How to Prepare for a CARE Assessment in Washington Without a Case Manager

The Assessment That Informs Your Child's Funded Services

Washington's Comprehensive Assessment Reporting Evaluation — the CARE assessment — is the evaluation the Developmental Disabilities Administration uses to assess support needs and inform service authorizations. Getting it right can mean the difference between a meaningful service authorization and landing on the No Paid Services caseload with over 20,000 other eligible Washingtonians who receive zero funded supports.

The problem is that DDA Case Resource Managers who conduct the assessment can't coach you on how to prepare. They administer the evaluation; they don't strategize with you beforehand. Private case managers who could help charge $200–$300/hour. Most families walk into this assessment blind, and the ones who describe their child's capabilities rather than their unassisted limitations walk out with lower service authorizations that can persist for years.

Here's how to prepare yourself.

Understand What the Assessment Actually Measures

The CARE assessment incorporates the Supports Intensity Scale (SIS-A) for clients aged 16 and older. The SIS-A doesn't measure what your child can do. It measures what your child needs — specifically, the frequency, duration, and type of support required for daily activities.

The critical concept is unaided performance. Every question the Case Resource Manager asks should be answered in terms of what your child can do without your help — no prompting, no reminders, no physical assistance, no verbal cuing, no environmental setup.

This creates a natural tension. Parents spend years teaching their children skills, building routines, creating supports. When asked "can your child manage their medications," the instinct is to say "yes, we have a system." But the CARE assessment isn't asking whether the system works. It's asking what happens without the system.

The Framing Distinction That Matters Most

Consider the difference between these two answers to the same assessment question:

Achievement framing (reduces service authorization): "She takes her medication every morning. We set up a pill organizer on Sunday nights and she's really consistent."

Unaided performance framing (accurately captures support needs): "Without the pill organizer I prepare weekly and the verbal reminder I give each morning, she does not initiate medication independently. She has missed doses during weekends when I wasn't available to prompt her."

Both statements are true. The first emphasizes success. The second accurately captures the support need. The SIS-A scoring model counts frequency, daily support time, and type of support (monitoring, verbal prompting, partial physical assistance, full physical assistance). Every domain where you describe competence rather than unassisted need reduces the assessed support level.

This isn't about being negative or misrepresenting your child's abilities. It's about answering the question the assessment is actually asking: what does your child need, not what your child has learned to do with your help.

Domain-by-Domain Preparation

Before the assessment, walk through each major life domain and document your child's performance without any support:

Home living. Can they prepare meals unsupervised? Do laundry from start to finish? Clean their room without reminders? Manage household safety (turning off burners, locking doors)? What happens if you're not there to prompt each step?

Community living. Can they navigate public transportation alone? Handle money at a store? Cross streets safely? Use a phone to call for help? What supervision do they need in unfamiliar environments?

Health and safety. Do they take medications independently? Recognize when they're ill? Communicate symptoms to a provider? Manage medical appointments? What happens with dental care, personal hygiene routines, or illness without someone else initiating the care?

Social activities. Can they initiate and maintain friendships? Navigate social situations without coaching? Handle conflict without intervention? What level of support do they need to participate in community activities?

Employment. Can they follow multi-step instructions independently? Manage a schedule? Handle workplace social dynamics? What ongoing support would they need in a job setting?

For each area, write down what actually happens when you're not involved. These notes become your reference during the assessment.

Documentation to Bring

The Case Resource Manager will complete the SIS-A through conversation with you and, when appropriate, your child. Having documentation reinforces your verbal descriptions:

• School IEP with transition plan — shows the formal assessment of support needs in an educational setting
• Medical provider letters — any documentation of functional limitations from doctors, therapists, or psychologists
• Behavioral support records — if your child has a behavioral support plan, bring it; it documents the intensity of support required
• Daily routine log — a one-week record of every prompt, reminder, physical assist, and supervisory check you provide; the specificity of "verbal prompt to brush teeth at 7:15 AM, physical assist to tie shoes, verbal redirect from stimming during breakfast" is far more compelling than "he needs help in the morning"
• Previous assessment reports — if your child has been evaluated by school psychologists, occupational therapists, or speech-language pathologists, bring those reports

What Happens After the Assessment

The CARE assessment determines your child's score, which maps to service authorization levels. The results affect which waiver programs your child qualifies for and how many funded hours they receive:

• Community First Choice requires meeting the functional criteria for an institutional level of care. CFC is a Medicaid State Plan entitlement — no waitlist. If your child qualifies, this is the fastest path to funded personal care.
• Waiver placement depends on assessed support needs. Core waiver serves individuals needing 24/7 residential support. Basic Plus covers community services up to $6,192 annually. Individual and Family Services provides self-directed allocations of $1,560–$4,680 per year.
• No Paid Services caseload consists of DDA-eligible clients who are not currently receiving paid services. This can happen when the family has not requested a specific funded service or when waiver slots are capped by available funding.

If you believe the assessment underrepresents your child's support needs, you can request a reassessment. Document what you think was missed and submit a written request through your regional DDA office.

The Mistake Families Make Most Often

The most common preparation mistake isn't about documentation or logistics. It's emotional. Parents who have spent years building their child's independence understandably want to highlight that progress. The CARE assessment creates a painful disconnect between celebrating growth and accurately representing ongoing need.

Remind yourself: the assessment isn't asking whether your child has made progress. It's asking what support your child still requires. Accurately describing that need doesn't diminish their achievements. It ensures they get the services that sustain those achievements.

The Washington SSI at 18 & Adult Disability Benefits Guide includes a complete CARE assessment preparation walkthrough with domain-by-domain unaided performance prompts, documentation checklists, and framing examples for the most commonly scored SIS-A items.

Frequently Asked Questions

How long does the CARE assessment take?

Plan for 2–3 hours. The Case Resource Manager works through the SIS-A domains conversationally, asking about each area of daily life. Having your notes and documentation organized reduces back-and-forth and ensures you cover everything important.

Can my child be present during the assessment?

Yes, and in many cases they should be — particularly if they can provide their own perspective on support needs. However, be aware that some young adults may minimize their needs to appear more independent. If this is a concern, you can request time to speak with the CRM separately.

What if I already had a CARE assessment and the results were too low?

You can request a new CARE assessment by contacting your regional DDA office in writing. Document specific areas where you believe support needs were underrepresented, and include any new medical or functional documentation that has become available since the last assessment. Ask the office what reassessment process and timing apply.

Does the CARE assessment affect Community First Choice eligibility?

Yes. Community First Choice requires meeting the functional criteria for an institutional level of care — the CARE assessment is how DDA determines whether your child meets that threshold. CFC is an entitlement (no waitlist) for anyone who qualifies, making accurate CARE assessment results critical for accessing the fastest path to funded services.

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