with the right ( active ) support
DESCRIPTION
PLEASE NOTE – This is an old presentation. Check out our latest work at www.i-can.org.au. With the right ( active ) support. ICF and the Supports paradigm I-CAN v3 Research Active Support I-CAN v4. Overview. Paradigm Shift in Conceptualization of Disability. Historical approaches - PowerPoint PPT PresentationTRANSCRIPT
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With the right (active) support
PLEASE NOTE – This is an old presentation. Check out our latest work
at www.i-can.org.au
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Overview
• ICF and the Supports paradigm
• I-CAN v3 Research
• Active Support
• I-CAN v4
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Paradigm Shift in Conceptualization of
Disability
• Emergence of bio-psycho-social model• Development of concept of supports• Person-environment interaction
•Historical approaches•False dichotomy medical versus social models
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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
Conceptual Frameworks
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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)
Functioning, Disability and
Health
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Interaction of Concepts
Health Condition Health Condition (disorder/disease)(disorder/disease)
Environmental Environmental FactorsFactors
Personal Personal FactorsFactors
Body function & Body function & structurestructure (Impairment(Impairment))
ActivitiesActivities(Limitation)(Limitation)
ParticipationParticipation(Restriction)(Restriction)
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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)
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“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.
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Support Intensities
• Time duration
• Frequency
• Resources
• Intrusiveness
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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
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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
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Disability Groupings
1. Intellectual (ID)23%
2. ID & neurological
15%
3. ID & mental illness
8%
4. ID & sensory7%
5. ID & physical6%
6. Multiple disabilities
28%
7. Other13%
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Health & Well Being Scales
•Physical Health
•Mental Emotional Health
•Behaviour
•Health Services
•Health and Well Being Total
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Physical Health Support Bands
0
5
10
15
20
25
30
35
40
45
50
None Mild Moderate Severe Complete
Physical health
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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.
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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)
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Support Bands Activity & Participation (N=1012)
0
10
20
30
40
50
60
70
80
%
KAT Communication Mobility SC DL IIRS CSCS A&P TotalAP Scales
None Mild Moderate Severe Complete
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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
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Participant Evaluations
Positive feedback from:
•People with disabilities
•Trained facilitators
•Family members and advocates
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Validity Studies
•Moderate and significant correlations between the I-CAN 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.
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Support HoursMultiple 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
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Research Findings Underpinning Active
SupportDirect 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.
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The Hotel Model
Residents are spectators in their own lives.
Staff feel like glorified domestics.
Staff Residents
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ProblemThere are many things which people with severe learning disabilities cannot entirely do for themselves
SolutionEveryone 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.
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The Active Support Model
People participate in everyday activities with support
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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.
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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.
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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
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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
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Activity and Support PlanStaff: Anne (A) and Colin (C)
Water plants
Gardening
Hang out clothes
AFinish laundryA
Mrs F
Start laundry
Have coffee with mother
CUnpack groceries
10:00
Go for a walk
Start laundry
Unload dishwasher
CShopping & PO – pay phone bill
AClean bedroom
CShopping9:00
Clear dishes
Wash up/load dishwasher
CStart laundryALoad dishwasher
AClear dishes (on own)
8:30
Put rubbish out
Set table
CEat breakfastCEat breakfast
AEat breakfast
8:00
OptionsHouseholdSW
DIANESW
PAULSW
HELENTime
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Ways of providing support to increase participation
ASK-INSTRUCT-PROMPT-SHOW-GUIDE
> > > > > > > > > > > > > > > > > > >
level of help increases
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.
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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
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Active Support
Designed to provide a bridge to participation in everyday activities for people who lack the skills to participate independently.
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A virtuous circle of positive interaction &
empowerment
Staff interact positively with service users and provide opportunities for them to participate
Service users participate successfully in some activities
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
Staff think of new ideas for more goals and activities. Staff see themselves as enablers
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The right support empowers people
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A model illustrating a system that aligns different levels of support around
the person with a disability (Gillinson, Green & Miller, 2005)
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How do you know what support needs to be provided?
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www.i-can.org.au
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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
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The right (active) support empowers people
www.i-can.org.au
I CAN DO IT!