NWD System Management Tool

OMB Control 0985-0062
Expires:

Administration for Community Living
No Wrong Door System Management Tool

Public Burden Statement:
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a
collection of information unless such collection displays a valid OMB control number (OMB
0985-0062). Public reporting burden for this collection of information is estimated to average
two hours per response, including time for gathering and maintaining the data needed and
completing and reviewing the collection of information. The obligation to respond to this
collection is required to maintain or retain benefit.

1

Table of Contents
Instructions............................................................................................................................... 3
Registration/Contact Information................................................................................................. 4
State Level Questions ................................................................................................................. 5
Governance and Administration ............................................................................................... 5
Streamlined Eligibility to Public Programs .................................................................................11
Person-Centered Counseling ...................................................................................................12
Public Outreach and Coordination with Key Referral Sources .......................................................13
Local-Level Questions ................................................................................................................14
Streamlined Eligibility to Public Programs .................................................................................14
Person-Centered Counseling ...................................................................................................15
Public Outreach and Coordination with Key Referral Sources .......................................................16
Care Transitions and Money Follows the Person .....................................................................16
NWD System Staff Capacity and Individuals Served ....................................................................19
Staffing ............................................................................................................................19
Demographics ...................................................................................................................20

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Instructions
The No Wrong Door (NWD) System Management Tool (NWD MT) is designed to provide the
Administration for Community Living (ACL) and its partners with qualitative and quantitative data
necessary for assessing the progress of the NWD System vision, tracking performance measures, and
identifying gaps and best practices. The NWD MT is organized by NWD System function and by statelevel and local-level questions. The four primary functions of the NWD System include:
1. State Governance and Administration
2. Streamlined Eligibility for Public Programs
3. Person-Centered Counseling
4. Public Outreach and Coordination with Key Referral Sources
The state-level questions provide insight to the structure, governance and administration of the state’s
NWD System. The state-level questions shall be answered by the state’s NWD System Governing Body
lead agency. This may be the State Unit on Aging, the State Medicaid Agency, or another state-level
agency administering programs for NWD System populations. The lead agency should coordinate
responses to state level questions with other state agencies. If the lead agency is not the state Medicaid
Agency, the lead agency should consult with the Medicaid agency to obtain data and ensure accurate
reporting.
The local-level questions provide understanding to service delivery and NWD reach at the community
level. The data submitted for local level questions shall represent all local NWD System partner
organizations, which may include:
•
•
•
•
•
•
•
•
•

Area Agencies on Aging (AAAs),
Aging and Disability Resource Centers (ADRCs),
Centers for Independent Living (CILs),
Developmental disabilities organizations,
University Centers for Excellence in Developmental Disabilities Education, Research & Service
(UCEDDs),
Mental/Behavioral health agencies,
Protection and Advocacy Agencies,
Native American tribal organizations (American Indian/Alaskan Native/Native Hawaiian), and
Other local organizations that serve persons with disabilities and/or older adults.

The state lead agency shall determine which questions are to be completed by each type of local
organization. Unless otherwise specified, the NWD MT shall be completed bi-annually. Further
instructions, including definitions and guidance for specific questions, are provided in blue boxes
throughout this document. In addition, text in red indicates notations for skip logic or other functionality
that will be in place once the NWD MT is loaded onto a web-based platform. Additional information
about NWD can be found at https://nwd.acl.gov/.

3

Registration/Contact Information
1.

Organization's Name:

2.

Organization's Physical Address
Street Address:
City:
State:
Zip Code:

3.

Contact Name
First Name:
Last Name:

4.

Contact Email:

5.

Contact Phone Number (Ex: 555-555-5555):

6.

State-level Administration Representative, validation, and date
First Name:
Last Name:
As a state-level Administration Representative, I certify that the information submitted is
accurate as of the date of submission. (Check box to validate.) ☐
Date:

4

State Level Questions
Governance and Administration
Questions 1 &2 - Governor Support and Multi-Agency Body
The development, implementation and oversight of a state’s NWD System has the support of the
Governor and active involvement of the multiple state agencies that administer programs that affect
LTSS populations.
The state has a formal multi-state agency body that coordinates the state government’s work to
develop a single No Wrong Door System for all people needing LTSS, regardless of income, age, or
disability, and this body includes the state Medicaid agency, the State Unit on Aging, the state agencies
that serve or represent the interests of individuals with physical disabilities, intellectual and
developmental disabilities, and the state authorities administering mental/behavioral health services.
1. Does the state have formal, written support by the Governor and/or state legislature for
developing a NWD System? Skip logic applied – only visible annually
o Yes
o No
1a. If yes, what gubernatorial actions or executive orders have occurred in the last year that directly
support the development and implementation of the state’s NWD System? Please list. Skip logic
applied – only visible if question above is “yes”
Functionality note: Responses should pre-populate from prior submissions.

