The Supports Intensity Scale™ and Person-Centered Planning for ORIENTATION TO THE VIRGINIA PROJECT The Supports Intensity Scale™ and Person-Centered Planning for Providers of MR/ID Waiver Services And ICF’s/MR Office of Intellectual Disability Supports Dept of Behavioral Health and Developmental Services 4/3/09

Why the SIS™….. The Supports Intensity Scale was developed by AAIDD over a five-year period in response to changes in how society views and relates to people with disabilities. Instructor Notes TELL PARTICIPANTS: “A lot of time was spent developing the first chapter of the SIS Users Manual. It is full of useful information. Please take the time to read it carefully.” Development of SIS was a 5-year process including: Literature review Analysis of existing support intensity assessment instruments Development of an assessment system Identification of functions and areas of supports Inventory of existing items and construction of additional items Field-testing/analysis/revisions 4/3/09

AAIDD is the largest association in the world for people with developmental disabilities. The SIS was developed over a 5 year period based on a review of the needs of several thousand people across the nation. It is now being used in 14 states and several other countires 4/3/09 3

SIS™ Makes Sense For Virginia #1: SIS™ reflects a a positive way of thinking about an assessment, focusing on the support needs for the individual to be successful, not on his or her deficits. 4/3/09

SIS™ Makes Sense For Virginia #2 SIS uses a small group interview: To engage the individual and other respondents To consider supports needed to meet individual needs and promote personal growth. 4/3/09

SIS™ Makes Sense For Virginia #3 It has reliability “What is Reliability?” The information is: - Dependable - Consistent - Un-changing - Desired 4/3/09

What makes an assessment reliable? We can depend on the scores, teams, and interviewers to be consistent When a person changes residences, the score will be the same, as long as the conditions and environments are similar 4/3/09

What makes an assessment reliable? This information then would result in an unchanging score that is desired to help with planning Thus, the rationale for doing the SIS every three years 4/3/09

What Does “Supports” Mean in the SIS Assessment? Intensity Scale™ SIS® What Does “Supports” Mean in the SIS Assessment? We want to make sure that you understand each of the terms used in the SIS 4/3/09

“Supports” mean the assistance the individual needs to do something successfully. “Success” means a level of performance, involvement, and participation in an activity that is comparable to that of typical adults without disabilities. 4/3/09 10

“Supports” are… Those things needed to have a life like yours and mine Home Friends and relationships Choice Paid work Participation in community activities 4/3/09

What Does “Intensity” Mean in the SIS Assessment? Supports Intensity Scale™ 4/3/09 12

Intensity is the level of support an individual needs. Trainer Note: In-ten-si-tee Intensity is the level of support an individual needs. SUPPORT Lots of support. Some support. A little support. 4/3/09

What Does “Scale” Mean in the SIS Assessment? Supports Intensity Scale™ 4/3/09 14

“Scale ” means a standardized way to measure support needs. Score = 1-2-3-4-5-6- 4/3/09 Scale for most of us means the thing we step on to weigh ourselves but for SIS… 15

The SIS™ assessment measures support needs to find out: what type of support is needed how often support is needed how much support is needed 4/3/09 Main Idea- these are 3 important questions that you will hear a lot in this show and in the interview that “measure” the supports need by each individual consumer 16

What will an Interview be like? 4/3/09 17

The interview may include: The Individual Support Coordinator/CM Guardians, Significant others, or Family members 1-2 staff from home 1-2 staff from day or work The Interviewer and Note Most often we expect there will be 1 staff person for each funded service. Your agency may choose to send 2 staff if there are specific extraordinary supports that are best known by a “specialist” staff like a nurse or behavior consultant Others in your agency have most likely already participated in determining “who” may attend and scheduling the interview 4/3/09 18

Should know about supports needed Each person at the interview: Should have known the individual for at least 3 months. Should know about supports needed Should be prepared and feel free to share information when asked 4/3/09 19

Together, the group meets with the interviewer. This will take about 2 hours. 4/3/09 The group will most often be 5-6 and the interview typically takes 2 hours or less. You will more than likely be asked to arrive 15 minutes early so everyone can set up and be ready to go 20

During the interview-YOU and others should: Answer all the questions even if they don’t seem to apply to the individual now or in the future.  Be ready to describe supports if asked. This is what makes the assessment picture complete and person-centered. 4/3/09 21

Help the individual tell the interviewer or What if YOU know any topics that may: make the individual feel uncomfortable or trigger uncomfortable responses Help the individual tell the interviewer or Tell the interviewer yourself, prior to starting the interview. 4/3/09 We would hope that a. This conversation may have occurred when the interview was being scheduled BUT b. Discussions in the interview should support a consumer speaking up, if possible c. if that is not possible, please help to make the interviewer aware of unique cues or signals that help identify the needs of the consumer 22

Who is the interviewer? An experienced person who is trained to do SIS assessments will ask the questions. Training Notebook Case Manager 4/3/09 23

What will the interviewer do? Explain the interview process. Ask you the interview questions. Write down your answers or enter them on a computer. Trainer Note: 4/3/09 24

The Interviewer will work with the group to reach agreement about supports needed, because… Not everyone sees the individual the same way or doing the same things Some items have many parts Individuals need different supports in different settings This process of small group discussion is an important part of the assessment interview. It can yield valuable information that will help shape and guide individualized planning 4/3/09 25

What Kind of Questions Will Be Asked at the Interview? . 4/3/09 26

The interviewer will ask about: All parts of a individual’s everyday life Some areas that are very personal Things that may not be happening now but could happen in the future Let’s look at sample questions in each section of the SIS….. 4/3/09 27

