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NC Department of Health and Human Services Division of Mental Health, Developmental Disabilities, and Substance Abuse Services

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NC SNAP (NC Support Needs Assessment Profile)

Frequently Asked Questions

Below are the answers to frequently asked questions about the NC-SNAP assessment instrument. Two categories of questions are addressed, including general information about the NC-SNAP and specifics on administering an NC-SNAP assessment.

NC-SNAP: General Questions

This section provides answers to questions regarding the policies and procedures applicable to the NC-SNAP.

How was the NC-SNAP developed?

The NC-SNAP was developed through a 2½-year research project with the aim of developing an easy-to-use, reliable, and valid measure of individual need. This was accomplished through an extensive comparative field test. 

How was the NC-SNAP validated?

The NC-SNAP was validated by determining its predictive qualities in an extensive field test, in which the NC-SNAP was administered to hundreds of persons in a variety of settings who were receiving good to ideal services with support arrays that ranged from low (Level 1) to high (Level 5).  The NC-SNAP predicted the level of need for the participant population at rates that are considered good for instruments assessing acuity of need. 

How reliable is the NC-SNAP?

During field-testing, inter-rater agreement of the NC-SNAP was about 70%, which compares favorably with other standardized assessment instruments.

How will the NC-SNAP be used?

The NC-SNAP will be used as a measure of intensity of need for persons served or waiting to be served by the North Carolina developmental disabilities service system. Additionally, the NC-SNAP can be used as an initial step in the development of a person-centered support plan.

Will NC-SNAP results be used to determine what services are delivered to a client? 

No.  The NC-SNAP does not specify services.  It identifies needs, which can be met through a variety of services. Therefore, services will be neither added nor taken away solely on the basis of an NC-SNAP score. 

Will funding be tied to the NC-SNAP?  If so, will funding be tied to individual budgets or will an area program/LME be given funding to develop aggregate budgets?

The NC-SNAP level of need criteria were used to replace non-reliable criteria formerly used to determine funding allocated to individuals in the service category Supported Living in the CAP MR/DD waiver. Information collected from this process has been helpful to the state in determining what issues must be addressed in any broader use of level of need related to cost. How the NC-SNAP can be used to determine cost is under consideration in North Carolina and in several other states. 

Do people living in DDA homes need an NC-SNAP? 

Yes. All persons diagnosed with a developmental disability who are currently served under the North Carolina DD service system should have an NC-SNAP administered annually. Individuals waiting for DD services should have an NC-SNAP administered upon initial contact with the service delivery system and when the individual enters the DD service system.

Do children in early intervention programs who do not have a formal diagnosis of a developmental disability need an NC-SNAP?

In the absence of a formal diagnosis of a developmental disability, children should receive an NC-SNAP only if there has been an application made on their behalf for CAP funding, they are receiving CAP funding, or they are receiving residential supports specifically designed for persons with developmental disabilities.

Will I need to be re-certified as an examiner if I move to another part of the state?

No. Examiners may continue to use their original NC-SNAP examiner number anywhere in North Carolina. Although there have been discussions about requiring periodic re-certification, currently there are no requirements in place that require re-certification of examiners.

How can I become an NC-SNAP instructor?

At this time, only co-instructors selected from staff at the MRCs can be trained to become instructors. All NC-SNAP instructors must be certified by the NC-SNAP researchers.

Will the NC-SNAP replace any other forms?

Hopefully, yes. It is anticipated that the LOE and MR2 will eventually be replaced; however, these forms should continue to be used until notification is received from the state DD Section.

Should I use a pencil or pen (blue or black ink) when I fill out the NC-SNAP?

We recommend using a pen.  Black ink is sometimes preferred or even required.

Where do we get blank forms when our supply runs low?

Examiners should contact the appropriate area program/LME to obtain additional NC-SNAP forms. /LMEs are responsible for keeping a stock of forms on hand for all NC-SNAP examiners including those working for private providers. Area program/LME DD Coordinators can contact the NC-SNAP coordinator at Murdoch Center for additional forms.

Will a registration fee be charged for examiner’s training?

No. There is not a fee for the required NC-SNAP training. 

Should the NC-SNAP be re-administered each time the individual obtains a new or different service?

No. The NC-SNAP does not specify services. It identifies needs, which can be met through a variety of services.

When should the NC-SNAP be re-administered?

The NC-SNAPshould be re-administered at least annually or whenever there is a significant change in the individual’s need profile (e.g., the individual suffers a debilitating stroke).

Must a case manager/support broker or provider be a QDDP to become an examiner?

Not necessarily. Although this will usually be the case, there is no strict educational requirement to become an NC-SNAP examiner.

If an individual has no assigned case manager/support broker, who will be responsible for administering the NC-SNAP?

The program DD authority should be responsible for the identification of appropriate persons to assume this responsibility.

Will examiners be issued a certification number after successfully completing NC-SNAP training?

Yes.  Examiners should be given their certification number at the completion of examiner’s training.

What if someone fails the training?

To be certified as an NC-SNAPexaminer, an individual must successfully pass an examiner’s training class. If someone does not successfully meet this certification criterion, he or she should repeat the training. If a person fails after a second training session, he or she will be ineligible to conduct NC-SNAPadministrations.

