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Make this table full screen Instruments Caregiver Support Choice and Control Community Inclusion Consumer Leadership in System Development Equity Fluctuation of Need Holistic Health and Functioning Human and Legal Rights Level of Caregiver Well-Being Person-Centered Planning and Coordination Service Delivery and Effectiveness System Performance and Accountability Workforce CAHPS Home and Community Based Services (HCBS) Survey EoC 0 12 18 0 2 0 4 9 0 10 20 0 30 Cash and Counseling Demonstration
Baseline Instrument 6 0 7 0 0 0 5 0 0 0 3 0 0 CQL Personal Outcome Measures (POM) 0 95 159 0 27 0 48 159 0 99 107 0 7 Money Follows the Person (MFP) Quality of Life Survey 0 16 9 0 0 0 14 14 0 7 13 0 12 Mental Health Statistics Improvement Program
(MHSIP) Adult Consumer Survey 0 3 12 0 0 0 1 4 0 0 18 0 7 National Core Indicators Adult Consumer Survey (NCI ACS) 0 26 62 0 11 0 29 18 0 4 10 0 9 National Core Indicators Aging and Disabilities (NCI AD) 0 26 22 0 11 0 56 22 0 42 54 0 18 Personal Experience Outcomes Integrated Interview and Evaluation System (PEONIES) 0 32 37 0 2 0 33 33 0 10 10 0 2 Participant Experience Surveys Elderly and Disabled (PES-ED) 1 7 6 0 0 0 2 7 0 13 14 0 20 The Performance Outcome Measurement Project (POMP 5): Caregiver Services Survey Instrument 36 0 1 0 0 0 27 0 27 0 1 0 0 AACP Rose-Recovery Oriented Services Evaluation 0 2 1 10 2 0 1 6 0 2 1 4 11 Agreement with Recovery Attitudes Scale 0 4 7 0 0 0 2 0 0 0 0 0 0 American Institutes for Research Self-Determination Assessment 0 3 0 0 0 0 0 0 0 0 3 0 0 Assessment of Quality of Life (AQoL) 0 1 7 0 0 0 27 0 0 0 0 0 0 Assistance with Caregiving 2 0 0 0 0 0 0 0 0 0 0 0 0 Attitudes Towards Treatment 0 0 0 0 0 0 3 0 0 0 0 0 0 Australian Community Participation Questionnaire 0 0 57 0 0 0 0 0 0 0 0 0 0 Burden Scale for Family Caregivers, Long Form (BSFC) 0 0 0 0 0 0 0 0 28 0 0 0 0 Burden Scale for Family Caregivers, Short Form (BSFC) 0 0 0 0 0 0 0 0 0 0 0 0 0 CAN - Camberwell Assessment of Need, Revised 0 0 15 0 0 0 18 0 0 81 0 0 0 Canadian Survey on Disability (CSD) 0 0 64 0 1 0 0 6 0 19 4 0 0 Caregiver Strain Index (CSI) 1 0 0 0 0 0 0 0 11 0 0 0 0 Caregiving Appraisal Scale (CAS) 0 0 0 0 0 0 0 0 36 0 0 0 0 CGUS: Caregiving in the U.S. 2015 41 0 3 0 0 0 0 0 6 1 0 0 0 Client Assessment Inventory (CAI) 0 0 0 0 0 0 0 0 0 0 2 0 1 CLMDP: SAMHSA’s NOMs Client-Level Measures for Discretionary Programs Providing 0 2 7 0 0 0 29 3 0 0 0 0 6 Community Integration Measure (CIM) 0 0 7 0 0 0 0 0 0 0 0 0 0 Community Integration Questionnaire - Revised (CIQ-R) 0 0 11 0 0 0 0 0 0 0 0 0 0 Community Participation Indicators (CPI) 0 0 23 0 0 0 1 0 0 0 0 0 0 Community Service Attitudes Inventory 9 0 0 0 0 0 0 0 6 0 0 0 0 Consumer Recovery Outcomes System (CROS 3.0) - only use consumer version 0 4 5 0 3 0 12 1 0 0 0 0 0 Coordinated Assessement System 0 9 32 0 0 0 162 5 3 26 13 0 0 CQL Basic Assurances 2 18 4 8 3 0 34 104 0 28 50 63 45 Craig Handicap Assessment and Reporting Technique (CHART) 0 0 8 0 0 0 0 0 0 0 3 0 0 Craig Hospital Inventory of Environmental Factors (CHIEF) 0 0 2 0 4 0 0 2 0 0 5 0 0 Decision Making Involvement Scale 0 15 0 0 0 0 0 0 0 0 0 0 0 Disability Rating Scale (DRS) 0 0 0 0 0 0 8 0 0 0 0 0 0 Empowering Arizona’s Individuals with
