Integrating Support Intensity Scale (SIS) Information into Individual Support Plans. Robert L. Schalock, Ph.D.

Transcription

1 Integrating Support Intensity Scale (SIS) Information into Individual Support Plans Robert L. Schalock, Ph.D. AAIDD Pre-Conference Workshop on Translating Person-Centered Planning and The Supports Intensity Scale into Meaningful Individual Support Plans June 18, 2012 Overview Five Best Practice Strategies to Integrate SIS Information into Individual Support Plans 1. Select Important Support Needs 2. Align Support Needs to An Individual Supports Plan Format 3. Align Support Needs to Specific Support Strategies 4. Specify a Specific Support Objective for Each Support Strategy 5. Develop the Individual Supports Plan 1

2 Strategy # 1: Select Important Support Needs Identifying support need areas that are important to the individual is based on the individual s goals, desires, and preferences. These need to be incorporated into the ISP to ensure that the individual s supports plan is the person s plan, and thus is meaningful to the individual. This inclusion ensures the individual s motivation, buy in, and commitment to being part of the Plan s successful implementation. Identifying support need areas that are important for the individual is based on: (a) high support need scores in the most relevant life activity areas; (b) needed supports in health and safety; and (c) interventions prescribed by a professional. Exhibit 1 Example of Needed Supports Based on What Is Important To and For the Individual Important To the Individual (Based on Personal Goals and Preferences): I want a job I want an apartment I want more friends Important For the Individual (Based on Assessed Support Needs): Home Living: Bathing and taking care of personal hygiene and grooming needs Employment: Accessing/receiving job/task accommodation Health-Safety: Taking medications Protection and Advocacy: Protecting self from exploitation Medical: Seizure management and control 2

3 Strategy # 2: Align Support Needs to an Individual Supports Plan Format Table 1 Matrix of Quality of Life Domains and Support Intensity Scale Support Areas QOL Domain SIS Support Areas Personal Development Toileting (A1) Taking care of clothes (A 2) Eating food (A 4) Preparing food (A 3) Dressing (A 6) Bathing-person. hygiene (A7) House keeping and cleaning (A 5) Operating home appliances (A 8) Interacting with others in learning activities (C 1) Participating in training/education decisions (C 2) Learning and using problem solving strategies (C 3) Using technology for learning (C 4) Accessing training/educational settings (C 5) Learning functional academics (C 6) Managing money and personal finances (P & A 2) Self-Determination Learning self-determination skills (C 8) Advocating for self (P & A 1) Belonging to/participating in self advocacy group (P & A 5) Making choices and decisions (P & A 7) Interpersonal Relations Going to visit family and friends (B 4) Interacting with community members (B 7) Interacting with co-workers (D 3) Interacting with supervisors/job coaches (D 4) Socializing within the household (F 1) Participating in recreation/leisure/others (F 2) Socializing outside the household (F 3) Making and keeping friends (F 4) Communicating about personal needs (F 5) Using appropriate social skills (F 6) Engaging in loving and intimate relationships (F 7) Social Inclusion Transportation (B 1) Participation in recreation/leisure activitiescommunity (B 2) Using public services in the community (B 3) 3

4 Social Inclusion (continued) Participating-preferred community activities (B 5) Shopping and purchasing goods and services (B 6) Accessing public building/settings (B 8) Engaging in volunteer work (F 8) Rights Protecting self from exploitation (P & A 3) Exercising legal responsibilities (P & A 4) Obtaining legal services (P & A 6) Advocating for others (P & A 8) Emotional Well-Being Learning self-management strategies (C 9) Maintains emotional well-being (E 8) Exceptional behavioral support needs (Section 3 B) Physical Well-Being Learning health and physical education skills (C 7) Taking medications (E 1) Avoiding health and safety hazards (E 2) Obtaining health care services (E 3) Ambulating and moving about (E 4) Learning how to access emergency services (E 5) Maintaining a nutritious diet (E 6) Maintaining physical health and fitness (E 7) Exceptional medical support needs (Section 3 A) Material Well-Being Accessing/receiving job/task accommodation (D 1) Learning and using specific job skills (D 2) Completing work-related tasks with acceptable speed (D 5) Completing work-related tasks with acceptable quality (D 6) Changing job assignments (D 7) Seeking information and assistance from an employer (D 8) 4

5 Exhibit 2 Example of Support Needs Aligned with Quality of Life Domains Quality of Life Domain Assessed Support Needs Personal Development Bathing-person hygiene (A 7) Learning functional academics (C 6) Self-Determination Learning self-determination skills (C 8) Advocating for self (P & A 1) Interpersonal Relations Making and keeping friends (F 4) Socializing within the household (F 1) Social Inclusion Transportation (B 1) Participation in recreation/leisure activities (B 2) Rights Protecting self from exploitation (P & A 3) Obtaining legal services (P & A 6) Emotional Well-Being Learning self-management strategies (C 9) Prevention of non-aggressive but inappropriate behavior (3 B # 8) Physical Well-Being Taking medication (E 1) Seizure management ( 3 A # 11) Material Well-Being Learning and using specific job skills (D 2) Completing work-related tasks with acceptable speed (D 5) 5

