AAMR Supports Intensity Scale Implementation Training

1. AAMR Supports Intensity Scale Implementation Training Presented by: Alan Tribble Steve Wrigley DSPD SIS Certified Trainers October through December 2005

2. Overview / Agenda Session One: • Overview of Supports Intensity Scale • SIS Pilot Program / Risk Assessment • Administration of the SIS / Risk Assessment Screening Tool • Review of Sections • Guidelines for Interviewing • Expanded Item Descriptions • SIS Frequently Asked Questions

3. Overview / Agenda Session One Continued: • Modifications for Children & Adolescents • Utah’s Risk Assessment Supplement Screening Tool • How to Score SIS Booklet • Practice Administering SIS / Questions • Homework Assignment for Session Two

4. Overview / Agenda Session Two: • Review of the SIS Administration Homework Assignment and Discussion • Using the SIS in the ISP Planning Process • Overview of SIS ISP Planning Process • SIS ISP Planning Case Examples • Implementation to Own Caseload Example • Questions Regarding Administration and Application

5. Roles and Responsibilities of Coordinators and Mentors Discussion of future trainings and roles of Coordinators and Mentors

6. Five Trends that Created the Need for the SIS A Paradigm Shift

7. Trend 1: Changes in Expectations for Persons with Disabilities. • Times have changed since ICAP • All people, including people with very significant functional limitations, can do meaningful work in the community. • Our consumers successfully challenged prevailing assumptions and questioned why things could not be different.

8. Trend 2: Functional Description of Disabilities • Medical descriptions have proven to be of limited usefulness in assisting people with intellectual disabilities to reach meaningful life goals. • Functional descriptions of disabilities do not focus solely on biological characteristics, but rather on indicators of a person’s performance on tasks that are required for successful functioning in contemporary society.

9. Trend 3: Chronologically Age Appropriate Activities • The chronologically age appropriate perspective holds that people, regardless of intellectual abilities or limitations, should have the opportunity to have life experiences and engage in activities consistent with their chronological age.

10. Trend 4: Consumer-Driven Services and Supports • The consumer-driven approach requires providers to tailor supports to the needs and preferences of the person and his or her family. • Providing funding directly towards people with disabilities individual needs as opposed to funding “programs” administered by the provider.

11. Trend 5: Support Networks that Provide Individualized Supports • Our consumers need support networks comprised of many individuals who provide many different types of supports. • The “supports paradigm” shifts the focus from caregiving to investing time in creating an nurturing supports network. • The paradigm shift redefines, but does not eliminate the role of paid support staff. • Supports should follow a person to whatever settings the person wants and need to be in.

12. How the SIS Differs from Instruments that Measure Personal Competence How Does the SIS Differ from the ICAP

13. Traditional IQ and Adaptive Behavioral Scales • For the past 50 years the two cornerstones have been. • IQ tests with a primary focus on the maximal performance of an individual on tasks related to conceptual intelligence. • Adaptive Behavioral Scales focus on the skill level a person typically displays when performing tasks in his or her environment.

14. Supports Needs Assessment Scales • Support Needs Assessment scales (SIS) focus on the pattern and intensity of supports needed to enable a person to participate in valued settings and activities. • The SIS is a supports needs assessment scale and is not a scale to measure personal competence. • The SIS reflects a new way of thinking about assessment, focusing on the support needs of the individual, not his/her deficits • The SIS attempts to directly measure support needs.

15. “Supports” are… …resources and strategies that promote the interests and welfare of individuals and that result in: • Enhanced personal independence and productivity • Greater participation in an interdependent society • Increased community integration, and/or • Improved quality of life - Thompson et al., 2004

16. SIS vs. ICAP • The SIS does not supplant the need for adaptive behavioral skills or other measures of personal competence that are essential for diagnosing the condition of intellectual disabilities. • Adaptive behavior = skills needed to successfully function in society. • Supports Intensity Scale = activates that a person does during the course of participating in everyday life. • Plan to replace ICAP with short assessment tool to directly assess Form 19 criteria for functional limitations

17. Multiple Uses for SIS • Individual Level – Basis for individualized Support Plan. • Agency Level – Basis for staffing, staff training, budgeting, strategic planning, and evaluation. • Systems Level – Basis for resource allocation, research / evaluation, and systems planning.