2. Which of the following organizations comprise the state’s NWD System multi-agency governing
body? Please select all that apply. Skip logic applied – only visible annually
☐ State Medicaid Agency
☐ State Unit on Aging
☐ State Agencies administering programs for people with Intellectual and Developmental
Disabilities
☐ State Agencies administering programs for people with Physical Disabilities
☐ State Agencies administering programs for Mental/Behavioral Health
☐ State Department on Military/Veteran’s Affairs
☐ Other
Please explain:

Questions 3 – NWD Key Functions
The four key functions of a NWD System are designed to help states in providing the leadership that
is necessary to effectively develop and implement a NWD System of access to all populations and all
payers. The state may consider various levels of investments and partnerships to meet the goals of
these functions. In question 3, select the function with the greatest need for your state. This may
support ACL in identifying technical assistance needs.

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3. Of the four key functions of a NWD System, which would require the most investment or
funding to support enhancement of your state’s NWD vision? Please select all that apply. Skip
logic applied – only visible annually
 State Governance and Administration
 Public Outreach and Coordination with Key Referral Sources
 Person-Centered Counseling
 Streamlined Eligibility to Public Programs
4. A NWD System that serves the populations below provides coordination of services, personcentered counseling, enrollment assistance, and/or application assistance. Which populations
are served by the state’s NWD System? Please select all that apply. Skip logic applied – only
visible annually
☐ Caregivers and others providing informal supports
☐ Older Adults
☐ People with cognitive impairments and/or Dementia
☐ People with Intellectual/Developmental Disabilities (I/DD)
☐ People with Mental Illness (MI) and/or Substance Use Disorders
☐People with Physical Disabilities (PD)
☐People with Traumatic Brain Injury
☐Veterans
☐Other (Please enter other populations below)

Question 5 – Formal Partnerships
Organizations with formal partners in the state’s NWD System may have access to a statewide data
system, are part of the referral process, and/or have a contract or MOU with the NWD lead agency.
Note: The number of organizations listed as formal partners in the right column below should not
exceed the number of organizations listed in the left column.
5. Complete the matrix below for the local organizations in the state.
Type of Organization

Total number of
organizations in the state

Total number of formal
partners in the state’s NWD
System

ADRCs
AAAs
Alzheimer’s Chapters
Assistive Technology Act
Programs
CILs
Intellectual/Developmental
6

disabilities organizations
Local Medicaid Agencies
Mental/Behavioral health
organizations
Native American tribal
organizations (American
Indian/Alaskan Native/Native
Hawaiian)
Protection and Advocacy
Agencies
University Centers for
Excellence in Developmental
Disabilities Education,
Research & Service (UCEDDs)
Other aging services
organizations
Other local service providers
for persons with disabilities
and/or older adults (open
text)

Question 6 – ADRC Designations
The NWD lead agency may designate local partners as Aging and Disability Resource Centers
(ADRCs) using either formal or informal methods. Please select the option that best describes the
ADRC designation in your state.
Note: An example of a designation by contract or memorandum of understanding (MOU) may occur
at the state or local level and could be a formal partnership between a AAA and CIL or other CBO
serving aging and disability populations.

6. How are ADRCs designated in the state? Skip logic applied – only visible annually
☐ All Area Agencies on Aging (AAAs) designated as ADRCs
☐ Designated based on funding or statute
☐ Designation by contract or MOU
☐ Other
Please explain:

7

Question 7 - State Administered Public Programs
The NWD System continually improves individual experiences, enrollment and eligibility processes for
any state administered public program that provides long term services and supports, such as
Medicaid or nutrition services programs. The first column lists all state administered programs for
which your NWD System entities provide some degree of coordinated service delivery, enrollment,
and/or eligibility determination. If there are additional programs in the state, please them in the
“other” fields. Coordinated service delivery, enrollment, and/or eligibility determination could include
coordination of services, person-centered counseling, application assistance, completing assessment
tools to determine potential eligibility, and/or making final eligibility decisions and completing
enrollment.
Indicate in the second column if a statewide universal/uniform tool is used to assess eligibility
benefits. This refers to a statewide assessment process and assessment instrument that is shared
across multiple programs and populations that can be used to assess eligibility for benefits.
Please also indicate whether public program is accessed through the NWD System.