Developmental Disabilities Consumer to Consumer Survey (EAZI) 0 5 1 0 0 0 0 3 0 0 6 0 25 Empowerment Affirmation Scale (ES - Corrigan) 0 0 0 0 0 0 0 0 0 0 0 0 0 Evaluating Social Inclusion Questionnaire 0 0 4 0 0 0 2 2 0 0 0 0 1 Experience of Care and Health Outcomes Survey, CAHPS Version 3.0 (ECHO) 0 0 0 0 1 0 10 7 0 1 3 0 6 Family and Individual Needs for Disability Supports (FINDS) Survey 7 1 11 0 0 0 0 0 5 1 18 0 0 Glasgow Outcome Scale-Extended (GOS-E) 0 0 9 0 0 0 4 0 0 14 0 0 0 Hopkins Symptom Checklist - 25 item version (HSC) 0 0 0 0 0 0 25 0 0 0 0 0 0 Illness Management and Recovery (IMR) Scales - Clinician rating 0 1 4 0 0 0 11 0 0 0 0 0 0 Illness Management and Recovery (IMR) Scales - Consumer Self-rating 0 1 4 0 0 0 11 0 0 0 0 0 0 Lehman Quality of Life Interview (QLI) 0 0 8 0 0 0 2 1 0 0 0 0 0 Maryland Assessment of Recovery in People with Serious Mental Illness 0 3 0 0 0 0 1 0 0 0 0 0 0 Mayo-Portland Adaptability Inventory-4 (MPAI-4) 0 0 5 0 0 0 26 0 0 0 0 0 0 Mental Health Statistics Improvement Program
(MHSIP) Family Survey 6 1 3 0 0 0 1 1 3 1 9 0 6 Mental Health Statistics Improvement Program
(MHSIP) Youth Consumer Survey 0 5 7 0 0 0 1 2 0 4 9 0 6 Minnesota Department of Human Services Resident Quality of Life Interview 2015 0 5 5 0 0 0 11 5 0 6 1 0 13 Minnesota Elderly Waiver Consumer Experience Survey (MNCES) 45 11 6 6 1 0 10 0 0 0 0 0 0 Minnesota Self-Determination Scales Decision-Making Preference Scale 0 90 0 0 0 0 0 0 0 0 0 0 0 Minnesota Self-Determination Scales Exercise of Control Scale 0 87 3 0 0 0 1 0 0 0 0 0 0 Minnesota Self-Determination Scales Exercise of Control Scale (Staff version) 0 93 0 0 0 0 0 0 0 0 0 0 0 Minnesota Self-Determination Scales Importance of Control Scale 0 49 22 0 0 0 12 0 0 0 3 0 1 Minnesota Self-Determination Scales Self-Determination Environment Scale 0 29 11 0 0 0 4 3 0 5 3 0 30 Minnesota Self-Determination Scales Self-Determination Environment Scale (Staff version) 0 4 5 3 0 0 1 1 0 3 1 0 23 MN LTSS Improvement Tool Form 7611 D (MN-LTSSIT-D) 0 8 2 0 1 0 0 4 0 3 8 0 1 MN LTSS Improvement Tool Form 7611A (MN-LTSSIT-A) 0 7 4 0 0 0 0 0 0 6 3 0 0 MN LTSS Improvement Tool Form 7611B (MN-LTSSIT-B) 0 2 2 0 0 0 0 3 0 2 9 0 1 MN LTSS Improvement Tool Form 7611C (MN-LTSSIT-C) 0 0 0 0 0 0 0 3 0 2 7 0 1 MN Service Provider (MNSP) 0 0 0 0 0 0 0 0 0 0 0 0 0 MNSP-CMEvalCSSP 0 0 2 0 0 0 1 0 0 6 7 0 1 MNSP-CMEvalProviders 0 0 0 0 0 0 0 0 0 0 4 0 5 MNSP-PersonEvalCM 0 5 0 0 0 0 0 0 0 1 0 0 3 MNSP-PersonEvalCSSP 0 7 9 0 0 0 0 0 0 3 2 0 0 MNSP-PersonEvalProviders 0 11 5 0 0 0 0 2 0 1 4 0 5 MOS Social Support Survey 0 0 12 0 0 0 0 1 0 0 19 0 0 National Core Indicators (NCI) Adult Family Survey (NCI AFS) 19 3 14 0 3 0 7 2 0 5 12 0 9 National Core Indicators (NCI) Child Family Survey (NCI CFS) 21 3 5 0 3 0 7 2 0 5 10 0 9 National Core