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

1. Forum B: DESDE - ein karthographisches Instrument zur örtlichen Hilfeplanung D Description E Evaluation S Services D Disabilities E Europe M. Garrido Cumbrera & Dr. L. Salvador-Carulla Forum B: Mapping instruments for regional disability planning

3. ASSESSMENT METHODOLOGY AND INTERNATIONAL COMPARISONS “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 international comparisons both of programmes and social and health reforms” Ljubljana chart (WHO, 1996)

4. SERVICE LISTS Lack of a common conceptual framework Simple service listing Lack of consensus on methods Do not allows national and international comparisons STANDARD DESCRIPTION National &International comparisons Evidence based care Planning Development Management Equity assessment Quality of care asessment SERVICE DESCRIPTION

5. STUDY FRAMEWORK • 1994 – BIOMED – EPCAT Team • 1997 – Development of services assessment methodology and instruments • EPCAT battery • 2000 – Feasibility and application in Spain Psicost Group • 2001 – Adaptation for disabilities services – University of Cadiz & Agency of the Ministry of Labour and Social Affairs (IMSERSO)

6. EPCAT Approach The European Service Mapping Schedule (ESMS)Johnson, Kuhlman & EPCAT, Acta Psych Scan, 2000 • Purpose: • Compiling an inventory of mental health services serving the adult mentally ill population of a catchment area • Describing and comparing between catchment areas the structure and range of mental health services • Measuring and comparing between catchment areas the levels of provision of major types of mental health service • ESMS A: Introduction • ESMS B: Service mapping (Main service descriptors) • ESMS C: Service counting (Utilisation) • ESMS D: Service characteristics (Service listing)

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

8. Tampere Community Mental Health Center (administrated by psychiatric hospital) Psychiatric hospital Community Mental Health Center (municipality’s) Mental health services bought from other municipalities (arrows) Mental Health Services arranged by buying some of the services, some arranged locally Federation of municipalities Pirkanmaa Hospital District (Finland): Mental Health Mapping

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

10. METHODOLOGY ESMS • 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) CONSENSUS STUDY I : CONCEPTUAL ADAPTATION (WORKING GROUP) CONSENSUS STUDY II : NATIONAL CONSENSUS GROUP DESDE WORKING VERSION II DESDE USEFULNESS STUDY ESTUDIO PILOTO PROVINCIA CADIZ DESCRIPTIVE VALIDITY INTERRATER RELIABILITY PILOT STUDY CADIZ PROVINCE DESDE

11. SECTION B (DESDE): Main Branches • Information and/or accesibility(I) • Self-help and voluntary(S) • Day and structured activities(D) • Community and outpatient care(O) • Residential services(R)

12. DAY & STRUCTURED ACTIVITIES MAPPING TREE (D)

13. 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%)

14. DESDE SERVICES BY 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 INFORMATION AND/OR ACCESIBILITY SELF-HELP AND VOLUNTARY DAY AND STRUCTURED ACTIVITIES COMMUNITY AND OUTPATIENT CARE RESIDENTIAL SERVICES

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

18. DESDE APPLICATION IN SPAIN

19. RESULTS DISSEMINATION CATALOGUE OF SERVICES CADIZ WEB DESDE IMSERSO PUB P.DESDE-DEP P. DESDAE DES-DEP ESCALA PARA LA DESCRIPCIÓN ESTANDARIZADA DE SERVICIOS PARA PERSONAS EN SITUACIÓN DE DEPENDENCIA Diciembre 2004

22. “Using the existing databases is hard to obtain about the care services of Dependent Adults” • “It is not possible to compare disability/dependency between the different European Union Member Countries” • “¿Is there a delay over the assessment in mental health?”

23. DESDE INCLUDED FOR ASSESING SERVICES IN SPAIN: AREA OF CARE OF DEPENDENT IN SPAIN White Book of Dependence

24. DESDE PROJECT PROGRESS • 2003: DESDAE Project (Dependent Ageing) • 2003: Piloto Study DESDE (Province of Cadiz-Andalusia) • 2004-5: DESDE Study of Navarra • 2004-5: DESDE Study of Castilla La Mancha • 2005: European Project MHEN-II (Review the ESMS) • 2005: PLANNET Project (Adaptation of DESDE to Europe context)

25. FINAL COMMENTS I International comparison of services for Intellectual Disabilities: DESDE (Description and Evaluation of Services for Disabilities in Europe) • Common Conceptual Framework: Model / Method • Common Socio-health Care Indicators • Description of Care Systems • Common Codes System and Glossary of Terms (Day hospital) • Standardised Instruments for Service Description

26. FINAL COMMENTS II • Psychometric properties of service assessment instruments should be tested before use in research • DESDE is a useful instrument for standard assessment of ID services in Spain • International feasibility and adaptation should be carried out • DESDE may be integrated in a GIS (maps and databases) • It allows regional comparisons in Spain • It may predict specific provision patterns • It may be use for services variation studies (both cross-sectional and longitudinal) • It may be used for policy planning and implementation • It may be used for setting up minimun standard of care and service provision

27. DISCUSSION AND QUESTIONS ABOUT THE DESDE INSTRUMENT M. Garrido Cumbrera & L. Salvador-Carulla marco.garrido@andaluciajunta.es