability that the person actually experiences in everyday life; • 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. An assessment process that uses invalid or unreliable instruments, that is subject to prejudice or arbitrariness, infringes the principles of human rights regarding respect for the dignity, autonomy and independence of those assessed. In order to maximize the chances of standardized and uniform use in all counties, the research team designed the new working tools to ensure that the qualification elements for the activity/participation dimensions and environmental factors are adequately complemented. They are also complemented by detailed instructions on how the qualifiers are assigned to each descriptor listed in the set of medical-psychosocial criteria. If there are standardized tests available for some of the descriptors, these tests are suggested, together with specific thresholds in each case (for body structures and functions, by or in close consultation with specialized physicians in the respective fields). Where no standardized tests are available and the assignment of the rating may involve a higher level of subjectivity, examples are given for the use of future assessors. Use of international best practices International best practices have been identified for each of the four stages of the comprehensive assessment and are available in the corresponding chapters. They have been studied, adapted or used to extract the main 17 elements to guide the development of new methodologies (part of Output 2), working tools (part of Output 3) and procedures (part of Output 4). The working instruments proposed in this report were built starting from the instruments provided in the current regulations that were modified taking into account the best international practices, adapted to the Romanian context based on the results of the Diagnosis Report (Output 1). They show that in Romania, at present: (i) there is no unified approach to comprehensive disability assessment at national level; (ii) the procedure and assessment tools used in the SECPAH comprehensive disability assessment are not aligned with the ICF functioning and disability model; (iii) there are no specific tools or methodologies for data analysis and no clear rules on the data to be used/analyzed for each of the six mandatory assessment areas. Although comprehensive assessment is a multi-criteria evaluation, there are no specific weights or rules that clearly establish the contribution of each area to the final outcome of the evaluation. As a result, the data are used and analyzed differently from one county to another, and sometimes from one specialist to another, especially since many SECPAHs have not developed specific working procedures in this regard. 20 Clarification and ease of use The new working tools are developed as a coherent package to reduce the burden for applicants (in obtaining documents) as well as for SECPAH specialists (in information checking and analysis). The instruments are built in a cascade system, as shown in Infographic 2, so that (1) unnecessary repetitions are eliminated (i.e. the assessed person does not have to provide the same information more than once) and (2) that information other than that strictly necessary in the assessment is not collected. Cascade construction means that each working tool takes from the information collected in the previous stages and records only the newly collected information through interview with the applicant. The retrieval of information from the tools completed in the previous stages will be done automatically within the online application developed specifically for the pilot study. With regard to the new information, a parsimonious 21 set of descriptors was selected for each instrument to make the tool as short and user-friendly as possible. Thus, the set of descriptors selected for the interview with the applicant corresponding to each working tool is designed not to last more than 30 minutes. Improving the distribution of the workload and facilitating teamwork The research team prepared and formatted the working tools for filling in ICF descriptors according to the type of expert or team, whenever appropriate, to reduce and balance the workload between SECPAH specialists and to stimulate teamwork. Depending on the specificity of the descriptors, certain SECPAH members must assign the qualifiers for either disability assessment or needs assessment. World Bank experts have worked on finding a balance between descriptors divided according to the competences of experts (doctor, psychologist, social worker) and descriptors completed by each of the experts in the multidisciplinary team or even by the entire team together (through professional consensus). Improve workflow and time management Carrying out both the disability assessment and the needs assessment for an applicant may require between one and seven different types of assessment, depending on the specific conditions of the applicant. For example, in the case of a person with a severe deficiency who requests a disability certificate, assisted decision and personal assistant, the process may require two separate meetings with SECPAH, with a total of 30 minutes (for completing WHODAS+RO) plus about 90 minutes (for needs assessment, including the Individualized Plan). Given also the significant number of casefiles to be assessed (250 thousand casefiles assessed over a year at national level), time management is essential to ensure an adequate workflow while allowing adaptations to specific conditions and requests of applicants. A good system provides satisfaction to both beneficiaries and staff involved in disability assessment. To this end, the World Bank team shaped the unified comprehensive assessment procedure by using a simple and 20 The only guidance available is in the ANPD instruction of 3.12.2018, on how to complete the complex assessment report. 21 A parsimonious model is a model that achieves the desired level of explanation or prediction with as few predictive variables as possible. Source: https://stats.stackexchange.com/questions/17565/choosing-the-best-model-from-among- different-best-models. 18 effective method of time management to be "a little happier and do a little more" or "work smarter, faster and better". 22 This is the Pomodoro technique to reduce the impact of internal and external disruptions 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 25 minutes. Work units are recorded upon 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. 23 Infographic 3 shows how to distribute the new toolkit over Pomodoro-type of work intervals. However, it should be borne in mind that the needs assessment is modular and voluntary, which implies that only some people will be eligible / opt for one or more modules; with a small number of applicants who will benefit from all the assessment modules. Infographic 3: New working tools set translated into Pomodoro (estimating working time) 100% of applicants ≤ 40% of applicants Info & F0 F1 F2 EIF initial Annex Social M0 M1 M2 M3 M4 PLIN Pilot F00 inquiry 10 min 10 min 15 min 20 min 10 min 30 min 10 min 15 min 30 min 10 min 15 min 15 min MIN 20 min 30 min 15 min 60 min 20 min 45 min 20 min 20 min MAX One day Another day SECPAH SPAS SECPAH Present time, According 15 ~ 10 min 5 47 ~5 PIR IS/ PIS ~ 10 min to Output 1 min REC min min min Dosar Note: The estimation of applicants for the assessment of individual needs (≤ 40% of applicants) is made based on the statistical data collected in Output 1 on the share of adults with disabilities with a degree of personal assistant and the share of beneficiaries of vocational evaluation. Only the pilot study will show the interest of people with disabilities in one or more of the modules for assessing individual needs. The technique involves five stages, namely planning, tracking, recording, processing and visualization. As such, it may be adjusted to the assessment activities of SECPAH specialists, in particular for needs assessment containing five modules (vocational, educational, assisted decision-making, independent living, etc.) applicable to certain categories of applicants. Each assessment module is seen as a unit of work (a Pomodoro). At the planning stage, the SECPAH team will draw up the daily list of applicants. They shall then estimate the effort required for each assessment module on the basis of their working experience and the documents in the applicants' files. Thus, they can organize the daily interview agenda of the team for each case and SECPAH specialist. PILOT The procedure will be tested in the pilot study (Outputs 5 and 7). However, not all steps of the procedure will be tested in the pilot study. The disability assessment and the needs 22 Pash and Trapani (2013). 23 This is a method widely used by applications and websites that offer time measurement tools (timers) and instructions. Retrieved on the 31st January 2022, from Wikipedia: The Free Encyclopedia: http://en.wikipedia.org/wiki/Pomodoro_Technique. 19 assessment will be carried out in one meeting with the beneficiary and not on two different days, as the procedure stipulates. Thus, in the pilot study: (1) Recruitment and registration steps involve: - Direct interaction with the beneficiary - Information and informed consent - Based on the documents from the file – Completing the F00 and F0 forms (2) The medico-psychological evaluation (form F1) is based on the documents from the file and the interview with the beneficiary carried out for the disability classification, according to the law. (3) The evaluation of functioning (form F2) is based on an interview to complete WHODAS+RO and FEI. (4) Needs assessment involves conducting an interview to complete a module between M1- M4, depending on the beneficiary's options, and PLIN. In conclusion, in the pilot study, the direct interaction between the SECAH/CEPAH team and the beneficiary is estimated to vary between 20 minutes and one hour. The online data collection application for the pilot study will include useful indicators for adjusting the procedure, which will help the SECPAH to organize itself in a way that improves workflow and time management. 2.2. Co-production: Consultations with stakeholders The new toolbox (together with the general methodology, criteria and procedures) has been developed in a highly participatory manner. The World Bank team developed a first version of the instruments, which was discussed and agreed with the five validation experts from ANPDPD. The initial version of the toolkit was then subject to a comprehensive consultation process with two main objectives. 1. The first objective was to adjust and validate the working tools and the unified procedure for the comprehensive assessment of disability, planned to be tested through the pilot study. 2. The second objective was to build a consensus on the fact that disability assessment is correct and ensures equitable access to existing benefits and services, and the reform we are designing, we are designing together and means "better" for both persons with disabilities and the specialists involved in the process. As regards working tools, for both disability and individual needs assessment, there is no defined and objective methodology for assigning ICF ratings to the different conditions of persons with disabilities, as already mentioned in Section 1. 1. In this respect, the best 24 option remains the use of international best practices and the organization, at national level, of consultation meetings to establish a consensus with experts in the field, who are qualified to agree on each descriptor and its significance. 25 The World Bank's multidisciplinary team included doctors, psychologists, social workers, sociologists, representatives of the rights of persons with disabilities and human rights, ICF and WHODAS specialists, lawyer and architect. This team worked in close collaboration with the ANPDPD experts not only in the improvement of the methodological package, but also in the consultation workshops for discussing the working tools. The consultation process involved a total of 15 workshops, carried out between 11 and 21 April 2022, attended by more than 300 professionals, including specialists from the DGASPC, SECPAH and CEPAH, representatives of the Higher Commission for Adults with Disabilities (CSEPAH), local social workers, experts from various 24 WHO (2013). 25 Bickenbach et al. (2015: 36-37). 20 national institutions or professional associations relevant to the disability assessment system, international experts in ICF, policy makers and activists for the rights of persons with disabilities. 26 In relation to the current Output – the new package of assessment tools – the following were carried out: • 13 workshops with SECPAH/CEPAH professionals, persons with disabilities and NGOs active in the field of disability, representatives of the College of Psychologists and the National College of Social Workers in Romania • In addition, a discussion was organized with representatives of the Romanian Institute for Human Rights. The consultation workshops for Output 3 lasted an average of 155 minutes each, the longest time span being 240 minutes. On average, 86 zoom connections were recorded per meeting (minimum 33 in the case of meeting with the College of Psychologists and a maximum of over 100 in the case of workshops with SECPAH/CEPAH). The number of participants per zoom connection varied between one person per connection and 5 people per connection. In preparation for the consultation process, the ANPDPD in collaboration with the World Bank sent invitations to all stakeholders and lists of people interested in taking part in the workshops were filled in. They were provided before the workshop with the materials proposed for analysis and, after the workshop, the presentations that were made by the World Bank team. The power point materials used in the above consultations are presented in Annex 4. The consultation process was carried out online, using the Zoom platform. During the events with international participation, the English-Romanian and Romanian-English interpretation was ensured. The consultation workshops were recorded both video and audio, and the suggestions, comments and recommendations received were noted by the research team and integrated into the present material. Overall, the new toolkit received positive feedback from the nearly 300 specialists and representatives of NGOs and persons with disabilities during the consultation workshops. 2.3. Pretesting and subsequent adjustment of the new work package The World Bank team has incorporated the feedback received during the aforementioned working meetings and technical meetings. In the next stage, as part of Output 4, the team pretests the working tools (including detailed instructions) and the Individualized Plan in cooperation with the ten DGASPC's selected for the pilot study. The objectives of the pretesting are to ensure that: (i) the filling in of the working tools is not problematic for the assessors; (ii) assessors follow a standard approach in filling in the instruments; and (iii) feedback from persons with disabilities is included. After being trained, SECPAH/CEPAH county teams will be invited to complete at least ten complete assessments each (including disability assessment, needs assessment and Individualized Plan). During the pretest, the research team will collect structured feedback for each tool, the difficulties of completing and the time it takes to complete them. With this built-in feedback, the working tools will be considered to be prepared for the pilot study. In the future, within Output 5, the team will start conducting the pilot study that will take place over the course of one year. However, during the first six months of piloting, several adjustments to the entire methodological package are expected. Two workshops will be organized in September 2022 to collect more feedback from practitioners and experts involved in the process, who will help prepare a mid-term workshop for the implementation of the pilot study (planned for November 2022) to discuss the main results and adjustments to the pilot study will be made as necessary (sample design, tools, data collection processes, etc.). 27 26 The list of workshops is presented in Annex 3, Output 2. 27 The two-stage piloting exercise (the first for improving the instruments and the second for testing the calculation formulas) is in line with how disability assessment has been implemented in Taiwan, see Chiu et al. (2013). 21 3. Tools for participation in the pilot study 3.1. Briefly about the pilot study Objectives of the pilot study The pilot study, corresponding to Outputs 5 and 7, aims to test, for a period of one year, the new four-stage process of the comprehensive assessment of disability and the corresponding methodological package, developed within the project. The methodological package includes new methodologies, tools and specific procedures, both for the assessment of disability and for the assessment of the service and support needs of adults with disabilities, as summarized in Infographic 1. The pilot study is not only a means of scientific research and validation of a new methodological package, but is an opportunity to create a consensus that the assessment of disability is correct and ensures equitable access to existing benefits and services. Selection of the pilot sample In the preparation phase of the pilot study, the research team selected ten DGASPCs to test the new methodological package, with the assistance of the World Bank. 28 Given the high heterogeneity of county practices, the pilot study must best cover existing practices to ensure that the new work package 29 for the comprehensive assessment of disability in adults can be applied uniformly at national level. In order to ensure the best possible coverage of the diversity in the territory, the selection took into account the following set of indicators: • The size of the population of adults classified in the degree of disability officially registered at the county level, according to the Statistical Bulletin • SECPAH/CEPAH workload — Total number of files assessed/classified annually in the degree of disability, according to data reported by SECPAH and CEPAH • Procedure - Share of files assessed by SECPAH that did not involve a face-to-face interaction with the evaluated person, according to the data reported by SECPAH • Development region • DGASPC institutional factors indicating the potential for active involvement and responsible implementation of the pilot study. The sample includes ten DGASPC's from Sectorul 3 from Bucharest and nine counties from all regions of the country, namely: Arad, Bacău, Constanța, Dolj, Giurgiu, Ialomiţa, Olt, Sălaj and Sibiu. In total, the DGASPC in the sample evaluates over the course of a year a total of about 56,000 files (with a reduction to about 38,500 files in 2020), which indicates the possibility of carrying out a pilot of at least 6,000 cases assessed using the new work package. County teams for the implementation of the pilot study In order to carry out the pilot study in proper conditions, it is essential to create a fair and trustworthy working atmosphere, which will contribute to the increase of institutional capacities and stimulate work in multidisciplinary teams. Precisely for this reason, instead of hiring only a part of the staff, the entire SECPAH team, plus representatives of the CEPAH (at least the president) and his/her secretariat, will form the county teams for the implementation of the pilot study. It is only in this way that the pilot study can achieve its objectives (i) to test new methodologies, tools and specific procedures for assessing the disability and (ii) to 28 Document Selection of counties for the pilot study was reviewed and handed over to the ANPDPD as a separate document on February 18, 2022. 29 World Bank (2021) Output 1. 22 assess the service and support needs of adults with disabilities. In total, the ten county teams will include more than 100 specialists from SECPAH and CEPAH. In the pilot study, county teams will have to: • identify and recruit volunteers for the pilot study, from among the applicants for determination of disability degree; • for the selected persons, the SECPAH/CEPAH specialists will have to apply the new working tools set, in accordance with the procedures established in the pilot study (without any legal consequence on the assessed persons), in addition to the assessment according to the legislation in force resulting in the determination of disability degree and type; • to record for the assessed cases all the information requested in the online data collection and analysis application developed for the pilot study. Precisely for this purpose, the ANPDPD acquired tablets to equip the county teams. General principles and criteria for inclusion Participation in the pilot study is voluntary. Persons requesting an assessment for a degree of disability will be informed about the conduct of the pilot study, what it consists of and will be invited to participate in the pilot study. The SECPAH/CEPAH team will make it clear that participation in the pilot study has no consequence on the status of a disabled person or on the benefits or services that the person may receive. The pilot study is only intended to test new tools and collect data to serve for a potential improvement in disability assessment. All adults (18+ years old) who apply for disability can participate in the pilot study, regardless of whether they are applying for the first time (throughout their lives) or applying for assessment for renewal of the certificate. The medical diagnosis, the time of onset of the disease, the type of disability or the degree of disability (if there is already one) are not criteria for including/excluding the participants in the pilot study. 3.2. Tools for participation in the pilot study With regard to participation in the pilot study, the research team developed two tools, namely: • F00 = Recruitment form for participants in the pilot study • F0 = Registration form. An informed consent form will be added to it. These working tools are available in Annex 1. Infographic 4: STAGE 0. Recruitment and registration of participants in the pilot study: Activity flow 23 Only applicants for determination of the degree of handicap (according to the current law) who, after being informed, agree to participate and sign a consent to do so, will be included in the pilot study. For applicants with psychiatric disorders with psychotic symptoms or intellectual disabilities who cannot respond alone, the closest relative/representative of the person may sign the informed consent to participate in the pilot study, if the person concerned agrees verbally to participate in the pilot study but is unable to sign. If the person is 18 years or over and signs the informed consent to participate in the pilot study, then the study implementation team must take over the person and follow the assessment procedure set out in Output 4. 3.2.1. Instrument F00: Recruitment of participants Who completes it: This tool is completed by the SECPAH specialist who receives the application file for determination of the degree of disability. It must be checked in each county who receives and records the files for classification in the degree of disability. If upon receipt it is not a SECPAH specialist, but, for example, a representative from the DGASPC Registry, then a mechanism must be put into operation by which every file is sent to a SECPAH specialist. For whom to fill in: For all persons who apply for degree of disability determination and who are informed of the opportunity to contribute to the modernization of the disability assessment system by participating in the pilot study. The F00 form is filled in for both persons who agree to participate in the pilot study, as well as for refusals. Content: The F00 form comprises two sections, the first section of socio-demographic data (address, gender, age, general situation) and the second section with information about the recruitment process. 3.2.2. Instrument F0: Registration of participants and informed consent Who completes it: This tool is completed by the SECPAH specialist who receives the application file for determination of the degree of disability. It must be checked in each county who receives and records the files for classification in the degree of disability. If upon receipt it is not a SECPAH specialist, but, for example, a representative from the DGASPC Registry, then a mechanism must be put into operation by which every file is sent to a SECPAH specialist. For whom to fill in: Only for informed persons who accept participation in the pilot study. Content: The F0 form consists of two sections. The first section contains socio-demographic data either automatically taken from the F00 form or filled in from the documents on file. The second section is about the existing certificate of degree of disability determination (if any), obtained by the applicant in accordance with the rules in force. Comments: In the F0 form is found the unique identification code (ID) automatically generated for each participant in the pilot study. This unique code will identify the person throughout the entire assessment process and will be used to anonymize the data. 4. Disability assessment instruments The scientific standards for assessment procedures require that evaluations are evidence-based, correct (valid) and consistently produced by all (reliable) assessors. With regard to the assessment of the person's disability as a whole, the only way to comply with scientific standards is for the assessment tools, the criteria for thresholds and procedures to be aligned with the conceptualization of the ICF on functioning and disability. A disability assessment that is random, unstructured, arbitrary or subject to the assessor's biases does not 24 meet any threshold of objectivity or validity. While no administrative process can be free of manipulation, corruption or fraud, each government is obliged to strive to make the process as fair and valid as possible. Moreover, as the rights and well-being of every citizen are at stake in the assessment of disability, both procedures and tools should be assessed in terms of equitable access for all citizens, the quality of the information used, and the validity and reliability of the assessment. These are acceptable minimum standards for assessing disability that no government can ignore. In line with the ICF theoretical model, the new general methodology defines disability assessment as a two- step process. The first stage is the medical (and psychological) assessment based on medical and psychological criteria, and the second stage is the assessment of functioning using the WHODAS+RO questionnaire, as shown by Output 2. Disability assessment, as a synthetic or global measure of disability, must necessarily be based both on the health of the individual and on levels of functioning in all areas of action, simple and complex, from walking, childcare, to employment. A summary disability assessment is only valid if specific assessments can be summarized statistically in a single assessment score. This implies that, first of all, the assessment of functioning is based on a solid psychometric tool, which allows to determine a single operating score from the evaluations of specific activities. The WHODAS 2.0 questionnaire meets the essential requirement of a psychometrically sound instrument. 30 Secondly, disability assessment is the statistically aggregated measure of the two specific scores of the medical assessment and functioning assessment, using a combination algorithm. PILOT Several types of medical score and performance score combination algorithms are included in Output 5 to determine the disability score of the person as a whole. They will be tested in the pilot study. The final decision on the mixing algorithm will be taken at the end of the one-year pilot study, depending on the results of the statistical analysis of the pilot data and international best practices in this field. Accordingly, the new package of assessment tools includes three medical and psychological assessment tools and the WHODAS+RO questionnaire for assessing the functioning which is accompanied by a Guide of ICF descriptors and qualifiers. These instruments can be found in Annex 2. 4.1. Working tools for medical and psychological assessment The three new tools for medical and psychological assessment (Annex 2.1) are as follows: • Standardized "green" form for doctors • Minimum requirements for the psychological assessment report • F1 = Medical and psychological assessment form. 4.1.1. Standardization of the documents to be included in the application file The legislation in force regarding the medical-psychological assessment procedure provides that a specialized doctor and, for certain medical conditions, a clinical psychologist provide the initial assessment and documentation for the certifying application file. The new unified comprehensive assessment procedure 31 puts forward to complete the documentation from the file requested by law with a "green form" for doctors and 30 The WHODAS+RO questionnaire is the adaptation for Romania of the WHODAS 2.0 questionnaire developed and validated by WHO. 31 This will be presented in Output 4. 25 with a list of minimum requirements for the assessment reports prepared by clinical psychologists. Introducing these two new tools can add value in a number of ways. First, the introduction of the 'green form' could contribute to increased access to disability assessment. The diagnosis report 32 shows that people with disabilities face numerous barriers to access, including the lack of awareness of the existence and ability to request a package of benefits-services associated with the certificate of degree of disability determination. The provision of a special (green) form by the doctor is a way of raising awareness, initial information and communicating with all the potential applicants for a disability certificate. Once the person receives such a form, the medical facility should provide an initial package of information. Then the person could make an informed decision whether or not to apply for a disability certificate. Also, the persons with disabilities interviewed mentioned such a procedure as "the best information option". Secondly, once a critical mass of doctors and psychologists will use the new tools, it will be possible to first estimate the number of people diagnosed by a specialist doctor as suffering from a medical condition related to disability criteria. It will also be possible to estimate the absorption rate and the extent of the abandonment/refusal phenomenon due to the barriers affecting admission and registration for obtaining a disability certificate. Until then, this type of data is not available in Romania. Thirdly, the introduction of new tools can help to solve some of the main problems associated with obtaining medical and psychological documents, as shown in the same diagnosis report. 33 Thus, the introduction of standardized forms is a way to limit the possibilities of obtaining / providing medical and psychological documents prone to fraud. At the same time, to complete the new tools, specialist doctors and clinical psychologists will have to use the list of diseases (ICD-10 codes), jointly approved by MMSS and MS, associated with the revised medical criteria. By doing so, specialist doctors and psychologists will become increasingly familiar with the disability criteria. Fourthly, the 'green form' for doctors and completed psychological assessment reports complying with the minimum requirements can add value by providing valuable information for medical and psychological assessment, which is currently only available at random. For this purpose, the green form intended for doctors is designed to collect data on the duration of the condition - the time passed from the onset to the present. The existence of a long-term deficiency is a key element that characterizes disability in the definition of UNCRPD, 34 while the Romanian legal definition of persons with disabilities does not take it into account. 35 However, in most European countries with a disability assessment system, the duration of the deficiency is a key element of the assessment. Other additional information relates to the temporary or permanent character of the deficiency and the possible effects of medical treatment on the overall functioning of the person. New standardized tools for doctors and psychologists should not replace the medical and psychological documentation necessary to determine disability, as required by law, 36 at least not suddenly or in the short term. There is a considerable risk that the approval by the Ministry of Health (and possibly the National Health Insurance House) of the "green form" will drag on. It is likely that the process of assimilation will be slow for specialist doctors, as well as for clinical psychologists, even after the new tools would be approved by the 32 World Bank (2021) Output 1. 33 There are three main problems associated with obtaining medical and psychological documents. The first involves the financial and geographical accessibility of specialized medical services. The second involves suspicions of fraud and how suspicious cases are handled. The third concerns the limited knowledge of medical professionals about disability criteria. 34 The CRPD considers disability to be the experiences of people "who have long term physical deficiencies, mental, intellectual or sensory which, in interaction with various barriers, may hinder their full and effective participation in society, on an equal basis with others'. 35 In accordance with Law no. 448/2006, "Persons with disabilities are those people whose social environment, not adapted to their physical, sensory, mental deficiencies, mental and/or associated, totally hinders them or limits their access with equal opportunities to the life of society, requiring protective measures in support of social integration and inclusion." 36 According to GD no. 430/2008 (art. 6), the application file for disability determination for adults must contain the following medical documents: (i) report on the present medical situation, elaborated by the specialist doctor. The law does not provide for particular requirements regarding the medical specialty; (ii) standard medical letter from the family doctor, only in the case of the first disability assessment (during lifetime); (iii) copies of exit/discharge tickets from the hospital, if applicable; and (iv) paraclinical investigations requested by the SECPAH. Also, a medical report from a clinical psychologist is required for certain medical conditions. 26 Ministry of Health/CNAS, respectively by the National College of Psychologists. Therefore, it is recommended to introduce these new tools as soon as possible, precisely because they need time to become a common practice. • The medical "green form" must be filled in by the specialist doctors (together with the report on the present medical situation) or by the family doctors (besides the medical-type letter), only in the case of the first assessment of the disability (during lifetime). • The minimum requirements should be observed by all clinical psychologists who draw up medical reports for disability assessment. • The medical "green form" and the psychological assessment report should have assigned a validity term, for example, of 12 months. In short, new standardized tools should collect data on: the main diagnosis, possible secondary diagnoses, the continuous or fluctuating nature of the symptoms of the health condition, the nature and dosage of treatment, and, if possible, prognostic elements on the course of the disease. 