Transcript Document

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With the right (active) support
Overview
• ICF and the Supports paradigm
• I-CAN v3 Research
• Active Support
• I-CAN v4
Paradigm Shift in
Conceptualization of Disability
•Historical approaches
•False dichotomy
medical versus social models
• Emergence of bio-psycho-social model
• Development of concept of supports
• Person-environment interaction
Conceptual Frameworks
International Classification of Function, Disability
and Health (ICF) (WHO, 2001)
•Health & Well Being
•Activities & Participation
•Environment & Personal factors
American Association on Intellectual &
Developmental Disability (AAIDD, 1992, 2002)
•Conceptualization of supports
Functioning, Disability
and Health
Functioning encompasses all human functions; at the level
of the body, the individual and society
Disability is perceived as a multi-dimensional phenomenon
resulting from the interaction between people and their
physical and social environment
Health is defined as ‘a state of complete physical, mental
and social well-being and not merely the absence of
disease.’
(WHO, 2001)
Interaction of Concepts
Health Condition
(disorder/disease)
Body function &
structure
(Impairment)
Activities
(Limitation)
Environmental
Factors
Participation
(Restriction)
Personal
Factors
Support Needs
Australian service agencies are
increasingly using the concept of
‘support needs’ in an attempt to
effectively and efficiently allocate
scarce resources to the rapidly
increasing proportion of the population
with a disability.
(AIHW, 1997)
“Supports are the resources and strategies that
aim to promote the development, education,
interests, and personal well-being of a person and
that enhance individual functioning.”
(AAIDD, 2002, p. 151)
Supports enable individuals to live meaningful and
productive lives that they choose.
Support Intensities
• Time duration
• Frequency
• Resources
• Intrusiveness
Research Project
•Development & trial of instrument & process
•Data collected in NSW, ACT, Vic & Qld
•Residential settings and some day program settings
•Process engaging 5071 participants
•Trained facilitators
•1012 complete data sets
Sample
•Ages 17 years to 77 years, average age 41 years,
SD =10 years
•Male 58% and female 42%
•The majority (84%) were persons whose primary
disability was intellectual disability.
•Most of the sample (72%) had more than one
recorded disability, and some had as many as four
disabilities.
•65% had 2 or more disabilities
Disability Groupings
7. Other
13%
6. Multiple
disabilities
28%
5. ID & physical
6%
1. Intellectual
(ID)
23%
2. ID &
neurological
15%
3. ID & mental
illness
8%
4. ID & sensory
7%
Health & Well Being
Scales
•Physical Health
•Mental Emotional Health
•Behaviour
•Health Services
•Health and Well Being Total
Physical Health
Support Bands
Physical health
50
45
40
35
30
25
20
15
10
5
0
None
Mild
Moderate
Severe
Complete
Definitions Activities
and Participation
Activity is the execution of a task or action by an
individual.
Participation is involvement in a life situation.
Activity limitations are difficulties an individual
may have in executing activities.
Participation restrictions are problems an
individual may experience in involvement in life
situations.
Activities &
Participation Scales
•Applying Knowledge, General Tasks & Demands (KAT)
•Communication
•Self Care & Domestic Life (SCDL)
•Mobility
•Interpersonal Interaction & Relationships (IIR)
•Life Long Learning (new in v4)
•Community, Social & Civic Life (CSCL)
Support Bands
Activity & Participation (N=1012)
80
70
60
50
% 40
30
20
10
0
KAT
C o m m unica tio n
Mo bility
No ne
Mild
SC DL
A P Scales
Mo de ra te Se ve re
IIR S
C o m ple te
C SC S
A&P T o ta l
Reliability Studies
•Internal consistency alpha 0.70 to 0.98
•Inter-rater reliability r = 0.96 to 1.00 Overall
agreements r = 0.99
•Test-retest reliability r = 0.21 to 0.94
1 year r = 0.21 Physical Health Scale
r = 0.93 for Mobility Scale
2 years r =-0.22 Mental Emotional Health
r = 0.94 Mobility Scale
Participant Evaluations
Positive feedback from:
•People with disabilities
•Trained facilitators
•Family members and advocates
Validity Studies
•Moderate and significant correlations between the ICAN domain scores and the Inventory for Client and
Agency Planning (ICAP) Service level score coefficients (.39 Communication to -.62 Behaviour)
•Generally low to moderate correlations between I-CAN &
Quality of Life Questionnaire (QOL-Q) (Schalock & Keith,
1993), but significant correlation between Community
Integration/Social Belonging and I-CAN scales of Mental
Emotional Health, Communication and Interpersonal
Interactions and Relationships.