18. SIS Pilot Group and Risk Assessment Committee How Did We Get Here?

19. Why the SIS vs. Other Assessment Tools • New USTEPS system require decision to continue use of ICAP or Alternative Tool • Statewide Committee formed to review National Assessment Instruments. • SIS was picked for pilot test and piloted by committee across the state. • DSPD chose to implement the SIS to address concerns of last CMS Review. Due date January 2006 • SIS has the ability to eventually be used to help develop individualized budgets (DOORS Model)

20. Administration of the SIS What you are dying to know about the SIS Administration.

21. The SIS Sections • Administration: 30 – 45 minutes • Section One: Supports Needs Scale (49 items) • Section Two: Supplemental Protection and Advocacy Scale (8 items) • Section Three: Exceptional Medical (16 items) and Behavioral (13 items) Support Needs • Section Four: Utah Additional Support Needs/ Risk Assessment Questions

22. SIS Administration • SIS is administered viaa semi-structured interview with preferably two or more respondents who know the individual well. • Respondentsshould be individuals who have known the person being evaluated for at least 3 months and have observed the person in one or more environments for substantial periods of time (parent, staff, job-coach, teacher, self).

23. Setting the Stage Introducing SIS to the respondents Key Points: • Look and speak directly to the respondents. • Briefly explain everyone’s role and reason for being present. • Briefly explain the purpose of SIS. • Practice this introduction before you do an interview.

24. Influences on the Intensity of a Person’s Support Needs What are the Factors?

25. Factors that influence Intensity of a Person’s Support Needs • Personal competence of the individual • Exceptional medical support needs. • Exceptional behavioral support needs. • Number and complexity of the settings in which a person participates. • Number and complexity of life activities in which the person participates.

26. Walkthrough of the Items • Open the SIS Users Manual to page 16–the Interview and Profile Form. Follow along as we go through the items on the Scale. • For further description of items use the Expanded Item Descriptions and Tables 2.1 – 2.9 in the SIS Users Manual(pp 27-37).

27. Section One: Support Needs Scale Six Life Activity Areas (49 life activities) • Home Living Activities • Community Living Activities • Lifelong Learning Activities • Employment Activities • Health and Safety Activities • Social Activities Note: You may start the SIS administration with any item/section, as long as ALL items are completed.

28. Section One: Supports Needs Scale Ratings • Frequency (how often is the support needed) • 0 to 4 (<monthly …. Hourly) • Daily Support Time (when needed, how much time is required for the support) • 0 to 4 (none to > 4 hours) • Type of Support (what is the type of support needed) • 0 to 4 (none to full physical assistance) (See page two Interview and Profile form for Rating Key)

29. Important “To” and “For” the Person • As you complete each interview question consider if the questions is most important “To the person” (what they tell us either verbally or behaviorally) or what others think is most important “For the person” to be successful. • Mark these questions with a “T” and/or “F” to the left of the question. • It is not necessary to mark a T or F for every question, only the ones you feel are most appropriate. • Use these questions when you are developing your Individuals Support Plan to help you address those objectives that are most important to the individual and/ or for their Health and Welfare.

30. Supports Needs Scale Ratings Continued • Ratings should reflect the supports that would be necessary for this person to be “successful” in each activity. • To be successful is defined as engaging in all aspects of an activity as judged against contemporary community standards and resulting in maximal involvement of the person in the activity.

31. Supports Needs Scale Ratings: Type of Support • Rating Type of Support – Focus on the following: • If a person were to engage in the activity on a regular basis over the next several months, what would be the nature of the extraordinary support needed to enable the individual to be successful in the activity? • This scale is concerned with identifying the kind of support provided by others.

32. Supports Needs Scale Ratings: Frequency • Rating Frequency – Focus on the following: • If the person were to engage in the activity on a regular basis over the next several months, how often would extraordinary support be needed to enable the individual to be successful in the activity? • The intent is not to measure how frequently the person currently engages in the activity, but rather how frequently the person would need support if they were to engage in the activity. • Every person must have the potential opportunity to score the highest score on every item.

33. Supports Needs Scale Ratings: Daily Support Time • Rating Daily Support Time – Focus on the following: • If a person were to engage in the activity on a regular basis over the next several months – during the course of a TYPICAL day (24hours) how much time would be needed to provide extraordinary supports to enable the individual to be successful in the activity? • This scale is concerned with identifying the kind of support provided by others.

34. Section Two: Supplemental Protection & Advocacy Scale • This is supplemental to Section One • Items • Encouragement and acceptance • Opportunity and access • Exercising legal responsibilities • Assisting with the acquisition and expression of skills. • Every activity is scored on frequency, time, and support

35. Section Three: Exceptional Medical and Behavioral Support Needs • This section consists of 15 medical conditions and 13 problem behaviors that typically require increased levels of support. • The interviewer assesses the individual’s intensity of supports need for each medical and behavioral item using a 3-point Likert rating scale. • Complete all items – the lower the rating, the lower the extent or intensity of supports needed

36. Using the Inventory • Complete all items even if a life activity is not applicable to the individual. • Complete items based on supports that would be necessary for the individual with disabilities to be successful in each activity. • If a person uses Assistive Technology (AT), then rate them with the AT in place. • Include 2 respondents who know the individual to determine appropriate ratings.

