Requirement 0 Points 1 Point 2 Points 3 Points Score Score at this level when the Score at this level if at least 4 Score at this level when all at this level when all required number of goals are of the 5 requirements are requirements are met for the requirements are met for the not included, OR when any met for all goals, or if all required number of goals required number of goals AND Habilitation Goals goal meets 3 or fewer of the requirements are met for at the reader can clearly “see” . requirements OR when least ½ of required goals the individual in the goal, why requirements are met for less it is important to them, the than ½ of the required goals goal shows evidence of recent revision, and/or components are detailed Mark all that apply: are included The minimum number of goals identified Minimum of two (2) habilitation support goals for individuals who are assessed at Support Levels1 and 2 Minimum of three (3) habilitation goals for individuals who are assessed at Support Levels 3A, 3B, 4, 5, and 6 The goal is specific and measurable Goal includes measurement criteria and timeline Goal includes specific active role staff take to support goal Goal includes documentation instructions Requirement 0 Points 1 Point 2 Points 3 Points Score Score at this level when there Score at this level when there at this level when Score at this level when the Evidence of is no documentation provided is documentation provided documentation provided documentation provided Habilitation Goal to support that goals have that goals have been shows that the goals have shows clear evidence that the Implementation been implemented implemented, but there is no been implemented as goals have been implemented (Documentation) OR indication of progress or described in plan (within 15% AND progress is being made Documentation provided revision of goals margin) and there is some toward goal OR when data shows that goals were not OR indication of progress for at includes visual representation supported Documentation provided least some of the goals (graph, chart) of progress only supports some of the required goals For purposes of data analysis only: Number of days out of specified 7 day period individual left their home: Is plan written on DDA Template? Yes No Has plan writer completed DDA’s IISP Training? Yes No
Requirement 0 Points 1 Point 2 Points 3 Points Score Habilitation Goals . Score at this level when the required number of goals are not included, OR when any goal meets 3 or fewer of the requirements OR when requirements are met for less than ½ of the required goals Score at this level if at least 4 of the 5 requirements are met for all goals, or if all requirements are met for at least ½ of required goals Score at this level when all requirements are met for the required number of goals at this level when all requirements are met for the required number of goals AND the reader can clearly “see” the individual in the goal, why it is important to them, the goal shows evidence of recent revision, and/or components are detailed Mark all that apply: The minimum number of goals identified are included Minimum of two (2) habilitation support goals for individuals who are assessed at Support Levels1 and 2 Minimum of three (3) habilitation goals for individuals who are assessed at Support Levels 3A, 3B, 4, 5, and 6 The goal is specific and measurable Goal includes measurement criteria and timeline Goal includes specific active role staff take to support goal Goal includes documentation instructions Requirement 0 Points 1 Point 2 Points 3 Points Score Evidence of Habilitation Goal Implementation (Documentation) Score at this level when there is no documentation provided to support that goals have been implemented OR Documentation provided shows that goals were not supported Score at this level when there is documentation provided that goals have been implemented, but there is no indication of progress or revision of goals OR Documentation provided only supports some of the required goals at this level when documentation provided shows that the goals have been implemented as described in plan (within 15% margin) and there is some indication of progress for at least some of the goals Score at this level when the documentation provided shows clear evidence that the goals have been implemented AND progress is being made toward goal OR when data includes visual representation (graph, chart) of progress For purposes of data analysis only: Number of days out of specified 7 day period individual left their home: Is plan written on DDA Template? Yes No Has plan writer completed DDA’s IISP Training? Yes No
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