I-CAN: Classification of Disability Support Needs

1. I-CAN: Classification of Disability Support Needs ARC Linkage project partners: University of Sydney Royal Rehabilitation Centre & Centre Developmental Disability Studies

2. 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

3. 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

4. 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

5. 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.

7. 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

8. 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)

9. Interaction of Concepts Body function & structure(Impairment) Activities (Limitation) Participation (Restriction) Environmental Factors Personal Factors Health Condition (disorder/disease)

10. 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

11. People with disability • N=1012 • Aged 17 - 77 years • Average age 41 years • Male 58% female 42%

12. 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%

13. Health and Well Being Scales • Physical health • Mental emotional health • Behaviour • Health Services • Health and Well being Total

14. Activity & Participation • Activity is the execution of a task or action by an individual. • Participationis 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.

15. Knowledge and Tasks (KAT) Mobility (Mob) Communication (Com) Self care & Domestic Life (SCDL) Interpersonal Interaction & Relationships (IIR) Community, social & civic life (CSCL) AP Total Activities & Participation Scales

16. Reliability Studies • Internal consistency alpha =.70 to .98 • Inter-rater reliability = .99 • Test-retest reliability = .21 to .94

17. 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

18. 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.

19. Participant evaluations Positive feedback from: • People with disabilities • Trained facilitators • Family members and advocates

20. Support hours Multiple 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

21. 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