4.1.2. Instrument F1: Medical and Psychological Assessment Who completes it: The medical and psychological assessment is carried out by a team consisting of at least the specialist doctor and a SECPAH/CEPAH psychologist. The decision on the composition of the team is taken by the head of the SECPAH, depending on the characteristics of the case and the availability of specialists. Infographic 5: STAGE 1. Medical and psychological assessment: Flow of activities For whom to fill in: Form F1 is filled in for all participants in the pilot study. Programming for the medical and psychological assessment from the pilot study should be correlated with the interview conducted according to the current legislation (so that the two assessments are possible at the same time). Content: The results and findings of the assessment team shall be recorded in the F1 form. 27 Remarks: The team consisting of doctor and psychologist makes the assessment by analyzing the medical and psychological documents in the file, in addition to face-to-face or online interviews with the applicant. The face-to-face interview can be conducted, based on a prior programming, either at SECPAH premises, or in the applicant’s home, for bedridden persons. The team uses the revised medical and psychological criteria (Output 2) to establish the medical/psychological score, in addition to the type of disability and the recommended validity term for the certificate. 4.2. Working tools for the functioning assessment The research team has developed two new tools for functioning assessment, namely: • F2 = Functioning assessment form containing the WHODAS+RO questionnaire (Annex 2.2), followed by the Expression of Interest Form (FEI) initiating the assessment of individual needs; 37 • Guide for ICF descriptors 38 and qualifiers from WHODAS+RO (Annex 2.3). The objective of this Advisory Services Agreement is to promote a paradigm shift, moving from the deficiency/impairment-based approach to the disability-based one, thus aligning the assessment of disability in Romania with the ICF principles. To this end, first of all, information from a psychosocial perspective must be collected in a scientific manner and in a coherent way, standardized in all counties of the country. Second, this information must have the same real, transparent and quantifiable impact on the final assessment for disability classification in all cases and in all counties. That is, the assessment of the functioning must be based on a psychometrically robust assessment tool that has been validated in practice and has been statistically proven to be both valid (it really identifies the phenomenon to be evaluated) and reliable (it constantly reaches the same result). Output 2 has already shown that the WHODAS+RO questionnaire is the tool for assessment of the functioning (and supported this choice). WHODAS+RO is an adaptation for Romania of the WHODAS 2.0 questionnaire which is the official standard tool developed by WHO for performance-based disability assessment. 39 37 The FEI is discussed in Output 2, section 4.4.1. 38 In this document, ICF categories/descriptors/parameters are used interchangeably. 39 WHO provides free access to and use of WHODAS 2.0. 28 4.2.1. Instrument F2: Functioning Assessment WHODAS+RO Who completes it: The assessment of functioning is carried out by applying the WHODAS+RO questionnaire, within a face-to-face interview or online, by a SECPAH / CEPAH practitioner, thoroughly trained to use the new tool, which can be a doctor, a psychologist, a psycho-pedagogue or a social worker. The face-to-face interview can be conducted, based on a prior programming, either at SECPAH premises, or in the applicant’s home, for bedridden persons. For whom to fill in: The F2 form is filled in for all participants in the pilot study. Within the pilot study, scheduling the interview for assessment of functioning should be correlated with the schedule for the medical and psychological assessment, while the latter ones should also be correlated with the assessment on disability determination, based on the current legislation. Content: The adaptations for Romania of the full standard version of WHODAS 2.0 mainly refer to the items included in the questionnaire and the guidelines for administration. More specifically, nine more items are added to the standard set of 36 items, which Romanian experts in the field of disability perceive as essential for the national context. The nine additional questions are aimed at "improving" WHODAS in areas 1. Cognition (especially for persons with intellectual and mental disabilities), 2. Mobility (especially for persons with physical and mobility disabilities) and 3. Personal autonomy. 40 Infographic 6: STAGE 2. Performance assessment: Activity flow WHODAS+RO is a standardized tool that contains 45 questions that correspond to the relevant categories in the ICF, selected in Output 2 (section 3.3) and capture the level of functioning in six areas of life. 41 This selection of ICF domains has been statistically generated and validated on the basis of hundreds of empirical studies. 40 According to the ANPDPD experts, a tool with only 36 items, compared to 99 for 17-year-olds, is likely to increase the gap between children and adults in terms of determining the degree of disability. 41 The six areas of life correspond for nine chapters of the ICF (Output 2, Table 3). 29 PILOT The entire set of 45 items of WHODAS+RO will be tested through the pilot study. The final set of questions will be decided only after the first six months of piloting, at the mid-term assessment of the implementation period, based on the statistical analysis of reliability and validity. Note: See Annex 2.2. The set of ICF descriptors included in WHODAS is relevant for all diseases, including mental, neurological and addictive disorders, and has associated population norms recently calculated on the population of the same region of the world as Romania, which provides a safe and meaningful comparison term for the data to be collected through the pilot study. All the questions in WHODAS+RO: (1) measure the degree of difficulty 42 in carrying out the activities, (2) because of the health condition 43 and not for other reasons, (3) taking into account the way in which the person usually carries out the activity, (4) are based on ICF descriptors, (5) refer to the same time interval (in the last 30 days) 44 and (6) uses the same five-level response scale in Table 2. 42 Increased effort, discomfort or pain, slowness, changes in the way the person does that activity. 43 Diseases, conditions or other health problems, injuries, mental or emotional problems, problems with alcohol, problems with drugs. 44 Where it exists variations in the degree of difficulty over the course of Last 30 days, Respondents Are ask them to give a score that averages the good days, and of the days Bad. 30 Table 2: The response scale used in WHODAS+RO Taking into account how the person usually Taking into account how the person usually carries out the activity carries out the activity NO personal or technical assistance usually WITH personal or technical support usually available available Not at A little Moderate Very Extreme Not at A little Moderate Very Extreme N/A all difficult difficult or I all difficult difficult or I couldn't couldn't do it do it 1 2 3 4 5 1 2 3 4 5 0 Will not be used Will be used Measurement without personal or technical to determine the metric and the synthetic score, assistance is an estimate of the person's which will contribute to the classification in a capabilities and not of performance (the degree of disability. perspective selected to be used in Romania). Note: N/A - Not applicable – Respondents may sometimes consider that a question does not apply to their situation, such as if they have not been confronted with the situation questioned (e.g. for question D4.5, relating to sexual activities). In this case, the N/A response option is recorded. The interviewer must check all the answers of the type "Not applicable". If, in the verification process, it appears that the respondents consider that a question is not applicable to them because they cannot do the respective activity, the item is marked with 5 "Extreme or I could not do". A proper check in this situation would be: - Can you tell me why this question does not apply to you? Among the reasons given by the respondents can be aspects such as the fact that they do not expect them in their culture to do this activity or that they have not experienced this activity in the past 30 days. In addition, WHODAS+RO is completed by a short section on the feedback from both the applicant and the assessor/interviewer (SECPAH practitioner). Table 3: In order to collect systematic feedback during the pilot study, WHODAS+RO will include: Feedback from applicants Feedback from SECPAH assessors - Do you think the - How many minutes did the interview last? questions are relevant? - How difficult was it to apply WHODAS+RO? - Was the interview - Have you encountered any difficulties in assigning the qualifiers? If so, for what conducted in a respectful items? way? - In your opinion, how reliable is the information provided by the applicant? Given all the data in the application file, an interviewer may not always agree with the respondent's response. - To what extent did you experience such discomfort during the application of the questionnaire? - Have you recorded the response given by the applicant or have you changed it to make the information more accurate? Comments: For applicants with psychiatric disorders with psychotic symptoms or intellectual disabilities, the participation of the legal representative/attendant/family in the interview will be allowed, as in these cases the person's answers to the WHODAS questions may not correctly reflect the reality. In addition, for these cases, the WHODAS+RO questionnaire will be accompanied by cards in easy-to-understand language, in order to facilitate the active participation of the applicants in the interview. The self-administered version of WHODAS was not selected because the probability of fraud and improper completion seems to be quite high in Romania. 31 PILOT However, WHODAS with 12 self-administered items will also be tested in the pilot study on a sample of 200-250 people to be statistically analyzed in a comparative manner. 4.2.2. WHODAS+RO Guide Standardization is an important feature of WHODAS, which must be ensured with care. For assigning the appropriate qualifier in a standardized manner, the WHODAS 2.0 Handbook 45 provides six reference frameworks to answer questions (which respondents should consider when answering). 46 For Romania, beyond the six reference frameworks, the research team has developed the WHODAS+RO Guide, available in Annex 2.3. The guide contains question-by-question instructions (from WHODAS+RO) to ensure that assessors do not provide their own interpretations when applicants ask for clarifications on a particular question. These instructions refer to (1) how each question should be applied and (2) how to assign qualifiers appropriately. In terms of survey administration rules, the team relied heavily on the WHODAS 2.0 Handbook. 47 Regarding the instructions for assigning qualifiers, the team developed helpful/verification questions, vignettes or examples for each question, mainly from the perspective of physical and rehabilitation medicine. However, the instructions for assigning qualifiers are only indicative and mainly refer to the level of pain/discomfort felt by the person being assessed (as patients report to a physical medicine and rehabilitation doctor). In the essence of WHODAS 2.0, as a tool that measures the performance of a person's activities in everyday life and in his/her real environment, the answers are from the perspective of the respondent and not of the specialist. Moreover, for these reasons, the questionnaire is accompanied by cards that facilitate administering the questionnaire. An assessment specialist may not always agree with the respondent's response, but the response received must be the one recorded. Even though this can be frustrating, the evaluator specialists must comply with this standard to ensure consistency in the administration of the tool. In addition, let us not forget that the assessed person is informed from the very beginning of the interview that the answer must refer to the degree of difficulty they encounter in carrying out the activity in question (increased effort, discomfort or pain, slowness, etc.) due to the health condition and not from other causes. 5. Tools for assessing service and support needs After completing the disability assessment phase, the degree of disability is determined based on an algorithm (applied automatically) that combines the medical-psychological score with the score obtained from WHODAS+RO). However, under the general methodology proposed in Output 2, granting access to certain services, such as personal assistance, is not automatic, but depends on the outcome of an individual needs assessment, a separate step that follows certification. Especially if the initial set of rights (granted immediately after certification) is minimal, as expected, it is unnecessary and costly to engage all applicants in a comprehensive disability assessment process. Certification is only a preliminary stage of eligibility that is followed by a more thorough assessment that can link individual needs to available services. Therefore, the new general methodology proposes a clear separation between the assessment of disability and the assessment of the support needs of adults with disabilities. The needs assessment follows the disability 45 WHO (2010). 46 See the six reference frames in Deliverable 2, Table 2. 47 WHO (2010) Chapter 7. 32 assessment: only people who obtain a disability certificate will benefit from the needs assessment. The needs assessment incorporates all the mandatory areas (in the law) of assessment that are not covered in the previous stages. The purpose of the individual needs assessment is to promote greater autonomy for persons with disabilities so that they can enjoy their rights and fully participate in social and economic life. Consequently, this stage is related to people's access to services, case management of adults with disabilities and service planning at the local and national level. The needs assessment methodology is extensively presented in Output 2. The needs assessment includes six modules, namely: social, vocational and educational, personal assistance, home adaptation, assisted decision-making and needs for other services. Accordingly, a specific tool has been developed for each assessment module, namely: Anexa_Asoc = Annex for adults with disabilities to the social inquiry M0 = First contact for the assessment of individual needs M1 = Support needs in education and work M2 = Personal assistance needs M3 = Support needs for independent living: home adaptation M4 = Needs for support in decision-making on the management of economic resources M5 = Inventory of needs not covered by services and support (included in PLIN) PLIN = Individualized Plan These tools are set out below. 5.1. Social assessment: Annex for adults with disabilities to the social inquiry The social assessment is carried out on the basis of a new model of Annex for adults with disabilities to the social inquiry (Anexa_Asoc) to be completed at the level of SPAS. Anexa_Asoc is available in Annex 3.1. From the point of view of the theoretical model, 48 Anexa_Asoc is aligned with the ICF and is designed from the perspective of performance (and not capacity), 49 that is, it shows what people actually do, their real experience in everyday life, in the context of all the environmental barriers and facilitators they face. In other words, Anexa_Asoc provides the information from the person's living environment, which is necessary for all modules for assessing individual needs. The focus is on identifying the answers to the question How can we remove barriers and what kind of support is needed? for each individual person. In this way, the new Anexa_Asoc model corrects the main problems related to the social assessment identified in the diagnosis report (Output 1), namely: The data for social assessment are not collected systematically or uniformly, although they come mainly from social inquiries carried out by most SPAS on the basis of the framework model provided for in the legislation. 50 According to SECPAH specialists, the completeness and accuracy of the information is unsatisfactory, especially with regard to dwelling/housing, individual’s material status and community services. In addition, the social inquiry from the file rarely includes comprehensive information about the applicant's life context, daily routine, lifestyle choices or difficulties, with a focus on contextual and environmental factors that could act as a resource (facilitator) or as a barrier (obstacle). In addition, the framework model of social 48 In agreement with, Senatsverwaltung fur Integration, Arbeit und Soziales (2020) TIB Teilhabeinstrument Berlin, Teilhabeorientierte Individuelle Bedarfsermittlung. 49 According to ICF, 'disability' is any level of problem or difficulty encountered in functioning in a given area from a performance perspective. 50 GD no. 430/2008, Annex 6. 33 inquiry lacks a section that should reflect the point of view of the person with disabilities, such as his or her fears and concerns, how he/she would like to live and plans for the future. Anexa_Asoc content In practical terms, the new Anexa_Asoc model was built by a reverse process. The research team first developed the needs assessment modules. Then, the Anexa_Asoc was designed by organizing the necessary information into sections (as shown in Infographic 7) to which general information on the applicant's household was added. Infographic 7: Content of the Anexa_Asoc in relation to the needs assessment modules Within the online data collection application for the pilot study, the information in the Anexa_Asoc once entered (before the date on which the interview(s) for the needs assessment is scheduled) is automatically pre-filled into the corresponding assessment modules. Social assessment, as part of the process of identifying the needs of the person with disabilities, mainly aims at collecting information that contributes to the analysis of personal factors and environmental factors as well as some information in the sphere of Activities and Participation (as described in the ICF). Therefore, the information in the Anexa_Asoc refers to the household/community in which the assessed person lives. For persons with disabilities living in a residential service (according to GD no. 867/2015), the collected data take into account the household / community to which the person belongs, where he/she will return / could be reintegrated after leaving the institution. The information requested in Anexa_Asoc comes from existing administrative data, direct interaction with the applicant and his/her family, including during a home visit, as well as from other local sources, such as other specialists in the community (doctor, community health nurses, mediator, teachers, policeman, priest, etc.). It is very important that all items in the Anexa_Asoc are completed with a sense of responsibility. If some items are missing, the person's assessment will not be able to be achieved because some scores will not be able to be determined. It is essential that social workers/ SPAS representatives know that the toolkit contains multiple verification keys that allow the identification of erroneous information. Who fills in Anexa_Asoc The social assessment is carried out at the local SPAS level by completing the Anexa_Asoc by the social worker employed or contracted by the SPAS, thoroughly trained to use the new tool. In the absence of a social worker employed or contracted at SPAS level, according to the legal provisions, under the supervision and 34 coordination of a contracted social worker, the social assistance technician, an employee of SPAS, can participate in carrying out the social assessment, within the limits of competences and legal norms. Infographic 8: STEP 4A. Social assessment: Activity flow In carrying out the social inquiry, the social worker will follow the norms regarding the practice of social worker, elaborated and approved by the National College of Social Workers in Romania (CNASR). 51 Thus, the documents resulting from the assessment will be organized within the Beneficiary's File structured in the public file 52 and the professional file. 53 Using the information in the Beneficiary's File, the social worker will prepare the Anexa_Asoc as a specific requirement for the vulnerable group of adults with disabilities, to serve SECPAH for the assessment of individual needs. For this purpose, during the consultation workshops held within the project, CNASR informed that it will organize training courses for specific competences in the social assessment of adults with disabilities and, correlated, will develop a specific Guide for the intervention of the social worker in the field of persons with disabilities which will include, among other things, instructions for the use and application of Anexa_Asoc along with specific references for the practice of the social worker. For whom the Anexa_Asoc is filled in The request for the Annex to the Social Inquiry is sent by SECPAH/DGASPC, via a standard email, sent once the person has completed the disability assessment phase and has expressed interest in one or more of the services covered by the needs assessment modules within the Expression of Interest Form (FEI within instrument F2). The application can also be submitted after the assessment, by persons with a disability certificate within the validity term, directly to the SPAS, which will inform the SECPAH / DGASPC and will set an appointment for the assessment of individual needs. SPAS fill in the Anexa_Asoc, according to the model in Annex 3.1, and send it (by post, email) to SECPAH. Once the SECPAH designates the case manager and sets a date for interviews, the date is communicated to SPAS, 51 Including Code of Ethics and Code of Practice of the Social Worker. 52 The public file contains the following documents: Social assessment report; Statements/opinions of the beneficiary/family members/other persons; Addresses, correspondence with other institutions. 53 The professional file contains the following documents (letters a to f are mandatory): (a) Anamnesis of the beneficiary, (b) Assessment of risk factors, (c) Observation notes, (d) Interview guide and interview notes, (e) Statements/opinions expressed by the beneficiary, (f) Statements/opinions expressed by family members/other close persons, (g) Ecomapa, (h) Genogram, (i) Other, as appropriate. 35 which will transmit it to the applicant. If possible, the town hall/SPAS can support the person with access to a computer connected to the Internet (if the person does not have) so that interviews can be held online. 54 Observations PILOT Within the pilot study, social inquiry reports with the Annex for adults with disabilities, on the new format developed within the project, will become available only after the first three months of data collection. Most likely, they will only be available for some cases and not for all. This depends on the willingness of the local social workers/SPAS representatives to participate and complete surveys on the new format for adult assessment applicants for disability. The data collection application for the pilot study contains a special module for the social inquiry that will accommodate both surveys on the new format sent by the SPASs and the surveys completed by the case-responsible, subject to data availability in the social inquiries from the file, prepared in accordance with the framework model currently in force. 5.2. Modules for the assessment of individual needs Currently, according to the diagnosis report (Output 1), the needs assessment is carried out by SECPAH, 55 but is not done with adequate assessment tools or according to a specific methodology. The only tools that include conclusions on service needs are the Individual Rehabilitation and Social Integration Program (PIRIS) and the Individual Service Plan (PIS). In addition, needs assessment is not related to case management for adults with disabilities (living in the family), which is underdeveloped. Services are poorly developed, mostly medicalized and highly fragmented. There is also no mechanism linking the data collected for needs assessment and service planning at local and national level. All these malfunctions are addressed within the framework of the new needs assessment methodology proposed for adults with disabilities (Output 2). The needs assessment follows the disability certification phase, which means that only people for whom the status of person with disabilities has been established can benefit from the assessment of individual needs. In accordance with the project terms of reference, in order to improve the needs assessment, the project team selected a relevant set of ICF categories corresponding to a set of services for persons with disabilities, identified with key stakeholders in a participatory manner, from those available in Romania. 56 The entire newly developed package of tools for needs assessment: - is based on ICF categories, - measure the frequency, intensity and type of support that is needed to ensure a level of activities and participation on equal terms with others, in different ICF areas of life - for each ICF domain, categories/descriptors regarding activities and participation are selected. And for each of these, it is explored (i) what the individual can do – the help received/facilitators, (ii) what the individual cannot do – the uncovered support//barriers, as well as (iii) the individual's will/plans/preferences - they relate to performance and not to capacity, that is, they take into account what a person actually does, in his/her daily life, in his/her real living environment - considers the will of the person as the key personal factor, in accordance with Article 9 of the UNCRPD. 54 Ideally, SPAS would have access to the online data collection application and would fill in the Anexa_Asoc directly in the system and not on paper. 55 In in accordance with Article 23 of GD no. 268/2007. 56 Of also, the selection of the ICF category set for needs assessment took into account the results of the 2017 PHRD technical assistance grant in Japan. More specifically, the ICF category set also took into account, inter alia, the core set of 'Gold D's' identified in the Japanese grant as relevant to all 42 homogeneous groups of analyzed medical conditions. 36 The needs assessment is organized according to the ICF areas (life areas) selected in terms of activities and participation. And the ICF domains are selected according to the existing services in Romania for persons with disabilities. The selection of the services according to which to structure the needs assessment followed a five- step approach, described in Output 2. Thus, the research team established four distinct needs assessment modules (M1, M2, M3 and M4) that are subsumed to the concept of independent living understood as choice and control in everyday life for persons with disabilities, on equal terms with the general population, to which two additional modules (M0 and M5) were added. 57 The specific tools developed for these assessment modules are discussed in the sections below and found in Annex 3. So, the assessment of individual needs is modular, based on UNCRPD principle according to which there is no solution / measure that suits everyone: persons with disabilities have diverse support needs and costs. The new individual needs assessment model takes into account that some persons with disabilities do not want or do not have a disability degree that qualifies them for one or more of the different types of benefits and services (available or expected to be developed). In fact, it is expected that most applicants will request services/support in one or two of the areas included in the assessment, while only a few will want/need a full assessment. The needs assessment is also voluntary to ensure freedom of choice and control of persons with disabilities over their own lives, including the support received, in line with the UNCRPD. Thus, each person with a disability certificate can decide according to their own conditions and lifestyle whether or not to participate in the needs assessment and, implicitly, to have access to the services targeted by it (professional potential profile, personal assistance, home accessibility profile, assisted decision or inventory of uncovered needs). And if he/she decides to take part in the needs assessment, he/she can choose the modules of interest, the assessment being completed with an Individualized Plan (PLIN) that includes all the information necessary to initiate the case management (as it will develop and become available to more adults with disabilities). 5.2.1. Instrument M0: First contact for the assessment of individual needs The assessment of individual needs is initiated at the end of the functioning assessment phase. At the end of the disability assessment phase, applicants are informed about the existence, content and purpose of the assessment of individual needs. Thereafter, in the last section of form F2 (Annex 2.2), the Expression of Interest Form (FEI) for each person is filled in, even if they declare that they have no interest in any needs assessment module. For persons requesting the needs assessment (one or more modules), after the SPAS submits the Anexa_Asoc, the head of the SECPAH appoints a case responsible who schedules the interviews. Appointments are communicated to the person (through SPAS) and the needs assessment is started with the first contact between the applicant and the case responsible. The M0 form is the instrument corresponding to the first contact. It is available in Annex 3.2. Who completes it The case responsible is the coordinator of the individual needs assessment and the contact person for the applicant. The case responsible ensures that all the required assessment modules are filled in, using various sources of information and participating in face-to-face/online interviews with the applicant. The face-to-face interview may be conducted, either at SECPAH premises or at the applicants' homes, for persons who are not able to move. 57 The choice of needs assessment modules has been confirmed as optimal in the current context, within the framework of the consultation process carried out with representatives of the SECPAH/CEPAH, NGOs and persons with disabilities,. 37 Infographic 9: STEP 4B. Individual Needs Assessment Modules: Activity Flow For whom to fill in For all persons with a disability certificate who have expressed their interest in one or more assessment modules (M1-M5). Content The M0 tool is organized into three sections. The first two sections are automatically prefilled selected information from those already obtained within the forms F00 (recruitment), F0 (registration), F1 (medical and psychological assessment), F2 (WHODAS+RO) and Anexa_Asoc. Section 3 collects new information on the applicant's choices regarding the assessment modules. Upon first contact with the case responsible (in M0), the person can change his or her mind and change the options expressed in the initiation phase (the initial FEI in F2). Using the last options of the assessed person, the case responsible establishes with him/her (and possibly his/her family/representative) the plan of interviews for the needs assessment, which is recorded in the last section of the M0 form. 38 Note: See also Annex 3.2. Observations As Output 2 already mentions, the concern of NGOs and persons with disabilities expressed during the consultation workshops is that, in the initiation phase, the SECPAH specialists will carry out the information on the needs assessment only formally, without ensuring that the person really understood. That is, there would be a considerable risk that many people would fill in and sign a FEI with a 'no' to all modules, and in this way, the right of many people to assessment would be infringed. In order to prevent this risk, the project provides for the training of SECPAH specialists involved in the pilot study and the development of an informative material 58 to support the SECPAH evaluators and be handed over to the person. Also, the unified assessment procedure (Output 4) proposes the possibility for the person to be able to express their interest and independently of the assessment / certification of the disability. That is, the person can go home, consult or find out from other people (or from the information sheet) more information that will make him/ her change his/ her mind and realize that he/ she wants to benefit from one or more modules of needs assessment. In this situation, it requests the realization of the Anexa_Asoc at SPAS, SPAS transmits the Anexa_Asoc to SECPAH and asks for the start of the needs assessment for that person. In addition, under Output 6, the World Bank team will develop proposals for building a mechanism to properly set dissatisfaction and appeals at DGASPC level. 5.2.2. Instrument M1: Support needs in education and work Output 1 showed that data for vocational and education assessment are currently collected sporadically and unevenly in the absence of a specific methodology or tool. This type of assessment is only available in 29-30 counties in the country. Moreover, according to SECPAH specialists, the data that is currently collected only allows for a less satisfactory assessment from a psychosocial point of view, both in terms of activity limitations, participation restrictions or environmental factors that can act as barriers or facilitators. For this reason, within the project, the research team selected this assessment module created with the aim of increasing the access of adults with disabilities to active services on the labor market and educational services. The M1 instrument is expected to be applied uniformly at national level. 58 Informative Worksheet "What you need to know about the assessment of individual needs" that will be part of Output 4. 39 How and by whom the assessment module is initiated Module 1 is made at the request of the person with disabilities or other persons or organizations/ institutions (for example, employer) who want to hire the assessed person or help them find a suitable job. If the M1 module is initiated at the request of someone else, the assessment is carried out only with the written consent of the person being assessed. Who fills in the tool Preferably, the M1 module is complemented by a multidisciplinary team of SECPAH specialists who, in addition to the case responsible, may include psycho-pedagogues, education instructors, rehabilitation pedagogues, psychologists with specialization in work and organizational psychology or with other specializations, professional guidance counselors, assisted employment specialists (COR 263507) or vocational assessment specialists (COR 263506). If this is not possible, the interview may also be conducted by the case responsible. The assessment shall be carried out in the framework of a face-to-face interview, organized at SECPAH headquarters, or online. 