Indicators (NCI) Family Guardian Survey (NCI FGS) 18 3 15 0 2 0 7 3 0 6 12 0 9 National Core Indicators (NCI) Staff Stability Survey 0 0 0 0 0 0 0 0 0 0 7 0 25 National Core Indicators In-Person Survey (NCI IPS) 0 0 0 0 0 0 0 0 0 0 0 0 0 National Health and Aging Trends Study Round 5 (NHATS) - Participation Module 0 0 20 0 0 0 12 0 0 4 0 0 0 National Long Term Care Survey Community Questionnaire, 2004 (NLTCS) 0 0 20 0 0 0 75 0 0 40 90 0 0 National Survey of Older Americans Act Participants (NSOAAP): Additional Service List Module 0 0 1 0 0 0 4 0 0 0 7 0 0 National Survey of Older Americans Act Participants (NSOAAP): DEMOGRAPHIC INTAKE Module 0 0 0 0 0 0 0 0 0 0 0 0 0 National Survey of Older Americans Act Participants (NSOAAP): Individual Service Modules 27 3 24 0 1 2 31 1 10 0 57 0 0 National Survey of Older Americans Act Participants (NSOAAP): PHYSICAL, SOCIAL, AND EMOTIONAL WELL-BEING Module 0 0 2 0 0 0 48 0 0 0 0 0 0 NSOC: National Study of Caregiving. 33 0 1 0 0 0 0 0 47 0 0 0 0 NYPSS - New York Traumatic Brain Injury
Waiver Program Participant Satisfaction Survey 1 18 8 0 0 0 0 3 0 1 9 0 9 Ohio Department of Aging Resident Satisfaction Survey (OH-RCF) 0 12 12 0 0 0 1 7 0 7 15 0 3 Older People’s Quality of Life Questionnaire (OPQOL-35) 0 1 12 0 0 0 7 1 0 0 0 0 0 ORIES - Oregon HCBS Individual Experience Survey, 2015 0 15 18 0 0 0 0 9 0 0 2 0 0 PART-E - Participation Assessment with Recombined Tools-Enfranchisement 0 6 9 0 0 0 0 0 0 0 0 0 0 PART-O - Participation Assessment with Recombined Tools-Objective 0 0 23 0 0 0 1 0 0 0 0 0 0 Participant Experience Survey Home- and Community-Based Services Experience Survey (PES-HCBS) 0 14 21 0 2 0 3 10 0 11 21 0 30 Participant Experience Survey Home- and Community-Based Services Experience Survey (PES-HCBS) Alternate Version 0 14 21 0 2 0 3 10 0 11 21 0 30 Participant Experience Survey Mental Retardation/Developmental Disabilities Version (PES-MRDD) 0 21 13 0 0 0 2 9 0 13 15 0 22 Pearlin Coping Mastery Scale (PCMS) 0 0 0 0 0 0 7 0 0 0 0 0 0 Peer Outcomes Protocol - Program satisfaction module and well-being module 0 11 7 1 0 0 5 9 0 0 21 0 10 Perceived Autonomy Support - The Mental Health Climate Questionnaire (PAS-MHCQ) 0 1 0 0 0 0 0 0 0 0 0 0 6 Perceived Competence for Recovery Scale (PCRS) 0 0 0 0 0 0 4 0 0 0 0 0 0 Perceived Quality of Life Scale (PQoL) 0 0 8 0 0 0 8 0 0 3 0 0 0 Person-Centered Practices in Assisted Living (PC-PAL), Resident and Staff Forms 6 19 21 2 0 0 6 9 1 7 6 3 56 Personal Empowerment 0 15 1 0 0 0 2 1 0 0 2 0 0 Personal Life Quality Protocol (PLQ) 0 38 74 0 0 0 6 6 0 11 0 0 0 Personal Wellbeing Index-Intellectual Disability 0 0 3 0 0 0 1 0 0 0 0 0 0 Preferences for Everyday Living Inventory-Nursing Home 0 164 40 0 0 0 2 5 0 0 0 0 4 PROMIS-ES - PROMIS Item Bank v2.0,
Emotional Support 0 0 15 0 0 0 1 0 0 0 0 0 0 PROMIS-GHS - PROMIS Item Bank v1.0/1.1,
Global Health Scale 0 0 2 0 0 0 8 0 0 0 0 0 0 PROMIS-SPDSA - PROMIS Item Bank v1.0,
Satisfaction with Participation in Discretionary Social Activities 0 0 12 0 0 0 0 0 0 0 0 0 0 PROMIS-SSRA - PROMIS Item Bank v2.0,
