Questionnaire for Situational Information 1. 2 3 What is the purpose of the QSI? The QSI is a standardized needs assessment tool. It is designed to gather

Questionnaire for Situational Information 1



What is the purpose of the QSI?• The QSI is a standardized needs assessment tool. It

is designed to gather information about a person’s life situation.

• This information will be used to assist in planning for support and service needs and is only one part of a person-centered planning process.


Why was the QSI developed?• Florida Statute 393.0661 and federal regulations for

Medicaid waivers require a standardized needs assessment process.– A systematic and reliable instrument will be used

to determine levels of services– Client characteristics and other appropriate

assessment methods are used along with the QSI to develop the support plan for the individual receiving services.


How was the QSI created?• Information was gathered from national experts to

identify major barriers and supports for good health, safety, and quality of life

• Instruments used in Florida were evaluated.– Florida Status Tracking Survey– Individual Cost Guidelines

• Assessments used in other states were also reviewed

• Validity and reliability tests for the QSI have been completed


How is the QSI different from previous assessment tools?

• The QSI gathers information for planning.– Impact of major life changes – Support needed for community inclusion and

fulfillment of adult roles• The QSI includes vision, hearing, and communication

in the assessment of Functional Status• The assessment of Behavioral Status focuses on the

types of support and intervention needed.• The assessment of Physical Status remains focused

on health and medical needs.


What is assessed by the QSI?• General Information• Life Change and Adjustment;

Community Inclusion andFulfillment of Valued Adult Roles

• Functional Status• Behavioral Intervention

and Support Status• Physical Status


How will the QSI be used?• The QSI will be administered at the time of

eligibility determination• The results of the QSI will be used as a part

of the person-centered planning process used to develop the person’s support plan

• The results of the QSI will be reviewed annually and re-administered at least every three years to identify possible changes


What is person centered planning?• The person has the authority to define and

pursue the goals important to them• Personal relationships and community

membership are valued• All networks and systems of support must

collaborate in support of the person’s goals and needs

• People and families must participate as valued partners in all decision making


How is the support plan developed using the QSI?• Uses information gathered from the individual,

family, and friends, the QSI, and other relevant information

• Reflects individually determined goals and needs and resources, including personal resources, natural supports, community resources, school systems, government programs, etc.

• The scores are not as critical as the information obtained from the QSI on the types of supports and services the individual needs.


Who can administer the QSI?• Qualified assessors are hired by APD area offices.

They must be certified to administer the Questionnaire.

• QSI assessors are required to have a bachelor’s degree and four years of related experience working with persons with developmental disabilities.

• They must demonstrate competencies in conducting interviews and reliability in rating the items.


How is the QSI completed?• The QSI assessor reviews the current Support Plan

and other relevant records to identify general information, accomplishments, goals, health history, and service details.

• Face-to-face interviews are conducted with the person with a disability and the legal representative, and others as appropriate.

• The QSI assessor analyzes the information and rates the items. The ratings are recorded in QSI online application.


Who gets the results?• A synopsis report is provided to the person or legal

representative. A complete copy can be provided, on request.

• The person or legal representative may give others a copy of the report, if they wish.

• The support coordinator will review the results of the completed QSI and review the support plan to be sure it addresses all necessary supports and services.


What is the QSI online tool?• All assessments are recorded and

stored using the QSI online tool, available on the APD intranet

• The support coordinator will be able to access the records of the persons served

• The local Area Office will provide training on the online tool.

• The Central Office will give the support coordinator a password and username.


What is required of the support coordinator?

• The support coordinator will provide access to the records for the QSI assessor.– Temporarily transfer records– Follow protocol in Central Records Policy to

secure records, including copies– Provide records to the QSI assessor within

three business days.


What else is required of the support coordinator?

• Participate in interviews when requested. • Use the results of the QSI and other relevant

information to develop the person’s support plan.• Responsible for noting changes in Life Changes and

Community Inclusion.


You have completed the first session.

Go the second session to learn more about the content of the QSI.



General Information/Demographic Information


General/Demographic Information• The information is pre-filled from the ABC database.• The support coordinator is responsible for ensuring

that the ABC database is accurate and up-to-date.

• The support coordinator should immediately update ABC when changes or errors are identified.

See pages 5-6


Life Change and Adjustment Information


Life Change and Adjustment Information• Keep track of any changes that occur• Include a description in your case notes for that day. • Notify the QSI assessor if there is a significant

change in condition• Keep the ABC demographic information up to date


8a. Life Changes (examples) No life changes experienced Death or loss of a long-term caregiver Survivor of a major physical assault Gaining a new family member Major change in living conditions Major change in daytime activities Major change in eating habits

See page 7


Levels of Life Change Stress Low Moderate Significant

To follow-up, you may want to let caregivers know about the particular life changes and observe the person for any health or behavioral changes. Referrals for medical or behavioral support may be required if problems arise.

See page 7


8b. Signs and Symptoms of Emotional or Behavioral Distress (examples)

Avoidance of favorite activities and friends Suicidal thoughts, plans or suicide attempts Property destruction (major, repeated) Self-injurious behaviors (pica, head banging, etc.)

8c. Was this person screened by a qualified professional for any of the conditions? See

page 8


8d. Life Changes that this Person is Likely to Experience (examples)

Loss/change of significant long-term primary caregiver

Major surgery requiring hospitalization Change in place of residence Major change in work or daytime activities

See page 8


9a. Does the Person Plan to Move in the Next 12 Months? (examples)

Chooses to remain in current home Chooses to remain in current home, but cannot do

so without additional help Must move for reasons of health and safety Is unsure about moving

See page 9


10. Legal Status (examples)

Person is an adult with no pre-need directives or any form of guardianships.