59 For whom to fill in For all persons with a disability certificate who have expressed their interest in module M1 regarding the needs in the field of work and education. M1 is strongly recommended for young people of 18-35 years. Content The M1 instrument (Annex 3.2) has been built on the basis of existing legislation and good practice (international and national), mainly: • Comănescu, G. M., Predescu, C. and Stanciu, M. (2014) Case study. Vocation and integration into work • Finger M., Escorpizo R., Bostan C., De Bie R., Work Rehabilitation Questionnaire (WORQ) • Nottinghamshire Healthcare Vocational Profile, Positive in Mental Health and Learning Disabilities, NHS Foundation Trust • Virtual DS and EUSE (2014) Vocational profile. Instruments for supported employment. Simplified guide • ROM-CAT evaluation tool (already used in some counties) • MMFPPV-MS-MEC Order no. 1985/1305/5805/2016, 60 ANNEX 6 Environmental factors - annex model of the social inquiry for children with disabilities and/or special educational needs • Law nr. 448/2006 on the protection and promotion of the rights of persons with disabilities, including the rights that support the stimulation of employment: professional training courses; reasonable adaptation to the workplace; counseling during the pre-employment period and during the employment, as well as during the probationary period, from an adviser specialized in labor mediation; a paid probationary period of at least 45 working days; a paid notice, of at least 30 working days, granted at the end of the individual employment contract at the initiative of the employer, for reasons not attributable to him, as well as the possibility to work less than 8 hours a day, under the law, if he/she benefits from the recommendation of the assessment committee in this regard. The M1 tool is organized into three sections. In the first two sections, selected information is automatically pre-filled from that already obtained in the M0 forms (first contact) and Anexa_Asoc. Section 3 gathers new information on future aspirations related to education, training and work, professional potential, skills and references, as well as the needs for support and adaptations for work of the assessed person. 59 Currently, according to legislation, online interviewing is only possible in the context of crisis situations (e.g., pandemics/epidemics). However, Deliverable 1 has already highlighted that in many counties, disability assessment is carried out only on paperwork, in the absence of an interview. 60 Order MMFPPV-MS-MEC No. 1985/1305/5805/2016 on the approval of the methodology for integrated evaluation and intervention in order to classify children with disabilities in the degree of disability, the school and professional orientation of children with special educational needs, as well as for the empowerment and rehabilitation of children with disabilities and/or special educational needs. 40 Note: See also Annex 3.2. What it ends with The M1 module ends with a Professional Potential Profile, which can be useful for identifying a suitable job or an alternative to complement education. The profile of professional potential is proposed to replace the current certificate of professional orientation that does not provide any information that could serve the person with disabilities in accessing active employment services or educational services. 61 It should be noted that the instrument corresponding to the M1 module was not designed as a vocational profile tool that matches a person with a specific job, nor as a profile in the preparation of a specific intervention. According to the legislation, vocational assessment falls within the responsibilities of the AJOFM, the institution that monitors the employment situation and undertakes job mediation. At the same time, the M1 instrument is neither a vocational advice tool, nor a work capacity test. Although the M1 tool contains some elements used in the aforementioned instrument types, M1 was created with the aim of serving as: - opportunity to encourage and reflect on the potential and abilities of the person with disabilities - opportunity to inform people with disabilities about the sphere of work and education - summary of a package of information that may be useful for any of the aforementioned types of instruments and for any type of employment – formal, assisted or voluntary (fulltime or part-time). In line with the CRPD, the M1 instrument contributes to the paradigm change by shifting the focus from the inability to work to the professional potential of adults with disabilities. Also, the profile of professional potential can contribute to the achievement of targets 11 and 12 of the Operational Plan on the implementation of the NSDP "A Fair Romania", 2022-2027, 62 to the extent that it will be completed for as many as possible persons with disabilities of working age and will be effectively used to support beneficiaries in finding a suitable job or an alternative to complement education. However, in the current context, most likely, the Professional Potential Profile will have symbolic value for persons with disabilities, but with low value on the labor market. And this is primarily due to the current institutional arrangement between SECPAH/DGASPC and AJOFM. Between the DGASPC and AJOFM there are no protocols or a referral system either for carrying out the vocational assessment or for taking over the 61 Format Professional Potential Profile standard will be part of Deliverable 4. 62 Operational Plan implementation of the NSDP, Annex 2. Target 11 = In 2027, people with a degree of disability accessing the employment incentive measures represent 2% of the total number of people accessing these measures; Target 12 = As of 2027, 5,000 people with disabilities receive work-related training and assisted employment. 41 persons benefiting from the Professional Potential Profile (currently a certificate of vocational guidance). And within the AJOFMs there is no specialist specially designated to deal with persons with disabilities, offering assistance services to those who want to enter the labor market, in order to find and access from the offer of existing services the most appropriate ones. Until the cooperation and allocation of legal responsibilities between these institutions is improved (including at national level, between ANPDPD and ANOFM), there is no way to increase the efficiency of the new Professional Potential Profile (or of any other type of vocational assessment carried out by SECPAH). Validity of the assessment module The M1 module has a validity term of maximum two years and can be renewed at any time at the request of the person with disabilities or other persons / institutions, with the consent of the assessed person. Observations Based on existing data, a small expected number of requests for this assessment module can be estimated. That is why increasing interest in the M1 module, especially among young people with disabilities, represents a challenge for SECPAH specialists involved in the pilot study. This challenge is even greater in the context of the DGASPC-AJOFM institutional arrangement mentioned above, along with a poor presence of assisted employment opportunities, protected units, occupational rehabilitation services and, more generally, active labor market services for vulnerable groups. 5.2.3. Instrument M2: Personal assistance needs The M2 assessment module takes into account all forms of personal assistance defined by the Romanian law. According to art. 5, point 6 of Law nr. 448/2006, the personal assistant of the person with severe disabilities is the person who supervises, provides assistance and care to the child or adult with severe disabilities, based on the empowerment-rehabilitation plan for the disabled child, respectively the individual service plan of the adult with disabilities. In point 7 of the same article 5 the professional personal assistant is defined - the certified person who ensures at his/her home the care and protection of the adult with a severe or marked disability, under the conditions specified by the law. And in section 8 of the law living assistance is defined, which includes animal assistance, such as the guide dog. Currently, the assessment of needs for personal assistance is merged with the assessment for disability. Thus, a person is not only classified in the severe degree of disability, but simultaneously is also granted/rejected the right to personal assistance, in the absence of a specific and explicit assessment. 63 Output 1 showed that the way in which this right is granted as well as the way in which access to the personal assistant service 64 is treated differs substantially between counties. Moreover, data to assess the level of social integration (degree of dependence) 65 are collected sporadically and unevenly. This type of assessment is only available in 34 counties and not in the whole country. And, from the ICF perspective, the tools currently used to assess the level of social integration are still too focused on the medical aspects, are not participatory enough and are based on models that need to be reviewed to include the person's resources, how they want to live and environmental factors, in addition to the needs identified by the assessment. 63 Legislation provides four degrees of disability – mild, medium, marked and severe. In fact, however, on the certificate, two subtypes of serious grade are recorded – with and without a personal assistant. 64 Adults with severe disabilities with a personal assistant can opt for a personal assistant or a monthly accompanying allowance, and this option is expressed by written application registered with DGASPC. Even so, only the CEPAH secretariats from 5 counties and 1 sector in Bucharest provided data in this regard, because although they collect them, these data are not recorded in a database from which they can be easily extracted. Among the 6 DGASPC's, the share of options for monthly allowances (instead of a personal assistant) is between 30% and over 90% of persons with severe disabilities with personal assistants in the county. In this regard, too, there is no unified approach at national level. 65 One of the six mandatory areas of assessment, in accordance with GD no. 268/2007, art. 48, respectively Order no. 2298/2012. art. 4. 42 As an aggregate effect, dissatisfaction with the degree of disability, in particular with regard to the decision with/without a personal assistant, is one of the main reasons for appeals against the disability certificate. Additionally, appeals abound not only in the courts of law in the country, but also in the European Court of Human Rights. As a solution, the general methodology developed in this project (Output 2) proposes the net separation between the assessment of the disability degree (and its certification) and the assessment of personal assistance needs. How and by whom the assessment module is initiated Module 2 is made at the request of the person with severe or marked degree of disability or of the legal representative / attendant / family caring for the person, on his/her behalf. The assessment shall be carried out only with the agreement of the person being assessed. 66 Who fills in the tool Preferably, this module is complemented by a multidisciplinary team of SECPAH specialists, under the coordination of the case responsible. The assessment team may include social workers, psychologists, psycho- pedagogues, doctors or physical therapists. It would be preferable for the legal representative/attendant/family of the person to participate in this interview. The assessment is carried out in a face-to-face interview or online. The face-to-face interview may be conducted, on the basis of prior planning, either at SECPAH premises or at the applicants' homes, for bedridden persons. For whom to fill in For all persons with a certificate of severe or marked degree of disability who have expressed their interest in module M2 regarding personal assistance needs. People with a mild or medium degree of disability are not eligible for personal assistance and therefore cannot opt for the M2 needs assessment module. Content The M2 instrument (Annex 3.2) was built on the basis of existing legislation and good practice (international and national), mainly: The needs assessment model developed by the Swedish Institute for Independent Living 67 • American Association on Intellectual and Developmental Disabilities (2004) Supports Intensity Scale • World Bank (2016-2017) results of the PHRD technical assistance grant in Japan • Katz S., T.D. Downs, Cash H.R., Grotz R.C. (1970) Progress in development of the index of ADL • Lawton M.P., Brody E.M. (1969) Assessment of older people: self-maintaining and instrumental activities of daily living • ROM-CAT assessment tool (already used in some counties) • MMFPPV-MS-MEC Order no. 1985/1305/5805/2016, ANNEX 6 Environmental factors - annex model of the social inquiry for children with disabilities and/or special educational needs 68 • Law no. 448/2006 on the protection and promotion of the rights of persons with disabilities. The M2 tool is organized into three sections. In the first two sections, selected information is automatically pre-filled from that already obtained in the M0 forms (first contact) and Anexa_Asoc. Data on the intensity of 66 Currently, according to the legislation, the procedures for granting a personal assistant and professional personal assistant are distinct. 67 Institute for Independent Living is a policy development center specializing in consumer-centric policies designed to ensure freedom of choice, self-determination, self-esteem and the dignity of persons with disabilities. It is a specialized, independent organization with experience in the design and implementation of direct payment schemes for personal assistance, taxi and assistive technology. Link: https://www.independentliving.org/ 68 Order MMFPPV-MS-MEC No. 1985/1305/5805/2016 on the approval of the methodology for integrated evaluation and intervention in order to classify children with disabilities in the degree of disability, the school and professional orientation of children with special educational needs, as well as for the empowerment and rehabilitation of children with disabilities and/or special educational needs. 43 support needs are collected under the Anexa_Asoc and automatically pre-filled in instrument M2. Section 3 collects new information on the daily help/support time (number of minutes and daytime part), the support network (who is currently providing help), the frequency and type of support needs for personal assistance. Note: See also Annex 3.2. To measure the needs for personal assistance, the M2 instrument is built using the needs typology developed by the Swedish Institute for Independent Living, as shown in the figure below. Then, for each type of needs, the relevant ICF categories for which the aforementioned information is identified (daily support time, frequency, intensity, etc.) were selected. 44 What it ends with Module M2 ends with a decision on the person's need for personal assistance and a recommendation on the most appropriate form of personal assistance (in the family, APP or animal). In addition, for persons who are recommended care by a professional personal assistant, information is collected on the preferences of the person with disabilities, in order to support the matching approach. 69 The tool allows the automatic calculation of an overall score by combining scores for the daily help time x the intensity x the frequency of support required. Based on the overall score, a metric can be created to estimate the number of hours/days of personal assistance required. The tool is also designed to enable the identification of the day part (exchange) in which help/support is needed and the types of needs to be covered (personal, domestic or social needs). However, it is only on the basis of the data collected in the pilot study that the appropriate level of analysis can be decided for the way in which personal assistance is provided in Romania, according to the law. Adopting the overall score and identifying a number of hours of personal assistance are the appropriate options if assistance can be provided for, for example, 2 hours/day, 4 hours/day or 24 hours/day if the person needs round-the-clock assistance or even 32 hours/day for non-stop assistance for a wide range of tasks and special needs. That is, it should be possible for the person with disabilities, depending on the identified needs, to benefit from a paid personal assistant for 2 hours / day for a specific set of tasks (for example, accompanying the person when leaving the house and for rehabilitation). But at the same time, for a fair approach, persons with non-stop assistance needs and special needs should be able to benefit from 3 personal assistants (ensuring continuity over the 24 hours of a day), plus possibly a fourth to provide support for a specific set of tasks. It should also be possible to ensure access to home care services as complementary to the personal assistance needed to cover domestic needs. In Romania, currently, the personal assistant is (at best) employed for a conventional number of 8 hours of work, although in fact he/she can provide assistance between 2 and 24 hours, without any differentiation between assistants covering a specific set of tasks versus assistants who provide a wide range of activities. As long as the personal assistance service is not redefined by law, home care services are still insufficiently developed, and a fair approach cannot be ensured (through adequate human and budgetary resources), the assessment of personal assistance needs is preferable to end with an overall score, on the basis of which SECPAH specialists only decide whether the right to personal assistance is granted or not. The transformation of the overall score into an estimated number of required hours of aid/support can be adopted (based on the same instrument) later, after reforming and strengthening the personal support service. Validity of the assessment module The M2 module has a validity term of maximum two years and can be renewed at any time at the request of the person with disabilities or of the legal representative / attendant / family caring for the person, on his/ her behalf. Even if the person has a certificate with a severe or marked degree of disability with a permanent validity term, the assessment of personal assistance needs must be performed every two years, because the circumstances of the person or personal assistant may change sufficiently to produce possible changes in the results of the assessment. Observations Based on existing data, a large expected number of requests for this assessment module can be estimated. Currently, according to the law, only people with a severe degree of disability can benefit from a personal assistant (from the family), while for the APP are eligible both people with a serious degree and with a marked degree of disability. In the new general methodology, people with a severe or marked degree of disability can apply for the M2 module for the assessment of personal assistance needs. Based on the data from the diagnosis report, about 88% of the files evaluated over a calendar year receive the serious or marked degree. 70 It is therefore possible that the vast majority of them require the M2 assessment module. 69 The person also receives an Information Sheet on the list of devices that are found in Romania, organized according to the 16 types of activities included in the assessment, which will be part of Output 4. 70 Across half of the assessed files (51%) receive a marked degree and 37% get a serious grade, of which 30% are with a personal assistant and 7% without a personal assistant (data for 2019, Output 1). 45 In terms of paradigm shift, the M2 assessment module proposes the transition from personal assistance based almost exclusively on the family (as it is currently) to the gradual development of a network of personal assistants from outside the family, employed on a contract basis, who provide a number of hours of care at the person's home, in accordance with his/her specific needs. This system (of non-family assistants) is the optimal alternative in the more general context of the deinstitutionalization process. Even though it involves high costs in the development phase, it has the potential to prevent the growing number of applications for residential social services (centers of all kinds, including sheltered housing) with substantial associated costs. Therefore, in parallel with the modernization of the disability assessment, another project should be developed aimed at developing the network of personal assistants from outside the family, which could be managed by NGOs, companies, DGASPC and city halls. To this end, the rules on personal support service should be rethought, with a clear distinction between services provided by the family and services provided by the network of non-family personal assistants (including APP). The regulation of the APP is not sufficient and, although it responds to specific needs (e.g. the continuity of foster care services when switching from children to adults with disabilities), it does not correspond to international models of good practice. The standard model is a FSS with hired assistants. The FSS makes a contract with the disabled person to whom it provides personal assistance services at home, for a fee. The contract clearly states the number of hours of care, activities, exchange (morning, afternoon, night) and the cost to be borne by the beneficiary. The FSS has a responsibility to train, supervise, monitor personal assistants and are accountable to the law for any irregularity. SECPAH makes the assessment of personal assistance needs and decides the number of hours and type of activities for which the person needs support, which turns into money that the person can use to purchase the services from the FSS. Special regulations are required for personal assistants in the family. Only they can provide the services until the market develops. But personal assistants in the family do not benefit from support, training, supervision, case management, etc., but only from a minimum wage or an attendant allowance without any other right. In addition, it is extremely important to develop personal assistance services correlated with home care services, so that these services can be purchased by persons of disabilities / local authorities. This issue becomes more critical as the cohorts of personal assistants are aging and will no longer be able to cope in the medium to long term. 5.2.4. Instrument M3: Support needs for an independent life: home adaptation The data on housing come from the social inquiry, in accordance with the framework model provided for in the legislation. Currently, Output 1 has shown that this data is not collected systematically or evenly, and their completeness and accuracy is unsatisfactory, according to SECPAH specialists. 71 As a solution, the new model of The Annex for Adults with Disabilities to the Social Inquiry (Anexa_Asoc), presented in section 5.1, includes a consistent battery of dwelling/housing data, to be applied uniformly at national level by SPAS. This represents the input data for the M3 tool. How and by whom the assessment module is initiated Module 3 is made at the request of the person with disabilities or of the legal representative / attendant / family caring for the person, on his/her behalf. The assessment shall be carried out only with the agreement of the person being assessed. Who fills in the tool Preferably, this module is complemented by a multidisciplinary team of SECPAH specialists, under the coordination of the case responsible. The assessment team may include social workers, psychologists, doctors or physical therapists. If this is not possible, the interview may also be conducted by the case responsible himself. 71 HG No. 430/2008, Annex 6. 46 It would be preferable for the legal representative/attendant/family of the person to participate in this interview. The assessment is carried out in a face-to-face interview or online. The face-to-face interview may be conducted, on the basis of prior planning, either at SECPAH premises or at the applicants' homes, bedridden persons. For whom to fill in For all persons with a disability certificate who have expressed their interest in module M3 regarding the adaptation needs of the dwelling. Content The M3 instrument (Annex 3.2) was built on the basis of existing legislation and good practice (international and national), mainly: • Lauria, A., Benesperi, B., Costa, P., Valli, F. (2019) Designing Autonomy at Home. The ADA Project. An Interdisciplinary Strategy for Adaptation of the Homes of Disabled Persons • Sbenghe, T. (1996) Medical recovery at home for the family doctor • Albu C. Albu A. Petcu I. (2000) Family assistance of the person with functional deficiency • Albu C. Albu A Tiberiu V. (2004) Passive physical therapy • Balteanu V. (2002) Occupational therapy and occupational therapy • ROM-CAT assessment tool (already used in some counties) • Institute of Design, Research and Calculation Technique in Constructions IPCT SA - Normative for the adaptation of civil buildings and urban spaces corresponding to the requirements of the person with disabilities- Indicative NP 0512001 • MMFPPV-MS-MEC Order no. 1985/1305/5805/2016, ANNEX 6 Environmental factors - annex model of the social inquiry for children with disabilities and/or special educational needs. The M3 tool is organized into three sections. In the first two sections, selected information is automatically pre-filled from that already obtained in the M0 forms (first contact) and Anexa_Asoc. Section 3 collects new information on future home aspirations and plans. Note: See also Annex 3.2. 47 What it ends with The M3 module ends with a Home Accessibility Profile 72 and a conclusion of the SECPAH team on the need for support in adapting the home. They are not a requirement imposed by regulations, but they can be useful if the person/family applies/obtains a loan with subsidized interest to increase the degree of adaptation of the home to the specific needs of the person with disabilities. Also, the results of the M3 module can be used by persons with disabilities to obtain the approval of co-residents for the adaptation of collective housing buildings. 73 In addition, the home accessibility profile could also be a tool used to certify professional personal assistants who must ensure the care of the disabled person at their home. However, the introduction of this assessment module is mainly related to the eventual funding of a program of vouchers/benefits/grants for home adaptation, in line with targets 5, 15 and 20 of the Operational Plan on the implementation of the NSDP "A Fair Romania", 2022-2027. 74 Such a program would not only contribute to achieving the targets of the SNDPD, but could also greatly improve the lives of persons with disabilities and their families. In addition, it would be an effective means of preventing the institutionalization of persons with disabilities who live in the family and are cared for by the elderly (mother, father), who no longer have power. If such a program does not develop, then this assessment module does not bring concrete benefits to persons with disabilities. The M3 is designed to enable not only a descriptive profile of home accessibility, but also the calculation of an overall home affordability score. However, this score can be adopted (based on the same instrument) later, after it is established and depending on how a possible program of vouchers/benefits/grants for the home adaptation is defined. Validity of the assessment module The M3 module has a validity term of maximum two years and can be renewed at any time at the request of the person with disabilities or of the legal representative / attendant / / family caring for the person, on his/ her behalf. Observations The main purpose of introducing the M3 assessment module is to shift the focus from investing in assisted housing (to the APP, center or in sheltered housing) to allocating resources in supporting families caring for an adult with disabilities to adapt the home. Existing data do not allow an estimate of the interest of persons with disabilities in adapting the home. It will only become known as a result of the pilot study. 5.2.5. Instrument M4: Needs to support decision-making on the management of economic resources Decision-making and assisted decision-making are new concepts introduced in Romania, related to the recent adoption of Law no. 140 of 17 May 2022 on certain protection measures for persons with intellectual and psychosocial disabilities and amending and supplementing certain normative acts. Until now, in the context 72 Standard Format of the Home Accessibility Profile will be part of Output 4. 73 Adult persons with severe or marked disabilities may benefit from a loan whose interest is borne from the State Budget, through transfers from the ANPD budget to the budgets of the DGASPC, based on a contract on the commitment to pay the interest for the purchase of a single vehicle and for home adaptation according to the individual needs of access, provided that the loan installments are paid at maturity, but also on the condition that the value of the loan does not exceed 10,000 euros, and the repayment of the loan does not exceed 10 years. 74 NSDP Operational Plan Implementation Annex 2. Target 5 = Measures to reduce the number of vulnerable persons with disabilities because they could not evacuate the home in case of calamities and other risk situations and humanitarian emergencies; Target 15 = Access technologies and assistive devices settled through sources of non-reimbursable external funds; Target 20 = Social housing or housing benefit for persons with a disability degree. 48 of establishing guardianship and curatorship, the decision-making capacity of a person with disabilities was established by the Institute of Forensic Medicine (IML), from a predominantly medical perspective. By Law no. 140/2022, the national legislation is aligned with the UNCRPD by creating adequate legal instruments of support and protection for individuals with intellectual and psychosocial disabilities that ensure the respect of their dignity, rights and freedoms, but also of their will, needs and preferences, as well as the safeguarding of their autonomy. Thus, the Law no. 140/2022 brings, among others, the following amendments and additions to the Civil Code and the Code of Civil Procedure (chapter. II): Article 164 1. A staff member who cannot take care of his/ her interests alone because of a deterioration in the mental capacities, temporary or permanent, partial or total, Conditions established as a result of the medical and psychosocial assessment, and who needs support in the formation or expression of his/ her will may benefit from judicial counseling or special guardianship, if such a measure is necessary for the exercise of his/ her civil capacity, on an equal basis with other persons. Article 165 The establishment of judicial counseling or special guardianship may be requested by the person in need of protection, by his/ her spouse or relatives, affinities, by the Persons who can ask person who lives with him or her and by the other persons, bodies, institutions or for protection authorities referred to in Article 111, applied accordingly. Article 166 1. Any person who has full legal capacity may designate by unilateral act or agreement, concluded in authentic form, the person to be appointed as guardian to Appointment of the take care of the person and his/ her property if he/ she were to be placed under guardian. Protection judicial advice or special guardianship. mandate Article 167 In case of need and pending the outcome of the application for the establishment of judicial counseling or special guardianship, the guardianship court may appoint a Appointment of a special curator for the care and representation of the person whose protection has special curator been sought, as well as for the administration of his/ her assets. Article 168 2. The institution of judicial counseling shall be ordered for a period not exceeding 3 years. 3. The establishment of special guardianship shall be ordered for a period not Procedure. Duration exceeding 5 years. However, if the deterioration of the mental capacities of the of the measure protected person is permanent, the court may order the extension of the special guardianship measure for a longer duration, which may not exceed 15 years. (4) By the decision establishing judicial counseling or special guardianship, the guardianship court shall determine, depending on the degree of autonomy of the person protected and his/ her specific needs, the categories of acts for which it is necessary to approve his/ her acts or, where appropriate, to represent him/ her. The court may order that the protection measure concern even a category of acts. The court may also order that the protection measure relates only to the person being protected or only to his or her property. (5) If the guardianship court proceeds according to paragraph 4, establishing of the protection measure shall be without prejudice to the ability of the protected person to conclude legal acts for which the court has established that the consent of the protector or, where appropriate, his/her representation is not necessary. (6) The protector or the representative of the protected person shall be compelled to refer the matter to the guardianship court whenever he/she finds that there are data and circumstances that justify the reassessment of the measure, as well as at least 6 months before the expiry of the period for which it was ordered, with a view to reassessing it. The guardianship authority verifies the performance of this duty, and in the absence of its performance it refers the matter to the guardianship court itself. The court may order, following the same procedure, the extension, replacement or lifting of the measure. In accordance with the law nr. 140/2022, the M4 assessment module combines medical and psychosocial data to identify the need for support of persons with disabilities to take care of their economic resources. With 49 regard to economic resources, Output 1 pointed out that, at present, in social inquiries, 75 the data are not collected systematically or uniformly and their quality is not satisfactory, according to SECPAH specialists. For this reason, the new model of the Annex for Adults with Disabilities to the Social Inquiry (Anexa_Asoc), presented in Section 5.1, includes a consistent battery of data on economic resources, to be applied uniformly at national level by SPAS. This represents the input data for the M4 tool. How and by whom the assessment module is initiated Module 4 is made at the request of the person with disabilities or of other persons or organizations / institutions provided for in the law (art. 165). If the M4 module is initiated at someone else's request, the assessment is carried out only with the written consent of the assessed person. Who fills in the tool Preferably, the M4 module is complemented by a multidisciplinary team of SECPAH specialists, under the coordination of the case responsible, which may include social workers, psychologists, psycho-pedagogues, doctors or physical therapists. It would be preferable for the legal representative/attendant/family of the person to participate in this interview. The assessment is carried out in a face-to-face interview or online. The face-to-face interview may be conducted, on the basis of prior planning, either at SECPAH premises or at the applicants' homes, for bedridden persons. For whom to fill in For all persons with a disability certificate who have expressed their interest in module M4 regarding assisted decision-making needs. M4 is strongly recommended for persons with a severe degree of disability, especially those with intellectual and psychosocial disabilities (according to the results of the disability assessment). Content The M4 instrument (Annex 3.2) was built on the basis of existing legislation and good practice (international and national), mainly: • Mackenzie, J. A and Wilkinson, K. E. (2020) Assessing mental capacity, A handbook to guide professionals from basic to advanced practice • Spreadburry, K. and Rachel Hubbard, R. (2020) The adult safeguarding practice handbook • Mental Capacity Act 2005, UK • People with disabilities and Supported Decision Making, A guide for NDIS providers in NSW • Pell, E. (2019) Supported decision making New York: evaluation report of an intentional pilot • ROM-CAT assessment tool (already used in some counties) • MMFPPV-MS-MEC Order no. 1985/1305/5805/2016, ANNEX 6 Environmental factors - annex model of the social inquiry for children with disabilities and/or special educational requirements • Law no. 140/2022 on certain protection measures for persons with intellectual and psychosocial disabilities and amending and supplementing certain normative acts. The M4 tool is organized into three sections. In the first two sections, selected information is automatically pre-filled from that already obtained in the M0 forms (first contact) and Anexa_Asoc. Section 3 collects new information on several areas of decision-making related to the management of economic resources, from understanding and using money to everyday shopping, managing a budget, managing properties, vulnerability to scams and plans for the future. 