Satisfaction with Social Roles and Activities 0 0 37 0 0 0 0 0 0 0 0 0 0 Quality of Life (Kane, 2004) 0 9 14 0 0 0 13 10 0 0 0 0 11 Quality of Life in Alzheimer's Disease Scale 0 0 4 0 0 0 7 0 0 0 0 0 0 Quality of Life Questionnaire (QOL - Schalock) 0 6 22 0 2 0 3 1 0 1 0 0 0 Quality of Life Scale, Flanagan (QOLS) 0 0 10 0 0 0 1 0 0 0 0 0 0 Recovery Assessment Scale (RAS) 0 0 4 0 0 0 5 0 0 0 0 0 0 Recovery Oriented Practices Index (ROPI) 0 0 4 3 0 0 6 0 0 4 24 2 1 Recovery Oriented System Indicators (ROSI) 1 3 4 0 2 0 3 7 0 1 7 0 14 Recovery Promotion Fidelity Scale (RPFS) 0 0 0 4 0 0 0 0 0 1 1 2 2 Recovery Self-Assessment Scale (RSA) Person in Recovery Version 0 2 1 4 0 0 0 0 0 0 5 0 22 Ridgway Recovery-Enhancing Environment Measure 0 2 18 3 0 0 23 6 0 0 16 1 46 Rochester Recovery Inventory 0 0 22 0 0 0 1 2 0 0 0 0 0 SCSPWD - Survey for Caregivers Supporting a Person with a Disability Outside of the Disability Support Service System. 14 0 1 0 1 0 0 0 15 1 0 0 0 Sense of Community Index 2 (SCI-2) 0 0 10 0 0 0 1 0 0 0 0 0 0 Social Acceptance Scale (SAS) 0 0 1 0 0 0 7 0 0 0 0 0 0 Social and Community Opportunities Profile 0 9 79 0 2 0 37 5 0 0 0 0 0 Social Relations Scale (Quality of Life Interview, Lehman) (QOLI-SRS) 0 0 11 0 0 0 0 0 0 0 0 0 0 Staff Relationship Scale (SRS) 0 0 0 0 0 0 0 1 0 0 0 0 18 Staff Survey of Social Inclusion 0 0 36 0 0 0 0 0 0 0 0 0 0 Stages of Recovery Instrument (STORI) 0 0 0 0 0 0 28 0 0 0 0 0 0 Tailored Caregiver Assessment, Personal Family Caregiver Survey (TCARE) 1 0 0 0 0 0 1 0 37 0 0 0 0 Temple University Community Participation Measure (TUCPM) 0 26 78 0 0 0 0 0 0 0 0 0 0 The Arc’s Self-Determination Scale,
Adult Version (ASDS) 0 17 25 0 0 0 4 0 0 3 0 0 0 The Empowerment Scale, Rogers (ESR) - AKA Making Decisions Empowerment Scale 0 2 0 0 0 0 8 0 0 0 0 0 0 The Family Quality of Life Scale (FQOL) 3 0 12 0 0 0 0 0 0 0 2 0 0 The Performance Outcome Measurement Project (POMP 5): Additional Services Received Module 0 0 1 0 0 0 4 0 0 0 2 0 0 The Performance Outcome Measurement Project (POMP 5): Case Management Survey Instrument 0 1 1 0 0 0 0 2 0 2 7 0 3 The Performance Outcome Measurement Project (POMP 5): Demographics Module 0 0 0 0 0 0 0 0 0 0 0 0 0 The Performance Outcome Measurement Project (POMP 5): Social and Emotional Well-Being Module 0 0 0 0 0 0 0 0 0 0 0 0 0 The Performance Outcome Measurement Project (POMP 5): Transportation Survey Instrument 0 0 31 0 0 0 1 0 0 4 8 0 1 TRAIL Leisure Assessment Battery 0 10 145 0 0 0 1 0 0 5 9 0 0 UCLA Loneliness Scale (UCLA LS) 0 1 18 0 0 0 5 0 0 0 0 0 0 Well-Being Scale 0 6 20 0 0 0 38 7 0 0 0 0 2 World Health Organization Quality of Life BREF (WHOQOL-BREF) 0 0 5 0 1 0 15 1 0 0 0 0 0 World Health Organization Quality of Life OLD (WHOQOL-OLD) 0 2 8 0 0 0 9 1 0 0 0 0 0 Youth Quality of Life Instrument - Short Form (YQOL-SF) 0 3 7 0 0 0 5 0 0 0 0 0 0 Youth Services Survey (YSS) 0 4 3 0 0 0 1 0 0 2 6 0 4 Zarit Burden Interview (ZBI) 2 0 0 0 0 0 0 0 19 0 0 0 0
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