If I am a certified examiner, may I show my assistant how to administer the NC-SNAPand let her use my examiner number?

No. Only certified examiners may administer the NC-SNAP, and only certified NC-SNAP instructors may train and certify examiners.

Can I make copies of the NC-SNAP form?

No. The NC-SNAP form and all related materials (i.e., database software, instructional video, NC-SNAP Instructor’s Manual, and NC-SNAP Examiner’s Guide) are copyrighted and cannot be reproduced without permission from the Murdoch Center Foundation.  

Where will the NC-SNAP be stored?

Store the completed NC-SNAPin the individual’s permanent record, in a centralized records location, or wherever other official records are maintained.


Questions: Completing the NC-SNAP 

This section provides answers to questions concerning the administration of the NC-SNAPand the completion of related forms. 

The NC-SNAP Summary Report & Supplemental Information sheet asks if the case has been reviewed by the single portal coordinator. How do I know if this has occurred?

The short answer is that if you don’t know, answer No.  However, if any member of the Inter-agency Council has reviewed the case, answer Yes and write in his or her name.

Sometimes a person lives in one county but is from another county.  Which county should be listed on the Summary Report & Supplemental Information sheet (and entered into the database)?

Enter the name of the responsible county (i.e., the county with legal or financial responsibility for the individual).

Similarly, some people are from an area program/LME, but live in an MRC.  What should I enter under Area Program/LME on the NC-SNAP and in the Consumer Data section of the NC-SNAP database software program? 

In this case, always enter the name of the MRC as the area program/LME.

How do you define significant natural supports?

Significant natural supports refers to natural (i.e., non-paid) supports that if no longer available would still have to be provided to assure the life and safety of the person on an extended, ongoing basis.  For example, if an individual lives at home with his or her parents, and the parents were to become incapacitated, would new supports be a necessity?  If yes, circle Yes on the coversheet.  

How should an examiner score an item when there is conflicting information?

Ultimately, the examiner should score the item based on his or her own judgment after reviewing all available information. If two sources disagree, the examiner should seek additional information (e.g., from other persons, evaluations, or direct observations) to make an accurate decision.

Instructions for the NC-SNAP specify that the examiner should assess the individual’s needs as opposed to the supports currently delivered.  However, the Physician’s Services column under Health Care Supports suggests that the examiner should average the number of physician visits during the previous year.  Is this a contradiction?

Not really, although we can see why this might seem unclear. When gauging the intensity of need associated with an individual’s chronic health care need, it is helpful to assess the frequency of required physician intervention. If, however, the examiner feels that the previous year’s average does not accurately reflect the individual’s most current needs (e.g., due to a recent significant change in medical status), the score that best represents the most current needs should be marked.

Does Equipment Supports refer to the purchase of equipment?

No. Score this item based on the amount of support that is required to maintain or service an individual’s equipment.  The purchase of the equipment should not be considered. For instance, some communication devices are very costly to purchase, but they may not require frequent repair or service. If the individual’s prescribed equipment does not require frequent (i.e., less often than once per month) repair or service, score Level 1.

How is the NC-SNAPused as part of a personal plan for support?

Page four of the NC-SNAPprovides a worksheet for developing a personal support plan.

Why doesn’t the NC-SNAPinclude a category specifically for vocation or communication supports?

The NC-SNAPis designed to functionally assess an individual’s level of intensity of need for supports and services. Some areas such as vocation and communication, while extremely important aspects of an individual’s life, do not easily fit into need levels. During field-testing of the NC-SNAP,the authors found that including some of these categories actually hurt the predictive validity of the instrument.  

How do I score psychiatric supports on the NC-SNAP?

Because a psychiatrist is an MD, medical services supplied by a licensed psychiatrist are scored under Physician Services (e.g., psychotropic medication monitoring). However, if a service being supplied by a psychiatrist could be provided by a psychologist or other mental health professional (e.g., counseling), the service should be scored under Mental Health Services (i.e., score the domain that reflects the individual’s true need). 

If an individual receives 24-hour awake supervision because the residential program’s policy requires it, should the individual be scored as requiring 24-hour awake supervision if their true need is only 24-hours without awake staff overnight?

No, if the individual would be adequately supported without awake staff overnight, score the individual accordingly.

If an individual’s only participation in self-care is to lift his arms to assist someone put on his shirt and walk to the bathroom with assistance, would this individual’s Assistance Needed score be Level 4 (Partial to Complete Assistance) or Level 5 (Extreme Need)?

Because the individual can participate, although in a very limited way, in self-care, the individual would not be scored at Level 5. Level 5 in Assistance Needed is reserved for those individuals who are completely and totally dependent on others for all of their care. The appropriate Assistance Needed score for this individual would be Level 4. 

Level 5 under Supervision in the Daily Living Supports section of the NC-SNAPrefers to continuous monitoring. What constitutes continuous monitoring?

Continuous monitoring means without interruption and refers to nonstop monitoring either by direct observation or direct electronic monitoring (e.g., a medical alarm that is constantly on and equipped to sound an alarm as required). A good rule of thumb is to ask if the monitoring staff can briefly leave the room to get a cup of coffee. If so, continuous monitoring does not apply and Level 5 should not be scored. If the staff member must be replaced by another staff member before leaving the room, continuous monitoring does apply and Level 5 should be scored.


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