75 According to the framework model set out in the GD no. 430/2008, Annex 6. 50 What it ends with Module M4 ends with a SECPAH decision on the need of the person to assist in making decisions regarding the management of economic resources and in what area the support is needed (shopping, payment of invoices, property management, etc.). This assessment may be useful to the courts in cases of the establishment of judicial counseling or special guardianship. The introduction of this assessment module is related to the establishment of assisted decision-making services which is provided in accordance with Law no. 140/2022 and with target 6 of the Operational Plan on the implementation of the NSDP "A fair Romania", 2022-2027. 76 If assisted decision-making services do not develop, then this assessment module does not bring concrete benefits to persons with disabilities. Validity of the assessment module Module M4 has a validity term of maximum three years (in accordance with the regulated duration for the judicial counseling measure) and can be renewed at any time at the request of the person with disabilities or of other persons or organizations / institutions provided for in the law (art. 165). Observations The introduction of Assessment Module 4 corresponds to the paradigm shift from substitution to support system regarding assistance in decision-making. Nonetheless, the introduction of this assessment module brings added value only to the extent that assisted decision-making services will be developed. The existing data do not allow an estimate of the interest of persons with disabilities in assisted decision- making in relation to the management of economic resources. It will only become known as a result of the pilot study. 76 NSDP Operational Plan Implementation, Annex 2. Target 6 = By 2027, at least 17,000 persons with disabilities benefit from assistance and support services for making a decision, within a pilot program. 51 5.3. Individualized plan (PLIN) According to the new methodology of comprehensive disability assessment described in Output 2, the individual needs assessment phase ends with a tool that specifies the activities and services needed by the adult with disabilities in the process of social integration. This is the Individualized Plan (PLIN) that was designed to replace the current PIRIS and PIS, on the model shown in Annex 3.3. 5.3.1. Instrument M5: Inventory of needs not covered by services and support Module 5 of assessment does not have a separate instrument associated with it, but a section within the Individualized Plan (PLIN). How and by whom the assessment module is initiated Module 5 is completed with the consent of the person with disabilities, recorded in FEI (under M0). Subsequently, as part of filling up PLIN, the person can accept or refuse to complete the M5 instrument (section in PLIN). Who fills in the tool The M5 tool, as part of the Individualized Plan (PLIN), is filled in by the responsible for all beneficiaries of comprehensive disability assessment, regardless of how many and which needs assessment modules have been completed. It would be preferable for the legal representative/attendant/family of the person to participate in this interview. PLIN, including the M5, is completed in a face-to-face interview or online. The face-to-face interview may be conducted, on the basis of prior planning, either at SECPAH headquarters or at the applicants' homes, for bedridden persons. Content The M5 tool makes an inventory of the services and benefits: A) recommended by SECPAH specialists following the assessment B) which the person has benefited from in the last 12 months, and C) which the person intends/wishes to benefit from in the next 12 months. The services and benefits envisaged under the M5 instrument relate to: (i) necessary services found by the doctor and psychologist following the medical-psychological assessment; (ii) personal assistance; (iii) services supporting independent living recommended by SECPAH specialists on the basis of the results obtained in modules M1-M4 for needs assessment; (iv) gratuities, subsidies and exemptions, according to the law; (v) social benefits addressed to disability, and (vi) social benefits addressed to poverty. Given the above structure, module M5 (and implicitly PLIN) can also be completed for persons who do not participate in the needs assessment, but in this case it will only contain information on points (i), (iv), (v) and (vi) that are collected in F1 (medical and psychological assessment) and Anexa_Asoc. What it ends with Module 5 contributes to the paradigm shift in disability assessment by being able to substantiate service planning at the local, county, national level and provide solid evidence to determine the extra cost of disability. Thus, by aggregating the data from the M5 module at the level of administrative-territorial, county and national unit, the specific needs of services and benefits of adults with disabilities can be quantified. They can 52 be used to develop evidence-based service development plans. For this purpose, it is proposed to finalize the M5 instrument with a County Report that would present the result of the aggregated analyses and be distributed annually by the DGASPC to the County Council and the mayoralties in the county. 77 5.3.2. PLIN instrument: Individualized plan The individual needs assessment phase ends with an Individualized Plan (PLIN) which is complemented by the case responsible for all beneficiaries of individual needs assessment, regardless of how many and what modules have been completed. Together with PLIN, the research team has also created a Monitoring Sheet for PLIN (M&E PLIN), for the use of SPAS representatives, which will be included in Output 4. PLIN is a summary of the conclusions of the assessment of individual needs. Thus, PLIN includes: • Essential data about the person (where he or she lives, if he/she is in any form of education or training, if he/she carries out some form of work, if he/she lives in a family at risk of monetary or extreme poverty, if he/she is caring for children under the age of 18 or if there are family members who have no income of their own and are economically dependent on the person with disabilities, as well as data on the disability certificate) • Conclusions and recommendations taken from each of the M1-M4 assessment modules • Module 5 is an inventory of the services and benefits that the person needs in the process of social integration: which are recommended, which they actually benefit from and which they want (and assume) for the next 12 months. At the individual level, PLIN is not an intervention plan, but only the starting point for the development of an intervention plan by a case responsible. Also, PLIN should not be confused with a rehabilitation plan that must be carried out by the rehabilitation doctor / psychologist. For the moment, the purpose of the assessment of individual needs is reduced, but it prepares the system for all the ongoing changes in the legal framework and provides the foundation on which the "profit" can be maximized in terms of using the existing money (in PNRR, POIDS, European funds, etc.) in order to develop not only some services, but of the most needed services for adults with disabilities. PILOT All needs assessment tools that have been presented in Chapter 5 and Annex 3 will be tested through the pilot study (Output 5 and 7). 77 The standard format for the County Report on the Service Needs of Adults with Disabilities will be part of Deliverable 4. 53 References Albu C., Albu A., Petcu I. (2000) Asistență în familie a persoanei cu deficiență funcțională, Iași: Ed. Polirom. Albu C., Albu A., Tiberiu V. (2004) Kinetoterapia pasivă, Iași: Ed. 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Recruitment for piloting new criteria, tools and procedures for assessment of the disability degree JUD County/sector: DATAGO Date of filling in |_z_| _z_|: |_l_|_l_|: |_a_|_a_|_a_|_a_| Automatically generated OMSGO SECPAH specialist Name and surname:* Cods. who received the file Profession: * Confidential information that will not be exported to the anonymized dataset for analysis. Dosar 1. SOCIO-DEMOGRAPHIC DATA DATA IMPORT FROM THE DOCUMENTS SUBMITTED TO THE FILE ADR Home address 1. UAT name: 1a. SIRUTA Automatically generated drop down list 2. Village/sector name: 2a. SIRUTA Automatically generated 3. Residential area: 1. Urban 0. Rural Automatically generated SEX Gender 1. M 2. F DN Date of birth* |_z_| _z_|: |_l_|_l_|: |_a_|_a_|_a_|_a_| AGE Age (in years of age) |__|__| years Automatically generated. COMPUTE AGE=DATAGO – DN. AFAM The person lives ... 1. In a family (APP included) 5. Another situation, namely ... 2. In a residential service (GD no. 867/2015) 3. In detention 4. Temporary treatment abroad/country PTUT The person is... 1. Under the guardianship of a family 1. Yes 0. No member 2. Under the guardianship of local 1. Yes 0. No authorities 3. Under curatorship 1. Yes 0. No 60 RCRT 2. RECRUITMENT OF THE PARTICIPANTS IN THE PILOT STUDY RCRT The person and the representative/accompanying person/family ... 1. ... were they informed of the pilot study and its objectives? 1. Yes 0. No 2. ... have they received the brochure/information form about the 1. Yes 0. No pilot study? 3. ... have agreed to participate in the pilot study (i.e., do they 1. Yes 0. No proceed to the registration of the disabled person)? Other information TIMEF0 a. How many minutes did the initial recruitment information and |__|__| Minutes discussion take? b. How many minutes did it take to fill in this form (F00) with the Estimat |__|__| Minutes data taken from the file? ed time 5+5 = Signatures Applicant: SECPAH specialist who received the file: 61 Annex 1.2_FORM 0: Pilot study registration data FORM 0 includes: 1. SOCIO-DEMOGRAPIC DATA 2. CERTIFICATE FOR DISABILITY DEGREE DETERMINATION 62 FORM 0. Registration for piloting new criteria, tools and procedures for assessment of the degree of disability JUD County/sector: DATE Date of filling in |_z_| _z_|: |_l_|_l_|: |_a_|_a_|_a_|_a_| Automatically generated WHO SECPAH specialist who Name and surname:* Cods. received the file Profession: * Confidential information that will not be exported to the anonymized dataset for analysis. Dosar 1. SOCIO-DEMOGRAPHIC DATA DATA TAKEN FROM O#3_F00. RECRUITMENT FORM AND FROM THE DOCUMENTS ON FILE NUMEP Assessed person a. Name:* b. First name 1:* c. First name 2:* ID Unique Identification Automatically generated Code 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 ADR Home address 1. UAT name: 1a. SIRUTA Automatically generated drop down 2. Village/district name: 2a. SIRUTA Automatically generated 3. Residential area: 1. 0. Rural Automatically generated Urban ADRBI From the identity Str..... No. ..., bl. , sc. ap. ... document:* Postal code... ADRDF De facto:* Str..... No. ..., bl. , sc. ap. ... 63 Postal code... ADRCO Mailing address* 1. From the identity document 2. De facto (ADRDF) (ADRBI) ACCOUNT1 Contact info 1. Phone:* 2. Email:* ACCOUNT2 How he/she prefers to 1. Post Office 2. Telephone 3. E-mail 4. SPAS be contacted* 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 residential service (GD no. 867/2015) 3. In detention 4. Temporary treatment abroad/country AINST1 If in AFAM=2 institution Name of service:* or in detention AFAM=3 AINST2 Type of residential service: 1. CIA 5. CabR 2. CITO 6. CPVI 3. CRRN/CRRNPH 7. Other types of centres 4. CRRPH/CRRPD/CRR 8. LP PASIST Does the person benefit 1. Yes, professional personal 2. Yes, personal assistant (AP) froma personal assistant (APP) 3. Yes, animal assistance assistance? 0. No 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 64 1. | spouse 2. son/daughter | 3. mother/father | 4. another 3. Relationship: relative, ... 5. another person (non-relatives), namely ... EDC 2. CERTIFICATE OF DISABILITY DEGREE DETERMINATION DATA TAKEN FROM THE CERTIFICATE OF DISABILITY, ACQUIRED BY THE APPLICANT IN ACCORDANCE WITH THE RULES IN FORCE. EDC1 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 as a result 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 EDC2 If ECD1=1 OR 4 The person does not have a valid certificate = > SWITCH TO Other information In the database, ECD2=0 If ECD1=2 OR 3 The person has a valid certificate and data below are filled in In the database, ECD2=1 EDC2 Disability certificate We refer to the previous certificate with which the person came to the assessment for determining the degree of disability a. Degree 1. Minor 2. Medium 3. Marked 4.Severe 5. Severe with personal assistant b. Type ... c. Validity 1= 12 months | 2 = 24 months | 3= Permanent Other information TIMEF0 c. How many minutes did it take to retrieve the data from the documents |__|__| Minutes on file to complete this form (F0)? Signatures Applicant: SECPAH specialist who received the file: Estimat ed time = 10 Min 65 Annex 1.3_Informed consent Informed consent to participate in the pilot study for adults who have applied for determination of degree and type of disability You are kindly asked to read this form very carefully and ask any questions regarding your participation in this pilot study, before granting your consent. You are invited to participate in a study conducted within the project Modernizing the Disability Assessment System in Romania, implemented by The National Authority for Protecting the Rights of Persons with Disabilities, with the technical assistance provided by the World Bank Romania. This study aims to improve the current assessment process of determining the degree and type of disability, within ten pilot counties. In the current project phase, beneficiaries and direct participants in this process are involved, similar to your case. Your personal data from this informed consent will be kept confidential, and only the members of the project team will have access to it. The processing of personal data is carried out in accordance with the European legislation in the field (GDPR). All data collected will only be used for statistical research purposes. In case of data publication, no individual information will be disclosed. 78 Your participation in this study is voluntary, will not be remunerated, nor will it require costs on your part. Participation in this study does not involve any kind of risk to your health. You can withdraw from the research at any time without providing any explanation. This will not affect the results of your assessment for issuing/ renewal of the disability certificate. If you wish, this discussion may also be attended by the person who provides you with support in your care (personal assistant, professional personal assistant or any other family member and/or from the support network), especially if he/she accompanies you in the process of obtaining the disability certificate. If you want to find out more information about this study, you can contact the project manager – Crina Gîrleanu, at the e-mail address: crina.girleanu@anpd.gov.ro or phone: 0735053333, or you can ask questions to the SECPAH team participating in this study in your county. Your participation in this pilot study could bring improvements in the current assessment system for determining the degree and type of disability. These improvements could yield positive effects for all persons with disabilities in Romania. By signing this form, I confirm that:  I can ask questions about research  If requested, I have received the necessary clarifications  I agree to participate in this study  I have read and understood this consent form 78 The project team undertakes to comply with ethical standards and ensure the confidentiality of data in accordance with Law no. 363 of 28 December 2018 on the protection of natural persons with regard to the processing of personal data by the competent authorities for the purpose of preventing, discovering, investigating, prosecuting and combating crimes or the execution of penalties, educational and security measures. Your personal data will be kept by National Authority for Protecting the Rights of Persons with Disabilities, for the purpose of documenting the project for five years from the date of completion of the project, in accordance with the rules related to the program. After this period, the information will be destroyed. The information will be stored by the National Authority for Protecting the Rights of Persons with Disabilities, in a secure environment, in accordance with data protection standards (Law no. 190/2018). 66  I received a copy of this form  I understand that I have the right to access, amend and request the deletion, at any time, in part or in full, of the personal data provided in the study. This does not retract my present agreement to use the information I provide for the purpose of the study. Once such a request has been received, it will be resolved within 15 days and I will be notified about it.  I understand that I can address the national data protection authority freely and free of charge at any time - National Supervisory Authority for Personal Data Processing - www.dataprotection.ro Name and surname _________________________________________________________ Locality ___________________________________________ Signature_______________ Date: _____________________________ 67 Annex 2. Instruments for disability assessment 68 Annex 2.1: Medical and psychological assessment Green medical form COUNTY: LOCALITY: HEALTH UNIT: DOCTOR: SPECIALTY: GREEN MEDICAL FORM FOR THE ATTENTION OF THE MEDICAL AND RELATED STAFF WHO FILL IN THE GREEN MEDICAL FORM This medical form, as well as any medical documents that will be attached to it, are necessary for the person who addressed you, in order to be able to submit an application for determining the status of a person with disabilities and for issuing a certificate of person with disabilities. The information contained in this form is useful to the assessment team at the level of the General Directorate of Social Assistance and Child Protection (DGASPC), in order to analyze the person's request and determine the status of a person with a disability. The Medical Green Form must be filled in by specialist physicians (together with the currently requested report on the current medical situation) or by family doctors (in addition to the standard medical letter), only in the case of the first disability assessment (throughout lifespan). INFORMATION ABOUT THE APPLICANT NAME _ _ _ _ _ _ Date of birth: _ _ _ _ _ _ __ _ _ Current address: _ _ _ _ _ _ _ Phone No.: _ _ _ _ _ _ _ CNP: _ _ _ _ _ _ _ _ Identity document: _ _ _ _ Series _ _ Issued by: _ _ _ _ _ _ _ 1. MAIN DIAGNOSIS Name: _ _ _ _ _ _ _ _ ICD code: _ _ _ _ _ _ _ _ _ _ _ _ _ 1.1. History of the main medical pathology (if information is available)  Congenital  Contracted 1.2. Known duration of the pathology  Less than 1 year  Between 1 and 2 years  More than 2 years 2. SECONDARY DIAGNOSIS(S)  Not applicable 2.1. Name: _ _ _ _ _ _ _ ICD code: _ _ _ _ _ _ _ _ _ _ _ _ _ 2.2. Name: _ _ _ _ _ _ _ ICD code: _ _ _ _ _ _ _ _ _ _ _ _ _ 2.3. Name: _ _ _ _ _ _ _ ICD code: _ _ _ _ _ _ _ _ _ _ _ _ _ 69 3. HISTORY OF MEDICAL PATHOLOGY If you have any information, please insert details about the circumstances of the occurrence of the disease/pathology: ________________________________________________________________________ 4. BRIEF DESCRIPTION OF THE CURRENT SYMPTOMATOLOGY ________________________________________________________________________ 5. IN THE LAST 12 MONTHS, HAVE SYMPTOMS OR MANIFESTATIONS  YES DUE TO DIAGNOSIS APPEARED, THAT AFFECTED THE PERSON'S  NO PERFORMANCE IN DAILY ACTIVITIES OR PROFESSIONAL ACTIVITY?  I DON'T KNOW/I CAN'T ASSESS IT If YES, briefly describe these symptoms and appreciate the frequency and intensity with which they affect the achievement of current activities, as well as the areas that could be affected. Description of symptomatology Frequency Area affected __________________________________  Permanent  Personal care __________________________________  Periodicals (occur  Food __________________________________ in <15 days/  Household or living __________________________________ month) environment care __________________________________  Punctual (occur  Mobility __________________________________ occasionally)  Cognition, activities with a __________________________________  I don't know/I cognitive characteristic ____________ _____________________ can't assess it  Communication __________________________________ Intensity  Relationships with others, __________________________________ emotional and relational  Mild damage __________________________________ behavior  Severe damage __________________________________  Adaptive behavior  I don't know/I __________________________________  Social participation can't assess it _________  Professional activity  I don't know/I can't assess it 6. PERSPECTIVES OF EVOLUTION OF SYMPTOMS  Evolution is stable. OR MANIFESTATIONS SPECIFIC TO DIAGNOSIS  A significant worsening is expected in the coming year.  Vital risk. To the extent that you can assess their progress,  A fluctuating impairment of the evolution of the disease, at please indicate if: different times of the year (non-permanent character) is anticipated.  It is not possible to predict the course of manifestations of the disease.  There is not enough information for assessment. 7. RECOMMENDED TREATMENT 7.1. Medication: _______________________________________________ 7.2. Therapeutic procedures: _______________________________________________ 8. ARE THERE ANY SIDE EFFECTS OF TREATMENT THAT AFFECT THE  YES PERSON'S PERFORMANCE IN DAILY ACTIVITIES?  NO  I DON'T KNOW/I CAN'T ASSESS IT If YES, briefly describe these side effects and how they affect carrying out current activities. ___________________________________________________________________________ 70 Minimum requirements for the psychological assessment report COUNTY: LOCALITY: CABINET: CLINICAL PSYCHOLOGIST: a) First name b) Degree /stage of specialization Minimum Requirements for the Psychological Assessment Report FOR THE ATTENTION OF THE PSYCHOLOGIST WHO FILLS IN THE MINIMUM REQUIREMENTS FOR THE PSYCOLOGICAL ASSESSMENT REPORT This form, as well as any medical documents that will be attached to it, are necessary for the person who addressed you, in order to be able to submit an application for determining the status of a person with disabilities and for issuing a certificate of a person with disabilities. The information contained in this form is useful to the assessment team at the level of the General Directorate of Social Assistance and Child Protection (DGASPC), in order to analyze the person's request and determine a status of a person with a disability. The Psychological Green Form must be filled in by clinical psychologists (along with the currently requested report on the current medical status). INFORMATION ABOUT THE APPLICANT NAME _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ FIRST NAME _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Date of birth: _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _Locality: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Current address: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Phone number: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ E-mail: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ CNP: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Identity card: _ _ _ Series _ _ _ No _ _ _ _ _ _ _ _ _ _ _ _ Issued by: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ on _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Purpose of the examination: To serve the assessment team from the General Directorate of Social Assistance and Child Protection (DGASPC), in order to analyze the person’s request and establish the status of a person with disability. 1. MAIN DIAGNOSIS Name: _ _ _ _ _ _ _ _ _ _ _ ICD Code: _ _ _ _ _ _ _ _ _ _ _ _ _ _ or DSM5 Code: _ _ _ _ _ _ _ _ _ _ _ _ _ 2. SECONDARY DIAGNOSIS  Not applicable or  Not applicable 2.1. Name: _ _ _ _ _ _ _ _ _ ICD Code: _ _ _ _ _ _ _ _ _ _ _ _ _ DSM5 Code: _ _ _ _ _ _ _ _ _ _ _ _ 2.2. Name: _ _ _ _ _ _ _ _ _ ICD Code: _ _ _ _ _ _ _ _ _ _ _ _ _ _ DSM5 Code: _ _ _ _ _ _ _ _ _ _ _ _ 2.3. Name: _ _ _ _ _ _ _ _ _ ICD Code: _ _ _ _ _ _ _ _ _ _ _ _ _ _ DSM5 Code: _ _ _ _ _ _ _ _ _ _ _ _ 71 3. HISTORY OF MEDICAL PATHOLOGY If you have any information, please insert details about the circumstances of the occurrence of the disease/pathology. Please mention the type of the source document, the issuing institution, name and date of issue (for instance, Discharge Ticket no………/ from ……, issued by the Hospital ……) _________________________________________________________________ _________________________________________________________________ 4. IN THE LAST 12 MONTHS, HAVE SYMPTOMS OR MANIFESTATIONS  YES DUE TO DIAGNOSIS APPEARED, WHICH HAVE AFFECTED THE  NO PERSON'S PERFORMANCE IN DAILY ACTIVITIES OR IN PROFESSIONAL  I DON'T KNOW/I CAN'T ACTIVITY? ASSESS IT If YES, briefly describe these symptoms and assess the frequency and intensity with which they affect carrying out current activities, as well as the areas that could be affected. 5. FICHE FOR SUMMING UP IMPAIRMENTS AND SPECIFIC SYMPTOMATOLOGY BY DIMENSIONS 0. ADAPTIVE BEHAVIOR D0.1. Used assessment instrument: __________________________________________ (please mention the name and the version) D0.2. Result of the assessment: __________________________________________ (write the score) D0.3. Severity degree of the |__| Minor |__| Medium |__| Marked |__| Severe impairment: D0.4. Type of impairment: |__| Continuous |__| Fluctuating |__| I don’t know/I can’t assess it |__| I don’t know/I D0.5. Frequency of symptoms: |__| Permanent |__| Periodic |__| Specific can’t assess it (in <15 days/ (occasionally) month) D0.6. Intensity of symptoms: |__| Mild |__| Moderate |__| Severe D0.7. Description of current __________________________________________ symptomatology: __________________________________________ __________________________________________ A1. COGNITIVE FUNCTIONS – QI A1.1. Used assessment instrument: __________________________________________ (please mention the name and the version) A1.2. Result of the assessment: |__| QI Level = 50-55; up to 70 |__| QI Level = 50-55; up to 70 (write the score) |__| QI Level = 35-40; up to 50-55 |__| QI Level = < 20-25 |__| QI Level = 20-25; up to 35-40 A1.3. Severity degree of the |__| Minor |__| Medium |__| Marked |__| Severe impairment: A1.4. Type of impairment: |__| Continuous |__| Fluctuating |__| I don’t know/I can’t assess it |__| I don’t know/I A1.5. Frequency of symptoms: |__| Permanent |__| Periodic |__| Specific can’t assess it 72 (in <15 days/ (occasionally) month) A1.6. Intensity of symptoms: |__| Mild |__| Moderate |__| Severe A1.7. Description of current __________________________________________ symptomatology: __________________________________________ __________________________________________ A2. COGNITIVE FUNCTIONS – ORIENTATION A2.1. Used assessment instrument: __________________________________________ (please mention the name and the version) A2.2. Result of the assessment: __________________________________________ (write the score) A2.3. Severity degree of the |__| Minor |__| Medium |__| Marked |__| Severe impairment: A2.4. Type of impairment: |__| Continuous |__| Fluctuating |__| I don’t know/I can’t assess it |__| I don’t know/I A2.5. Frequency of symptoms: |__| Permanent |__| Periodic |__| Specific can’t assess it (in <15 days/ (occasionally) month) A2.6. Intensity of symptoms: |__| Mild |__| Moderate |__| Severe A2.7. Description of current __________________________________________ symptomatology: __________________________________________ __________________________________________ A3. COGNITIVE FUNCTIONS – ATTENTION A3.1. Used assessment instrument: __________________________________________ (please mention the name and the version) A3.2. Result of the assessment: __________________________________________ (write the score) A3.3. Severity degree of the |__| Minor |__| Medium |__| Marked |__| Severe impairment: A3.4. Type of impairment: |__| Continuous |__| Fluctuating |__| I don’t know/I can’t assess it |__| I don’t know/I A3.5. Frequency of symptoms: |__| Permanent |__| Periodic |__| Specific can’t assess it (in <15 days/ (occasionally) month) A3.6. Intensity of symptoms: |__| Mild |__| Moderate |__| Severe A3.7. Description of current __________________________________________ symptomatology: __________________________________________ (Provided information can regard: complex __________________________________________ attention – time for performing routine activities, difficulties in environments with multiple stimuli, concentration impairments, concentration on tasks, latency in commuting atention between two concepts/ rules or tasks, etc..) 73 A4. COGNITIVE FUNCTIONS – MEMORY A4.1. Used assessment instrument: __________________________________________ (please mention the name and the version) A4.2. Result of the assessment: __________________________________________ (write the score) A4.3. Severity degree of the |__| Minor |__| Medium |__| Marked |__| Severe impairment: A4.4. Type of impairment: |__| Continuous |__| Fluctuating |__| I don’t know/I can’t assess it |__| I don’t know/I A4.5. Frequency of symptoms: |__| Permanent |__| Periodic |__| Specific can’t assess it (in <15 days/ (occasionally) month) A4.6. Intensity of symptoms: |__| Mild |__| Moderate |__| Severe A4.7. Description of current __________________________________________ symptomatology: __________________________________________ (Provided information can regard: learning __________________________________________ and memory – for instance, mental storing of recent information; quantitative memory impairments – amnesia, hypomnesia, hypermnesia – and/or qualitative; impairments of remembering the past) A5. COGNITIVE FUNCTIONS – THOUGHT A5.1. Used assessment instrument: __________________________________________ (please mention the name and the version) A5.2. Result of the assessment: __________________________________________ (write the score) A5.3. Severity degree of the |__| Minor |__| Medium |__| Marked |__| Severe impairment: A5.4. Type of impairment: |__| Continuous |__| Fluctuating |__| I don’t know/I can’t assess it |__| I don’t know/I A5.5. Frequency of symptoms: |__| Permanent |__| Periodic |__| Specific can’t assess it (in <15 days/ (occasionally) month) A5.6. Intensity of symptoms: |__| Mild |__| Moderate |__| Severe A5.7. Description of current __________________________________________ symptomatology: __________________________________________ (Provided information can regard: __________________________________________ impairments of thought pace and coherence; content impairments – obsessions, delusion ideas, disorganized thought (speech); rigid thinking models, rituals; intellectual functioning – deficiencies of intellectual functions, like: reasoning, problem solving, planning, abstract thinking, judging, learning in a school environment and learning by experience). 74 A6. COGNITIVE FUNCTIONS – LANGUAGE A6.1. Used assessment instrument: __________________________________________ (please mention the name and the version) A6.2. Result of the assessment: __________________________________________ (write the score) A6.3. Severity degree of the |__| Minor |__| Medium |__| Marked |__| Severe impairment: A6.4. Type of impairment: |__| Continuous |__| Fluctuating |__| I don’t know/I can’t assess it |__| I don’t know/I A6.5. Frequency of symptoms: |__| Permanent |__| Periodic |__| Specific can’t assess it (in <15 days/ (occasionally) month) A6.6. Intensity of symptoms: |__| Mild |__| Moderate |__| Severe A6.7. Description of current __________________________________________ symptomatology: __________________________________________ (Provided information can regard: __________________________________________ impairments of spoken and graphic language; impairments of oral language - dyslogy, dysphasia, dyslalia, etc.; impairments of written language; speech with stereotypical and repetitive character, ecolaly, idiosyncratic phrases; ritualization of patterns of verbal and nonverbal behavior; communication and social interaction; deficiencies in nonverbal communication behaviors used in social interactions, abnormalities in eye contact and body language, deficiencies in understanding and using gestures, facial expressiveness and nonverbal communication). A7. COGNITIVE FUNCTIONS – EXECUTIVE FUNCTIONS A7.1. Used assessment instrument: __________________________________________ (please mention the name and the version) A7.2. Result of the assessment: __________________________________________ (write the score) A7.3. Severity degree of the |__| Minor |__| Medium |__| Marked |__| Severe impairment: A7.4. Type of impairment: |__| Continuous |__| Fluctuating |__| I don’t know/I can’t assess it |__| I don’t know/I A7.5. Frequency of symptoms: |__| Permanent |__| Periodic |__| Specific can’t assess it (in <15 days/ (occasionally) month) A7.6. Intensity of symptoms: |__| Mild |__| Moderate |__| Severe A7.7. Description of current __________________________________________ symptomatology: __________________________________________ (Provided information can regard: planning, __________________________________________ organizing, sequencing, abstraction). 