M. GarridoM. Garrido Cumbrera & Dr. Cumbrera & Dr. L. Salvador-CarullaL. Salvador-Carulla

Forum B: Mapping instruments for regional disability planning 

Forum B: DESDE - ein karthographisches Instrument zur örtlichen Hilfeplanung 

D Description

E Evaluation

S Services

D Disabilities

E Europe

“There is a great diversity of social and health services in Europe, making the development of an

adequate assessment methodology extremely difficult”

(WHO, 1987)

““There is a need to promote national and There is a need to promote national and international comparisons both of international comparisons both of programmes and social and health programmes and social and health

reforms”reforms”

LjubljanaLjubljana chart (WHO, 1996) chart (WHO, 1996)

ASSESSMENT METHODOLOGY AND INTERNATIONAL COMPARISONS

SERVICE DESCRIPTION

SERVICE LISTSSERVICE LISTS Lack of a common Lack of a common

conceptual frameworkconceptual framework Simple service listing Simple service listing Lack of consensus on Lack of consensus on

methods methods Do not allows national Do not allows national

and international and international comparisonscomparisons

STANDARD DESCRIPTIONSTANDARD DESCRIPTION National &International National &International

comparisonscomparisons Evidence based careEvidence based care

PlanningPlanning DevelopmentDevelopment ManagementManagement

Equity assessmentEquity assessment Quality of care asessmentQuality of care asessment

STUDY FRAMEWORK

1994 – BIOMED – 1994 – BIOMED – EPCAT TeamEPCAT Team 1997 – Development of services assessment 1997 – Development of services assessment

methodology and instrumentsmethodology and instruments• EPCAT batteryEPCAT battery

2000 – Feasibility and application in Spain 2000 – Feasibility and application in Spain Psicost Psicost Group Group

2001 – Adaptation for disabilities services – 2001 – Adaptation for disabilities services – University of Cadiz & Agency of the Ministry of University of Cadiz & Agency of the Ministry of Labour and Social Affairs (IMSERSO)Labour and Social Affairs (IMSERSO)

The European Service Mapping Schedule (ESMS)Johnson, Kuhlman & EPCAT, Acta Psych Scan, 2000

Purpose:Purpose: Compiling an inventory of mental health services serving the adult Compiling an inventory of mental health services serving the adult

mentally ill population of a catchment areamentally ill population of a catchment area Describing and comparing between catchment areas the structure Describing and comparing between catchment areas the structure

and range of mental health servicesand range of mental health services Measuring and comparing between catchment areas the levels of Measuring and comparing between catchment areas the levels of

provision of major types of mental health serviceprovision of major types of mental health service

ESMS A: IntroductionESMS A: Introduction ESMS B: Service mapping (Main service descriptors)ESMS B: Service mapping (Main service descriptors) ESMS C: Service counting (Utilisation)ESMS C: Service counting (Utilisation) ESMS D: Service characteristics (Service listing)ESMS D: Service characteristics (Service listing)

EPCAT Approach

ESMS: Utilisation of day care activities services in 6 cities (JASP, 2002)

Tampere

Federation of municipalities

Psychiatric hospital

Mental health services bought from other municipalities (arrows)

Community Mental Health Center (administrated by psychiatric hospital)

Community Mental Health Center (municipality’s)

Mental Health Services arranged by buying some of the services, some arranged locally

Pirkanmaa Hospital District (Finland): Mental Health Mapping

“Our study demonstrates the feasibility of standardised comparison of mental health service inputs and processes at a local level and the potential usefulness of the data this yields, both in service planning and research”.

DESDE

CONSENSUS STUDY I : CONCEPTUAL ADAPTATION (WORKING GROUP)

DESDE WORKING VERSION II

ESTUDIO PILOTO PROVINCIA CADIZ

DESDE USEFULNESS STUDY

INTERRATER RELIABILITYDESCRIPTIVE VALIDITY

CONSENSUS STUDY II : NATIONAL CONSENSUS GROUP

PILOT STUDY CADIZ PROVINCE

ESMS

METHODOLOGY

FOCUS GROUP• NATIONAL AGENCY OF THE MINISTRY OF LABOUR & SOCIAL AFFAIRES (IMSERSO)