7. Which state administered public programs are assessed using a statewide universal/uniform
assessment or accessed through the NWD System? Skip logic applied – only visible annually
Program

Eligibility benefits
assessed using a
statewide
universal/uniform
assessment

Accessed through
the NWD System

Brain Health and/or Alzheimer’s Disease Services and
Support Program

☐

☐

Caregiver Services and Support Programs

☐

☐

☐

☐

☐

☐

Low Income Home Energy Assistance Program (LIHEAP)

☐

☐

Medicaid

☐
☐
☐

☐
☐
☐

☐

☐

☐

☐

Elder Rights Services and Supports Programs (e.g. legal
assistance, Ombudsman programs)
Lifespan Respite Services

Medicare Low-Income Subsidies
Mental/Behavioral Health
Nutrition Services and Support Programs, including OAA
funded meals programs
Older American Indians, Alaska Natives & Native
Hawaiians Services and Support Programs

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Program

Eligibility benefits
assessed using a
statewide
universal/uniform
assessment

Accessed through
the NWD System

Preventive Health Services (e.g., Chronic Disease SelfManagement Program, falls prevention)

☐

☐

Rehab Act Funded Programs, including State vocational
rehabilitation programs and Vocational Rehabilitation
Services Projects for American Indians with Disabilities

☐

☐

Senior Medicare Patrol (SMP)

☐

☐

SNAP (Supplemental Nutrition Assistance Program)

☐

☐

State Health Insurance Assistance Program (SHIP)

☐

☐

State Information and Referral & Assistance programs

☐

☐

☐

☐

☐

☐

☐

☐

Other programs:
Other programs:
Other programs:

8. Does the state have a formal process in place for routinely involving external stakeholder groups
and individuals including older adults, persons with disabilities, (physical, mental/behavioral and
I/DD) and family caregivers in the development and on-going implementation of the NWD
System vision/functions? Skip logic applied – only visible annually
o Yes
o No
o Other, please explain:

Question 9 – All Populations
The NWD System Key Elements defines “all populations” as those who need or may at some point
need LTSS. This includes, but is not limited to:
• Older Adults
• Individuals with Physical Disabilities (PD)
• Individuals with Intellectual/Developmental Disabilities (I/DD)
• Individuals with Mental Illness (MI) and/or Substance Use Disorders
• Individuals with Traumatic Brain Injury (TBI)
• Individuals with Dementia
• Veterans
• Caregivers and other providing informal supports
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9. Has the state conducted a formal assessment within the past 12 months of its access programs
and functions, including its enrollment and eligibility determinations processes, documenting
the challenges individuals face when accessing LTSS programs? Skip logic applied – only visible
annually
o Yes, for all populations
• If an assessment has been conducted, please upload here.
o Yes, for some populations
• If an assessment has been conducted, please upload here.
o No assessment completed

10. Does your state conduct a review to monitor performance of ADRCs in your NWD System? Skip
logic applied – only visible annually
o Yes
o No
o Other
Please explain:

11. Do the state or local NWD partner organizations collaborate with additional IT system or referral
platform vendors to manage/receive healthcare referrals?
o Yes, state only
o Yes, local only
o Yes, both
o None
o Other
Please explain:

Question 13 - Understanding Future Demand
As defined in the NWD System Key Elements, the state shall be able to project future demand for NWD
System functions as the demographics of the state changes over time, including projections specific to
different populations and to different regional or sub-state geographic areas. Examples of
methodologies to estimate demand include assessments (quantitative and qualitative) for tracking
community tenure (i.e., the number of individuals able to transition from a facility and/or remain in the
community) and assessments to determine unserved or underserved individuals by service type. Data
may also come from consumer satisfaction surveys that ask about unmet need.
The state shall also track NWD System costs across NWD System functions and geographic areas, as
well as statewide cost-savings. At a minimum, this can include cost savings accruing to the Medicaid
program as a result of helping Medicaid-eligible individuals use lower-cost LTSS services and helping
private-paying individuals avoid the unnecessary use of costly services and subsequent spend down to
Medicaid.
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12. Does the state have a documented method to estimate current and future demand (i.e.,
demand for number of people in need of services, demand for funding, and/or populations
serviced, etc.) for any of the following? Please select all that apply. Skip logic applied – only
visible annually
☐ No Wrong Door Systems (if selected, please describe methodology below)

