Transcript I-CAN: Classification of disability support needs

I-CAN:
Classification of
Disability Support Needs
ARC Linkage project partners:
University of Sydney
Royal Rehabilitation Centre &
Centre Developmental Disability Studies
Problems with past assessment
 Eligibility for service provision
determined by disability definitions &
classifications
 Focus on strengths and weaknesses deficit model
 People with disabilities feel they are
made to fit available programs
 Significant gaps and overlaps in service
provision occur
 Fragmentation with different disciplines
and different agencies working more or
less in parallel
Requirements
 A rigorous and robust system to
accurately determine the type and
intensity of support needed
 Using a team approach
 Permit people with disabilities to pursue
their personal goals and chosen life
activities
 Ensure an equitable resource allocation
CONCEPTUAL FRAMEWORKS
 AAMR (1992, 2002) conceptualization of
supports.
 WHO International Classification of
Functioning, Disability and Health (ICF) (2001)
Health & Well Being
Activities & Participation
Environment & personal factors
SUPPORTS
“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.”
(AAMR, 2002, p. 151)
 Supports enable individuals to live meaningful
and productive lives that they choose.
Person’s Capabilities &
Adaptive Skills
Risk/ Protective
Factors
Participation in Life Environments
(Requirements & Demands)
Support Areas
 Human Development
 Employment
 Teaching & Education
 Health & Safety
 Home Living
 Behavioural
 Community Living
 Social
 Protection & Advocacy
Support Functions
 Teaching
 In Home Living Assistance
 Befriending
 Community Access & Use
 Financial Planning
 Employee Assistance
 Health Assistance
Intensity of
Support Need
Source of Support
Intensity of
Support Need
Personal Outcomes
 Independence
 Relationships
 Contributions
 School & Community Participation
 Personal Well-being
Figure 1: Supports model (Luckasson, et al., 2002).
Evaluation of
Supports
Bio-psycho-social approach
 The medical model views disability as a problem
of the person, directly caused by disease,
trauma or other health related conditions, &
requiring medical care through individual
treatment by professionals
 The social model sees disability as a complex
collection of conditions, many created by the
social environment, & requiring social action &
environmental modifications for full
participation of people with disabilities in all
areas of social life
 ICF seeks a synthesis of these 2 opposing
models
Functioning, Disability & 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’.
(ICF, WHO, 2001)
Interaction of Concepts
Health Condition
(disorder/disease)
Body function &
structure
(Impairment)
Activities
(Limitation)
Environmental
Factors
Participation
(Restriction)
Personal
Factors
ARC RESEARCH PROJECT
 Development & trial of instrument & process
 NSW, ACT, Vic & Qld
 In residential & some day program settings
 Process engaging 5071 participants
 Trained facilitators
 1012 complete data sets
People with disability
 N=1012
 Aged 17 - 77 years
 Average age 41 years
 Male 58% female 42%
Disability Groupings
Multiple disabilities
N=290
28.7%
Intellectual only (ID)
N=232
22.9%
ID & neurological
N=156
15.4%
ID & mental illness
N= 78
7.7%
ID & sensory disabilities
N= 73
7.2%
ID & physical disability
N= 56
5.5%
Other e.g. physical, ABI
N=127
12.5%
Health and Well Being Scales
 Physical health
 Mental emotional health
 Behaviour
 Health Services
 Health and Well being Total
Activity & 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
 Knowledge and Tasks (KAT)
 Mobility (Mob)
 Communication (Com)
 Self care & Domestic Life (SCDL)
 Interpersonal Interaction & Relationships
(IIR)
 Community, social & civic life (CSCL)
 AP Total
Reliability Studies
 Internal consistency alpha =.70 to .98
 Inter-rater reliability = .99
 Test-retest reliability = .21 to .94
Test -Retest Reliability
Overall reliability .21 to .94
Retest 6-12 months
r = .21 Physical Health Scale
r = .93 Mobility Scale
Retest at 2 years
r =-.22 Mental Emotional Health
r = .94 Mobility Scale
Validity Studies
 Moderate and significant correlations between
I-CAN domain scores and ICAP Service Level
Score co-efficients -.39 to -.62
 Low to moderate correlations I-CAN Total &
QOL-Q (Schalock & Keith, 1993)
 Significant correlation between I-CAN
Mental Emotional Health, Communication and
IIR Scales and QOL-Q Community
Integration/Social Belonging.
Participant evaluations
Positive feedback from:
 People with disabilities
 Trained facilitators
 Family members and advocates
Support hours
Multiple regression analyses against
– Day time support hours
– Night support hours
– 24 hour support clock
Allocation of support hours includes
up to 40% factors relating to the
individual but the remainder appear
to relate to organisational factors
such as policies, staffing, resources
References for ICF
 World Health Organization (2001).
International Classification of Functioning,
Disability and Health. Geneva: Author.
 AIHW (2003) ICF Australian User Guide
Version 1.0
http://www.aihw.gov.au/disability/icf
ug/index.html