6 Strategy # 3: Align Support Needs to Specific Support Strategies Table 2 Elements and Components of a System of Supports Element Component/Specific Support Strategies Natural Supports Cognitive Prosthetics Skills and Knowledge Environmental Accommodation Incentives Personal Characteristics Professional Services Positive Behavior Supports Policies and Practices (Organizational) Support networks (e.g. family, friends, colleagues, generic agencies) advocacy, befriending, community involvement, social engagement, and interactions Assistive and information technology (e.g. communication devices, cell phones, ipads, medication dispensing devices, med alert monitors, speech recognition devices Sensory aides and motoric assistance devices Task analysis, applied behavior analysis, information availability, functional/real-life learning opportunities, education and training strategies such as Universal Design for Learning Ramps, brail, push buttons, modified counters and work spaces, modified transportation, secure and predictable environments, adapted texts and signs, environments that are conducive to learning, matching tasks to an individual s relative strengths and interests Role status involvement, recognition, appreciation, money, personal goal setting, empowerment, self-directed ISP, community participation Choice making, decision making, interests, motivation, skills and knowledge, positive attitudes and expectations, self-management program Physical Therapy, Occupational Therapy, Speech Therapy, Medical, Psychological, Psychiatric, Nursing Functional assessment of problem behavior and focusing on altering the environment before a problem behavior occurs and teaching appropriate behaviors Aligning staff and professionals work, increasing staff involvement, providing needed transportation, reducing turnover and continual change of direct support staff, establishing a reference person for each client, partnering with universities and other research and training centers Resource allocation patterns, interagency networks, public relations campaigns, information services Policies and Practices (Societal) 6

7 Exhibit 3 Example of Assessed Support Needs Aligned to Specific Support Strategies Assessed Support Need Specific Support Strategy Bathing-personal hygiene Incentive program Learning functional skills Universal design for learning Learning self-determination skills Opportunities for choice-decision making Shopping and purchasing goods Pictorial shopping guide Making and keeping friends Support network Socializing within the household Incentive program Transportation Modified transportation Participation in recreation/leisure activities Interests and motivation Engaging in loving and intimate Social engagement and interactions relationships Accessing training/education settings Transportation Learning self management strategies Self management program Prevention of non-aggressive by inappropriate behavior Applied behavior analysis Taking medication Medicationl dispensing device Seizure management Med alert device Learning and using specific job skills Supported employment Completing work-related tasks with Supported employment acceptable speed 7

8 Strategy # 4: Specify a Specific Support Objective for Each Support Strategy Table 3 Exemplary Support Objectives Use personal goal setting to promote social inclusion Provide a behavior support plan to increase incentives Implement computer and video-based instruction on food preparation and safety skills Implement a positive behavior support program to reduce self injurious behavior Use local self-help advocacy group and iphone to increase community involvement Use Facebook or other social media to communicate with friends Use video-based instruction to increase functional skills Use a med alert device and mobile support team to allow semi-independent living Use a computer-based augmentative communication system to increase expressive language Advocate for community-based environmental accommodation to increase mobility access Develop on-line communities to increase social interaction and community participation Network with community-based self help groups to increase social inclusion Use Facebook to recruit allies within the community Access community and neighborhood support groups to facilitation successful community living 8

9 Strategy # 5: Develop the Individual Supports Plan Table 4 Individual Supports Plan Development Principles 1. The client and the client s family are actively involved in the plan s development and implementation. 2. The support team that develops and implements the ISP is composed of agency staff who know the individual well and will be involved in the plan s implementation and monitoring. 3. Priority is given to those outcome areas that reflect the person goals, relevant major life activity areas, and exceptional medial and behavioral support needs. 4. An outcomes-focused framework is used to aggregate support strategies and objectives to person-referenced outcomes that are either important to or important for the individual. 5. Support objectives are referenced to specific support strategies composing a system of supports and not to person-specific attitudes or behaviors. 6. The ISP is implemented via multiple entities including the service recipient, one or more family members, direct support staff, and a case manager/supports coordinator. 7. The ISP format should be user friendly and easy to communicate so as to facilitate effective implementation. Table 5 Sequential Steps in ISP Development 1. Identify the individual s primary support needs based on: (a) what is important to the individual (i.e. the individual s goals and preferences); and (b) what is important for the individual (i.e. assessed support needs in relevant major life activity areas, exceptional medical and behavior support needs, and professional recommendations. (Strategy # 1) 2. Aggregate the support needs into the respective quality of life domains (or other organizing framework). Best practices require a holistic approach that reflects the multidimensionality of human behavior. (Strategy # 2) 3. Align the targeted support needs with specific support strategies. (Strategy # 3). 4. Specify a specific support objective for each support strategy. (Strategy # 4) 5. Identify who is responsible for implementing each support objective. 9

10 Alignment Framework QOL Domains (Table 1) Personal Development Self-Determination Interpersonal Relations Social Inclusion Rights Emotional Well-Being Important/Relevant Assessed Support Needs (Table 2) Bathing-personal hygiene Learning functional academics Learning self-determination skills Shopping and purchasing goods Making and keeping friends Socializing within the household Transportation Participation in recreation/leisure activities Engaging in loving and intimate relationships Accessing training/education settings Learning self-management strategies Specific Support Strategy (Table 3) Incentive program Universal design for learning Opportunities for choicedecision making Pictorial shopping guide Support network Support Objective (Table 4) Implement an incentive program Use universal design for learning Provide opportunities for choice-decision making Develop and use a pictorial shopping guide Expand support network Incentive program Implement an incentive program Modified transportation Provide modified transportation Interests and motivation Increase interests and motivation through highly valued activities Social engagement and Demonstrate/pattern social interactions engagement and interactions Transportation Provide frequent transportation Self-management program Implement an IT-based and monitored self- Responsible Entity 10

11 Physical Well-Being Material Well-Being Prevention of nonaggressive but inappropriate behavior Taking medication Seizure management Learning and using specific job skills Completing work-related tasks with acceptable speed Applied behavior analysis Medication dispensing device Med alert device Supported employment Supported employment management program Apply applied behavior analysis Procure and use medication dispensing device Procure and use med alert device Enroll in supported employment Enroll in supported employment Exhibit 4. Individual Supports Plan Alignment Framework 11

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