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Needs assessment forms


rehaKIND e. V. | Internationale Fördergemeinschaft Kinder- und Jugendrehabilitation

Our needs assessment forms (NAF) have become a widely recognised tool for the targeted and verifiable provision of care. They are an important and pioneering component in contracts with some health insurers, e.g. Techniker Krankenkasse. An English language version is available.

With the rehaKIND needs assessment forms (NAF in short) for the provision of disability aids in the childcare sector, we aim to ensure that the quality of our work is maintained and to make the provision of care transparent for all parties involved.

Changes in healthcare legislation stress the importance of a measurable and transparent quality of care provision and its documentation. The forms also help to provide children with disabilities with the best care in order to enable them to lead a life that is as independent as possible.

Please read the following recommendations to make the best use of this tool.

  1. Parents/caregivers/patients are the owners of the forms and manage the communication. Copies should be sent to all parts of the care team (physician/therapist and OT technician/ rehabilitation consultants as well as – with consent – the insurance company) to ensure a smooth communication process.
  2. The forms are based on the directory of assistive devices and are sorted by product group.
  3. The forms are divided into two parts. Part A is a status survey. Part B is the product section. The status survey only needs to be filled out once, 
the product section for each assistive device that is being ordered. We recommend an update to the status survey whenever the child has clearly developed, grown, the life circumstances have changed, or at least once a year.
  4. The forms of the individual product groups are organized in numerical order. The gray boxes on the right side of pages 1 and 2 serve for a subsequent review. The box titled “check at delivery” should be checked by the care team on the date of delivery and the “results check” box is to be filled out after a 3 to 6 month period of use of the aids.
  5. The status survey as well as the formulation and assessment of goals and the final check and acceptance of the aid from a technical point of view, should always be carried out together with the doctor and/or the therapist. It is crucial that all parties of the interdisciplinary team sign and thus share the responsibility and “pull together”.

The NAF is filled out by all the persons involved in the aid provision process. This serves to give all parties a comprehensive and shared picture of the patient.

The NAF does not constitute a finding, but serves as a basis for the selection of an aid. Therefore, it is best practice to fill it out only once the information necessary for developing an assistive technology concept is available. If more detailed information on individual areas is required, it will be made available by the appropriate specialist. In most cases, this is done by the therapist; however, there are many cases in which the other parties (parents, physicians, and rehabilitation consultants) have to contribute. Under such conditions, filling out the NAF will not take more than 15 minutes. When using the interactive PDF file as a download, this work can be done even quicker.

The 1/2020 version is based on the ICF (minimum list ICFcy, p. 320), some items have been taken off due to experience with previous lists, and some items have been covered in more detail due to the conceptual formulation of the NAF.

In order to assess the degree of limitation, the qualifiers of the ICF are used.

Some items are divided into subgroups in order to offer a more accurate picture than in previous versions. Under “communication as a transmitter” and “movement”, please circle the appropriate type and rate that type only.

If there are differences regarding the characteristics between regions of the body, mark them as follows:

R: Right side of the body

L: Left side of the body

T: Upper extremity

B: Lower extremity.

Classification of the degree of disability based on the GMFCS (Gross Motor Function Classification System):

Based on this classification, the usual performance and not the best possible capabilities should be the focus. The stages demonstrate the capabilities a child can be expected to reach between 6 and12 years of age. The classification of the motor function should be performed by a physician or therapist and provides a classification in terms of a prognosis.

You can find detailed information under “downloads”.

Table on body structures, functions and activities:

In order to be able to work with this table, please use the key at the bottom. Tick only one number per item when rating the severity of the restrictions of the child in this individual area: Number 1 means: There are no difficulties in this area; number 5 means: The difficulties are at a maximum or the function is completely impossible.

Signatures of the care team:

An essential point of these forms is that goals for the aid are tracked and that their practical implementation is supported by the whole care team. This team always includes: parents or caregivers, a physician or therapist and the provider (OT technicians/rehabilitation consultants).

Important note:

Even if a therapist is part of the care team and the treating physician is not directly present during the individual steps of the assessment process, a close cooperation between the therapist and the physician and a prescription by the doctor are crucial and absolutely necessary.

Consent form:

On the consent form parents agree that the assessment and treatment process are documented with photographs. They also agree that both the medical supply store employees and the health insurer will receive this documentation. This point is important in order to ensure that the treatment process is supported by all parties involved. Greater transparency can have a positive influence on the health insurer ́s decisions during the authorization process.

Care provision goals:

In the goal setting section (item 5), the goals for care provision are structured according to the ICF (International Classification of Functioning, Disability and Health) and reflect the different ICF levels of the bio-psychosocial model “Body Functions/Structures” and “Activities/ Participation”. The goals can be ticked.

(For more information about ICF, visit www. dimdi.de/static/de/klassi/icf/index.htm or the homepage of the WHO). There is additional space at the bottom for three individual goals you can set yourself. (SMART rule).

S Specific
  Goals must be clearly defined

M Measurable  Goals must be measurable (who, what, when, how much, how often)

A Appropriate  Goals must be achievable (resources)

R Relevant
  Goals must be significant (added value)

T Timed  Every goal has a clear deadline requirement

Goals should be formulated in such a way that their achievement or the possibility of their achievement in the future can be assessed within 3–6 months after receiving the aid.

Inspection upon delivery:

When the medical supply store delivers the aid, it is mandatory to ensure that the aid has been designed or equipped as originally discussed. It should be checked whether all components are present and whether they fit the needs. If this is not the case, the provider agrees to change or improve these points as soon as possible by ticking the box on the far right.

Signatures of the care team:

An essential point of these forms is that goals for the aid are tracked and that their practical implementation is supported by the whole care team. This team always includes: parents or caregivers, a physician or therapist and the provider (OT technicians/rehabilitation consultants).

Product forms by product groups

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