Maine DHHS - Questionnaire - Child Inpatient DDU


Status: Incomplete
   


1. What are the required intensive interventions on a 24-hour day basis in the last review period:

(Please select one.)


2. Is a high frequency, intensity and duration of intervention is required to address repeated aggression or self-injury severe enough to have causes serious injury, or there is significant potential of serious injury to self or others?

(Please select one.)


3. Are the symptoms of ID/DD of such severity that one is unable to care for oneself at a developmentally appropriate level, and treatment at a less restrictive level of care would be unsafe or is unavailable?

(Please select one.)


4. Has member not previously responded to a less restrictive level of care?

(Please select one.)


6. Would member have a significant risk of harm to self or others, or serious functional deterioration, if a less restrictive setting was used?

(Please select one.)


7. Is a lower level of care available?

(Please select one.)


8. Describe the guardian(s) active participation since the last authorization review period:



9. Has guardian shadowed staff implementing the behavior plan on the unit?

(Please select one.)


10. Has guardian attended coordination meetings?

(Please select one.)



Disclaimers (please check to confirm acceptance):