☐ Long Term Services and Supports needs (if selected, please describe methodology below)

☐ Home and Community Based Services (if selected, please describe methodology below)

Streamlined Eligibility to Public Programs
Question 14 – Medicaid enrollment system(s)
Through partnership with the State Medicaid Agency, NWD System staff may have access to Medicaid
enrollment data systems to track individuals’ eligibility status throughout the process of eligibility
determination and redetermination. This may also include access to enrollment systems for conducting
applications or assessments. In question 14, please indicate if any local NWD System partners have
access to this type of Medicaid system.
13. . Do your state’s NWD System partners have access to the state’s Medicaid enrollment
system(s)?
o Yes
o No
14. Is the state currently using NWD Medicaid Administrative Claiming to support NWD System
operations? If the state is planning to claim or currently developing their Medicaid
Administrative Claiming infrastructure, please explain in “Other” below.
o Yes
o No
o Other

14 a. If yes, please select the claiming methodology for ADRC/NWD administrative functions.
o Direct payment for specific administrative functions through contract/MOU with the
state Medicaid Agency
o Established claiming structure through Random Moment Time Studies
o Established claiming structure through 100% daily time tracking
o Other

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15. Is the state currently using Medicaid service dollars to support NWD System operations?
o Yes
o No
15a. If yes, please explain the types of non-administrative activities performed by NWD
System partners that are supported by Medicaid service dollars (i.e. care coordination/case
management, level of care determinations, eligibility determinations, etc.)

Questions 17-19 – Person-Centered Counseling Defined
Person-centered counseling, thinking and practice empowers individuals to make informed choices about
their LTSS options, consistent with their personal goals and needs, and assists individuals with navigating
the various organizations, agencies, and other resources in their communities. The skills and knowledge
base of person-centered counseling includes:
•
•
•
•

A personal interview to discover strengths, values, and preferences and the utilization of
screenings and assessments necessary to determine potential program eligibility.
A facilitated decision-making process which explores resources and support options and
provides tools to the individual in weighing pros and cons.
Developing action steps toward a goal or a long-term support plan and assistance in applying
for and accessing support options when requested.
Quality assurance and follow-up to ensure supports are working for the individual.

The person-centered counseling function within a NWD System embeds the state-of-the art practice for
promoting individual choice, self-determination, and supportive decision-making and can be used in a
variety of settings.
Note: “Person-centered counseling” used in this document is intended to describe systems structures,
functions and job duties, but not intended to serve as a brand that all states may use in labeling their access
functions or job titles. For instance, states are implementing person-centered planning in various ways,
including through training programs designed to bolster and upgrade the skills of their existing Options
Counselors and other staff who use different titles. It is expected that many states will continue to use the
term “Options Counselor” and other such job titles.

Person-Centered Counseling
16. Does the state have person-centered counseling guidelines, standards or requirements in place
for the NWD System? Skip logic applied – only visible annually
o Yes
o No
17. Which of the following resources are part of the state’s person-centered counseling training
program? (Check all that apply) Skip logic applied – only visible annually
 National Center on Advancing Person-Centered Practices and Systems (NCAPPS)
 ACL Person-Centered Counseling Training Program
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 State-Developed Training
 Other
Please explain:

18. Does the state NWD System have protocols in place for routinely conducting follow-up with
individuals who have been assisted by staff to determine if further assistance is needed?
o Yes
o No
o Other, please explain:

Public Outreach and Coordination with Key Referral Sources
19. Does the state’s NWD System have one publicly searchable website that includes regularly
updated information about public and private LTSS resources, programs, and services, and is
accessible to persons with disabilities?
o Yes
o No
20a. How many unique visitors accessed the state’s NWD System website? Skip logic applied –
only visible if response to question above is “yes”

20. How many statewide toll-free numbers does the state have to increase access to the NWD
System? (This may include established statewide numbers for aging and disability networks,
partnerships with statewide call centers, such as 2-1-1, etc.)

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Local-Level Questions
The state/territory NWD Lead Agency is to submit aggregated data on behalf of local NWD System
partner organizations that are part of the NWD System, which may include:
•
•
•
•
•
•
•
•
•
•

Area Agencies on Aging (AAAs),
Aging and Disability Resource Centers (ADRCs),
Centers for Independent Living (CILs),
Developmental disabilities organizations,
University Centers for Excellence in Developmental Disabilities Education, Research & Service
(UCEDDs),
Mental/Behavioral health organizations,
Protection and Advocacy Agencies,
Native American tribal organizations (American Indian/Alaskan Native/Native Hawaiian), and
Local organizations that serve underserved populations, including racial and ethnic minority
groups
Other local organizations that serve persons with disabilities and/or older adults.