75 B. PERCEPTION B.1. Used assessment instrument: __________________________________________ (please mention the name and the version) B.2. Result of the assessment: __________________________________________ (write the score) B.3. Severity degree of the |__| Minor |__| Medium |__| Marked |__| Severe impairment: B.4. Type of impairment: |__| Continuous |__| Fluctuating |__| I don’t know/I can’t assess it |__| I don’t know/I B.5. Frequency of symptoms: |__| Permanent |__| Periodic |__| Specific can’t assess it (in <15 days/ (occasionally) month) B.6. Intensity of symptoms: |__| Mild |__| Moderate |__| Severe B.7. Description of current __________________________________________ symptomatology: __________________________________________ (Provided information can regard: sensory __________________________________________ sensitivity – hippo or hyper reactivity to sensory stimuli; impairments of sensory functions/ sensory impairments – hearing, seeing, etc; illusions, agnosia; hallucinations and pseudo-hallucinations; perceptive-motor, for example, if he/she needs help to get to unfamiliar places, etc.). C. AFFECTION C.1. Used assessment instrument: __________________________________________ (please mention the name and the version) C.2. Result of the assessment: __________________________________________ (write the score) C.3. Severity degree of the |__| Minor |__| Medium |__| Marked |__| Severe impairment: C.4. Type of impairment: |__| Continuous |__| Fluctuating |__| I don’t know/I can’t assess it |__| I don’t know/I C.5. Frequency of symptoms: |__| Permanent |__| Periodic |__| Specific can’t assess it (in <15 days/ (occasionally) month) C.6. Intensity of symptoms: |__| Mild |__| Moderate |__| Severe C.7. Description of current __________________________________________ symptomatology: __________________________________________ (Provided information can regard: _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ psychopathology of instinctive manifestations, disorders of the eating instinct, defense instinct, sexual instinct, etc.). D. BEHAVIOR D.1. Used assessment instrument: __________________________________________ (please mention the name and the version) D.2. Result of the assessment: __________________________________________ (write the score) 76 D. BEHAVIOR D.3. Severity degree of the |__| Minor |__| Medium |__| Marked |__| Severe impairment: D.4. Type of impairment: |__| Continuous |__| Fluctuating |__| I don’t know/I can’t assess it |__| I don’t know/I D.5. Frequency of symptoms: |__| Permanent |__| Periodic |__| Specific can’t assess it (in <15 days/ (occasionally) month) D.6. Intensity of symptoms: |__| Mild |__| Moderate |__| Severe D.7. Description of current __________________________________________ symptomatology: __________________________________________ (Provided information can regard: restrictive, __________________________________________ repetitive behavior patterns, interests or activities that are manifested by simple motor stereotypes, alignment or throwing of objects, fluttering of objects, hands, perseverance on uniformity, inflexible adherence to routine rituals, disorganized or abnormal motor behavior; eating behavior characterized by food selection or eating behavior disorders; affecting mutual social communication and social interaction in supporting a dialogue, the level of interests sharing, emotions or affections; impairments regarding development, maintenance and understanding of relationships, or in making friends, social dysfunctions in the professional fields or in that of interpersonal relationships). E. PERSONAL AND SOCIAL AUTONOMY LEVEL E.1. Used assessment instrument: __________________________________________ (please mention the name and the version) E.2. Result of the assessment: __________________________________________ (write the score): E.3. Severity degree of the |__| Minor |__| Medium |__| Marked |__| Severe impairment: E.4. Type of impairment: |__| Continuous |__| Fluctuating |__| I don’t know/I can’t assess it |__| I don’t know/I E.5. Frequency of symptoms: |__| Permanent |__| Periodic |__| Specific can’t assess it (in <15 days/ (occasionally) month) E.6. Intensity of symptoms: |__| Mild |__| Moderate |__| Severe E.7. Description of current __________________________________________ symptomatology: __________________________________________ __________________________________________ E1. SELF-CARE E1.1. Used assessment instrument: __________________________________________ (please mention the name and the version) E1.2. Result of the assessment: __________________________________________ (write the score) 77 E. PERSONAL AND SOCIAL AUTONOMY LEVEL E1.3. Severity degree of the |__| Minor |__| Medium |__| Marked |__| Severe impairment: E1.4. Type of impairment: |__| Continuous |__| Fluctuating |__| I don’t know/I can’t assess it |__| I don’t know/I E1.5. Frequency of symptoms: |__| Permanent |__| Periodic |__| Specific can’t assess it (in <15 days/ (occasionally) month) E1.6. Intensity of symptoms: |__| Mild |__| Moderate |__| Severe E1.7. Description of current __________________________________________ symptomatology: __________________________________________ (Provided information can regard own __________________________________________ hygiene, dressing, self-catering, self-serving etc.). E2. SELF-DETERMINATION E2.1. Used assessment instrument: __________________________________________ (please mention the name and the version) E2.2. Result of the assessment: __________________________________________ (write the score) E2.3. Severity degree of the |__| Minor |__| Medium |__| Marked |__| Severe impairment: E2.4. Type of impairment: |__| Continuous |__| Fluctuating |__| I don’t know/I can’t assess it |__| I don’t know/I E2.5. Frequency of symptoms: |__| Permanent |__| Periodic |__| Specific can’t assess it (in <15 days/ (occasionally) month) E2.6. Intensity of symptoms: |__| Mild |__| Moderate |__| Severe E2.7. Description of current __________________________________________ symptomatology: __________________________________________ (Provided information can regard the capacity __________________________________________ of the assessed person to decide on his/her own for the problems that he/she is interested in). E3. Social and emotional behavior. Interaction and social integration E3.1. Used assessment instrument: __________________________________________ (please mention the name and the version) E3.2. Result of the assessment: __________________________________________ (write the score) E3.3. Severity degree of the |__| Minor |__| Medium |__| Marked |__| Severe impairment: E3.4. Type of impairment: |__| Continuous |__| Fluctuating |__| I don’t know/I can’t assess it |__| I don’t know/I E3.5. Frequency of symptoms: |__| Permanent |__| Periodic |__| Specific can’t assess it (in <15 days/ (occasionally) month) E3.6. Intensity of symptoms: |__| Mild |__| Moderate |__| Severe 78 E3. Social and emotional behavior. Interaction and social integration E3.7. Description of current __________________________________________ symptomatology: __________________________________________ __________________________________________ F. Resilient adaptive capacity 79 F.1. Used assessment instrument: __________________________________________ (please mention the name and the version) F.2. Result of the assessment: __________________________________________ (write the score) F.3. Severity degree of the |__| Minor |__| Medium |__| Marked |__| Severe impairment: F.4. Type of impairment: |__| Continuous |__| Fluctuating |__| I don’t know/I can’t assess it |__| I don’t know/I F.5. Frequency of symptoms: |__| Permanent |__| Periodic |__| Specific can’t assess it (in <15 days/ (occasionally) month) F.6. Intensity of symptoms: |__| Mild |__| Moderate |__| Severe F.7. Description of current __________________________________________ symptomatology: __________________________________________ __________________________________________ F1. Coping skills F1.1. Used assessment instrument: __________________________________________ (please mention the name and the version) F1.2. Result of the assessment: __________________________________________ (write the score) F1.3. Severity degree of the |__| Minor |__| Medium |__| Marked |__| Severe impairment: F1.4. Type of impairment: |__| Continuous |__| Fluctuating |__| I don’t know/I can’t assess it |__| I don’t know/I F1.5. Frequency of symptoms: |__| Permanent |__| Periodic |__| Specific can’t assess it (in <15 days/ (occasionally) month) F1.6. Intensity of symptoms: |__| Mild |__| Moderate |__| Severe F1.7. Description of current __________________________________________ symptomatology: __________________________________________ __________________________________________ 79 Based on ICF perspective, final objective of the medical-psychological-social assessment should be REHABILITATION (not only disability assessment and establishing the status). Therefore, the assessment instruments used in the clinical psychological assessment should measure, alongside basic affected psychological functions, other supplementary functions that can support us to set up a recovery/ rehabilitation prognostic. 79 F2. RESILIENCE F2.1. Used assessment instrument: __________________________________________ (please mention the name and the version) F2.2. Result of the assessment: __________________________________________ (write the score) F2.3. Severity degree of the |__| Minor |__| Medium |__| Marked |__| Severe impairment: F2.4. Type of impairment: |__| Continuous |__| Fluctuating |__| I don’t know/I can’t assess it |__| I don’t know/I F2.5. Frequency of symptoms: |__| Permanent |__| Periodic |__| Specific can’t assess it (in <15 days/ (occasionally) month) F2.6. Intensity of symptoms: |__| Mild |__| Moderate |__| Severe F2.7. Description of current __________________________________________ symptomatology: __________________________________________ __________________________________________ 6. CLINICAL PSYCHOLOGICAL ASSESSMENT 80 6.1. CONCLUSIONS: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _________________________________________________________________________ ________________________________________________________________________ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _. __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _. __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _.__ 6.2. RECOMMENDATIONS:  Individual psychological counseling  Individual psychotherapy  Psychotherapy for couples  Psychological counseling for families  Family psychotherapy  Group psychological counseling (support group)  Group psychotherapy  Cognitive stimulation program  Career guidance 80 Clinical psychological assessment process should have as a result: 1. drafting CONCLUSIONS aimed at disability assessment and facilitate determination of disability degree; 2. Drafting RECOMMENDATIONS that address specific needs of assessed person with disability (identified alongside assessment) that will be used in the Individual Rehabilitation Plan – PLIN – which is aimed at supporting psycho-social and professssional rehabilitation of the person with disabilities. 80 FORM 1: Medical and psychological assessment FORM 1 includes: 1. AUTOMATICALLY PREFILLED DATA THAT THE ASSESSMENT TEAM CAN CONSULT BEFORE THE INTERVIEW 1.1. SOCIO-DEMOGRAPHIC DATA 1.2. CERTIFICATE OF DISABILITY DEGREE DETERMINATION 2. MEDICAL AND PSYHCHOLOGICAL ASSESSMENT 2.1. ABOUT THE INTERVIEW 2.2. RESULTS OF THE MEDICAL AND PSYCHOLOGICAL ASSESSMENT 2.3. NECESSARY SUPPORT FOR SPECIAL NEEDS 3. QUALITY OF INFORMATION FROM THE MEDICAL AND PSYHCOLOGICAL DOCUMENTS FROM THE APPLICANT’S FILE 81 FORM 1. The results of the medical and psychological assessment, based on the revised medical and psychological criteria JUD County/sector: DATE Date of filling in: |_z_| _z_|: |_l_|_l_|: |_a_|_a_|_a_|_a_| Automatically generated Assessment team: OMSM 1. Member 1 Name and surname:* Cods. Profession: 2. Member 2 Name and surname:* Cods. Profession: 3. Member 3 Name and surname:* Cods. Profession: * Confidential information that will not be exported to the anonymized dataset for analysis. 1. AUTOMATICALLY PRE-FILLED DATA THAT THE ASSESSMENT TEAM CAN CONSULT BEFORE THE INTERVIEW Dosar 1.1. Socio-demographic data DATA AUTOMATICALLY RETRIEVED FROM O#3_F0. REGISTRATION FORM ECD 1.2. Disability certification DATA AUTOMATICALLY RETRIEVED FROM O#3_F0. REGISTRATION FORM 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 82 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. 4. German 5. another, namely: interview Romanian Hungarian Romani ... INTM2 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, 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 1. Yes 0. No diagnoses? If YES 1a. Name: 1b. CODE ICD-10/DSM5: 2a. Name: 2b. CODE ICD-10/DSM5: 3a. Name: 3b. CODE ICD-10/DSM5: 83 SCOR MEDICAL SCORE* indicating an M 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: 1= 12 months 2= 24 months 3= permanent EVM3 Type of disability mentioned in 0 the revised criteria: 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 1. Yes 0. No -1. I can't assess it (funded by CNAS) 5. Medical devices, technologies and 1. Yes 0. No -1. I can't assess it assistive devices intended to recover 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 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. 84 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 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 85 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 0 1 2 damage 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 1. Yes  FILL IN THE TABLE BELOW behavioral needs, any of the ones in 0. No  STOP the table below? -1. NŞ/NR 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 86 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 or was it requested to complete the file with paraclinical investigations or additional 1 0 1 0 documents (of any type)? 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? 87 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? Other information TIMEF1 a. How many minutes did it take to retrieve the data from O#3_F0. |__|__| Minutes Registration form? b. 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? Signatures Applicant: Member 1: Member 2: Member 3: Estimat ed time 5 + 20 = 88 ANNEX 2.2_FORM 2: Assessment of functioning and start of individual needs analysis FORM 2 includes: 1. AUTOMATICALLY PREFILLED DATA THAT THE ASSESSOR CAN CONSULT BEFORE THE INTERVIEW 1.1. SOCIO-DEMOGRAPHIC DATA 1.2. CERTIFICATE OF DISABILITY DEGREE DETERMINATION 1.3. RESULTS OF MEDICAL AND PSYCHOLOGICAL ASSESSMENT 2. ASSSESSMENT OF FUNCTIONING 3. WHODAS+RO 45 ITEMS 3.1. PREAMBLE 3.2. DOMAIN 1 – UNDERSTANDING AND COMMUNICATION 3.3. DOMAIN 2 – MOBILITY/ ACTIVITIES IN THE NEARBY ENVIRONMENT 3.4. DOMAIN 3 – PERSONAL AUTONOMY/ SELF-CARE 3.5. DOMAIN 4 – INTERPERSONAL RELATIONSHIPS 3.6. DOMAIN 5 – DAILY ACTIVITIES: 5(1) HOUSEHOLD ACTIVITIES 3.7. DOMAIN 5 – DAILY ACTIVITIES: 5(2) PROFESSIONAL OR SCHOOL ACTIVITIES 3.8. DOMAIN 6 – SOCIAL PARTICIPATION 3.9. FEEDBACK 4. STARTING INDIVIDUAL NEEDS ASSESSMENT: EXPRESSION OF INTEREST FORM (FEI) 89 FORM 2. WHODAS+RO and FEI questionnaire JUD County/sector: DATE Date of filling in: |_z_| _z_|: |_l_|_l_|: |_a_|_a_|_a_|_a_| Automatically generated WHO Assessor: Name and surname: * Cods. Profession: Other SECPAH specialists: WHO 1. Member 1 Name and surname: * Cods. Profession: 2. Member 2 Name and surname: * Cods. Profession: * Confidential information that will not be exported to the anonymized dataset for analysis. 1. AUTOMATICALLY PREFILLED DATA THAT THE ASSESSOR Dosar CAN CONSULT BEFORE THE INTERVIEW DATA RETRIEVED FROM O#3_F0. REGISTRATION FORM ALSO FROM O#3_F1. MEDICAL ASSESSMENT Dosar 1.1. Socio-demographic data DATA AUTOMATICALLY RETRIEVED FROM O#3_F0. REGISTRATION FORM EDC 1.2. Certificate of disability degree determination DATA AUTOMATICALLY RETRIEVED FROM O#3_F0. REGISTRATION FORM EVM 1.3. Results of the medical and psychological assessment 90 DATA AUTOMATICALLY RETRIEVED FROM O#3_F1. MEDICAL AND PSYCHOLOGICAL ASSESSMENT 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. INTW1 Where does the 1. SECPAH headquarters interaction take 2. Applicant's home (for bedridden persons) place? 3. Online 4. Another situation, namely: ... INTW3 Language of the 1. 2. 3. 4. German 5. another, namely: interview Romanian Hungarian Romani ... 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. 91 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 If in the last 30 days there have been good 30 days. I would also like you to answer these questions by days 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. 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 The questions refer to the activity reflect the point of view of degree of difficulty 2. Considering all the help/ all the the assessed person! encountered by the technical and personal assistance applicant: they receive. 92 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 respondent's 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 1 2 3 4 5 0 say? 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/ do you keep your blood cold 1 2 3 4 5 0 when you get angry? DRO1.9 Using your phone? 1 2 3 4 5 0 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 respondent's 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 93 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 1 2 3 4 5 0 or a box? DRO2.7 Using your hand and fingers to manipulate or let go of a small object such 1 2 3 4 5 0 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 respondent's I am going to ask you a series of questions about the difficulties you encounter in taking care of yourself. Extreme or In the past 30 days, how much difficulty cannot did 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 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 respondent's 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. None Mild Moderate Severe N/A 94 In the past 30 days, how much difficulty did Extreme you have in... or cannot do 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 1 2 3 4 5 0 to you? D4.4 Making new friends? 1 2 3 4 5 0 D4.5 Sexual activities? 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 respondent's 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. 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? Getting all the household work done D5.3 1 2 3 4 5 0 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 D5.01 |__|__| days work because of your health condition? Does the person currently carry out any  FILL IN SECTION 3.7. DOMAIN 1. Yes form of paid or non-paid work (even for a 5(2) NEXT OCED few hours a week) or attends any form of  JUMP TO SECTION 3.8. DOMAIN education or training (of any kind)? 0. No 6 95 Dom.52 3.7. Domain 5 — Day-to-day activities: 5(2) Professional or school 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 respondent's 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 D5.02 you miss work for half a day or more because |__|__| days of 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? 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 respondent's 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 In the past 30 days,... None Mild Moderate Severe or N/A 96 cannot do 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 1 2 3 4 5 0 around 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 D6.4 1 2 3 4 5 0 health 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. the financial resources of you or your 1 2 3 4 5 0 family? How difficult was it for your family because D6.7 1 2 3 4 5 0 of your health problems? How difficult was it for you doing D6.8 things/activities for relaxation or 1 2 3 4 5 0 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? 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 |__|__|-1. NŞ/NR think 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 97 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? 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 information more accurate (to correctly mirror reality)? answer given by the respondent -7. Not applicable, there was no discomfort 98 4. START OF THE ASSESSMENT OF INDIVIDUAL NEEDS: Aneed EXPRESSION OF INTEREST FORM (FEI) ONCE THE APPLICANT IS INFORMED OF THE EXISTENCE, ORGANISATION, PURPOSE AND POTENTIAL BENEFITS OF THE INDIVIDUAL NEEDS ANALYSIS, THE FEI SHALL BE COMPLETED FOR ALL ASSESSED PERSONS. Assessed needs and usefulness The applicant's initial option or rule FEI0M1 MODULE Needs in the field of education and 1. Upon applicant’s request 1. work 2. Strongly recommended for young Ends with a profile of professional potential useful people 18-35 years old for identifying a suitable job or alternative to (for beneficiaries aged 18-35 who do not apply complement education on request) 0. Unselected FEI0M2 MODULE Support for an independent life – -7. The person does not have a severe 2. Personal assistance or marked degree It ends with a decision on access to the personal 1. Upon applicant’s request assistance service. 0. Unselected FEI0M3 MODULE Support for independent living – Home 1. Upon applicant’s request 3. adaptation 0. Unselected It ends with a home accessibility profile useful for people who want to make a bank loan for home adaptation or as soon as the subsidies/vouchers for the home adaptation, provided for in the SNDPD, become available. FEI0M4 MODULE Needs for support in deciding on the 1. Upon applicant’s request 4. management of economic resources 2. Strongly recommended for people It ends with a decision on the need for assistance in with a severe degree of disability taking decisions related to the management of (for beneficiaries with a severe degree of economic resources and as soon as the assisted disability who do not apply on request) decision-making service becomes available. 0. Unselected FEI0M5 MODULE Inventory of needs not covered by 1. Participation agreement 5. services for persons with disabilities 0. Refusal It ends with a monthly report that is sent to the County Council to substantiate and boost the development of social services at the local and national level. IF THE APPLICANT WISHES TO PARTICIPATE IN ANY OF THE NEEDS ASSESSMENT MODULES (Code value higher than zero in any of modules 1-5) FEIEM Should the standard email requesting the social 1. Yes 0. No inquiry to be conducted by SPAS from the applicant's locality of residence be sent? Other information 99 TIMEF2 a. How many minutes did it take to retrieve the data from O#3_F0. |__|__| Minutes Registration form also from O#3_F1. Medical Assessment? b. How many minutes did it take to apply WHODAS+RO (including the |__|__| Minutes feedback section)? c. How many minutes did it take to inform the needs assessment and filling |__|__| Minutes in of the FEI? Signatures Applicant: Assessor: 100 ANNEX 2.3_WHODAS Guideline A separate document should be consulted: WHODAS – Guideline for completing descriptors and qualifiers. 101 Annex 3. Instruments for assessment of services and support needs 102 Annex 3.1. Annex to the social inquiry for adults with disabilities ANNEX TO THE SOCIAL INQUIRY includes: 1. SOCIO-DEMOGRAPHIC DATA 2. HOUSEHOLD GRID 3. EDUCATION AND WORK 3.1. PARTICIPATION OF THE PERSON WITH DISABILITIES IN EDUCATION AND TRAINING 3.2. CONNECTION OF THE PERSON WITH DISABILITIES WITH THE LABOR MARKET 4. SUPPORT NEEDS OF THE PERSON WITH DISABILITIES 4.1. SPECIAL BEHAVIORAL NEEDS 5. HOUSING 5.1. GENERAL DATA ABOUT THE DWELLING 5.2. HOME EQUIPMENT 5.3. ACCESSIBILITY ISSUES INSIDE THE HOME 6. MOVING OUSIDE THE HOUSE 7. FAMILY INCOME AND EXPENSES 8. ENVIRONMENTAL FACTORS: BARRIERS AND FACILITATORS 103 SOCIAL INQUIRY Annex for adults with disabilities requesting disability assessment or individual needs assessment JUD County/sector: DATAS Date of social inquiry |_z_| _z_|: |_l_|_l_|: |_a_|_a_|_a_|_a_| OMSL Social worker/ SPAS Name and surname:* Cods. representative Profession: 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 * 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:* 104 2. Email:* CONT2AS How he/she prefers to 1. Post Office 2. Telephone 3. E-mail 4. SPAS be 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 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 AFAM>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. If AFAM>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 Respondent =1 + |__|__| + |__|__| the 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 105 People in the household P0 = Person PERSON'S CODE with p1 p2 p3 p4 p5 p6 disabilities 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 1. employed person, including women on 8. unemployed person who is not registered (no longer maternity leave receiving unemployment benefit/support allowance and 2. other status of employed person (day workers, is 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 A who 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 PTUTAS The person is... 1. Under the guardianship of a family 1. Yes 0. No member 2. Under the guardianship of local authorities 1. Yes 0. No 106 3. Under curatorship 1. Yes 0. No PRLEGAS 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 ... PASISTAS Does the person have a 1. Yes 0. No personal assistant? If YES, data about AP 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 personal assistant live 1. Yes 0. No with the 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 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 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 is valid for the early (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 outsc school>0 107 TIPSC What type of school did he/she 1. Mainstream school 4. Homeschooling attend? 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 1. Yes 0. No of 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 Does the person/family remember ever having SFATE received school or professional counselling or 1. Yes 0. No 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, reason for repetition, etc.) dropping 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. 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 1. Yes 0. No training? (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 108 Asoc 3.2. The connection of the person with disabilities with the labor 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 form, including domestic work), for at (e.g. practice, apprenticeship, volunteering, etc.) least one hour/week? 3. Paid work If OCUP = 1, 2, 3, 4, 5 or 6 OR OCUP1>0 OCNOW Currently, does the person carry out some form of 1. Yes 0. No (Automatically work (of any type)? generated) 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? of work in the last 12 months 1. The work consisted of ... (Write down clearly) OCHO Does the person work (from) home? 1. Yes 0. No Only for people who have ever/currently had paid work OCUP4 Overall, throughout life, what work experience has |__|__| Years the 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. 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 109 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 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 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 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 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 3 He/she doesn't speak; uses gestures when he/she wants to communicate 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. 110 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 a wheelchair, lock the brakes, lift the footrests, safely climb into bed, lie down, sit (to be completed on the edge of the bed, change the position of the wheelchair, sit back on it also in 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. 3 He/she is not able to participate in the transfer. Two people are needed to transfer the disabled person, 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. D450_ Walking, 0 He/she can move independently, without problems 60_65 moving 1 Only with help (cane, supported unilaterally) 2 Only with help (frame, wheelchair, supported bilaterally), for short distances 3 Can't do the work 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 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 0 No problems hygiene (intense 1 Occasional incontinent or needs occasional help and bladder control) 2 Incontinent, he/she needs partial, constant help 3 Incontinent or permanent catheter, he/she is not able to perform the activity 111 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. 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 0 storage 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. 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. 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 and finds it very difficult to manage one-on-one social and 3 group situations 112 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 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 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 on 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 home/the immediate area without informing day, 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 113 2. In the last year, the person has had problems with the police or received treatment/has been diagnosed with a problem of abuse NX5 Risk factors of abuse and neglect of the 0. I can not appreciate, I do not know person with disabilities by family members, 1. There are some signs and information that neighbors, colleagues or other people in the suggest the possibility of abuse and neglect of community? 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 family) 0. No, the person lives in a center, LP,  GO TO SECTION 5.2 have a home? hospital, asylum, where he/she grabs or on the streets If YES LOCTIP Housing type Single-family dwellings (houses in 5. Semi-collective dwellings (residential which only one family lives), namely: buildings divided into several According to NP apartments, the division being made 057/2002 – 1. isolated (buildings/houses detached either by levels or by building bodies, Regulatory from all sides of the plot/land) each with individual access from a framework common courtyard) (standard) on 2. coupled (buildings/houses coupled designing two by two on one side) 6. Collective housing (residential residential buildings buildings, blocks where several families 3. stock (buildings/houses glued on two live, access to them through a common sides to other buildings and occupying space / hallway) the entire width of the creek/land) 7. Makeshift shelter / space that is not 4. carpet (buildings/houses glued on two intended for habitation – storerooms, or 3 sides to other buildings) water houses, sewerage elements, 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 114 ETJ On what floor is the 0. Ground floor -1. Basement At floor number |__|__| dwelling located? ETJL Number of floors in the Write down zero if there are no floors inside the |__|__| Floors dwelling? dwelling. ETJD Within the dwelling, on what floor, is the bedroom At floor number -1. Basement 0. Ground floor 99. Mezzanine of the disabled person |__|__| located? ETJB Within the dwelling, on what floor, is the At floor number -1. Basement 0. Ground floor 99. Mezzanine bathroom of the person |__|__| with disabilities located? USAS From the roadway/street to the interior of the home, are there curbs, culverts, 1. Yes 0. No stairs 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 |__|__| persons in the Automatically in 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? 115 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 3. Rented to private (the family pays rent) family 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 1. Yes 0. No dwelling is built? LOCB1 Does the family benefit from the exemption from the 1. Yes 0. No land/housing tax? 116 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 2. The person with Asoc 5.2. Home equipment system/device is disabilities or available in the home his/her main carer uses the respective system/device Yes No Yes No DL1 Lifting/moving systems for the disabled person, 1 0 1 0 including elevator system Mechanical systems for windows, doors, blinds or 1 0 1 0 DL2 other home automation systems Systems for individuals to control the environment in which they live (scanners, remote control systems, 1 0 1 0 e11511 voice 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 1 0 1 0 e11513 the needs of persons with disabilities Communication devices 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 0 117 1. The person with 2. Accessibility disabilities uses issue that makes it Asoc 5.3. Accessibility issues inside the (autonomously or difficult or hinders home assisted) or would like the performance of to use the space the activity Observation! This section is about the household where the assessed person actually lives. For persons with disabilities 1. Yes 1. Yes living in a residential center (according to GD no. 867/2015), 0. No 0. No this section refers to the household to which the person -7. Not applicable belongs to, where he or she can be reintegrated after leaving (space does not exist in the institution. the dwelling) Accessibility issues concern both the person with disabilities and their assistants. That is, it is possible that a space that is not used by the person with disabilities still represents an accessibility issue 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 B. Transfer to bidet/bathtub/shower 1 0 -7 1 0 118 1. The person with 2. Accessibility disabilities uses issue that makes it Asoc 5.3. Accessibility issues inside the (autonomously or difficult or hinders home assisted) or would like the performance of to use the space the activity Observation! This section is about the household where the assessed person actually lives. For persons with disabilities 1. Yes 1. Yes living in a residential center (according to GD no. 867/2015), 0. No 0. No this section refers to the household to which the person -7. Not applicable belongs to, where he or she can be reintegrated after leaving (space does not exist in the institution. the dwelling) Accessibility issues concern both the person with disabilities and their assistants. That is, it is possible that a space that is not used by the person with disabilities still represents an accessibility issue for the family. 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 1 0 -7 1 0 Is. of 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 ... 6. MOVING OUTSIDE THE HOUSE/ THE RESIDENTIAL Asoc 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 -7. The person does not need it, goes by car, bicycle, taxi, etc. 119 station or other means of transport? 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 it 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 transport and subway, for people with severe and marked -7. The person is not eligible or disabilities? does not live in the urban 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, -7. The person is not eligible for 12 round trips per calendar year (severe handicap) and 6 trips (marked disability)? 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. SHAWL In the past month, the total amount of money obtained from salaries, pensions, allowances, benefits, sales, day ............................. Lei 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 ............................. Lei sources, was ... NPERS Total number of persons in the household |__|__| persons in the household 120 Automatically generated VPP Total income recorded last month per family member ............................. lei/person Automatically generated COMPUTE VPP=SAL/NPERS RISK1a 1. Yes 0. No Family at risk of monetary poverty Automatically generated If the total income recorded per family member is below the RSI = 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 1. Yes 0. No for all members and some members did not succeed to eat, at least a few times a month (includes daily, weekly)? RISK1b 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 IF VPP<525.5 lei AND lei (VPPs<525.5 lei) and the family did not benefit from support (VMG VMG=ASF=URG=LMN=ALUE=MEAL=0 and 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 people with 1. Yes 0. No disabilities BDZ3 Salary of personal assistant 1. Yes 0. No BDZ4 Monthly allowance (in place of the personal assistant - AP) for the degree of severe disability with AP, other than the 1. Yes 0. No blind BDZ5 Carer's allowance for adults with a severe eyesight disability 1. Yes 0. No 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 1. Yes 0. No Hall -7. Not from Bucharest SAL In the past month, the total amount of money spent by all household members (including the person with ............................. Lei disabilities), on food, payment of utilities, health 121 services/medicines, any other goods and services (of any 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 1. Yes 0. No marked disabilities, for income from self-employment, -7. The assessed person is not salaries, pensions, income from agricultural activities, eligible or does not have the tax- forestry and fisheries? exempt income CARD Does the disabled person have a card/bank account? 