Vivienne Riches

Classification of Support Needs in a Residential Setting.

A supports classification and assessment system is required in residential settings that enables accurate classification and resource allocation in the context of limited resources. In developing such a system, the American Association on Mental Retardation intensities of supports framework was used and consultation with all stakeholders resulted in a process and instrument that examined support needs in a community living environment across key domains. In all, 116 clients who had an intellectual disability were assessed and classified during 1999. The instrument was favourably received by all stakeholders and validity and reliability results were sound. A multidimensional scoring model and multiple regression analyses were used to evaluate how well the five domain scales and the risk profile predicted current support, measured by current staff hours per 24‐hour period. Results are reported along with recommendations for future research and development.A supports classification and assessment system is required in residential settings that enables accurate classification and resource allocation in the context of limited resources. In developing such a system, the American Association on Mental Retardation intensities of supports framework was used and consultation with all stakeholders resulted in a process and instrument that examined support needs in a community living environment across key domains. In all, 116 clients who had an intellectual disability were assessed and classified during 1999. The instrument was favourably received by all stakeholders and validity and reliability results were sound. A multidimensional scoring model and multiple regression analyses were used to evaluate how well the five domain scales and the risk profile predicted current support, measured by current staff hours per 24‐hour period. Results are reported along with recommendations for future research and development.

Transforming staff practice through active support

Abstract Background Active support is being introduced in many residential and respite homes in an effort to improve engagement in meaningful activity of people with intellectual disability. Method A train-the-trainer approach was used in a large government organisation that supports people with intellectual disability in Australia. Five apprentice trainers were trained to provide active support training to 65 staff associated with 6 group homes. These 5 trainers were then monitored to provide training to 54 staff in another 6 group homes. Staff evaluated their interactive training experiences, and pre and post outcome data were collected for a small number of service users from the second set of group homes, along with staff outcome data regarding residential working practices, group home management, and staffing practices. Results The train-the-trainer model proved to be an effective strategy for training large numbers of staff. The interactive training component was particularly effective and was associated with improvements in service user engagement in domestic tasks and decreased depression levels. Staff job satisfaction increased and significant improvements were recorded in residential working practices. Conclusions Active support training is an effective strategy for empowering staff to better support people with an intellectual disability to be meaningfully engaged in daily activities. There are implications for organisations related to ongoing implementation and practice improvement.

Intelligence Is as Intelligence Does: Can Additional Support Needs Replace Disability?.

Abstract In many developed cultures there is an assumption that IQ is intelligence. However, emerging theories of multiple intelligences, of emotional intelligence, as well as the application of IQ testing to other cultural groups, and to people with disability, raises many questions as to what IQ actually measures. Despite recent research that shows IQ testing produces a floor effect when applied to people with lower IQ, as well as research that shows the Flynn effect also applies to people with lower IQ, in practice IQ scores below a certain cut-off are still being used to determine and classify a persons intellectual disability. However, a new paradigm is emerging, almost returning to the original intent of Binet, where measurement is made of the supports the person needs. In this paper, we argue that if one extends the notions of this supports paradigm that diagnosis of intellectual or physical disability could potentially be replaced by diagnosis of additional intellectual support needs, or additional physical support needs.

Day occupation is associated with psychopathology for adolescents and young adults with Down syndrome

BackgroundYoung adults with Down syndrome experience increased rates of emotional and behavioural problems compared with the general population. Most adolescents with Down syndrome living in Western Australia participate in sheltered employment as their main day occupation. Relationship between day occupation and changes in behaviour has not been examined. Therefore, the aim of this research was to explore any relationship between post school day occupations and changes in the young person’s behaviour.MethodsThe Down syndrome Needs Opinion Wishes database was used for case ascertainment of young adults aged 15 to 32 years with Down syndrome. Families of 118 young people in this population-based database completed questionnaires in 2004, 2009 and 2011. The questionnaires addressed both young person characteristics such as age, gender, presence of impairments, behaviour, functioning in activities of daily living, and family characteristics such as income and family functioning. Post-school day occupations in which the young people were participating included open and sheltered employment, training and day recreation programs. Change in behaviour of young adults who remained in the same post-school day occupation from 2009 to 2011 (n = 103) were examined in a linear regression model adjusting for confounding variables including age, gender, prior functioning and behaviour in 2004 and family income.ResultsIn comparison to those young adults attending open employment from 2009 to 2011, those attending day recreation programs were reported to experience worsening in behaviour both in the unadjusted (effect size −0.14, 95% CI −0.24, −0.05) and adjusted models (effect size −0.15, 95% CI −0.29, −0.01).ConclusionsWe found that the behaviour of those participating in open employment improved compared to those attending other day occupations. Further examination of the direction of this association is required.

I-CAN: The Classification and Prediction of Support Needs.

BACKGROUND Since 1992, the diagnosis and classification of intellectual disability has been dependent upon three constructs: intelligence, adaptive behaviour and support needs (Luckasson et al. 1992. Mental Retardation: Definition, Classification and Systems of Support. American Association on Intellectual and Developmental Disability, Washington, DC). While the methods and instruments to measure intelligence and adaptive behaviour are well established and generally accepted, the measurement and classification of support needs is still in its infancy. This article explores the measurement and classification of support needs. METHOD A study is presented comparing scores on the ICF (WHO, 2001) based I-CAN v4.2 support needs assessment and planning tool with expert clinical judgment using a proposed classification of support needs. A logical classification algorithm was developed and validated on a separate sample. RESULTS Good internal consistency (range 0.73-0.91, N = 186) and criterion validity (κ = 0.94, n = 49) were found. CONCLUSIONS Further advances in our understanding and measurement of support needs could change the way we assess, describe and classify disability.

Does a Measure of Support Needs Predict Funding Need Better Than a Measure of Adaptive and Maladaptive Behavior

Internationally, various approaches are used for the allocation of individualized funding. When using a databased approach, a key question is the predictive validity of adaptive behavior versus support needs assessment. This article reports on a subset of data from a larger project that allowed for a comparison of support needs and adaptive behavior assessments when predicting person-centered funding allocation. The first phase of the project involved a trial of the Inventory for Client and Agency Planning (ICAP) adaptive behavior and Instrument for the Classification and Assessment of Support Needs (I-CAN)-Brief Research version support needs assessments. Participants were in receipt of an individual support package allocated using a person-centered planning process, and were stable in their support arrangements. Regression analysis showed that the most useful items in predicting funding allocation came from the I-CAN-Brief Research. No additional variance could be explained by adding the ICAP, or using the ICAP alone. A further unique approach of including only items from the I-CAN-Brief Research marked as funded supports showed high predictive validity. It appears support need is more effective at determining resource need than adaptive behavior.