Responses shall represent all services and support provided by these local partner organizations. This
means the data reported in this Tool is not limited to grant-specific activities or budgets and instead
shall represent statewide activity as best as possible. State/territory lead agencies will also have the
opportunity to have each local level entity submit their data individually.

Streamlined Eligibility to Public Programs
Question 1 – Assistance with Applications
Please include the number of individuals assisted by organizations that subcontract with your
organization for application assistance, and/or to complete assessments and intake, unless those
organizations are also submitting responses to the NWD System Management Tool.

1. Complete the matrix below indicating the number of individuals (assisted by local NWD
organizations) with applications for one or more public LTSS programs in the last six months.
Program

How many people
were assisted with
applications for the
following programs?

How many people did
your organization
support to complete
financial assessment(s)
for the following
programs in the last six
months?

How many people did
your organization
support to complete
functional
assessment(s) for the
following programs in
the last six months?

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Medicaid LTSS
Programs
VA Programs

Other Federal and
State Funded LTSS
Program

Person-Centered Counseling
Questions 2 – Person-Centered Counseling Defined
Person-centered counseling, thinking and practice empowers individuals to make informed choices about their
LTSS options, consistent with their personal goals and needs, and assists individuals with navigating the
various organizations, agencies, and other resources in their communities. The skills and knowledge base of
person-centered counseling includes:
•
•
•
•

A personal interview to discover strengths, values, and preferences and the utilization of
screenings and assessments necessary to determine potential program eligibility.
A facilitated decision-making process which explores resources and support options and provides
tools to the individual in weighing pros and cons
Developing action steps toward a goal or a long-term support plan and assistance in applying for
and accessing support options when requested.
Quality assurance and follow-up to ensure supports are working for the individual.

The person-centered counseling function within a NWD System embeds the state-of-the art practice for
promoting individual choice, self-determination, and supportive decision-making and can be used in a variety
of settings.
Note: “Person-Centered Counseling” used in this document is intended to describe systems structures,
functions and job duties, but not intended to serve as a brand that all states may use in labeling their access
functions or job titles. For instance, states are implementing person-centered planning in various ways,
including through training programs designed to bolster and upgrade the skills of their existing Options
Counselors and other staff who use different titles. It is expected that many states will continue to use the term
“Options Counselor” and other such job titles.
2. How many individuals received person-centered counseling through your organization during the last
six months?

a. How many individuals received a documented (i.e., written, video, or other avenue)
person-centered plan in the last six months? Skip logic applied – only visible if response
to question above is greater than 0

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Public Outreach and Coordination with Key Referral Sources
3. How many direct outreach activities has your organization performed in the last six months? Direct
outreach activities may include meetings, communication with local partners, such as VAMCs, health
fairs, and webinars.

a. How many people been reached through the direct outreach activities in the last six
months? Skip logic applied – only visible if response to question above is greater than 0

4. How many indirect outreach activities has your organization performed in the last six months?
Indirect outreach activities may include billboards, and TV, radio, newspaper ads, and social media
postings.

Care Transitions and Money Follows the Person
5. Do your NWD partner organizations have a formal partnership (MOU, contract, or written
agreement) with any of the following organizations? Please select all that apply.












Hospital/ hospital system
Primary care offices
Accountable Care Organizations (ACOs)
Health plans
Nursing facilities
Private housing providers
Public housing authority
State Medicaid Agency
Money Follows the Person contracted entities
Veterans Administration
None of the above

6. How many individuals were transitioned FROM any of the following settings during the reporting
period?
# of individuals
age 60 and over

# of individuals Setting
under age 60
with a disability
Hospital
16

Nursing Facility
Intermediate Care Facility
(ICF)/Intellectual/Developmental
Disability (IDD) Facility
Psychiatric hospital
Other institutional setting

7. How many individuals were transitioned from a hospital TO any of the following settings during the
reporting period?
# of individuals
age 60 and
over

# of individuals
under age 60
with a disability

Setting

% of Housing Vouchers

Primary Residence
(e.g., home the
individual lived in
prior to admission)
Newly identified
residence (e.g. not the
individual’s previous
primary residence)
Other

n/a

_____ % receiving no housing vouchers
_____ % receiving Mainstream Housing Vouchers
______% receiving Emergency Housing Vouchers
n/a