1. Yes 0. No 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 ECON 1. Yes 0. No Does the family have savings? If YES 1. Approximately, how much is saved? ............................. Lei 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 122 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 -1. Rather barrier -7. Not applicable (not valid for the 0. It does not influence person’s status or the performance of does not exist in the the person's daily community) activities - 9. I don't know if it 1. Rather facilitator 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 -1 0 1 -7 -9 (regardless 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 -1 0 1 -7 -9 123 -1. Rather barrier -7. Not applicable (not valid for the 0. It does not influence person’s status or the performance of does not exist in the the person's daily community) activities - 9. I don't know if it 1. Rather facilitator affects the person's life Services provided either from state or private funds, or otherwise, on a voluntary basis, for example, household support providers, personal attendants, transport support persons, paid aid, nannies and other individuals providing primary care. e315 Extended family -1 0 1 -7 -9 e320 Friends -1 0 1 -7 -9 e320 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 ... 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 ... Assistive/supportive products or technologies 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 ... 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 -1 0 1 -7 -9 systems and special software and hardware, hearing implants, hearing aids, frequency modulation hearing adapters, voice prostheses, communication tablets, glasses and contact lenses. If e1201=-1. Barrier or e1201=1. Facilitator a. Namely ... 124 -1. Rather barrier -7. Not applicable (not valid for the 0. It does not influence person’s status or the performance of does not exist in the the person's daily community) activities - 9. I don't know if it 1. Rather facilitator affects the person's life 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, -1 0 1 -7 -9 mayor, etc.) e440 Attitudes of companions and personal assistants -1 0 1 -7 -9 Products for personal use in everyday life e1151 Equipment, products and technologies, adapted or specially designed to help people in everyday life, e.g. prosthetic and orthopedic devices, neural prostheses -1 0 1 -7 -9 (e.g. 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 -1 0 1 -7 -9 lawyers, 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 -1 0 1 -7 -9 machine, etc. e540 Public transport services -1 0 1 -7 -9 e5750 a. Home care services (regardless of funding and -1 0 1 -7 -9 provider) b. Day care centers for adults and the elderly -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 125 -1. Rather barrier -7. Not applicable (not valid for the 0. It does not influence person’s status or the performance of does not exist in the the person's daily community) activities - 9. I don't know if it 1. Rather facilitator affects the person's life e150 Physical accessibility of buildings for public use (including hospital, dispensary, town hall, school, -1 0 1 -7 -9 cultural or sports spaces, shops, etc.) e155 Physical accessibility of buildings where relatives and friends of the assessed person live (whom he/she likes -1 0 1 -7 -9 or 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 -1 0 1 -7 -9 distance from the services) 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? |__|__| Minutes c. How many minutes did the visit/discussion with the assessed person and |__|__| Minutes his/her family last? Estimat ed time = Signatures Social worker/ 10+30 Applicant: SPAS +30 representative: 126 Annex 3.2. Modules for individual needs assessment Module 0: Socio-demographic data, what we already know about the applicant and organization MODULE 0 includes: 1. WHAT WE ALREADY KNOW, AUTOMATICALLY PREFILLED DATA THAT THE CASE RESPONSIBLE CAN CONSULT BEFORE THE INTERVIEW 1.1. SOCIO-DEMOGRAPHIC DATA 1.2. CERTIFICATE OF DISABILITY DEGREE DETERMINATION 1.3. RESULTS OF THE MEDICAL AND PSYCHOLOGICAL ASSESSMENT 1.4. NEEDED SUPPORT FOR SPECIAL NEEDS 1.5. RESULTS FROM WHODAS+RO 2. WHAT WE LEARNED IN ADDITION FROM THE SOCIAL INQUIRY– AUTOMATICALLY PREFILLED DATA 3. ORGANIZATION OF THE ASSESSMENT OF INDIVIDUAL NEEDS 3.1. FIRST CONTACT BETWEEN THE APPLICANT AND THE CASE RESPONSIBLE 3.2. ASSESSMENT MODULES - PLAN OF INTERVIEWS 3.3. SETTING UP INTERVIEWS BY MODULES 127 MODULE 0. Applicant data and organization of the needs assessment JUD County/sector: DATE Date of filling in |_z_| _z_|: |_l_|_l_|: |_a_|_a_|_a_|_a_| Automatically generated WHO Case responsible Name and surname:* Cods. Profession: * Confidential information that will not be exported to the anonymized dataset for analysis. 1. WHAT WE ALREADY KNOW - AUTOMATICALLY Dosar PREFILLED DATA THAT THE CASE RESPONSIBLE CAN CONSULT BEFORE THE INTERVIEW DATA RETRIEVED FROM O#3_F0. REGISTRATION FORM, O#3_F1. MEDICAL AND PSYCHOLOGICAL ASSESSMENT AND FROM O#3_F2. ASSESSMENT OF FUNCTIONING Dosar 1.1. Socio-demographic data DATA AUTOMATICALLY RETRIEVED FROM O#3_F0. REGISTRATION FORM EDC 1.2. Certificate of disability degree determination DATA AUTOMATICALLY RETRIEVED FROM O#3_F0. REGISTRATION FORM EVM 1.3. Results of the medical and psychological assessment DATA AUTOMATICALLY RETRIEVED FROM O#3_F1. MEDICAL AND PSYCHOLOGICAL ASSESSMENT. WHERE APPROPRIATE, THE CASE RESPONSIBLE MAY ALSO CONSULT THE MEDICAL AND PSYCHOLOGICAL DOCUMENTS FROM THE FILE. 128 EVM 1.4. Needed support for special needs DATA AUTOMATICALLY RETRIEVED FROM O#3_F1. MEDICAL AND PSYCHOLOGICAL ASSESSMENT. THIS INFORMATION WILL BE USED IN THE INDIVIDUAL NEEDS ASSESSMENT TO DETERMINE THE RIGHT TO PERSONAL ASSISTANCE EVF 1.5. Results from WHODAS+RO DATA AUTOMATICALLY RETRIEVED FROM O#3_F2. FUNCTIONING ASSESSMENT. 2. WHAT WE LEARNED IN ADDITION FROM THE SOCIAL Ashock INQUIRY– AUTOMATICALLY PREFILLED DATA ADDITIONAL SOCIO-DEMOGRAPHIC DATA RETRIEVED FROM O#3_ANEXA ASOC Only after the first three months of the pilot study the social inquiry reports will become available on the new format developed within the project and, most likely, only for some cases and not for all. This depends on the willingness of the local social workers/SPAS representatives to participate and complete surveys on the new format for adult assessment applicants for disability. The data collection application contains a special module for the social inquiry that will accommodate both surveys on the new format sent by SPAS and the surveys completed by the case responsible, subject to data availability in the surveys prepared in accordance with the regulated framework model, from the applicant’s file. 3. ORGANIZATION OF THE ASSESSMENT OF INDIVIDUAL NEEDS INT.0 3.1. First contact between the applicant and the case responsible In the framework of the individual needs assessment, this is the first direct interaction between the applicant and the case responsible, followed by interviews on assessment modules. DATAIN0 Date of first contact |_z_| _z_|: |_l_|_l_|: |_a_|_a_|_a_|_a_| INT01 Where does the 1. SECPAH headquarters interaction take 2. Applicant's home (for bedridden persons) place? 3. Online 4. Another situation, namely: ... INT03 Language of the 1. 2. 3. 4. German 5. another, namely: interview Romanian Hungarian Romani ... INT02 Participants a. Person to be assessed/Applicant 1. Yes 0. No b. Designated case responsible 1. Yes 0. No 129 c. Legal representative/accompanying person/ 1. Yes 0. No family d. Other SECPAH specialists 1. Yes 0. No If YES d1. Profession:... Cods. is. Other people who are not SECPAH specialists 1. Yes 0. No If YES e1. Namely: ... FEI 3.2. Assessment modules - interview plan DATA RETRIEVED FROM Section 4. FEI – O#3_F2 Expression of Interest Form. FUNCTIONING ASSESSMENT AND RECONFIRMED BY FACE-TO-FACE INTERVIEW OR ONLINE In the first step, the plan of interviews (assessment modules) to be carried out is reconfirmed with the applicant. The applicant may change the initial options expressed within the FEI and waive or add some modules, except for those which are mandatory under the methodology. The final interview plan is the one decided together during the interview. Assessed needs and usefulness FEI0M. The applicant's FEIM. According to the initial option or rule interview with the case responsible PREFILLED DATA FEI0M1/ MODULE 1. 1. Upon applicant’s 1. Upon applicant’s FEIM1 request request Needs in the field of education and work 2. Strongly 2. Strongly Ends with a profile of professional potential useful recommended for recommended for for identifying a suitable job or alternative to young people 18-35 young people 18-35 complement education years old years old (for beneficiaries aged 18-35 (for beneficiaries aged 18-35 who do not apply on request) who do not apply on request) 0. Unselected 3. At the request/referral from another person or institution and with the consent of the person 0. Unselected FEI0M2/ MODULE 2. -7. The person does not -7. The person does not FEIM2 have a severe or marked have a severe or marked Support for an independent life – degree degree Personal assistance It ends with a decision on access to the personal 1. Upon applicant’s 1. Upon applicant’s assistance service. request request 0. Unselected 0. Unselected FEI0M3/ MODULE 3. 1. Upon applicant’s 1. Upon applicant’s FEIM3 request request Support for independent living – Home Adaptation 0. Unselected 0. Unselected It ends with a home accessibility profile useful for people who want to make a bank loan for home adaptation or as soon as the subsidies/vouchers for 130 Assessed needs and usefulness FEI0M. The applicant's FEIM. According to the initial option or rule interview with the case responsible PREFILLED DATA the home adaptation, provisioned in the SNDPD, become available. FEI0M4/ MODULE 4. 1. Upon applicant’s 1. Upon applicant’s FEIM4 request request Needs for support in deciding on the management of economic resources 2. Strongly 2. Strongly It ends with a decision on the need for assistance in recommended for recommended for taking decisions related to the management of people with a severe people with a severe economic resources and as soon as the assisted degree of disability degree of disability decision-making service becomes available. (for beneficiaries with a (for beneficiaries with a severe degree of disability severe degree of disability who do not apply on request) who do not apply on request) 0. Unselected 3. Upon request/referral from another person or institution and with the consent of the person 0. Unselected FEI0M5/ MODULE 5. 1. Participation 1. Participation FEIM5 agreement agreement Inventory of needs not covered by services for persons with disabilities 0. Refusal 0. Refusal It ends with a monthly report that is sent to the County Council to substantiate and boost the development of social services at the local and national level. FEI Final plan of interviews MODULE MODULE MODULE MODULE MODULE M1 1 2 3 4 5 a. Note 1 (one) for modules that are part of the final interview plan and are to be completed b. Next to the modules in the final interview plan, note the number of specialists, other than the case responsible, who will form the assessment team Write down zero if only the case responsible will participate in the interview. Note: According to the methodology, the case responsible accompanies the applicant in all the assessment modules decided together. Even though some modules can be performed by the case responsible alone – modules 1 and 3, for modules 2 and 4 it is recommended that there be at least 1-2 more SECPAH members with other team specializations, along with the case responsible. 131 EVN.0 3.3. Preparation of interviews by module FACE-TO-FACE OR ONLINE INTERVIEW. EVN01 Eyesight problems 1. Yes 0. No If YES a. Should tailored cards be used for interviews? 1. Yes 0. No EVN02 Hearing problems 1. Da 0. Nu * If YES a. Is the presence of a sign language interpreter 1. Yes 0. No necessary in the interviews? EVN03 Comprehension Does the person have psychiatric disorders with 1. Yes 0. No issues ** psychotic symptoms or intellectual disabilities, as a primary or associated diagnosis? EVN04 Need for Is there a need for an interpreter/translator or 1. Yes 0. No translation translation of documents? If YES a. Namely, translation into the language ... Notes: * For deaf people, the presence of a sign language interpreter is allowed in the interview. ** For applicants with psychiatric disorders with psychotic symptoms or intellectual disabilities, the participation of the legal representative/attendant/family in the interview is allowed. In addition, for these cases, the cards used in the interviews will be in easy-to-understand language, in order to facilitate the active participation of the applicants in the interview. Other information TIME0 a. How many minutes did it take to retrieve the data from the different |__|__| Minutes sources to complete sections 1 and 2 of this form? b. How many minutes did the first interaction with the applicant take? |__|__| Minutes Estimated Signatures Responsible for the Applicant: time case: 10+10 = 132 Module 1: Support and service needs in education and work Module 1 is strongly recommended for young people aged 18-35 years MODULE 1 includes: 1. ABOUT THE INTERVIEW 2. AUTOMATICALLY PRE-FILLED DATA FROM THE SOCIAL INQUIRY – ACTIVITIES AND PARTICIPATION 2.1. EDUCATION AND TRAINING 2.2. CONNECTION TO THE LABOR MARKET 2.3. AUTOMATICALLY PREFILLED DATA FROM THE ASSESSMENT OF FUNCTIONING: RESULTS FROM WHODAS+RO 3. ASPIRATIONS AND PLANS FOR THE FUTURE OF EDUCATION, TRAINING AND WORK 4. PROFESSIONAL POTENTIAL 5. SKILLS AND PREFERENCES 6. NEEDS FOR SUPPORT AND ADAPTATIONS FOR WORK 6.1. AUTOMATICALLY PREFILLED DATA FROM THE MEDICAL AND PSYCHOLOGICAL ASSESSMENT 6.2. AUTOMATICALLY PREFILLED DATA FROM THE SOCIAL INQUIRY: SUPPORT NEEDS 7. DATA AUTOMATICALLY RETRIEVED FROM THE SOCIAL INQUIRY 7.1. BARRIERS AND FACILITATORS FOR EDUCATION AND WORK 7.2. MOVING OUTSIDE HOME 133 MODULE 1. Profile of professional potential useful for identifying a suitable job or an alternative to complement education JUD County/sector: DATE Date of filling in |_z_| _z_|: |_l_|_l_|: |_a_|_a_|_a_|_a_| Automatically generated WHO To the case Name and surname:* Cods. responsible Profession: NUMEP Assessed person Name and surname:* ID. * Confidential information that will not be exported to the anonymized dataset for analysis. INT.1 1. ABOUT THE INTERVIEW Socio-demographic data and other information about the applicant can be found in MODULE 0. What we already know INT11 Where does the 1. SECPAH headquarters interaction take 2. Applicant's home (for bedridden persons) place? 3. Online 4. Another situation, namely: ... INT13 Language of the 1. 2. 3. 4. German 5. another, namely: interview Romanian Hungarian Romani ... INT12 Participants a. Person to be assessed/Applicant 1. Yes 0. No b. Designated case responsible 1. Yes 0. No c. Legal representative / accompanying person / 1. Yes 0. No family is. Other people who are not SECPAH specialists 1. Yes 0. No If YES e1. Namely: ... OMS1 Interview Team In addition to the case responsible, other SECPAH 1. Yes 0. No members with other specializations participate in the interview** 134 If YES OMS11 Member 1 Specialization: Cods. OMS12 Member 2 Specialization: Cods. ** Preferably the assessment team for this module includes psycho-pedagogues, education instructors, recovery pedagogues, psychologists with specialization in work and organizational psychology or with other specializations, career guidance counselors, specialists in assisted employment (COR 263507) or specialists in vocational assessment (COR 263506). mot1 This module is 0. Persistent recommendation for young people between 18 and 35 years completed ... old 1. At the request of the assessed person with disabilities 2. At the request/referral of another person or institution If MOT1=2 mo.10 Is there the written consent of the person 1. Yes 0. No being assessed? mot11 Who submitted the 1. Legal representative / guardian / direct family member application? 2. Other relative of the person with disabilities 3. Friend 4. Neighbor or other member of the community (but not employer or institution) 5. SPAS Representative 6. Representative of a social service 7. Representative of a medical service 8. Employer/company representative/ONG/enterprise/protected unit 9. Another situation, namely ... mo.12 The reason why the 1. Wants to help the person find a suitable job assessment was 2. Wants to hire the person requested? 3. Another reason, namely ... 2. AUTOMATICALLY PREFILLED DATA FROM THE SOCIAL Asoc INQUIRY – ACTIVITIES AND PARTICIPATION DATA RETRIEVED FROM THE SOCIAL INQUIRY Asoc 2.1. Education and training Asoc 2.2. Connection with the labor market 135 2.3. Automatically prefilled data from the assessment of EVF functioning: Results from WHODAS+RO DATA RETRIEVED FROM O#3_F2. FUNCTIONING ASSESSMENT or MODE 0. WHAT WE ALREADY KNOW 3. ASPIRATIONS AND PLANS FOR THE FUTURE OF Aviitor EDUCATION, TRAINING AND WORK FACE-TO-FACE OR ONLINE INTERVIEW. Is the person interested/would ever like/have thought AVED about starting or continuing education or any form of 1. Yes 0. No -7. Not applicable vocational training? If YES 1. What exactly would they like to learn? ... 2. Does he/she usually need help learning 1. Yes 0. No new things? 3. Does he/she have anyone to help 1. Yes 0. No him/her? 4. How does he/ she learn best? 1. He/she is told what to do 2. He/she is shown what to do 3. He/she has a list of what to do 4. Uses images that show him/ her what to do Is the person interested/would ever like/thought of AVW looking for a (new) job (of any type, formal or informal, 1. Yes 0. No -7. Not applicable volunteering, even just a few hours or days a week, or just on holidays)? If YES 1. Why would you want to work? 1. To earn (more) money 2. To meet (other) people 3. To learn new things 4. Because it would bring you joy 5. Another reason, namely: ... 2. What would he/she like to work on? ... 3. Does he/she usually need help finding or 1. Yes 0. No keeping a job? 4. Does he/she have anyone to help 1. Yes 0. No him/her? 136 0. Alone, without problems (without or PP 4. PROFESSIONAL POTENTIAL with devices if using) 1. Alone, but with difficulty FACE-TO-FACE OR ONLINE INTERVIEW. 2. Needs little assistance (monitoring, verbal/gestural suggestions) Basic: -1. Don't answer/I can't assess it 3. Only with intensive assistance from someone else 4. Can't do it/full help 1. He/ she wants to take part in learning new things 0 1 2 3 4 DEPENDING ON HOW HE/SHE RESPONDED TO AVED 2. Easily learn new behavioral patterns 0 1 2 3 4 3. Can copy the actions of another person 0 1 2 3 4 4. Expresses his/her choices and refusals in an appropriate manner 0 1 2 3 4 5. Is aware of his/her own abilities/needs 0 1 2 3 4 6. He/she can cope with responsibilities 0 1 2 3 4 7. He/she is aware of the world of work THAT IS, he/she knows what important people like family, friends, etc. are working 0 1 2 3 4 on. 8. Has professional aspirations 0 1 2 3 4 DEPENDING ON HOW HE/SHE RESPONDED TO AVW 9. Is aware of risks and dangers 0 1 2 3 4 10. Can tolerate change, criticism and/or frustration 0 1 2 3 4 11. Understand the value of money 0 1 2 3 4 12. He uses his/her free time constructively 0 1 2 3 4 THAT IS, he/she has interests/ hobbies, meetings with friends, practices sports, etc. TOTAL SCORE (Hofstede index) AB/PF 5. SKILLS AND PREFERENCES FACE-TO-FACE OR ONLINE INTERVIEW. EASY-TO-UNDERSTAND CARDS Skills AB1 I like to use my hands 1 2 3 4 5 6 I don't like to use my hands AB2 I have good eyesight 1 2 3 4 5 6 I have eyesight problems AB3 I have good hearing 1 2 3 4 5 6 I have hearing problems AB4 I am a good communicator 1 2 3 4 5 6 I do not communicate AB5 I can lift heavy weights 1 2 3 4 5 6 I do not like to lift heavy weights AB6 I am resistant 1 2 3 4 5 6 I'm not too resistant AB7 I like to work with words/books 1 2 3 4 5 6 I don't like to read AB8 I like to work with figures 1 2 3 4 5 6 I don't like to work with figures 137 Skills AB9 I can/like to work with money 1 2 3 4 5 6 I can/don't like to work with money AB10 I know how to read the clock 1 2 3 4 5 6 I don't know how to read the clock AB11 1 2 3 4 5 6 I do not know how to work on the I know how to work at the computer computer AB12 1 2 3 4 5 6 I don't know how to use my mobile I know how to use my mobile phone phone AB13 I can work quickly 1 2 3 4 5 6 I prefer to work slowly AB14 I like various tasks 1 2 3 4 5 6 I like to repeat only 1 or 2 tasks AB15 I like to work without being 1 2 3 4 5 6 I prefer work with direct support supported AB16 I can use a bank card and cash 1 2 3 4 5 6 I don't know how to use a bank card machine or cash machine AB17 1 2 3 4 5 6 I can't take a bath/shower alone and I like to be clean and neatly dressed prepare clean clothes Favorites PF1 I would love a manual work 1 2 3 4 5 6 I prefer office work PF2 I would love to work full time (8 1 2 3 4 5 6 I prefer to work at most 4-5 hours a hours a day) day or just on some days of the week PF3 On the inside 1 2 3 4 5 6 On the outside PF4 Static work 1 2 3 4 5 6 Change of place PF5 Dynamic workplace 1 2 3 4 5 6 Relaxed workplace PF6 Warm workplace 1 2 3 4 5 6 Cool workplace PF7 Noisy workplace 1 2 3 4 5 6 Quiet workplace PF8 Clean/tidy workplace 1 2 3 4 5 6 Messy job PF9 Hard work 1 2 3 4 5 6 Moderate work PF10 Large workspace 1 2 3 4 5 6 Small workspace PF11 In uniform 1 2 3 4 5 6 No uniform PF12 I like to work independently 1 2 3 4 5 6 I prefer to work in a team PF13 1 2 3 4 5 6 I can/don't like to use public I like to use public transport transport NSA 6. NEEDS FOR SUPPORT AND ADAPTATIONS FOR WORK FACE-TO-FACE OR ONLINE INTERVIEW. NSA Any assistance and adaptations which might support the person in training and professional activities, of the following: 1. Special chair 1. Yes 0. No 4. Special office 1. Yes 0. No 138 2. Equipment to help 5. Work preparer (someone you see your 1. Yes 0. No who helps you learn the 1. Yes 0. No computer screen work tasks) 3. Special phone 1. Yes 0. No 6. Sign language interpreter 1. Yes 0. No 8. Modifying and/ or adapting the working schedule according to the functional potential of the person with disabilities (according to art. 5, pct. 4. from Law no. 448/2006) According to art. 83 from the Law no. 448/2006, employed persons with disabilities can work less than 8 hours per day, according to the law, if he/she holds a recommendation for a reduced working schedule from 1. Yes 0. No a doctor specialized in the medicine of labor or from CEPAH. In these cases, remuneration is set according to the provisions of art. 106, para. (2) from Labor Code, which states that ,,remuneration rights are awarded according to the working time, in relation to the benefits for the normal working time”. 7. Other aids and adaptations 1. Yes 0. No If YES Namely: ... EVM 6.1. Automatically prefilled data from the medical and psychological assessment DATA RETRIEVED FROM O#3_F1. MEDICAL ASSESSMENT or MODE 0. WHAT WE ALREADY KNOW SCORM MEDICAL SCORE* indicating an impairment of the functions and structures of the body ...: 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: 1= 12 months 2= 24 months 3= permanent 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 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 therapy etc.) 9. Current mental health medication 1. Yes 0. No -1. I can’t assess it treatment 139 Note: * Medical score resulting from the medical assessment, established on the basis of O#2_MED1. Revised medical criteria. EVM5 Any kind of health problem recorded in the medical documents that could affect the work, of 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. Hepatitis B 1. Yes 0. No 12. Asperger's syndrome/ 1. Yes 0. No autism spectrum disorders 13. Rare diseases Asoc 6.2. Support needs AUTOMATICALLY PREFILLED DATA FROM THE SOCIAL INQUIRY D155 Indications 0 He/she can remember and carry out a sequence of directions (a shopping list, 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 D230 Carrying out the Able to plan, organize, and complete tasks such as time management and planning 0 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 D330 Communication He/she speaks well and intelligibly, using a language that can be understood; can 0 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 3 He/she doesn't speak; uses gestures when he/she wants to communicate 140 D510_ Personal care He/she can take care of herself completely and independently – personal hygiene, 0 20_40 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 certain 1 toilet, dressing) things He/she needs help, for example with transferring to the shower/bathtub, washing 2 or drying, with certain stages of the personal hygiene process, handling buttons, zippers, bras, laces, etc. 3 Depends on other people for personal care D710 Social relations 0 He/she has no difficulty in making friends and being sociable 1 Needs to be encouraged and supported to engage on a personal level with others Considers group situations as uncomfortable and needs support in one-on-one 2 situations He/she is isolated and finds it very difficult to manage one-on-one social and 3 group situations 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 calmed 1 down 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 7. DATA AUTOMATICALLY RETRIEVED FROM THE SOCIAL Asoc INQUIRY -1. Rather barrier -7. Not applicable (not valid for the Asoc 7.1. Barriers and facilitators for 0. It does not influence person’s status or education and work the performance of does not exist in the the person's daily community) activities - 9. I don't know if it AUTOMATICALLY PREFILLED DATA FROM THE SOCIAL INQUIRY 1. Rather facilitator affects the person's life Education and work 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. Assistive/supportive products or technologies Any products, tools, equipment or technologies adapted or specifically designed to improve/maximize the potential of people with disabilities Attitudes towards participation in education and work of the person with disabilities, with an influence on the individual behavior and social life 141 -1. Rather barrier -7. Not applicable (not valid for the Asoc 7.1. Barriers and facilitators for 0. It does not influence person’s status or education and work the performance of does not exist in the the person's daily community) activities - 9. I don't know if it AUTOMATICALLY PREFILLED DATA FROM THE SOCIAL INQUIRY 1. Rather facilitator affects the person's life For example, individual or societal attitudes about the person's credibility and value, that can motivate positive practices or negative and discriminatory practices (e.g., stigmatization, stereotyping and marginalization or neglect of a person). Asoc 7.2. Moving outside home/ residential center AUTOMATICALLY PREFILLED DATA FROM THE SOCIAL INQUIRY Other information TIME1 a. How many minutes did it take to retrieve the data from the different |__|__| Minutes sources to complete sections 2, 6 and 7 of this form? b. How many minutes did the interview with the applicant last? |__|__| Minutes Estimat Signatures Responsible for the Applicant: ed time case: 15 + 20 Members 1: = Member 2: 142 Module 2: Personal assistance needs Module 2 is only accessible for persons with a severe or marked degree of disability MODULE2 includes: 1. ABOUT THE INTERVIEW 2. AUTOMATICALLY PREFILLED DATA FROM THE SOCIAL INQUIRY 2.1. DATA ABOUT THE PERSON’S HOUSEHOLD 2.2. HOUSING AND PROPERTY DATA 2.3. BARRIERS AND FACILITATORS ON ACCESS TO RELEVANT SERVICES 3. REGULAR SCHEDULE AND CARE NETWORK 3.1. A TYPICAL DAY 3.2. CARE NETWORK 4. ASSESSMENT OF PERSONAL NEEDS 4.1. AUTOMATICALLY PREFILLED DATA FROM THE SOCIAL INQUIRY 4.2. FREQUENCY AND TYPES OF SUPPORT RELATED TO PERSONAL NEEDS 5. HOUSEHOLD NEEDS ASSESSMENT 5.1. AUTOMATICALLY PREFILLED DATA FROM THE SOCIAL INQUIRY 5.2. FREQUENCY AND TYPES OF SUPPORT RELATED TO HOUSEHOLD NEEDS 6. ASSESSMENT OF SOCIAL NEEDS 6.1. AUTOMATICALLY PREFILLED DATA FROM THE SOCIAL INQUIRY 6.2. FREQUENCY AND TYPES OF SUPPORT RELATED TO SOCIAL NEEDS 7. EXISTENCE OF SPECIAL NEEDS 7.1. AUTOMATICALLY PREFILLED DATA FROM THE MEDICAL AND PSYCHOLOGICAL ASSESSMENT: SPECIAL MEDICAL AND BEHAVIORAL NEEDS 7.2. AUTOMATICALLY PREFILLED DATA FROM THE SOCIAL INQUIRY: SPECIAL BEHAVIORAL NEEDS 7.3. OTHER MENTIONINGS 8. FINAL PERSONAL ASSISSTANCE NEEDS SCORE 143 MODULE 2. Identification of personal assistance needs (human or animal) JUD County/sector: DATE Date of filling in |_z_| _z_|: |_l_|_l_|: |_a_|_a_|_a_|_a_| Automatically generated WHO To the case Name and surname:* Cods. responsible Profession: NUMEP Assessed person Name and surname:* ID. * Confidential information that will not be exported to the anonymized dataset for analysis. INT.2 1. ABOUT THE INTERVIEW Socio-demographic data and other information about the applicant can be found in MODULE 0. What we already know INT21 Where does the 1. SECPAH headquarters interaction take 2. Applicant's home (for bedridden persons) place? 3. Online 4. Another situation, namely: ... INT23 Language of the 1. 2. 3. 4. German 5. another, namely: interview Romanian Hungarian Romani ... INT22 Participants a. Person to be assessed 1. Yes 0. No b. Designated case responsible 1. Yes 0. No c. Legal representative / accompanying person / 1. Yes 0. No family** is. Other people who are not SECPAH specialists 1. Yes 0. No If YES e1. Namely: ... ** It would be preferable for the legal representative / attendant / family of the person to participate in this interview. 144 WHO2 Interview Team In addition to the case responsible other SECPAH 1. Yes 0. No members with other specializations participate in the interview*** If YES WHO21 Member 1 Specialization: Cods. WHO22 Member 2 Specialization: Cods. Preferably the assessment team for this module includes social workers, psychologists, psycho-pedagogues, doctors, physical therapists. 2. DATA AUTOMATICALLY PREFILLED FROM THE SOCIAL Asoc INQUIRY DATA ABOUT THE PERSON BEING ASSESSED Asoc 2.1. Data about the person's household DATA RETRIEVED FROM THE SOCIAL INQUIRY Asoc 2.2. Housing and property data DATA RETRIEVED FROM THE SOCIAL INQUIRY -1. Rather barrier -7. Not applicable (not valid for the Asoc 2.3. Barriers and facilitators on 0. It does not influence person’s status or access to relevant services the performance of does not exist in the the person's daily community) DATA RETRIEVED FROM THE SOCIAL INQUIRY activities - 9. I don't know if it 1. Rather facilitator affects the person's Services life e540 Public transport services -1 0 1 -7 -9 e5750 a. Home care services (regardless of funding and -1 0 1 -7 -9 provider) b. Day care centers for adults and older people -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, -1 0 1 -7 -9 cultural or sports spaces, shops, etc.) 145 -1. Rather barrier -7. Not applicable (not valid for the Asoc 2.3. Barriers and facilitators on 0. It does not influence person’s status or access to relevant services the performance of does not exist in the the person's daily community) DATA RETRIEVED FROM THE SOCIAL INQUIRY activities - 9. I don't know if it 1. Rather facilitator affects the person's Services life e155 Physical accessibility of buildings where relatives and friends of the assessed person live (whom he/she likes -1 0 1 -7 -9 or 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 nature of the -1 0 1 -7 -9 land surface (grass, gravel, sand, mud, etc.) c. Location of your residence (depending on the -1 0 1 -7 -9 distance from the services) NORM 3. REGULAR SCHEDULE AND CARE NETWORK FACE-TO-FACE OR ONLINE INTERVIEW. BTZ DAILY HELP/SUPPORT TIME 3.1. A typical day 0 = Not at all, the activity is not carried out or there is no need for So your day starts at ... and ends at ... help We divide the day into 3 parts ... and 1 = less than 30 minutes we're talking about what you're doing in 2 = 30 minutes to less than 2 hours each of these. 3 = 2 hours to less than 4 hours 4 = 4 hours to 8 hours EASY-TO-UNDERSTAND CARD Morning-noon Afternoon-evening Night WITH SCALE 06.00-14.00 14.00-22.00 22.00-06.00 Time of waking up in the BTZ_A morning BTZ_B Bedtime in the evening Body and intimate hygiene / btz1 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 getting dressed / undressing btz2 Feeding 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 btz4 Meal preparation 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 Shopping/ household activities / btz5 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 care of household items btz6 Rest/sleep 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 Health care, medication, exercise, specialized care (physical therapy, btz7 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 physiotherapy, psychologist, speech therapist, etc.) 146 BTZ DAILY HELP/SUPPORT TIME 3.1. A typical day 0 = Not at all, the activity is not carried out or there is no need for So your day starts at ... and ends at ... help We divide the day into 3 parts ... and 1 = less than 30 minutes we're talking about what you're doing in 2 = 30 minutes to less than 2 hours each of these. 3 = 2 hours to less than 4 hours 4 = 4 hours to 8 hours EASY-TO-UNDERSTAND CARD Morning-noon Afternoon-evening Night WITH SCALE 06.00-14.00 14.00-22.00 22.00-06.00 Btz9 Socialization/communication 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 Watched TV, listened to the radio btz10 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 (including on the computer) Sports, cultural and other leisure btz11 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 activities (hobby, reading, etc.) Travel/transport/road between btz8 different places outside the house 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 (for any purpose) btz12 Parental activities 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 btz13 School/study at home/work 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 OBS: The application will include a validation condition, namely, on each part of the day, the total duration of the marked activities must be between min = 6 hours and max 10 hours, because some activities can be carried out in parallel. For summing up, the answers are recoded as follows: 0=0; 1=0.25 hours; 2=1.25 hours; 3=3 hours; 4=6 hours. RIN 3.2. Care network FACE-TO-FACE OR ONLINE INTERVIEW. O#3_M0_What we already know tells us if the person has a personal assistant or benefits from home care services. Here we reconfirm the information. PASIST Does the person benefit from 1. Yes, a professional personal assistant (APP) personal assistance? 2. Yes, a personal assistant (AP) 3. Yes, animal assistance 0. No If YES, data on APP or AP 1. Gender: 1. M 2. F 2. Age in years of age: |__|__| Years 3. Relationship: 1. | spouse 2. son/daughter | 3. mother/father | 4. another relative, ... 5. another person (non-relatives), namely ... 4. Does the personal assistant live 1. Yes 0. No with the person? sim2 Does the family benefit from 1. Yes 0. No Generated Automatically home care services? 