I-CAN: Classification of Disability Support Needs ARC Linkage project partners: University of Sydney Royal 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.

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 Concepts Health Condition (disorder/disease) Environmental Factors Personal Factors Body function & structure (Impairment ) Activities(Limitation)Participation(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 years  Average age 41 years  Male 58% female 42%

Disability Groupings Multiple disabilitiesN= % Intellectual only (ID) N= % ID & neurological N= % ID & mental illnessN= % ID & sensory disabilitiesN= % ID & physical disabilityN= % Other e.g. physical, ABIN= %

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 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

References for ICF  World Health Organization (2001). International Classification of Functioning, Disability and Health. Geneva: Author.  AIHW (2003) ICF Australian User Guide Version ug/index.html