Support Hours
Multiple regression analyses against
•Day time support hours
•Night support hours
•24 hour support clock
•Support functions (AAIDD)
Allocation of support hours includes up to 40%
factors relating to the individual but up to
60% appears to relate to organizational
factors such as policies, staffing, resources
Research Findings
Underpinning Active Support
Direct observation in group homes shows that
many people with severe intellectual disability
spend lots of time doing little or nothing.
These people need support to initiate and
participate in activities.
Staff can be trained to provide the support
needed and so substantially increase
residents’ participation.
The Hotel Model
Staff
Residents
Residents are spectators in their
own lives.
Staff feel like glorified
domestics.
Problem
There are many things which people
with severe learning disabilities
cannot entirely do for themselves
Solution
Everyone has some ability and can be
involved in every activity if given
enough direct assistance and if the
task is broken down into sufficiently
small steps.
Providing support bridges the gap
between what people can & cannot
do.
The Active Support
Model
People participate in everyday
activities with support
The Active Support
Model
•Examines what staff do, how they are deployed and
supported, and the day-to-day organisation of the group
home
•Staff are taught to provide a higher proportion of
assistance and praise for participation and so increase
resident involvement in constructive activities.
•Activities and support are planned carefully and staff
take on specific roles and responsibilities.
Doing with,
not doing for
•Staff members’ main job should be to work directly with
residents. Active Support helps us refocus on this.
•Need to avoid the ”hotel model” where staff do things
for residents and residents become non-participating
spectators in their own lives.
Maximising Choice and
Control
Whose life is it anyway?
Offer options
Respect preferences
Broaden experience by encouraging
participation ‘little and often’
Not just support for domestic tasks, but
often a good place to start
Active Support
Procedures
Detailed staff training in procedures, including 1:1
on-site training in supporting a resident to
participate in activity.
Straightforward paper planning tools to produce:
•Daily Activity and Support Plan
•Opportunity plans (for practising new skills)
•Protocols
Activity and Support Plan
Staff: Anne (A) and Colin (C)
Time
HELEN
S PAUL
W
S
W
DIANE
S Household
W
8:00
Eat
breakfast
A
Eat
breakfast
C
Eat breakfast
C
Put rubbish
out
Set table
8:30
Clear
dishes (on
own)
A
Load
A
dishwasher
Start laundry
C
Clear dishes
Wash up/load
dishwasher
9:00
Shopping
C
Clean
bedroom
A
Shopping &
PO – pay
phone bill
C
Start laundry
Unload
dishwasher
Go for a
walk
10:00
Unpack
groceries
C
Start
laundry
Have
coffee with
mother
A
Finish laundry A
Hang out
clothes
Water
plants
Mrs
F
Options
Gardening
Ways of providing support to
increase participation
ASK-INSTRUCT-PROMPT-SHOW-GUIDE
>>>>
>>>>>
>>>>>
level of help increa
>>>>
ses
>
Use FLEXIBLY - In practice the different levels can be
used together and you switch back and
forth between them depending
on the person’s needs.
Active Support
Providing enough help to enable people to
participate successfully in meaningful
activities and relationships
…so that people gain more control, become
more included, and gain independence
…irrespective of degree of disability or
presence of extra problems
Active Support
Designed to provide a bridge to
participation in everyday activities for
people who lack the skills to participate
independently.
A virtuous circle of positive
interaction & empowerment
Staff interact positively with service
users and provide opportunities for
them to participate
Staff think of new
ideas for more goals
and activities. Staff
see themselves as
enablers
Staff perceive service users as more
competent, & valued. Staff give
service users more respect, control &
attention. Staff feel more confident,
successful & eager to try new things
Service users
participate
successfully in
some activities
The right support empowers people
A model illustrating a system that aligns different levels of support around
the person with a disability (Gillinson, Green & Miller, 2005)
How do you know what support needs to
be provided?
www.i-can.org.au
I-CAN v4
•Web-based
•Redesigned to more user friendly and holistic with
better specificity
•Recording during interview to generate a
comprehensive supports profile
•Much greater practical utility in support planning
and many new functions:
•Concurrent collection of MDS data
•Online tracking, group reporting and specific
support costs analysis possibilities
•Many more research opportunities
The right (active) support empowers
people
I CAN DO IT!
www.i-can.org.au