• NATIONAL FED. FAMILIES PWID (FEAPS)

• NATIONAL FED. PHYSICAL DISABILITIES (COCEMFE)

•NATIONAL FED. OF AUDITIVE IMPAIRMENT

• NGOs FOR VOCATIONAL INTEGRATION (AMICA & PROMI)

• REGIONAL AGENCIES (ANDALUCIA & CASTILLA)

SECTION B (DESDE): Main Branches

Information and/or accesibilityInformation and/or accesibility (I)(I)

Self-help and voluntarySelf-help and voluntary (S)(S)

Day and structured activitiesDay and structured activities (D)(D)

Community and outpatient careCommunity and outpatient care (O)(O)

Residential servicesResidential services (R)(R)

DAY & STRUCTURED ACTIVITIES DAY & STRUCTURED ACTIVITIES MAPPING TREE (D)MAPPING TREE (D)

IM M EDIAT E AVAILABIL IT YBranchD1

O rdinary jo bBranch D21

S pecia l jo bBranch D22

H IG H IN T E N S IT YBranch D2

O rdinary jo bBranch D61

S pecia l jo bBranch D62

LO W IN T E N S IT YBranch D6

W O R K

T im e lim itedBranch D31

Indef initeBranch D32

H IG H IN T E N S IT YBranch D3

T im e lim itedBranch D71

Indef initeBranch D72

LO W IN T E N S IT YBranch D7

W O R K R E LA T E D A C T IV IT Y

E ducato n re la ted activ iyBranch D41

H ealth pro m o tio n activ ityBranch D42

S o cia l co ntact and culturere la ted activ ityBranch D43

O ther s tructuredactiv itiesBranch D44

H IG H IN T E N S IT YBranch D4

E ducatio n re la ted activ ityBranch D81

H ealth pro m o tio n activ ityBranch D82

S o cia l co ntact and culturere la ted activ ityBranch D83

O ther s tructuredactiv itiesBranch D84

LO W IN T E N S IT YBranch D8

O T H E R S T R U C T U R E DA C T IV IT IE S

H IG H IN T E N S IT YBranch D5

LO W IN T E N S IT YBranch D9

N O N S T R U C T U R E DA C T IV IT IE S

PROG RAM M ED AVAILABIL IT Y

DAY & STRUCUTRED ACT IV IT IES SERVICES

SERVICES FOR PEOPLEW ITH DISABILIT IES

CADIZ PROVINCE (SPAIN)• INHABITANT: 1,125,105• EXTENSIÓN: 7,294 KM2

• DENSITY OF POPULATION: 152 INHAB./KM.2 • 44 MUNICIPALITIES. • THREE LARGE URBAN AREAS: CÁDIZ, JEREZ DE LA

FRONTERA & ALGECIRAS • LOW LEVEL INCOME.• HIGH UNEMPLOYMENT RATE (26,1%)

DESDE SERVICESBY BRANCHES 

  

GENERAL DISABILITY SERVICES

SERVICES FOR

PEOPLE WITH ID

SERVICES FOR PEOPLE WITH

MENTAL DISORDERS

I 139 21 3

S 76 14 2

D 635 90 40

O 100 19 19

R 65 23 20

TOTAL 

1015 167 84

COMMUNITY AND OUTPATIENT CARE

DAY AND STRUCTURED ACTIVITIES

SELF-HELP AND VOLUNTARY

INFORMATION AND/OR ACCESIBILITY

RESIDENTIAL SERVICES

PROVINCE OF

CADIZ

(SPAIN) 

Codes in General Disability Services

0 0 0 5 0 7 7 9 1 635

Codes in Disability Services for people with Intellectual Disabilities

0 0 0 1 0 5 2 3 1 90

Codes in Services for people with Mental Disorders

0 0 0 0 0 1 2 1 0 40

DAY AND STRUCTURED ACTIVITIES SERVICES (D)

TOTAL D

Programmed availabilityLOW INTENSITY

Work

Non-

structured

activities

D9

Common

work

D61

Especial

Work

D62

Time

limited

D71

Indefinite

time

D72

Work related activities Other structured activities

Related

education

activities

D81

Related

health

promotion

act.

D82

Social and

cultural

participatio

n act.

