Integrated Intake and Assessment Materials Page

The Department, HCBS Strategies, stakeholders, and case managers have been diligently working to develop a single intake and assessment process that will be used to identify level of care and service needs for all long term service and support (LTSS) populations. 

Below are historic versions of the Intake Screen and Assessment modules from June 2018 as well as draft updates from February 2020. 

  • Intake Screen: Collects basic information about the individual. Information obtained through the Screen is used to inform whether the individual should receive an assessment.
    • 2018 version can be found here.
    • 2020 version can be found here. 
  • Level of Care Screen: This module pulls the items necessary to determine and verify that the participant meets level of care (LOC) prior to completing the broader assessment.
    • 2018 draft version of the module can be found here. 
    • 2020 draft version of the module can be found here
  • Personal Story: Allows the participant an opportunity to provide information that she or he feels is important for providers and others providing support to know.  This module is voluntary and is planned to be available online.  Participants could complete this module at their convenience online or could enlist help from the assessor during the assessment process.  This information is collected early in the process so that the assessor can consider the participant’s goals and objectives from the beginning of the assessment and support planning process.  Two versions of this module were developed, 1) for participants ages 0-7 and those with significant cognitive impairments and 2) participants ages 8+ without significant cognitive impairments.
    • 2018 draft version of the module can be found here. 
    • 2020 version of the module for individuals age 0-7 can be found here. 
    • 2020 version of the module for individuals age 8+ can be found here. 
  • Case Manager Introduction: Facilitates a discussion between the case manager and participant around which assessment path, Brief or Comprehensive, the participant would like to follow.
    • 2018 draft version of the module can be found here. 
    • 2020 draft version of the module can be found here. 
  • Basic Assessment: The Basic Assessment will go over only the items that are mandatory for us to discuss to determine your eligibility for services and develop your Support Plan. While this is a shorter assessment, we will not discuss in-depth your preferences for how services are delivered or talk about other areas that LTSS supports are available beyond those areas that address your personal goals and health and safety needs. The Basic Assessment will still result in a comprehensive Support Plan, however it will be limited to the topics that we cover within the mandatory items and information you choose to share. Participants who may be appropriate to forego the Comprehensive assessment include: 1) Participants who are currently receiving services and are very familiar with the spectrum of LTSS offered in Colorado and 2)  Participants who are only looking for specific services and are not interested in any additional supports. A draft version of the module, last updated on 6/30/18, can be found here. Because this module is comprised only of items from other modules in the Comprehensive Assessment, the 2020 version of this module will be posted after all draft changes to the Comprehensive Assessment are finalized.
  • Functioning:  There are two versions of the functioning module that are tailored to specific age groups: ages 0-3 and 4+. The version of the module for individuals age 0-3 assesses Activities of Daily Living (ADL) tasks and impact on functioning. The version for individuals age 4+ is similar to the adult module. This version contains items to assess the needs, strengths and preferences of the participant in performing and receiving support for 1) Activities of Daily Living (ADL) such as dressing, eating and bathing, and 2) Instrumental Activities of Daily Living (IADL) such as housekeeping, meal preparation and shopping.  The module also includes needs for training or assistive devices to increase independence whenever possible. Specific items are skipped based on the individual’s age.
    • 2018 version of the module for individuals age 0-3 can be found here. 
    • 2020 version of the module for individuals age 0-3 can be found here. 
    • 2018 version of the module for individuals age 4+ can be found here. 
    • 2020 version of the module for individuals age 4+ can be found here. 

  • Health: Contains items to assess health status of the participant and needs for support or treatment to maintain health.  This module appears as the longest, however, many areas can be skipped over if there are no health issues. This module also offers brief screening for 1) health risks that could indicate a need for further follow-up with a physician or agency, and 2) undiagnosed brain injury (traumatic or acquired).
    • 2018 version of the module can be found here
    • 2020 version of the module can be found here
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  • Memory and Cognition:  Contains items to assess the current functional status of the person to recall and understand information, make judgments, express ideas, and make decisions necessary for daily life.
    • 2018 draft version of the module can be found here
    • 2020 draft version of the module can be found here
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  • Psychosocial:  Contains items to assess the presence and intensity of behavioral needs  and provides an initial screening to determine the need for a referral to assess and treat depression, suicide and substance abuse, compulsive gambling, and tobacco usage.
    • 2018 draft version of the module can be found here.
    • 2020 draft version of the module can be found here.
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  • Sensory and Communication:  Contains items related to hearing and vision, functional communication, and sensory integration.  In addition to looking at needs, this module considers training and assistive devices to increase independence and community inclusion. In addition to the core module, a supplement has been developed to collect age-specific information about functioning.
    • 2018 draft version of the module can be found here 
    • 2020 draft version of the module can be found here 
    • 2018 draft version of the supplement can be found here.
    • 2020 draft version of the supplement can be found here.

  • Employment, Volunteering and Training (EVT):  Contains items to explore interests in work, a volunteer position, or education and training opportunities and to find out what barriers exist for the participant in those areas.  The items will also help to identify the support needed to achieve the outcomes the participant would like to see.
    • 2018 version can be found here
    • 2020 version can be found here.

  • Housing and Environment:  Contains items related to the participant’s current living situation, environmental safety and quality, and interests/needs for housing and environment that support and maximize independence of the participant.  This module also helps to identify transitional needs for individuals leaving institutions or hospitals or those who may be in temporary housing or be homeless.
    • 2018 version of the module can be found here
    • 2020 draft version of the module can be found here

  • Participant Engagement:  Contains items for determining the participant’s desire and needs related to advocacy.  This includes looking at the need/desire for training and assistance to enhance engagement and control of service planning and service delivery.  This module also identifies individual preferences for how information about services is obtained and interest in participant direction. Two versions of this module were developed, 1) for participants ages 0-13 and those with significant cognitive impairments and 2) participants ages 14+ without significant cognitive impairments.
    • 2018 draft version of the module can be found here.
    • 2020 version of the module for individuals age 0-13 can be found here
    • 2020 version of the module for individuals age 14+ can be found here
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  • Safety and Self-preservation:  Contains items to help evaluate the participant’s capacity and need for assistance in personal safety and self-preservation.  This module addresses the need for supervision and oversight.  It also includes items about the need for training to avoid abuse, neglect or exploitation and the supports necessary to ensure the health and welfare of the individual. The 2020 version of the module incorporates the former Assessment Summary modules, which collects information about supervision and support needs across a variety of settings, including home, community, and day programs, and provides space for assessors to document additional information that was not covered in the assessment.
    • 2018 draft version of the Safety and Self Preservation  module can be found here.
    • 2018 draft version of the Assessment Summary module can be found here.
    • 2020 draft version of the module can be found here.
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  • Caregiver:  Contains items to assess the level of support provided by informal caregiver(s) and is designed to be used to 1) identify situations in which relief or support is critical to the continuation of informal caregiving and 2) identify situations in which paid supports should be initiated.
    • 2018 version can be found here. 
    • 2020 version can be found here

  • Hospital Level of Care Summary: The purpose of the Hospital Level of Care (LOC) Supplement is to identify participants who may need additional supports because of medical complexity and/or fragility and meet Hospital LOC.
    • 2018 draft version of the module can be found here.
    • 2020 draft version of the module can be found here.  

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