147 FOR ACTIVITIES REQUIRING HELP WHO offers the help? EASY-TO-UNDERSTAND CARD 0 = No one, uncovered need WITH SCALE The activity 1 = Personal assistant does not 2 = (Other) direct family member require help or 3 = Extended family is not carried 4 = Home care services out 5 = Social service (center, LP) 6 = Other persons Body and intimate hygiene / RIN1 -7 0 1 2 3 4 5 6 dressing / undressing RIN2 Feeding -7 0 1 2 3 4 5 6 RIN4 Meal preparation -7 0 1 2 3 4 5 6 Shopping/ household activities / RIN5 -7 0 1 2 3 4 5 6 care of household items Health care, medication, exercise, specialized care (physical therapy, RIN7 -7 0 1 2 3 4 5 6 physiotherapy, psychologist, speech therapist, etc.) RIN9 Socialization/communication -7 0 1 2 3 4 5 6 Sports, cultural and other leisure RIN11 -7 0 1 2 3 4 5 6 activities (hobby, reading, etc.) Travel/transport/road between RIN8 different places outside the house -7 0 1 2 3 4 5 6 (for any purpose) RIN12 Parental activities -7 0 1 2 3 4 5 6 RIN13 School/study at home/work -7 0 1 2 3 4 5 6 Now we take each of these activities one at a time to better understand how much and what kind of help/support you need. Let's start with personal needs, namely ... NP 4. ASSESSMENT OF PERSONAL NEEDS PERSONAL NEEDS INCLUDE: (1) Body hygiene (d510, d520) (2) Intimate hygiene and toilet use (d530) (3) Getting dressed/undressed (d540) (4) Feeding (d550) (5) Changing the position of the body, moving around the house or lifting objects, other (d410, d415, d420, d430, d440, d455) movements (6) Communication (d310-d399) Asoc 4.1. Automatically prefilled data from the social inquiry DATA RETRIEVED FROM THE SOCIAL INQUIRY ON THE INTENSITY OF SUPPORT 148 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 0 No problems hygiene (intense 1 Occasional incontinent or needs occasional help and bladder control) 2 Incontinent, he/she needs partial, constant help 3 Incontinent or permanent catheter, he/she is not able to perform the activity 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 a wheelchair, lock the brakes, lift the footrests, safely climb into bed, lie down, sit (to be completed on the edge of the bed, change the position of the wheelchair, sit back on it also in 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. 3 He/she is not able to participate in the transfer. Two people are needed to transfer the disabled person, 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. D550 Feeding 0 He/she can feed herself and organize all his/her dining activities without any problem 149 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. D330 Communication He/she speaks well and intelligibly, using a language that can be understood; can 0 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 3 He/she doesn't speak; uses gestures when he/she wants to communicate NP 4.2. Frequency and types of support related to personal needs FACE-TO-FACE OR ONLINE INTERVIEW. (1) Body hygiene includes washing and drying all or some parts of the body. It also includes skin, nail, hair and dental care. Does the person need help/support in 1. Yes  FILL IN NEXT NP1 terms of body hygiene? 0. No  SWITCH TO (2) NP2 CARD NEED HELP Activities: For example... Yes No NC Washing or drying of the d5101 1 0 -7 body completely or partially d5200 Skin care use of creams / ointments, cosmetics 1 0 -7 d5201 Dental care brushing your teeth, caring for dentures/bridges 1 0 -7 d5202 Hair care combing, styling, shaving, epilation, hair cut 1 0 -7 cleaning, cutting or polishing of nails, on hands and d5203 Nail care 1 0 -7 feet NP1a Others, namely: Given the support needs for all body hygiene activities, fill in below: |___| 0 = Less often than once a month NP11. INTENSITY 1 = Several times a month, but not every week support = D510_ 20_40 NP13. FREQUENCY of 2 = A few times a week, but not every day required support: 3 = Every day, but not every hour NP12. PART OF THE DAY = Write down the appropriate code 4 = Every hour/ non-stop BTZ1 150 (2) Intimate hygiene and toilet use using the toilet seat, choosing and arriving at the right place, handling clothes before and after visits to the toilet, washing and drying. Consider catheters, diapers, enemas, etc. Does the person need help/support 1. Yes  FILL IN NEXT NP2 regarding intimate hygiene and toilet use? 0. No  GO TO (3) NP3 CARD NEED HELP Activities: For example... Yes No NC d5300 Hygiene of urination Including diapers 1 0 -7 d5301 Hygiene of defecation Including diapers, enemas, etc. 1 0 -7 d5302 Menstruation hygiene 1 0 -7 d420 Use of toilet seat Including transferring 1 0 -7 NP2a Can use a bed or urinal pad at night Including cleaning them 1 0 -7 NP2b Others, namely: Given the support needs for all intimate hygiene activities and the use of the toilet, fill in below: |___| 0 = Less often than once a month NP21. INTENSITY 1 = Several times a month, but not every week support = max (D420a, D530) NP23. FREQUENCY of 2 = A few times a week, but not every day required support: 3 = Every day, but not every hour NP22. PART OF THE DAY = Write down the appropriate code 4 = Every hour/ non-stop BTZ1 (3) Dressing/undressing includes removing/placing clothes and shoes, removing/dressing outerwear. They also include the laying/removal of orthotics, the use of support bars. Does the person need help/support in 1. Yes  FILL IN NEXT NP3 dressing/undressing? 0. No  SWITCH TO (4) NP4 CARD NEED HELP Activities: For example... Yes No NC d5404 Choosing the right clothes 1 0 -7 d5400 Getting dressed handling of buttons, zippers, bras 1 0 -7 d5402 Footwear tying laces, boot shoes 1 0 -7 d5401 Undressing removing and placing outdoor or winter clothes 1 0 -7 NP3a Others, namely: Given the support needs for all dressing/undressing activities, fill in below: |___| 0 = Less often than once a month NP31. INTENSITY 1 = Several times a month, but not every week support = D510_ 20_40 NP33. FREQUENCY of 2 = A few times a week, but not every day required support: 3 = Every day, but not every hour NP32. PART OF THE DAY = 151 Write down the appropriate 4 = Every hour/ non-stop BTZ1 code (4) Feeding includes all activities related to eating or drinking, for example, using cutlery / bringing food or drink to the mouth, cutting food, feeding with the help of a probe, and laying and lifting from the table. Does the person need help/support in 1. Yes  FILL IN NEXT NP4 feeding? 0. No  SWITCH TO (5) NP5 CARD NEED HELP Activities: For example... Yes No NC d5501 Eating chewing and swallowing food, handling dishes 1 0 -7 d5508 Cutting food into pieces use of fork and knife 1 0 -7 d5608 Opening bottles, caps 1 0 -7 NP4a Others, namely: Given the support needs for all feeding activities, fill in below: |___| 0 = Less often than once a month NP41. INTENSITY 1 = Several times a month, but not every week support = D550 NP43. FREQUENCY of 2 = A few times a week, but not every day required support: 3 = Every day, but not every hour NP42. PART OF THE DAY = Write down the appropriate code 4 = Every hour/ non-stop BTZ2 (5) Making movements, cum are changing and maintaining the position of the body, moving around the house or lifting objects, including transferring to bed or wheelchair and using stairs. Does the person need help/support in 1. Yes  FILL IN NEXT NP5 changing/maintaining body position and 0. No  SKIP TO (6) NP6 movement? CARD NEED HELP Activities: Yes No NC D4100 To lie down in bed and then move to any other position 1 0 -7 D4200 Changing the place in the seated position 1 0 -7 D4105 Bending the back down or to the side 1 0 -7 D430 Picking up and bringing objects 1 0 -7 D440 Handling and releasing objects 1 0 -7 D4152 Maintaining the position on your knees, as in prayer 1 0 -7 D4551 Use of stairs 1 0 -7 NP5a Others, namely: 152 Considering the support needs for all activities of changing / maintaining the position of the body and moving in the home, fill in below: |___| 0 = Less often than once a month NP51. INTENSITY 1 = Several times a month, but not every week support = max (D410_ 15, NP53. FREQUENCY of 2 = A few times a week, but not every day D420b, D4551) required support: 3 = Every day, but not every hour Write down the appropriate code 4 = Every hour/ non-stop NP52. PART OF THE DAY = NC (6) Communication means that you can make yourself understood, receive information and maintain social contacts. Being able to speak is not the same as being able to communicate. Communication includes receiving and developing verbal and non-verbal messages, speaking, body language, conversation, discussion, and the use of communication tools and techniques. Does the person need help/support 1. Yes  FILL IN NEXT NP6 regarding communication? 0. No  SKIP TO 5. Household needs If YES a. Does the person use any means of 1. Yes 0. No communication? Namely: ... b. Is a third person needed to make 1. Yes 0. No communication possible? c. Other support needs, namely: ... Given the support needs for all communication activities, fill in below: |___| 0 = Less often than once a month NP61. INTENSITY 1 = Several times a month, but not every week support = D330 NP63. FREQUENCY of 2 = A few times a week, but not every day required support: 3 = Every day, but not every hour NP62. PART OF THE DAY = Write down the appropriate code 4 = Every hour/ non-stop BTZ9 Now let's move on to household needs, namely (read below) ... NC 5. ASSESSMENT OF HOUSEHOLD NEEDS HOUSEHOLD NEEDS INCLUDE: (1) Shopping (d620) (2) Meal preparation (d630) (3) Carrying out household responsibilities and caring for household items (d640, d650) (4) Health care and medication (d570) (5) Parental activities (d660, d230, d240) Asoc 5.1. Automatically prefilled data from the social inquiry DATA RETRIEVED FROM THE SOCIAL INQUIRY ON THE INTENSITY OF SUPPORT 153 D620 Shopping Can shop alone, without problems in the selection, payment, transport or 0 storage 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. 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. D570 Health care 0 The person can take care of his/her own health, does not expose himself/ herself and to health risks, follows the advice of the doctor and knows how to prevent medication worsening of his/her health condition administration 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. 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 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 NC 5.2. Frequency and types of support related to household needs 154 FACE-TO-FACE OR ONLINE INTERVIEW. (1) Shopping means planning purchases, moving to and from the store, picking up and transporting goods at home, as well as performing other tasks such as going to the bank, post office, pharmacy, paying bills, etc. Does the person need help/support with 1. Yes  FILL IN NEXT NC (1) their shopping? 0. No  SKIP TO (2) NC2 CARD NEED HELP Activities: Yes No NC D62001 Plan your shopping list 1 0 -7 D62002 Travel to and from the store 1 0 -7 D62003 Getting prescriptions from the pharmacy 1 0 -7 D62004 Payment of invoices 1 0 -7 D62005 Transporting your shopping at home 1 0 -7 NC1a Online shopping 1 0 -7 NC1b Others, namely: Given the support needs for all shopping-related activities, fill in below: |___| 0 = Less often than once a month NC11. INTENSITY 1 = Several times a month, but not every week support = D620 NC13. FREQUENCY of 2 = A few times a week, but not every day required support: 3 = Every day, but not every hour NC12.PART OF THE DAY = BTZ5 Write down the appropriate code 4 = Every hour/ non-stop (2) Meal preparation includes activities such as planning, organizing and cooking simple or complex meals. Does the person need help/support in 1. Yes  FILL IN NEXT NC 2 preparing meals? 0. No  SKIP TO (3) NC3 CARD NEED HELP Activities: Yes No NC d63001 Making tea/coffee 1 0 -7 d63002 Breakfast preparation 1 0 -7 d6301 Preparing lunch 1 0 -7 d6302 Laying tables 1 0 -7 NC2a Others, namely: Given the support needs for all food preparation activities, fill in below: 0 = Less often than once a month NC21. INTENSITY 155 1 = Several times a month, but not every week support = D630 |___| 2 = A few times a week, but not every day NC23. FREQUENCY of 3 = Every day, but not every hour NC22. PART OF THE DAY = required support: BTZ4 Write down the appropriate 4 = Every hour/ non-stop code (3) Household activities include cleaning, washing and drying clothes, washing dishes, making the bed and changing linen, using household appliances, littering and others. In addition, this category also covers the maintenance of household items comprising activities such as ironing, repairing clothes, maintenance of wheelchairs or other supporting devices, care of plants (indoor and outdoor) and pets. Does the person need help/support 1. Yes  FILL IN NEXT N.C. 3 regarding household responsibilities? 0. No  SWITCH TO (4) NC4 CARD NEED HELP Activities: Yes No NC d6400 Washing and drying of laundry 1 0 -7 d6401 Dishwashing 1 0 -7 d6402 Vacuuming and cleaning dust 1 0 -7 d6403 Use of household appliances 1 0 -7 d6504 Care of support, communication and recreation devices 1 0 -7 D6506 Care of yard and home animals 1 0 -7 NC3a Others, namely: Given the support needs for all household activities, fill in below: |___| 0 = Less often than once a month NC31. INTENSITY 1 = Several times a month, but not every week support = D640 NC33. FREQUENCY of 2 = A few times a week, but not every day required support: 3 = Every day, but not every hour NC32. PART OF THE DAY = Write down the appropriate code 4 = Every hour/ non-stop BTZ5 (4) Health care includes activities such as the administration of prescribed medicines and medical recommendations, self-care, exercise, specialized services within health centers, hospitals, dental offices, rehabilitation centers, etc. Does the person need help/support in 1. Yes  FILL IN NEXT N.C. (4) terms of health care? 0. No  SWITCH TO (5) NP5 CARD NEED HELP Activities: Yes No NC d5700 Ensuring your own comfort 1 0 -7 d57011 Keeping a healthy diet or prescribed by the doctor 1 0 -7 D57012 Individual exercises to maintain physical form 1 0 -7 156 Specialized care (kineto, physiotherapy, psychologist, D57013 speech therapist, etc.) in the framework of medical and 1 0 -7 social services D57014 Transport to and from relevant medical and social services 1 0 -7 d57020 Administering medication 1 0 -7 D57022 Avoiding the risks of drug and alcohol abuse 1 0 -7 D571 Avoiding risks to one's own safety NC4a Others, namely: Given the support needs for all health care activities, fill in below: |___| 0 = Less often than once a month NC41. INTENSITY 1 = Several times a month, but not every week support = D570 NC43. FREQUENCY of 2 = A few times a week, but not every day required support: 3 = Every day, but not every hour NC42. PART OF THE DAY = Write down the appropriate code 4 = Every hour/ non-stop BTZ7 (5) This part concerns the parenthood of the person with disabilities. Therefore, only applicants who care for children under 18 who live at home must respond to this part. IF IN SECTION 2.1 THE QUESTION NKID>0 1. Yes  FILL IN NEXT Does the person need help/support to NC5 0. No  SKIP TO 6. Social needs fulfill their role as a parent? -7. NC  SKIP TO 6. Social needs CARD NEED HELP Activities: Yes No NC D2400 Coping with the responsibilities of a parent 1 0 -7 D2401 Coping with stressful situations related to the child 1 0 -7 d6601 Help your child move to school/different activities 1 0 -7 d6604 To prepare the meal and feed the baby 1 0 -7 NC5a Others, namely: Given the support needs for all parental activities, fill in below: |___| 0 = Less often than once a month NC51. INTENSITY 1 = Several times a month, but not every week support = max (D2304, D240) NC53. FREQUENCY of 2 = A few times a week, but not every day required support: 3 = Every day, but not every hour NC52. PART OF THE DAY = Write down the appropriate code 4 = Every hour/ non-stop BTZ12 Now we move on to social needs, namely (read below) ... NS 6. ASSESSMENT OF SOCIAL NEEDS 157 SOCIAL NEEDS INCLUDE: (1) Education and work (d810, d820, d830, d845, d850, d855) (2) Own revenue management (d860, d865, d870) (3) Leisure activities (d920, d930, d950) (4) Travelling to different places and using public transport (d450, d460, d465, d470) (5) Participation in interpersonal interactions (d710, d720, d750, d770) Asoc 6.1. Automatically prefilled data from the social inquiry DATA RETRIEVED FROM THE SOCIAL INQUIRY ON THE INTENSITY OF SUPPORT D230 Carrying out Able to plan, organize, and complete tasks such as time management and 0 planning distinct tasks throughout the day the 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 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 Without problems he/she can save money, keep a bank account, manage 70 0 properties and other personal economic resources, to ensure economic security of economic resources / for present and future needs Economic 1 Mostly alone, with occasional help independence 2 With partial help, constantly 3 Totally dependent on the management of economic resources D160 Ability to He/she has no difficulty concentrating on the same activity for a long period of 0 time concentrate 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 D450_ Walking, 0 He/she can move independently, without problems 60_65 moving 1 Only with help (cane, supported unilaterally) 2 Only with help (frame, wheelchair, supported bilaterally), for short distances 3 Can't do the work D4708 Finding the 0 He/she has no difficulty finding his/her way into a new area way in the 1 He/she must be trained in the use of public transport and suggested certain routes local to use community 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 D710 Social relations 0 He/she has no difficulty in making friends and being sociable 158 1 Needs to be encouraged and supported to engage on a personal level with others Considers group situations as uncomfortable and needs support in one-on-one 2 situations He/she is isolated and finds it very difficult to manage one-on-one social and 3 group situations 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 calmed 1 down 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 NS 6.2. Frequency and types of support related to social needs FACE-TO-FACE OR ONLINE INTERVIEW. (1) This section, about work and participation in education, should only be completed for applicants who are currently doing some form of work or education. FURTHER INFORMATION CAN BE FOUND IN MODULE 1. SUPPORT NEEDS IN THE FIELD OF EDUCATION AND WORK, IF THE APPLICANT IS 18-35 YEARS OLD OR IF HE/SHE HAS COMPLETED IT UPON REQUEST. IF IN SECTION 2, EDNOW=1 OR OCNOW=1 1. Yes  FILL IN NEXT Does the person need help/support in ns1 carrying out his/her work or in 0. No  SWITCH TO (2) NS2 completing education? -7. NC  SWITCH TO (2) NS2 159 CARD NEED HELP Activities: Yes No NC EDOCT Transport to and from work/school 1 0 -7 D7402 Interaction with colleagues 1 0 -7 D7400 Interaction with superiors 1 0 -7 D8451 Effective performance of tasks 1 0 -7 NS1a Others, namely: Given the support needs for all work and education activities, fill in below: |___| 0 = Less often than once a month NS11. INTENSITY 1 = Several times a month, but not every week support = D230 NS13. FREQUENCY of 2 = A few times a week, but not every day required support: 3 = Every day, but not every hour NS12. PART OF THE DAY = Write down the appropriate code 4 = Every hour/ non-stop BTZ13 (2) Managing your own income includes using money, saving, managing property and valuables, managing a bank account, etc. Shopping and payment of invoices covered by section 5.2 point (1) are excluded. FURTHER INFORMATION CAN BE FOUND IN MODULE 4. NEEDS FOR DECISION-MAKING SUPPORT, IF THE APPLICANT HAS A SEVERE DEGREE OF DISABILITY OR IF HE/SHE HAS COMPLETED IT UPON REQUEST. Does the person need help/support in 1. Yes  FILL IN NEXT ns2 managing their own income and 0. No  SWITCH TO (3) NS3 economic resources? CARD NEED HELP Activities: Yes No NC D8600 Understanding and using money 1 0 -7 D8651 Understanding and using a bank account/card 1 0 -7 D8652 Property and valuables management 1 0 -7 D8791 Avoiding the risk of being the victim of a scam 1 0 -7 D8792 Avoiding/refraining from slots/gambling 1 0 -7 NS2a Others, namely: Given the support needs for all activities related to the management of own revenues, fill in below: |___| 0 = Less often than once a month ns21. INTENSITY 1 = Several times a month, but not every week support = max (d860, d865_70) NS23. FREQUENCY of 2 = A few times a week, but not every day required support: 3 = Every day, but not every hour nS22. PART OF THE DAY = NC Write down the appropriate code 4 = Every hour/ non-stop 160 (3) Leisure activities include participation in games or sports activities, cultural, hobbies, reading, musical activities, excursions, holidays, visits to friends and relatives, socializing. In addition, this category also includes watching TV and listening to the radio (including on the computer, ipad or other devices), as well as social activities in the community, like participation in organizations, associations, political life or the practice of religion. Does the person need help/support in 1. Yes  FILL IN NEXT NS3 participating in leisure activities or social 0. No  SWITCH TO (4) NS4 activities in the community? CARD NEED HELP Activities: Yes No NC D9205 Socializing outside the home 1 0 -7 D9208 Watching programs or using TV/radio 1 0 -7 D9204 Leisure time with others 1 0 -7 D9300 Participation in religious activities and events 1 0 -7 D950 Participation in political/social life in the community 1 0 -7 NS3a Others, namely: Given the support needs for all leisure activities, fill in below: |___| 0 = Less often than once a month ns31. INTENSITY 1 = Several times a month, but not every week support = d160 NS33. FREQUENCY of 2 = A few times a week, but not every day required support: 3 = Every day, but not every hour ns32. PART OF THE DAY = Write down the appropriate code 4 = Every hour/ non-stop max (btz9, btz10, btz11) (4) Travelling in different places includes walking and travelling using equipment or by means of transport, outside the home. Does the person need help/support to 1. Yes  FILL IN NEXT NS4 move outside the home? 0. No  SWITCH TO (5) NS5 a. Does the person use any means of 1. Yes 0. No transport (public or private)? Namely: ... b. Does the person need a caregiver to be 1. Yes 0. No able to move outside the home? c. Other support needs, namely: ... Given the support needs for all out-of-home travel, fill in below: |___| 0 = Less often than once a month ns41. INTENSITY 1 = Several times a month, but not every week support = NS43. FREQUENCY of 2 = A few times a week, but not every day max (d450_60_65, d470) required support: 3 = Every day, but not every hour Write down the appropriate code 4 = Every hour/ non-stop NS42. PART OF THE DAY = BTZ8 161 (5) Participation in interpersonal interactions refers to the establishment of interactions, simple and complex, with people (unknown persons, friends, relatives, family members and loved ones) in an appropriate contextual and social manner. Does the person need help/support in 1. Yes  FILL IN NEXT NS5 participating in interpersonal 0. No  SKIP TO 7. Special needs interactions? CARD NEED HELP Activities: Yes No NC D7500 To make and maintain friendships 1 0 -7 D730 Interacting with strangers 1 0 -7 D770 To create and maintain intimate relationships of love, marriage 1 0 -7 and sexual intercourse NS5a Others, namely: Given the support needs for participation in interpersonal interactions, fill in below: |___| 0 = Less often than once a month NS51. INTENSITY 1 = Several times a month, but not every week support = max (d710, d720) NS53. FREQUENCY of 2 = A few times a week, but not every day required support: 3 = Every day, but not every hour NS52. PART OF THE DAY = Write down the appropriate code 4 = Every hour/ non-stop BTZ9 Finally, the last ones are the special medical or behavioral needs ... NX 7. EXISTENCE OF SPECIAL NEEDS SPECIAL NEEDS ARE AUTOMATICALLY PREFILLED FROM O#3_F1. MEDICAL AND PSYCHOLOGICAL ASSESSMENT AND SOCIAL O#3_SOCIAL INQUIRY. EVM 7.1. Automatically prefilled data from the medical and psychological assessment: Special medical and behavioral needs Asoc 7.2. Automatically prefilled data from the social inquiry: Special behavioral needs 162 NV 7.3. Other information FACE-TO-FACE OR ONLINE INTERVIEW. OTHN Does the applicant need other forms of help, not mentioned above 1. Yes 0. No and important for his or her well-being? 1. 2. 3. Cdec 8. FINAL SCORE OF PERSONAL SUPPORT NEEDS IT WILL BE GENERATED AUTOMATICALLY. IT WILL ONLY BECOME AVAILABLE AFTER THE FIRST 6 MONTHS OF THE PILOT. Intensity Frequency Daily time ITEM SCORE NP. PERSONAL NEEDS (1) Body hygiene (2) Intimate hygiene and toilet use (3) Getting dressed/undressed (4) Feeding (5) Changing the position of the body, moving around the house or lifting objects, other movements (6) Communication CN. HOUSEHOLD NEEDS (1) Shopping (2) Meal preparation (3) Carrying out household responsibilities and caring for household items (4) Health care and medication (5) Parental activities NS. SOCIAL NEEDS (1) Education and work (2) Own revenue management (3) Leisure activities (4) Travelling to different places and using public transport (5) Participation in interpersonal interactions TOTAL SCORE: AUGMENTATION NX. SPECIAL NEEDS (1) Medical (2) Behavioral DECISION OF THE SECPAH TEAM 163 CLDAP In order to achieve the purpose stated in the law to ensure a fulfilled life for persons with disabilities, under equal conditions, and ensure decent living conditions, according to the Law no. 448/2006,... 1 The applicant needs personal assistance ... 2. Yes 1. Partially 0. No 2 The estimated number of hours of personal support... |__|__| hours/day 3 During a day, assistance is especially necessary ... To complete the dominant part of the day 4 The assistance is considering, ... 1. Personal 2. Household 3. Social needs needs needs IF THE NEED FOR PERSONAL ASSISTANCE IS CONFIRMED ORGANIZING THE ASSISTANCE ORGAP In order to recommend the type pf personal assistance, please first revisit the information from the sections 3.2. Care Network and 6.2 Special Needs (in particular, NX5 and NX6 questions) automatically prefilled from the social inquiry. 1 The applicant has an adequate care network and has 1. Yes 0. No -7. NC, no available no abuse or neglect risk factors information 2 Is the family (or a family member) or someone from 1. Yes 0. No -7. NC, no available the care network willing to offer care for the applicant, information until next assessment of personal needs? 3 Is the applicant willing to be cared for by the family 1. Yes 0. No -7. NC, no available (or a family member) or someone from the care information network? 4 Is the applicant willing to live in the house of the 1. Yes 0. No -7. Not sure, he/she does person certified as professional personal assistant, in not know order to receive care and assistance? DECAP Based on analyzing all the information, SECPAH 1. Personal assistant (from the family) specialists recommend personal assistance to be 2. Professional personal assistant (APP) provided through: According to Law no. 448/2006, art. 5, points 6-8 3. Animal assistance IF DECAP=2 (APP) For improving the matching procedure, the applicant’s preferences can be taken into consideration, regarding: o Does it matter if your personal assistant is a woman or a man or a family (with or without children)? o Does the age of the professional personal assistant matter? If yes, what would be the preffered age group? o Does it matter if the professional personal assistant smokes? o Is it important for you to have a house in order? o Do you like to have a quiet house? o Are there any TV programs that you would like to watch? o Is religion important for you? o Are you willing to hand over some tasks? o Do you like to have a preset routine? o Do you like to always wake up at the same time? o Do you like to plan the meals? o Do you disapprove meat consumption? 164 o Usually, would you rather eat alone? o Do you like to choose the clothes you are wearing? o Is personal look important for you? o Do you mind if other people use your personal objects? o Do you like to receive guests? o Do you like your friends to stay overnight? Set of questions adapted based on the Institute for Independent Life from Sweden Other information TIME4 a. How many minutes did it take to retrieve the data from the different |__|__| Minutes sources to fill in the pre-filled sections of this form? b. How many minutes did the interview with the applicant last? |__|__| Minutes Estimat Signatures Applicant: Case responsible: ed time Member 1: 15+ 35 = Member 2: At the end of the interview, the case responsible hands the person the list of devices available in Romania, organized according to the 16 types of activities included in the assessment. 165 Module 3: Support for independent living: home adaptation Module 3 is applied on request without any further condition MODULE 3 includes: 1. ABOUT THE INTERVIEW 2. AUTOMATICALLY PREFILLED DATA FROM THE SOCIAL INQUIRY 2.1. SUPPORT NEEDS 2.2. HOUSING AND PHYSICAL ENVIRONMENT DATA 2.3. HOME EQUIPMENT 2.4. ACCESSIBILITY ISSUES INSIDE THE HOME 2.5. BARRIERS AND FACILITATORS RELATED TO THE PHYSICAL ENVIRONMENT 3. ASPIRATIONS AND FUTURE PLANS FOR THE HOME 166 MODULE 3. Home accessibility profile JUD County/sector: DATE Date of filling in |_z_| _z_|: |_l_|_l_|: |_a_|_a_|_a_|_a_| Automatically generated WHO To the case Name and surname:* Cods. responsible Profession: NUMEP Assessed person Name and surname:* ID. * Confidential information that will not be exported to the anonymized dataset for analysis. INT.3 1. ABOUT THE INTERVIEW Socio-demographic data and other information about the applicant can be found in MODULE 0. What we already know INT31 Where does the 1. SECPAH headquarters interaction take 2. Applicant's home (for bedridden persons) place? 3. Online 4. Another situation, namely: ... INT33 Language of the 1. 2. 3. 4. German 5. another, namely: interview Romanian Hungarian Romani ... INT32 Participants a. Person to be assessed /Applicant 1. Yes 0. No b. Designated case responsible 1. Yes 0. No c. Legal representative / accompanying person / 1. Yes 0. No family** is. Other people who are not SECPAH specialists 1. Yes 0. No If YES e1. Namely: ... ** It would be preferable for the legal representative / attendant / family of the person to participate in this interview. OMS3 Interview Team In addition to the case responsible, other 1. Yes 0. No SECPAH members with other specializations participate in the interview*** If YES 167 OMS31 Member 1 Specialization: Cods. OMS32 Member 2 Specialization: Cods. Preferably the assessment team for this module includes social workers, psychologists, doctors, physical therapists. 2. DATA AUTOMATICALLY PREFILLED FROM THE SOCIAL Asoc INQUIRY DATA ABOUT THE ASSESSED PERSON Asoc 2.1. Support needs DATA RETRIEVED FROM THE SOCIAL INQUIRY 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. D510_ Personal care He/she can take care of herself completely and independently – personal hygiene, 20_40 0 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 certain 1 toilet, dressing) things He/she needs help, for example with transferring to the shower/ bathtub, washing 2 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 0 No problems hygiene (intense 1 Occasional incontinent or needs occasional help and bladder control) 2 Incontinent, he/she needs partial, constant help 3 Incontinent or permanent catheter, he/she is not able to perform the activity 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 use 0 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 with 1 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 168 D420b Transfer to bed 0 Independent in all phases of the transfer. He/she can safely approach the bed in a or wheelchair wheelchair, lock the brakes, lift the footrests, safely climb into bed, lie down, sit on (to be completed the edge of the bed, change the position of the wheelchair, sit back on it safely. also in the case of 1 The presence of another person is necessary either to give confidence, for safety bedridden persons) 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. 3 He/she is not able to participate in the transfer. Two people are needed to transfer the disabled person, with or without a mechanical device. D450_ Walking, 0 He/she can move independently, without problems 60_65 moving 1 Only with help (cane, supported unilaterally) 2 Only with help (frame, wheelchair, supported bilaterally), for short distances 3 Can't do the work 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. Asoc 2.2. Housing and physical environment data DATA RETRIEVED FROM THE SOCIAL INQUIRY Asoc 2.3. Home equipment DATA RETRIEVED FROM THE SOCIAL INQUIRY Asoc 2.4. Accessibility issues within the home DATA RETRIEVED FROM THE SOCIAL INQUIRY -1. Rather barrier -7. Not applicable (not valid for the Asoc 2.5. Barriers and facilitators related 0. It does not influence person’s status or to the physical environment the performance of does not exist in the the person's daily community) DATA RETRIEVED FROM THE SOCIAL INQUIRY activities - 9. I don't know if it 1. Rather facilitator affects the person's Environmental factors life Products for personal use in everyday life 169 -1. Rather barrier -7. Not applicable (not valid for the Asoc 2.5. Barriers and facilitators related 0. It does not influence person’s status or to the physical environment the performance of does not exist in the the person's daily community) DATA RETRIEVED FROM THE SOCIAL INQUIRY activities - 9. I don't know if it 1. Rather facilitator affects the person's Environmental factors life Equipment, products and technologies, adapted or specially designed to help people in everyday life, e.g. prosthetic and orthopedic devices, neural prostheses -1 0 1 -7 -9 (e.g. functional stimulation devices that control the bladder, intestines, heart rate and respiratory rate) Aviitor 3. ASPIRATIONS AND FUTURE PLANS FOR THE HOME FACE-TO-FACE OR ONLINE INTERVIEW. Is the person satisfied 1. He/ she wants to continue living with the same people in the same with the current housing dwelling (or in the same service/center where he/she currently lives) situation or would 2. He/ she wants to live with the same people, but the family to change the he/she like to move? home 3. He/she wants to move on his/ her own AVL1 4. He/ she wants to move in with his/ her partner 5. He/ she wants to move in with some friends or colleagues (from school, work, center, etc.) 6. He/ she wants to be cared for in a residential service, asylum, medical- social institution If AVL1= 3, 4 or 5 wants to move alone, with his/ her partner or with friends, colleagues a. Would like to move: 0. Uncertain or incapable of deciding 1. In a dwelling found on its own, without services 2. In a dwelling with services provided (e.g. sheltered dwelling) 3. In a center or other residential service where other persons live (CIA, CITO, asylum, CRRN, etc.) 4. Another variant, which ... What would be the 1. He/ she wants the assessed person to continue living with the family in guardian's/family's the same dwelling (or in the same service/center where he/ she currently preference for housing lives) arrangements for the 2. He/ she wants the assessed person to continue living with the family, but assessed person? there is a need for the family to change the home AVL2 3. He/ she wants the assessed person to move to another home, alone, with his/her partner, colleagues or friends 4. He/ she wants the assessed person to move, he/ she does not care where and with whom 5. He wants the assessed person to be cared for in a residential service, asylum, medical-social institution 170 If the assessed person wants to continue living with the family (AVL1=1 or 2) and the guardian/family wants the person to remain in the family (AVL2=1 or 2). Does the family plan to make a subsidized 2. Yes, we would like and can afford it interest loan to increase the degree of 1. Yes, we would like it, but we would not adaptation of the home to the specific needs of afford it the person with disabilities? AVL3 0. We would not like it in any way -1. The person is indecisive, NS/NR -7. Have already taken such a loan (see section 2.2, question CRED11) IF THE PERSON IS ELIGIBLE AND DOES NOT KNOW ABOUT THE POSSIBILITY OF TAKING A SUBSIDIZED LOAN Provide at least the following information: Adults with severe or marked disabilities can benefit from a loan whose interest is paid from the state budget, through transfers from the ANPD budget to the budgets of the DGASPC, based on a contract on the commitment to pay interest for the purchase of a single vehicle and for the adaptation of a home according to individual access needs, provided that the loan installments are paid at maturity, but also on the condition that the value of the loan does not exceed 10,000 euros, and the repayment of the loan does not exceed 10 years. In the case of the purchase of vehicles especially adapted for the transport of non-transferable disabled people, dependent on wheelchairs, the value of the loan cannot exceed 20,000 euros, the repayment period being 15 years. But if some grants or vouchers for home 1. Yes, definitely adaptation became available, would the family 2. Probably yes apply for such a grant/voucher? AVL4 3. Probably not 4. No, for sure -1. The person is indecisive, NS/NR AVL5 Of all the accessibility issues, what would you change about your home in the first place? a. ... b. ... c. ... Do you think you will be able to find an 1. Yes, definitely architect or builder to help you make 2. Probably yes adaptations on your own? e515 3. Probably not 4. No, for sure -1. The person is indecisive, NS/NR CONCLUSIONS OF THE SECPAH TEAM CL1 Does the applicant need support in adapting 2. Yes 1. Partial0. No the home? 171 CL2 The necessary support is considering ...? 