Person has a partial or full guardian advocate. Person is an adult and has a guardian ad litem. Person is a minor child

See page 9


11. Language Spoken or Understood

The primary language that is spoken or understood by the person:

English, Spanish, Sign Language, Does Not Apply or Other

See page 9


Community Inclusion & Valued Adult Roles• These items are only required for individuals 18 years

or older.

Community Inclusion

Valued Adult Roles

Employment• The rating is based on the level of personal support

required by the person to complete tasks now and for the next year.


Community Inclusion & Valued Adult RolesLevel 1: The individual does not need any personal

support.

Level 2: The individual needs personal support and it is limited to occasional reminders or verbal prompts and/or physical assistance.

Level 3: The individual needs personal support and requires daily reminders, verbal and/or physical prompts.

Levels 4/5: The individual needs personal support from someone and requires supervisionto complete See

page 10


Community Inclusion Activities (examples)

12a. The person can find a place to live and manage leases or rent arrangements

12d. The person can shop for food, clothes, and other personal items.

12e. The person can arrange and attend social outings…

12h. The person can keep him/herself safe in the neighborhood

12j. The person can do his/her own housekeeping

See page 10


Fulfillment of Valued Adult Roles in the Community

12l. The person can parent his/her minor children…

12m. The person can function as a spouse or domestic partner…

12n. The person can fulfill the role of a valued and trusted employee…

12o. The person can vote, follow community rules…

See page 11


Employment Information

13a. Does the person currently have a job?

13b. Does the person need help with a job currently held?

13c. … is the person interested in getting a job?

See page 12


QSI Scoring Plan

Functional, Behavioral, and Physical StatusIndividual items are rated: 0 to 4

A status rating is calculated for each section:

1 (minimum) to 6 (maximum)

QSI Overall Support Level1 (Basic) to 5 (Intensive)


Functional Status


Functional Status: Sensory Functioning

14. Vision15. Hearing

See pages 13-14


Functional Status: Essential Living Skills

16. Eating

17. Ambulation

18. Transfers

See pages 15-16



19. Toileting

20. Hygiene

21. Dressing

See pages 17-18



22. Communications

23. Self-protection

24. Ability to Evacuate (place of residence)

See pages 18-19


Behavioral Intervention

and Support Status


0. NONE required

1. OCCASIONAL verbal prompts, instructions, or redirection from caregiver

2. FREQUENT prompts, instructions, or redirection, environmental modification, restriction from caregiver

3. Frequent, PLANNED INTERVENTION Or – Assistance from others or restrictions are frequently

necessary – Uses one psychotropic medication – Was admitted to crisis stabilization unit

4. Use of physical, mechanical, or chemical restraint Or – Uses one psychotropic medication with changes or two or

more medications, or intensive behavioral services – Resides in secure facility, intensive residential

treatment center, or psychiatric hospitalSee page 21


Behavioral Status

25. Hurtful to Self/Self-injurious Behaviors

26. Aggressive/Hurtful to Others

27. Destructive to Property

See pages 22-24


Behavioral Status

28. Inappropriate Sexual Behavior

29. Running Away

30. Other Behaviors That May Result in Separation from Others

See pages 25-27


Guidelines for Behavior Follow-up Consultation

• Need for assistance from the Area Behavior Analyst to complete the scoring of the QSI tool

• Behavioral Status Rating of 3 or higher• Emergency health and safety need• Urgent need that requires a provider to complete a

behavior assessment• Need for a change in behavioral services

See page 28


Physical Status


Physical Status

32. Injury Caused by Self-injurious Behavior

33. Injury Caused by Aggression toward Others or Property

See pages 30-31


Physical Status

34. Use of Mechanical Restraints or Protective Equipment for Maladaptive Behavior

35. Use of Emergency Chemical Restraints

36. Use of Psychotropic Medications

See pages 32-33


Physical Status

37. Gastrointestinal Conditions (include vomiting, reflux, heartburn, or ulcer)

38. Seizures39. Antiepileptic Medication Use

See pages 34-35


Physical Status

40. Skin Breakdown41. Bowel Elimination42. Nutrition

See pages 36-37


Physical Status

43. Treatments (Physician Prescribed)44. Assistance in Meeting Chronic Health Care Needs45. Individual’s Injuries46. Falls

See pages 38-41


Physical Status

47. Physician Visits/Nursing Services

48. Emergency Room Visits

49. Hospital Admissions

50. Days Missed at Job, School, Recreation, or Other Day Activities Due to Illness (past 12 months)

See pages 41-42


Guidelines for Medical Follow-up Consultation

• Need for assistance from Medical Case Manager to complete the scoring of the QSI tool

• Physical Status Rating of 3 or higher

• Emergency health and safety need

• Urgent need that requires a provider to complete a nursing assessment

• Need for a change in medical services

See page 43



What if I have more questions?

• Contact your own area office• Check the APD website

http://apd.myflorida.com/


Thank you You have completed the presentation on the Questionnaire for Situational Information for Waiver Support Coordinators. You will be sent an email verifying that you have completed this presentation.

You will also be required to attend an area office training specific to QSI procedures.

Please print the certificate verifying that you have completed this presentation and take it with you to the area office training. Click on this icon:

Documents

Questionnaire for Situational Information 1. 2 3 What is the purpose of the QSI? The QSI is a standardized needs assessment tool. It is designed to gather