I-CAN: Classification of Disability Support NeedsARC Linkage project partners:University of SydneyRoyal 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.
Figure 1: Supports model (Luckasson, et al., 2002).
Person’s Capabilities &Adaptive Skills
Risk/ ProtectiveFactors
Participation in Life Environments(Requirements & Demands)
Support Areas Human Development Employment Teaching & Education Health & Safety Home Living Behavioural Community Living Social Protection & Advocacy
Intensity ofSupport Need
Source of Support
Intensity ofSupport Need
Evaluation ofSupports
Support Functions Teaching In Home Living Assistance Befriending Community Access & Use Financial Planning Employee Assistance Health Assistance
Personal Outcomes Independence Relationships Contributions School & Community Participation Personal Well-being
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 ConceptsInteraction 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)
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 hoursMultiple 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