37. Using the Inventory Continued • The scale should be completed without regard to services or supports currently provided or available. • All medical and behavioral issues should be taken into considerations when completing the SIS. • In cases where there is an “even split” in someone’s intensity of supports needs, the higher or MORE INTENSE rating should be selected.

38. Scoring of SIS Scoring the SIS Made Easy?

39. Review of Sections • Look Over Section One: Life Activities and the Corresponding item descriptions • Look over Section Two: Support Considerations Based on Protection and Advocacy Scores • Look over Section Three: Exceptional Behavioral Support Needs • Question???

40. Data Provided by SIS • Profile of needed supports • Standard scores computed for each of the 6 Activity Subscales provide a pattern of an individual’s support needs • A composite standard score calculated from scores from the 6 Activity Subscales provides an indication of the intensity of supports needs. • Protection and advocacy scores • Exceptional medical and behavioral support needs

41. Scoring and Interpreting the SIS • SIS Users Manual (pages39-42) • Cover Page – Demographics • Section One: Support Needs Scale • Raw Scores • Subscale Standard Scores and Percentiles (Appendix 6.2) • SIS Supports Needs Index (Appendix 6.3) • Supports Needs Profile

42. Scoring Section 1 • ADD the scores horizontally for Frequency (F), Daily Support Time (DST), and Type of Support (TS) for each life activity in all of the 6 Activity Domains to get the RAW SCORES(pp 2-5, SIS Interview and Profile Form). • ADD the RAW SCORES vertically for all items within each of the 6 Activity Domains to get the TOTAL RAW SCORES. 3. Enter the TOTAL RAW SCORES for each of the 6 Activity Domains Subscales in the corresponding space in the table labeled Section 1A: Support Needs Ratings on page 8 of the SIS Interview and Profile Form.

43. Scoring Section 1, cont. 4. Using the table on page 119 of the SIS Users Manual, use the TOTAL RAW SCORE to find the STANDARD SCORE and PERCENTILE RANKING for each of the 6 Activity Domain Subscales (A–F). 5.Enter the STANDARD SCORE and PERCENTILE RANKING for each of the 6 Activity Domain Subscales in the appropriate space on the Section 1A table on page 8.(SIS Interview and Profile Form). 6. Using the Section 1A table, ADD the STANDARD SCORES for each of the 6 Activity Domain Subscales to get the STANDARD SCORES TOTAL. Enter this total in the corresponding box. 7. Using the Table on page 123 of the SIS Users Manual, use the STANDARD SCORES TOTAL to find the SUPPORT NEEDS INDEX(Composite Standard Score) and the SUPPORT NEEDS INDEXPERCENTILE RANK. 8. Enter the SUPPORT NEEDS INDEX and the SUPPORT NEEDS INDEXPERCENTILE RANK in the corresponding box in the Section 1A table.

44. Scoring and Interpreting the SIS • Section Two: • Booklet page 8- List four highest ranked Activities • Highly ranked P&A activities will be helpful in developing individualized support plans. • Section Three: • Transfer information on pages 6 &7 to Section 3 page 8. • Is this total larger than 5? • Is at least one “2” circled? • If yes was circled on any of these questions, it is highly likely that the individual has greater support needs than others with similar SIS Support Needs Index.

45. Scoring Section 2 • Add the 3 ratings (F, DST, TS) across for each item to get a RAW SCORE. • Rank order the items from highest to lowest RAW SCORE. • List the FOUR highest ranked Protection & Advocacy Activities in order and enter their raw scores on page 8. Activity Raw Score • _________________________ __________ • _________________________ __________ • _________________________ __________ • _________________________ __________

46. Scoring Section 3 In both the Medical and Behavioral supports needs sections: • ADD the ratings of “1” for each item = SUBTOTAL of “1” column. • ADD the ratings of “2” for each item = SUBTOTAL of “2” column. • ADD the subtotals from both “1” and “2” columns = TOTAL. • Enter the corresponding totals in the two boxes on page 8, Section 3.

47. Scoring Section 3, cont. A. MEDICAL 1. Enter the TOTAL 2. Is this TOTAL larger than 5? 3. Is at least one “2” circled? B. BEHAVIORAL 1. Enter the TOTAL 2. Is this TOTAL larger than 5? 3. Is at least one “2” circled? If “YES” has been circled on any of the questions above, it is highly likely that this individual has greater support needs than others with a similar SIS Support Needs Index.

48. Scoring and Interpreting the SIS • The subscale standard scores provide a pattern or profile of an individual’s support needs. • The SIS Support Needs Index provides an overall indication of the intensity of an individual’s support needs.

49. Interpreting the SIS Score • The 6 Activity Domain (subscale) Standard Scores provide a pattern or profile of an individual's support needs. • The SIS Support Needs Index provides an overall indication of the intensity of an individual's support needs.

50. Cautions in Using SIS Information • SIS data should not be viewed in isolation. • Overreliance on scores and labels contradicts the primary philosophy of person-centered planning.