8. How many individuals were transitioned from a nursing facility TO any of the following settings
during the reporting period?
# of individuals
age 60 and
over

# of individuals
under age 60
with a disability

Setting

% of Housing Vouchers

Primary Residence
(e.g., home the
individual lived in
prior to admission)
Newly identified
residence (e.g. not the
individual’s previous
primary residence)
Other

n/a

_____ % receiving no housing vouchers
_____ % receiving Mainstream Housing Vouchers
______% receiving Emergency Housing Vouchers
n/a

9. If you are an MFP contracted entity, how many individuals were transitioned from a nursing facility
to another setting during the reporting period?

17

# of individuals
age 60 and over

# of individuals
under age 60
with a disability

Setting

Primary Residence
(e.g., home the
individual lived in
prior to admission)
Newly identified
residence (e.g. not the
individual’s previous
primary residence)
Other

10. Do your NWD System Partners receive MDS 3.0 Section Q data?
 Yes
 No
10a. If yes, how many individuals were referred to a NWD System organization because of the MDS
3.0 Section Q requirement during the last six months? Skip logic applied – only visible if response to
question above is “yes”
.
Number: _____________________________
11. What are the primary barriers to transitioning individuals to the community? Select all that apply.









Lack of affordable housing
Lack of accessible housing
Lack of available home and community-based services
Lack of direct service workforce (e.g., personal care attendants, home care aides)
Lack of informal caregiver support
Lack of assistive technology
Lack of household set-up
Other _______________________________________________

12. What funding sources are used to sustain care transition programs? Select all that apply.










Hospital contracts
Physician Office contracts
Medicare: Medicare Advantage plan contracts
Medicare: Fee for Service
Medicare: ACOs
Medicaid: Managed care organization contracts
Medicaid: Money Follows the Person
Medicaid: American Rescue Plan Act (ARPA) Section 9817 (enhanced FMAP)
Other Medicaid funding
18

 Other ARPA funds (please specify):_____________________________________
 Grant funds (please list source(s): ______________________________________
 Other
If other, please list:
_____________________________________________________________

NWD System Staff Capacity and Individuals Served
Staffing
Question 13 – Number of Staff
The total number of staff at your organization includes front line staff, administrative staff, fiscal staff,
and management staff (e.g., directors).
13. How many staff in your organization are providing person-centered counseling?

a. Of these, how many have received any type of online or in-person training on
person-centered planning, thinking and practice? Skip logic applied – only visible if
response to question above is greater than 0

19

Demographics
Questions 14 & 15 – Total Number of Contacts and Person-Centered Counseling
The total number of people served or total number of contacts shall include any type of contacts made
with your organization, regardless of which program or service the individual encountered first or
regardless of whether the contact was a simple information and referral or information and assistance
encounter.
Person-centered counseling is defined as a process whereby individuals are empowered to make informed
choices about their LTSS options, consistent with their personal goals and needs that assists individuals
with navigating the various organizations, agencies, and other resources in their communities. The skills
and knowledge base of person-centered counseling includes:
•
•
•
•

A personal interview to discover strengths, values, and preferences and the utilization of
screenings and assessments necessary to determine potential program eligibility.
A facilitated decision-making process which explores resources and support options and
provides tools to the individual in weighing pros and cons
Developing action steps toward a goal or a long-term support plan and assistance in applying
for and accessing support options when requested.
Quality assurance and follow-up to ensure supports are working for the individual.

The person-centered counseling function within a NWD System embeds the state-of-the art practice for
promoting individual choice, self-determination, and supportive decision-making and can be used in a
variety of settings.
14. How many unduplicated people did your organization serve during the last six months?

15. Enter the total number of contacts in the past six months for each of the following demographics in
the first column. Enter the number of those contacts that received person-centered counseling in the
past six months in the second column. Individuals that meet multiple demographic categories should be
counted in all applicable categories. For example, a 65-year-old with a disability should be counted in
both the “Age 60+” row and the “Individuals with Disabilities” row.

Demographic

Total number of
people served

Total number of people
that received personcentered counseling

Age 60+
Aged 21 to 59
Age 20 and below
Unknown age

20

Individuals with Disabilities
Veterans
Caregivers and Informal Supports
Individuals in rural or frontier areas
Black, Indigenous, people of color (BIPOC) or nonEnglish speaking populations

21