1. Structural changes Multiple response 2. Equipping the home with equipment and accessibility systems 3. Design and construction services 4. Others, namely ... Other information TIME3 a. How many minutes did it take to retrieve the data from the different |__|__| Minutes sources to complete section 2 of this form? b. How many minutes did the interview with the applicant last? |__|__| Minutes Signatures Applicant: Case responsible: Member 1: Estimat Member 2: ed time 15 + 10 = 172 Module 4: Decision-making support needs Module 4 is strongly recommended for persons with a severe degree of disability MODULE 4 includes: 1. ABOUT THE INTERVIEW 2. AUTOMATICALLY PREFILLED DATA FROM THE SOCIAL INQUIRY 2.1. SUPPORT NEEDS 2.2. FAMILY INCOME AND EXPENSES 2.3. BARRIERS AND FACILITATORS 3. SUPPORT NEEDS IN DECISION-MAKING RELATED TO FINANCIAL RESOURCES 3.1. UNDERSTANDING AND USING MONEY 3.2. DAILY SHOPPING AND MONTHLY PAYMENTS 3.3. MANAGING A BUDGET 3.4. PROPERTY AND VALUABLES MANAGEMENT 3.5. VULNERABILITY TO SCAMS AND AT-RISK BEHAVIORS 3.6. FUTURE PLANS AND SUPPORT 3.7. CONCLUSIONS: SELF-ASSESSMENT AND ASSESSMENT OF SPECIALISTS 173 MODULE 4. Identification of decision-making support needs in the management of financial resources and properties JUD County/sector: DATA Date of filling in |_z_| _z_|: |_l_|_l_|: |_a_|_a_|_a_|_a_| Automatically generated OMS To the case Name and surname:* Cods. responsible Profession: NUMEP Assessed person Name and surname:* ID. * Confidential information that will not be exported to the anonymized dataset for analysis. INT.4 1. ABOUT THE INTERVIEW Socio-demographic data and other information about the applicant can be found in MODULE 0. What we already know INT41 Where does the 1. SECPAH headquarters interaction take 2. Applicant's home (for bedridden persons) place? 3. Online 4. Another situation, namely: ... INT43 Language of the 1. 2. 3. 4. German 5. another, namely: interview Romanian Hungarian Romani ... INT42 Participants a. Person to be assessed 1. Yes 0. No b. Designated case-responsible 1. Yes 0. No c. Legal representative / accompanying person / 1. Yes 0. No family** is. Other people who are not SECPAH specialists 1. Yes 0. No If YES e1. Namely: ... ** It would be preferable for the legal representative / attendant / family of the person to participate in this interview. OMS4 Interview Team In addition to the case responsible, other SECPAH 1. Yes 0. No members with other specializations participate in the interview*** 174 If YES OMS41 Member 1 Specialization: Cods. OMS42 Member 2 Specialization: Cods. Preferably the assessment team for this module includes social workers, psychologists, psycho-pedagogues, doctors. MOT4 This module is 0. Strongly recommended because the person has a severe level of completed ... disability 1. At the request of the assessed person with disabilities 2. At the request/referral of another person or institution If MOT4=2 MOT40 Is there the written consent of the 1. Yes 0. No assessed person? MOT41 Who submitted the 1. Legal representative / guardian / direct family member application? 2. Other relative of the person with disabilities Law 140/2022, art. 165: 3. Friend Setting up the legal 4. Neighbor or other member of the community (but not institution) counseling or a special 5. Representative of SPAS guardianship that can be requested by the one who 6. Representative of a social service needs protection, his/her 7. Representative of a medical service husband or his/ her relatives, by the person 8. Employer/company representative/NGO/enterprise/protected unit living with him/her, and 9. Another situation, namely ... also by other persons, institutions or authorities provisioned in art. 111, which is applicable correspondingly MOT42 The reason why the 1. Spending the pension and other monthly income of the assessed assessment was person requested? 2. Administration of the accounts of the assessed person Law 140/2022, art. 168: 3. Administration of the property (of any type) or valuables of the (4) The decision by which assessed person the legal counseling or special guardianship has 4. Sale or purchase of property (of any type) or valuable goods of the been set, the guardianship assessed person court sets, based on the individual autonomy level 5. Drawing up notarial documents to take or leave an inheritance of the protected persons and his/her specific needs, 6. Another reason, namely ... the categories of documents for which is necessary to approve the documents or, if applicable, his/ her representation, the court can set the protection measure only for one category of documents. In addition, the court can set that the protection measure only refers to the 175 protected person or only to his/her goods. MOT43 Did the person/institution that requested the assessment provide 1. Yes 0. No concrete evidence showing that the person is not able to manage his or her financial resources/properties? If YES a. What is the 1. Bank statements evidence presented? 2. Gambling debts 3. Others, namely ... 2. DATA AUTOMATICALLY PREFILLED FROM THE SOCIAL Asoc INQUIRY DATA ABOUT THE ASSESSED PERSON NIVE The highest graduated level of education? Write down the corresponding code here |__|__| 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 EDNOW Is the person currently undergoing any 1. Yes 0. No (Automatically generated) form of education or training? OCUP Main employment status in the last 12 Write down the corresponding code here months |__|__| 1. employed person, including women on 7. registered unemployed person (receives maternity leave unemployment benefits) 2. other status of employed person (day laborer, 8. unemployed person who is not registered (no longer informal worker, seasonal work, etc.) receiving unemployment benefit/support allowance 3. employer who has employees and is looking for work) 4. self-employed person in non-agricultural 9. old-age pensioner activities (PFA, AF, self-employed, etc.) 10. other type of pensioner 5. self-employed person in agriculture 11. pupil, student 6. family help (unpaid household activities) 12. housewife 13. person unable to work 14. other status of inactive person (dependent person) OCNOW Currently, does the person carry out some 1. Yes 0. No (Automatically generated) form of work (of any type)? Asoc 2.1. Support needs DATA RETRIEVED FROM THE SOCIAL INQUIRY 176 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 D620 Shopping Can shop alone, without problems in the selection, payment, transport or 0 storage of products and services necessary for everyday life Mostly alone, with occasional help, for example with the payment of utility 1 bills 2 With partial help, constantly 3 Depends on other people for the purchase of goods and services D865_70 Management Without problems he/she can save money, keep a bank account, manage of economic 0 properties and other personal economic resources, to ensure economic resources / security for present and future needs Economic 1 Mostly alone, with occasional help independence 2 With partial help, constantly 3 Totally dependent on the management of economic resources D177 Decision 0 Independently, the person can make decisions that are generally in line with making on the his/her lifestyle, values and goals management 1 The person can make safe decisions in familiar/routine situations, but of economic requires 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 Asoc 2.2. Family income and expenses DATA RETRIEVED FROM THE SOCIAL INQUIRY -1. Rather barrier -7. Not applicable Asoc 2.3. Barriers and facilitators 0. It does not (not valid for the person’s status or influence the does not exist in DATA RETRIEVED FROM THE SOCIAL INQUIRY performance of the the community) person's daily - 9. I don't know if activities it affects the Services 1. Rather facilitator person's life e550 Legal services 0 For example, court houses and other agencies for hearing and settling civil disputes and criminal proceedings, representation by -1 0 1 -7 -9 lawyers, notary services, mediation, arbitration and correctional or criminal facilities, including those who provide these services e565 Financial services -1 0 1 -7 -9 0 177 -1. Rather barrier -7. Not applicable Asoc 2.3. Barriers and facilitators 0. It does not (not valid for the person’s status or DATA RETRIEVED FROM THE SOCIAL INQUIRY influence the does not exist in performance of the the community) person's daily - 9. I don't know if activities it affects the Services 1. Rather facilitator person's life Including banks, insurance services, mutual aid houses, cash machine, etc. 3. SUPPORT NEEDS IN DECISION-MAKING RELATED TO Cdec FINANCIAL RESOURCES FACE-TO-FACE OR ONLINE INTERVIEW. Cdec 3.1. Understanding and using money The SECPAH team has at its disposal an envelope containing various banknotes and coins. Ask the assessed person to recognize the money and make simple calculations of addition and subtraction. EXP11 Does he/she recognize banknotes? 1. Yes 0. No EXP12 Does he/she recognize coins? 1. Yes 0. No EXP13 Does he/she know how to say how much money there is in total? 1. Yes 0. No EXP14 Does he/she have any idea what he/she can buy with that amount? 1. Yes 0. No 0. Has no difficulty in making calculations Write down the 1. Can make calculations using addition and corresponding code here subtraction D172 Computing skills 2. Can understand addition and subtraction using concrete materials |__|__| 3. Cannot understand or calculate amounts or differences D860 Use of money |__|__| |__|__| CONCLUSION Score according to the SPAS social A. Score according to SECPAH team inquiry (Section 3) (interview conclusion) Answer variants: 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 178 Cdec 3.2. Daily shopping and monthly payments FACE-TO-FACE OR ONLINE INTERVIEW. EXP21 Does the person do his/her own shopping? 1. Yes 0. No If YES (alone or with support) a. Does he/she know how to say when was the last time he/she was shopping in the last week, what he/she bought and what amount he/she 1. Yes 0. No paid? b. Does he/she know how to say how he/she selected the products he/she 1. Yes 0. No bought and how he/she transported them home? EXP22 Does the person pay their own monthly bills? 1. Yes 0. No If YES (alone or with support) a. Does he/she know how to list what bills he/she has to pay monthly? 1. Yes 0. No b. Does he/she know how to say the approximate amount he/she pays on 1. Yes 0. No the monthly bills (whatever they may be)? c. Does he/she know how to say what happens if you don't pay the bills? 1. Yes 0. No The SECPAH team has an electricity bill at their disposal. Check that he/she understands what is written on the invoice and that he/ she knows how to answer the following questions correctly: EXP23 a. What is the period covered by the invoice? 1. Yes 0. No b. How much is to be paid? 1. Yes 0. No c. What is the due date of the invoice? 1. Yes 0. No d. If he/she has complaints about consumption or the amount to be paid, 1. Yes 0. No to whom can he/she address? D620 Shopping |__|__| |__|__| CONCLUSION Score according to the SPAS social A. Score according to the SECPAH team inquiry (Section 3) (interview conclusion) Answer variants: 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 Cdec 3.3. Managing a budget FACE-TO-FACE OR ONLINE INTERVIEW. 179 EXP31 a. Does he/she know how to say what are earnings from 1. The reply corresponds to Section 4 last month? 0. Does not correspond -1. NŞ/NR b. Does he/she know how to say how he/she receives the 1. Yes 0. No income? For example, in a bank account, by postal order, he/she personally collects cash, another person collects the money and brings him/her a monthly amount of money in cash. c. Does he/she remember the date on which he/she usually 1. Yes 0. No collects the money? EXP32 Does the person have a sum of money on his/her own, as 1. Manage the entire family budget he/she considers, or does the money go into the family 2. Manage only a personal budget, the budget/pay for the service that is managed by someone family/ service budget being managed by else? someone else 3. Does not manage any budget EXP33 a. Does/understand what a card/bank account is? 1. Yes 0. No b. Does he/she understand that there is a difference 1. Yes 0. No between the debit card and the credit card and what is it? c. Does he/she use/knows how to use a cash machine? 1. Yes 0. No EXP34 Does he/ she know how to say if his/her family has bank 1. The reply corresponds to Section 4 rates? 0. Does not correspond -1. NŞ/NR EXP35 a. Does he/she know how to say if his/her family is in debt? 1. The reply corresponds to Section 4 0. Does not correspond -1. NŞ/NR b. Does he/she understand what it means to have debt? 1. Yes 0. No c. Does he/she understand what it means to lend money? 1. Yes 0. No EXP36 a. Does he/she know how to say if his/her family has 1. The reply corresponds to Section 4 savings? 0. Does not correspond -1. NŞ/NR b. Does he/she understand what it means to have debt? 1. Yes 0. No Cdec 3.4. Management of property and valuables FACE-TO-FACE OR ONLINE INTERVIEW. EXP41 a. Does he/she know how to say if the house is owned by 1. The reply corresponds to Section 4 the family? 0. Does not correspond -1. NŞ/NR 180 b. Does he/she know how to say about himself if he/she is 1. Yes 0. No the owner/co-owner of the home? c. Does he/she know how to say if the family has 1. The reply corresponds to Section 4 documents on the house? 0. Does not correspond -1. NŞ/NR d. Knows how to say if the family benefits from the 1. The reply corresponds to Section 4 exemption from the land/housing tax 0. Does not correspond -1. NŞ/NR e. Does he/she know if the family has mortgage rates for 1. The reply corresponds to Section 4 the home or if he/she pays rent, as the case may be? 0. Does not correspond -1. NŞ/NR f. Reasonably approximates the mortgage rate/monthly 1. Yes 0. No rent g. Reasonably approximates how much the house is worth 1. Yes 0. No on the free market EXP42 a. Does he/she know how to say if the family owns one or 1. The reply corresponds to Section 4 more cars? 0. Does not correspond -1. NŞ/NR b. Does he/she know how to say about himself if he/she is 1. The reply corresponds to Section 4 the owner/co-owner of the car? 0. Does not correspond -1. NŞ/NR c. Reasonably approximates how much the car is worth on 1. Yes 0. No the free market EXP43 a. Does he/she know how to say if the family owns property 1. The reply corresponds to Section 4 and knows how to name them (at least some of them)? 0. Does not correspond -1. NŞ/NR b. Does he/she know how to tell about himself if he/she is 1. The reply corresponds to Section 4 the owner/co-owner of a property(s)? 0. Does not correspond -1. NŞ/NR D865 Management of |__|__| |__|__| _70 economic Score according to the SPAS social A. Score according to the SECPAH team resources inquiry (Section 3) (interview conclusion) CONCLUSION Answer variants: Without problems he/she can save money, keep a bank account, manage 0 properties and other personal economic resources, to ensure economic security for present and future needs 1 Mostly alone, with occasional help 2 With partial help, constantly 3 Totally dependent on the management of economic resources 181 Cdec 3.5. Vulnerability to scams and at-risk behaviors FACE-TO-FACE OR ONLINE INTERVIEW. EXP51 Let's say that the assessed person receives from a person who seems 1. Yes, would buy trustworthy the proposal to buy a "wonder antenna that captures from the 0. He/she wouldn't air TV signals that no other antenna has been able to capture until now and buy ... you get over 100 TV channels completely free of charge and legal, for only -1. NŞ/NR 100 lei". What would the person do? EXP52 Let's say that the evaluated person receives from a person who seems 1. Yes, would buy trustworthy the proposal to buy a "lamp with colors that cures all diseases, 0. He/she wouldn't which costs only 500 lei and can be paid in five installments". What would the buy person do? -1. NŞ/NR EXP53 Let's say that the evaluated person receives from a person who seems 1. Yes, he/she would trustworthy the proposal to invest "with only 100 lei and the act from the accept 2,000 lei house can receive on the spot 2,000 lei". What would the person do? 0. No, would refuse -1. NŞ/NR EXP54 Let's say that on the day he/she receives the money, a neighbor would come 1. Yes, he/she would and ask him to lend him half of the amount he/she received, for a month. give the money What would the person do? 0. Would not give the money -1. NŞ/NR EXP55 What does the person like to do in his/her free time? Among the activities 1. Yes 0. No mentioned are somehow "played at the slot", betting or gambling? Vulnerability to |__|__| scams A. Score according to the SECPAH team (interview conclusion) CONCLUSION Answer variants 0 No problems 1 A gullible person who, however, knows how to ask for advice to protect himself 2 A gullible person or too generous with money under certain conditions 3 Almost certain a victim Cdec 3.6. Future plans and support received FACE-TO-FACE OR ONLINE INTERVIEW. EXP61 In the next 12 months, the person wants to sell/buy a property 1. Yes 0. No -7. NC or a valuable asset? EXP62 In the next 12 months, the person wants to invest an amount of 1. Yes 0. No -7. NC money of more than three total monthly incomes? 182 EXP63 In the next 12 months, the person wants to draw up notarial 1. Yes 0. No -7. NC documents in order to receive or leave an inheritance? EXP64 In the next 12 months, the person wants to buy products or 1. Yes 0. No -7. NC services with a value of more than three total monthly incomes? EXP65 In the next 12 months, the person wants to make a bank loan or take a loan from a financial institution or from relatives / friends 1. Yes 0. No -7. NC / neighbors, etc.? A. Frequency of support B. Type of support 0. No, never, does not need 0. None, needs support support 1. Monitoring 1. Yes, but only in special cases 2. Verbal/gestural suggestions, 2. Yes, only sometimes advice, occasional assistance 3. Yes, most of the time 3. Full support Currently, the person receives 4. Yes, always support (from any source) on -7. Not applicable for the person's -7. Not applicable for the person's situation ...? situation AJB1 0 1 2 3 4 -7 0 1 2 3 -7 Understanding money AJB2 0 1 2 3 4 -7 0 1 2 3 -7 Use of money AJB3 0 1 2 3 4 -7 0 1 2 3 -7 Daily shopping AJB4 Monthly payments (invoices, 0 1 2 3 4 -7 0 1 2 3 -7 installments, etc.) AJB5 Manage a personal budget (not 0 1 2 3 4 -7 0 1 2 3 -7 your family's) AJB6 Manage a family budget (and 0 1 2 3 4 -7 0 1 2 3 -7 for others) AJB7 Administration of bank 0 1 2 3 4 -7 0 1 2 3 -7 accounts (income, savings) AJB8 Property and valuables 0 1 2 3 4 -7 0 1 2 3 -7 management AJB9 0 1 2 3 4 -7 0 1 2 3 -7 Payment of taxes and duties Cdec 3.7. Conclusions: Self-assessment and assessment of specialists FACE-TO-FACE OR ONLINE INTERVIEW. Considering all the information collected from the interview D177 Decision making on the |__|__| management of |__|__| A. Score according to the economic resources Score according to the SPAS social SECPAH team (interview inquiry (Section 3) conclusion) CONCLUSION Answer variants: 0 Independently, the person can make decisions that are generally in line with his/her lifestyle, values and goals 183 1 The person can make safe decisions in familiar/routine situations, but requires help in making decisions when faced with new tasks or situations 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 EXP71 In the last 12 months, how 1. Positive evolution – it was easier to make decisions/fulfilled without or well things went in terms of with few problems the tasks that you found out in the interview that making decisions on the he/she usually does management of economic 2. Flat evolution – nothing has changed resources, according to the 3. Negative evolution – he/ she has made decisions harder/he/she has assessed person’s fulfilled with greater difficulty (with more errors, failures or unwanted evaluation? results) some of the tasks that you found out in the interview that he/she usually does, or some tasks that you found out he/she was doing before, and at the time of the interview is no longer able to perform them -1. He/she doesn't know how to appreciate/he/she doesn't remember/the person is confused EXP72 Self-assessment 0. No, in any circumstances, is able to decide and carry out all the activities discussed in the interview on his/her own In the next 12 months, would the person like/agree to receive support in the 1. Yes, occasional, punctual or partial help management of economic resources? 2. Yes, complete help in all respects -1. He/she doesn't know how to assess/ he/she doesn't remember/the person is confused If YES, EXP72=1 a. What would the necessary support consist of? Write down the answer in clear... If YES, EXP72=1 or 2 b. Who could/would like the person to 0. I don't have anyone who likes me, whom I can trust provide the necessary support? Write down the answer in clear or zero code, as appropriate... SECPAH team’s Assessment CLDA1 Does he/she understand the relevant 2. Yes, completely 1. Yes, partial 0. No information about his/her own situation? CLDA2 Does he/she remember the relevant 2. Yes, completely 1. Yes, partial 0. No information? CLDA3 Does he/she use and evaluate the relevant information to result into an informed 2. Yes, completely 1. Yes, partial 0. No choice? CLDA4 Does he/she communicate this choice? 2. Yes, completely 1. Yes, partial 0. No 184 DECISION OF THE SECPAH TEAM CL1 Does the applicant need support in making decisions on the management of economic 2. Yes 1. Partial0. No resources? CL2 The necessary support regards ...? 1. Understanding and using money Multiple response 2. Daily shopping 3. Monthly payments (invoices, installments, etc.) 4. Managing a personal budget (not the family budget) 5. Manage a family budget (and for others) 6. Administration of bank accounts (income, savings) 7. Management of property and valuables 8. Payment of taxes and duties 9. Others, namely ... OTHER RECOMMENDATIONS Other information TIME4 a. How many minutes did it take to retrieve the data from the different |__|__| Minutes sources to complete section 2 of this form? b. How many minutes did the interview with the applicant last? |__|__| Minutes Estimat ed time Signatures Applicant: Case responsible: 10+ 20 = Member 1: Member 2: 185 Annex 3.3. PLIN: Individualized plan The Individualized Plan (PLIN) is completed by the case responsible for all beneficiaries of individual needs assessment, regardless of how many and what modules have been completed. PLIN includes: 1. ABOUT THE INTERVIEW 2. RESULTS OF THE COMPREHENSVE DISABILITY ASSESSMENT 2.1. MODULE 1. SUPPORT IN THE FIELD OF EDUCATION AND WORK 2.2. MODULE 2. PERSONAL ASSISTANCE 2.3. MODULE 3. HOME ADAPTATION 2.4. MODULE 4. SUPPORT IN DECISION-MAKING ON THE MANAGEMENT OF ECONOMIC RESOURCES 2.5. MODULE 5. INVENTORY OF NEEDS NOT COVERED BY SERVICES AND SUPPORT 186 PLIN. Conclusions of the assessment of individual needs and the Individualized Service Plan JUD County/sector: DATE Date of filling in |_z_| _z_|: |_l_|_l_|: |_a_|_a_|_a_|_a_| Automatically generated WHO To the case Name and surname:* Cods. responsible Profession: NUME Assessed person Name and surname:* ID. P * Confidential information that will not be exported to the anonymized dataset for analysis. DATA AUTOMATICALLY RETRIEVED FROM O#3_F0. REGISTRATION FORM ADR Home address 1. UAT name: 1a. SIRUTA Automatically generated drop down 2. Village/sector name: 2a. SIRUTA Automatically generated 3. Residential environment:1. Urban 0. Rural Automatically generated SEX Gender 1. M 2. F DN Date of birth* |_z_| _z_|: |_l_|_l_|: |_a_|_a_|_a_|_a_| AGE Age (in years of age) |__|__| years automatically generated. 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 residential service 3. In detention 4. Temporary treatment abroad/country AINST1 If in AFAM=2 institution Name of service:* or in detention AFAM=3 AINST2 Type of residential service: 1. CIA 5. CabR 187 2. CITO 6. CPVI 3. CRRN/CRRNPH 7. Other types of centers 4. CRRPH/CRRPD/CRR 8. LP DATA AUTOMATICALLY RETRIEVED FROM THE ANNEX TO THE SOCIAL INQUIRY If in the family AFAM=1 Household data refers to the household in which the person lives (this includes people living alone, in the community) If AFAM>1 and the person has The household data refers to the household to which the person a family belongs to, where he/she will return/could be reintegrated after leaving the institution. If AFAM>1 and the person has The assessed person is considered to be a one-person household, so no family 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 RISC1a Family at risk of monetary poverty 1. Yes 0. No If the total income recorded per family member is below the RSI = 525.5 lei (VPP<525.5 Automatically generated lei). RISC1b Family at risk of extreme poverty 1. Yes 0. No If FRG=1 or HNGR=1. Automatically generated DEPDZ Are there family members who do not have their own income and are 1. Yes 0. No economically dependent on the person with disabilities? Automatically generated NKID |__|__| children The number of children under 18 that the person has in his/her care? Automatically generated EDNOW Is the person currently undergoing any form of education or training? 1. Yes 0. No (Automatically generated) If YES EDHO Is the person studying at home? 1. Yes 0. No OCNOW Currently, does the person carry out some form of work (of any type)? 1. Yes 0. No (Automatically generated) If YES OCHO Does the person work at home? 1. Yes 0. No DATA RELATING TO THE (MOST RECENT) CERTIFICATE OBTAINED BY THE PERSON THROUGH THE ASSESSMENT CARRIED OUT BEFORE THE ASSESSMENT OF INDIVIDUAL NEEDS 188 During the pilot study, the data on the disability certificate obtained on the basis of the assessment according to the legislation in force will be completed. EDC3a a. Degree 1. Minor | 2. | Medium | 3. Marked | 4. Severe | 5. Severe with personal assistant EDC3b b. Type ... ECD3c c. Validity 1= 12 months | 2 = 24 months | 3= permanent INT.1 1. ABOUT THE INTERVIEW THIS IS THE LAST SEQUENCE OF THE NEEDS ASSESSMENT, THAT CONCLUDES AND CONSOLIDATES THE RESULTS OF THE COMPLETED MODULES. INT01 Where does the 1. SECPAH headquarters interaction take 2. Applicant's home (for bedridden persons) place? 3. Online 4. Another situation, namely: ... INT03 Language of the 1. 2. 3. 4. German 5. another, namely: interview Romanian Hungarian Romani ... INT02 Participants a. Person to be assessed/Applicant 1. Yes 0. No b. Designated case responsible 1. Yes 0. No c. Legal representative / accompanying person / 1. Yes 0. No family d. Other SECPAH specialists 1. Yes 0. No If YES d1. Profession: Cods. is. Other people who are not SECPAH specialists 1. Yes 0. No If YES e1. Namely: ... ** It would be preferable for the legal representative / attendant / family of the assessed person to participate in this interview. PIN 2. RESULTS OF THE COMPREHENSIVE DISABILITY ASSESSMENT FM1 2.1. MODULE 1. Support in the field of education and work DATA AUTOMATICALLY RETRIEVED FROM O#3_M1_ED&WORK. The standard Professional Potential Profile format will be part of O#4. 189 In addition, people will also receive the list of devices available in Romania, organized according to the 16 types of activities (support needs) included in the assessment. FM2 2.2. MODULE 2. Personal assistance DATA AUTOMATICALLY RETRIEVED FROM O#3_M2_AP. In addition, the assessed person will also receive the information sheet on the list of devices available in Romania, organized according to the 16 types of activities (support needs) included in the assessment. FM3 2.3. MODULE 3. Home adaptation DATA AUTOMATICALLY RETRIEVED FROM O#3_M3_HOME. The standard Home Accessibility Profile format will be part of O#4. In addition, the evaluated person will also receive the information sheet on loans with subsidized interest for the adaptation of the home or car. FM4 2.4. MODULE 4. Support in decision-making on the management of economic resources DATA AUTOMATICALLY RETRIEVED FROM O#3_M4_DECIZIE. FM5 2.5. MODULE 5. Inventory of needs not covered by services and support COMBINATION OF AUTOMATICALLY RETRIEVED DATA AND FACE-TO-FACE OR ONLINE INTERVIEW. 190 A. B. C. Law Specialist The person has The person recommendati benefited in intends/wants on the last 12 to benefit in months the next 12 months Yes No Yes Not Yes No Services recommended by the physician and psychologist within F1_Medical and Psychological Assessment EVM41 1. Specialized medical services 1 0 1 0 1 0 EVM42 2. Current drug treatment 1 0 1 0 1 0 EVM43 3. Medical rehabilitation (recovery), including 1 0 1 0 1 0 in spa resort EVM44 4. Medical home care services (funded by 1 0 1 0 1 0 CNAS) EVM45 5. Medical devices, technologies and assistive devices intended to recover organic 1 0 1 0 1 0 or functional deficiencies in outpatient settings EVM46 6. Other assistive technologies and devices 1 0 1 0 1 0 and access technologies EVM47 7. Psychological counseling 1 0 1 0 1 0 EVM48 8. Individual or group psychotherapy 1 0 1 0 1 0 EVM49 9. Current mental health medication 1 0 1 0 1 0 treatment In the framework of physical medicine and rehabilitation assistance: EVM410 10. Free individual spa treatment ticket 1 0 1 0 1 0 EVM411 11. Free spa treatment ticket with personal 1 0 1 0 1 0 assistant / attendant EVM412 80. Other psychological services/ therapies (speech therapy, occupational therapy, music 1 0 1 0 1 0 therapy etc.) Personal assistance (see O#3_M2. AP) PASIST 1 Professional Personal Assistant (APP) 1 0 1 0 1 0 PASIST 2 Personal Assistant (AP) 1 0 1 0 1 0 PASIST 3 Live Animal assistance 1 0 1 0 1 0 A. B. C. Law Specialist The person has The person recommendati benefited in intends/wants on the last 12 to benefit in months the next 12 months Yes No Yes No Yes No Independent living services recommended by SECPAH specialists, 191 A. B. C. Law Specialist The person has The person recommendati benefited in intends/wants on the last 12 to benefit in months the next 12 months Yes No Yes No Yes No based on the results obtained in modules 1 to 4 of needs assessment (Target 19. By 2027, at least 300 services are in place in the community, which support the independent life of persons with disabilities, SNDPD) RRC1 Center for Independent Living 1 0 1 0 1 0 SIM23 Home care services other than those financed by the CNAS 1 0 1 0 1 0 (see SIM=2 or 3 in ANNEX Asoc) RRC2 Home services for adults with disabilities 1 0 1 0 1 0 through the mobile team RRC3 Day care center 1 0 1 0 1 0 RRC4 Outpatient neuromotor recovery service 1 0 1 0 1 0 center Other services resulting from the needs assessment RAS1 Free psychological assessment 1 0 1 0 1 0 RAS2 Vocational counseling/rehabilitation 1 0 1 0 1 0 RAS3 Assisted employment 1 0 1 0 1 0 RAS4 Mediation on the labor market and support 1 0 1 0 1 0 in finding a job from AJOFM/ALOFM RAS5 Social counseling/rehabilitation 1 0 1 0 1 0 RAS6 Assisted decision 1 0 1 0 1 0 RAS7 Judicial public aid in civil matters (free legal 1 0 1 0 1 0 aid) RAS8 Residential centers such as CRRN, CIA, CABR 1 0 1 0 1 0 RAS9 Assisted housing/protected housing 1 0 1 0 1 0 RAS10 a. Others, namely: b. Others, namely: c. Other, namely: Column B = DATA AUTOMATICALLY TAKEN FROM THE B. C. ANNEX TO THE SOCIAL INQUIRY The person has The person Column C = FACE-TO-FACE OR ONLINE INTERVIEW benefited in intends/wants the last 12 to benefit in months the next 12 months Yes No Yes No Bonuses, subsidies and exemptions, according to the law SDZ Income tax exemption for persons with severe or marked 1 0 1 0 disabilities, for income from self-employment, salaries, 192 Column B = DATA AUTOMATICALLY TAKEN FROM THE B. C. ANNEX TO THE SOCIAL INQUIRY The person has The person Column C = FACE-TO-FACE OR ONLINE INTERVIEW benefited in intends/wants the last 12 to benefit in months the next 12 months Yes No Yes No pensions, income from agricultural activities, forestry and fisheries? CRED11 Loan for people with severe or marked disabilities for the adaptation of the home (up to 10,000 euros, with subsidized 1 0 1 0 interest paid by the DGASPC) CAR3 Exemption from car tax 1 0 1 0 CAR4 Parking card for people with disabilities 1 0 1 0 OUTT1 Free of charge for urban surface transport and subway, for 1 0 1 0 people with severe and marked disabilities OUTT2 Free of charge interurban transport, at your choice, by any type of train, within the limit of the cost of a ticket to inter-regio IR train with reservation regime for class II, by buses or vessels for 1 0 1 0 river transport, for 12 round trips per calendar year (severe disability) and 6 journeys (severe disability) LOCB1 Exemption from the land/dwelling tax 1 0 1 0 LOCB2 Exemption from the payment of rent in social housing 1 0 1 0 RAB1 Entrance tickets to shows, museums, artistic events 1 0 1 0 DATA AUTOMATICALLY RETRIEVED FROM THE ANNEX TO B. THE SOCIAL INQUIRY The person has benefited in the last 12 months Yes No Social benefits addressed to disability BDZ1 Monthly allowance for persons with disabilities 1 0 BDZ2 Complementary personal budget for people with disabilities 1 0 BDZ3 Salary of personal assistant 1 0 BDZ4 Monthly allowance (in place of the personal assistant - AP) for 1 0 the degree of severe disability with AP, other than the blind BDZ5 Carer's allowance for adults with a severe eyesight disability 1 0 PDZ1 Pension for determined degree of disability 1 0 PDZ2 Invalidity pension 1 0 BBDZ Social integration incentive offered by the Bucharest City Hall 1 0 Social benefits addressed to poverty GMV ... social aid (minimum income guarantee) 1 0 ASF ... family support allowance 1 0 URG ... emergency aid 1 0 MRL ... support for heating the house (heating subsidy, wood) 1 0 ALUE ... received food from the city hall (EU) 1 0 MEAL ... the services of a social canteen, hot meal, meal on wheels 1 0 193 Other information TIME1 a. How many minutes did it take to retrieve the data from the different |__|__| Minutes sources to fill in the data in this form? b. How many minutes did the interview with the applicant last? |__|__| Minutes Estimat Signatures Applicant: Case responsible: ed time 10 + 20 = 194