D83

Others

estruct. act.

D84

DAY AND STRUCTURED ACTIVITIES SERVICES IN PROVINCE OF CADIZ (SPAIN) DESDE-2003

DESDE APPLICATION IN SPAIN

CATALOGUE OF

SERVICES CADIZ

WEB DESDE

P. DESDAE

DES-MD

ESCALA PARA LA DESCRIPCION ESTANDARIZADA

DE SERVICIOS PARA

MAYORES EN SITUACIÓN DE DEPENDENCIA

Versión diciembre 2002

L. Salvador, R Fernandez, M. PooleInstituto de Medicina Psicosocial

Universidad de Cádiz

INSTITUTO DEMEDICINAPSICOSOCIAL

RESULTS DISSEMINATION

DES-DEPESCALA PARA LA DESCRIPCIÓN

ESTANDARIZADA DE SERVICIOS PARA PERSONAS EN SITUACIÓN DE

DEPENDENCIA

Diciembre 2004

P.DESDE-DEP

IMSERSO PUB

““Using the existing databases is hard to obtain about the care Using the existing databases is hard to obtain about the care services of Dependent Adults”services of Dependent Adults”

““It is not possible to compare disability/dependency between the It is not possible to compare disability/dependency between the different European Union Member Countries”different European Union Member Countries”

““¿Is there a delay over the assessment in mental health?”¿Is there a delay over the assessment in mental health?”

White Book of Dependence

AREA OF CARE OF AREA OF CARE OF

DEPENDENT IN SPAINDEPENDENT IN SPAIN

DESDE INCLUDED FOR ASSESING SERVICES IN SPAIN:

DESDE PROJECT PROGRESS

2003: DESDAE Project (Dependent Ageing) 2003: DESDAE Project (Dependent Ageing)

2003: Piloto Study DESDE (Province of Cadiz-2003: Piloto Study DESDE (Province of Cadiz-

Andalusia)Andalusia)

2004-5: DESDE Study of Navarra2004-5: DESDE Study of Navarra

2004-5: DESDE Study of Castilla La Mancha2004-5: DESDE Study of Castilla La Mancha

2005: European Project MHEN-II (Review the ESMS)2005: European Project MHEN-II (Review the ESMS)

2005: PLANNET Project (Adaptation of DESDE to 2005: PLANNET Project (Adaptation of DESDE to

Europe context)Europe context)

International comparison of services for Intellectual Disabilities: DESDE (Description and Evaluation of Services for Disabilities in Europe)

Common Conceptual Framework: Model / Method Common Conceptual Framework: Model / Method

Common Socio-health Care Indicators Common Socio-health Care Indicators

Description of Care Systems Description of Care Systems

Common Codes System and Glossary of Terms Common Codes System and Glossary of Terms

(Day hospital) (Day hospital)

Standardised Instruments for Service DescriptionStandardised Instruments for Service Description

FINAL COMMENTS I

FINAL COMMENTS II

Psychometric properties of service assessment instruments Psychometric properties of service assessment instruments should be tested before use in researchshould be tested before use in research

DESDE is a useful instrument for standard assessment of ID DESDE is a useful instrument for standard assessment of ID services in Spainservices in Spain

International feasibility and adaptation should be carried out International feasibility and adaptation should be carried out

DESDE may be integrated in a GIS (maps and databases) DESDE may be integrated in a GIS (maps and databases) It allows regional comparisons in SpainIt allows regional comparisons in Spain It may predict specific provision patternsIt may predict specific provision patterns It may be use for services variation studies (both cross-It may be use for services variation studies (both cross-

sectional and longitudinal)sectional and longitudinal) It may be used for policy planning and implementation It may be used for policy planning and implementation It may be used for setting up minimun standard of care and It may be used for setting up minimun standard of care and

service provisionservice provision

M. GarridoM. Garrido Cumbrera & Cumbrera & L. Salvador-L. Salvador-CarullaCarulla

marco.garrido@andaluciajunta.esmarco.garrido@andaluciajunta.es

DISCUSSION AND DISCUSSION AND QUESTIONS ABOUT THE QUESTIONS ABOUT THE

DESDE INSTRUMENTDESDE INSTRUMENT