ICAN: An Instrument to Classify and Assess Support Needs

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I-CAN An Instrument to Classify and Assess
Support Needs

• Vivienne C. Riches PhD
• CDDS and The University of Sydney

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Traditional Classification Systems

• Disability defined and classified according to
  aetiology or diagnosis
• World Health Organisation (1992-1994)
  International Classification of Diseases, Tenth
  Revision (ICD-10)
• American Psychiatric Association (1995)
  Diagnostic and Statistical Manual of Mental
  Disorders, Fourth Edition (DSM-IV)

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Problems

• Eligibility for service provision determined by
  disability definitions classifications
• People with disabilities feel they are made to
  fit available programs
• Significant gaps and overlaps in service
  provision
• Fragmentation with different disciplines and
  different agencies working more or less in
  parallel

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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

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Conceptual Frameworks

• ICF (WHO, 2001)
• Intensities of support - American Association of
  Mental Retardation (AAMR, 1992, 2002)

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Supports

• 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, 2001)
• Supports enable individuals to live meaningful
  and productive lives that they choose.

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Research Project

• ARC Linkage Grant Scheme 2002-2004
• Partners
• The University Sydney
• Centre for Developmental Disability Studies
• Royal Rehabilitation Centre Sydney
• Development trial of instrument process

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Sample

• 16 agencies supporting people with disability
• Located in NSW, ACT, Vic Qld
• Residential some day program settings
• Process engaging 5071 participants
• 1012 people with disability
• Aged 17 - 77 years,
• Average 41 years, SD 10
• Male 58 female 42

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Disability Groupings

• Multiple disabilities N290 28.7
• Intellectual only (ID) N232 22.9
• ID neurological N156 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 N127 12.5

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Health Well Being Scales

• Physical Health
• Mental Emotional Health
• Behaviour
• Health Services
• Health and Well being Total

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Activities Participation

• ICF AP Areas
• Learning applying knowledge
• General tasks demands
• Communication
• Mobility
• Self-care
• Domestic skills
• Interpersonal Interaction Relationships
• Major life areas
• Community, social civic life

• I-CAN AP Scales
• Knowledge Tasks (KAT)
• Communication (COM)
• Mobility (MOB)
• Self Care Domestic Life (SCDL)
• Interpersonal Interaction Relationships (IIR)
• Community, Social Civic Life (CSCL)
• AP Total

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Support Bands

• ICF Qualifiers
• 0 NO support
• (none, absent, negligible...) 0-4
• 1 MILD support
• (slight, low) 5-24
• 2 MODERATE support
• (medium, fair) 25-49
• 3 SEVERE support
• (high, extreme) 50-95
• 4 COMPLETE
• (total) 96-100
• 8 not specified
• 9 not applicable

• AAMR intensities
• 0 None
• 1 Intermittent
• 2 Limited
• 3 Extensive
• 4 Pervasive

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Support Bands Health Well Being V3.0
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Activity Participation Support Bands
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Reliability Studies

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

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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

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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.

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Participant Evaluations

• Positive feedback from
• People with disabilities
• Trained facilitators
• Family members and advocates

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Support Hours

• Multiple regression analyses
• Allocation of support hours includes up to 40
  factors relating to the individual
• Other issues appear to relate to organizational
  factors such as policies, staffing resources
  etc.

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Computerization