Section 1: Activity Domains Home Living Community Living Lifelong Learning Employment Social Activities Health & Safety 4/3/09 28

Bathing-Personal Grooming: Example: In Home Living, a question you will be asked about is: Bathing-Personal Grooming: (Showering, bathing, personal cleanliness, and proper grooming) Does___ need support for personal grooming? If so, what type of support is needed? How often is it needed? How much time does the support take each day? 4/3/09

Example: In Community Living, a question you will be asked about is: Transportation: (Getting from place to place in the community - going shopping, to the bank, to leisure activities) Does___ need support for transportation? If so, what type of support is needed? How often is it needed? How much time does the support take on a day it occurs? 4/3/09

Learning Health & Physical Education Skills: Example: In Life Long Learning, a question you will be asked about is: Learning Health & Physical Education Skills: (Learn skills in how to stay healthy, fit, and safe) Does___ need support to follow a diet or exercise? If so, what type of support is needed? How often is it needed? How much time does the support take? 4/3/09

Changing Job Assignments: Example: In Employment, a question you will be asked about is: Changing Job Assignments: (Difficulty in adapting to changes in work tasks, supports for job transition) Does___ need support at times of change? If so, what type of support is needed? How often is it needed? When needed, how much time does the support take? 4/3/09

Socializing in the home: Example: In Social Activity, a question you will be asked about is: Socializing in the home: (Effective interaction with roommates and family) Does___ need support to socialize? If so, what type of support is needed? How often is it needed? How much time does the support take? 4/3/09

Example: In Health & Safety, a question you will be asked about is: Taking medication: (At the correct time and prescribed level) How often is medication taken each day? How much support is needed to take medication? How long does it take someone to help with daily medication? 4/3/09

Section 2: Protection and Advocacy Advocating for Self Managing Money - Finances Protecting Self -Exploitation Participating Self-Advocacy Obtaining Legal Services Exercising Responsibilities Making Choices Decisions Advocating For Others 4/3/09 35

Example: In Protection and Advocacy, a question you will be asked about is: Advocating For Self: (Expressing personal preferences including wants and needs, understanding choices and decisions) What type of support is needed in advocacy? How often is it needed? How much daily support time is needed? 4/3/09

Section 3: Exceptional Medical and Behavioral Supports Exceptional Behavioral Support Needs Externally directed destructiveness - Injury to Others Self-directed destructiveness - Injury to Self Sexual Issues Other Exceptional Behavioral Support Exceptional Medical Support Needs Respiratory Care Feeding Assistance Skin Care Other Exceptional Medical Care 4/3/09

Example: In Exceptional Medical Supports, a question you will be asked about is: Skin Care: (Turning or positioning: is assistance needed to reposition in chair or bed to prevent sores?) If “YES” What is the level of support needed? The scale changes to: No Support Some Support Extensive Support 4/3/09

Externally-Directed Destructiveness: Example: In Exceptional Behavior Supports, a question you will be asked about is: Externally-Directed Destructiveness: (Aggression against others, stealing, arson, etc.) If “YES” What is the level of support needed? The scale changes to: No Support Some Support Extensive Support 4/3/09

SECTION 4: RISK ASSESSMENT Caretaker and Environmental Risks Individual Behavioral Risks Other Health Risks 4/3/09

Example: In Additional Heath Risks, a question you will be asked about is: RISK OF FALLING (Issues that effect balance and falling) Does _______ have an unsteady gait, seizures or issues that effect balance? The scale changes to: - No Support - Some Support - Extensive Support 4/3/09

The SIS™ gives the opportunity to record what is important “TO” the person and “FOR” the person. These are based on the person-centered thinking training that will be offered to teams throughout the year. 4/3/09

Important “TO” the Person What individuals say “in their own words’ What individuals say with "their own behavior” What you hear depends on what you are listening for: ELP Learning Community 2005 Instructor Notes Tell the participants: “Let’s look more closely at how the Team decides on what is important “to” the person.” Where what people say is different from what they do the bias is to rely on behavior. Behavior seems to be more reliable in discerning what individuals mean. LISTEN UNDERSTAND 4/3/09

IMPORTANT “FOR” THE PERSON ONLY THOSE THINGS AROUND: ISSUES OF HEALTH, SAFETY and Well-being WHAT OTHERS SEE AS IMPORTANT TO HELP THE PERSON What is needed to BE VALUED MEMBERS OF THEIR COMMUNITY ELP Learning Community 2005 4/3/09

Typical adult expectations/abilities SIS™ measures the difference Current expectations/abilities/support Instructor Notes: SUPPORTS VS ABILITIES/OPPORTUNITIES that currently exist SUPPORTS VS AVAILABLE/ CURRENT Supports/PROGRAMS SIS measures the gaps. Gaps in quality of life, dreams, aspirations, opportunities, responsibilities, relationships, abilities, community, work, family and home life 4/3/09 Training Curriculum Slide 45

The Implementation Schedule The SIS will be administered every three years, for every individual in Waiver or a training center. Each year only 1/3 of the waiver individuals will be evaluated by each CSB/TC and the individual’s team. The Person Centered plan will be completed every year. 4/3/09

This Means a Time Frame of: Year one: PCP and Full SIS Years two and three: PCP and Risk assessment Year four: PCP and Full SIS™ Instructor Notes: 4/3/09

IMPLEMENTATION (cont.) Risk Assessment Section 4 is a pull out that is updated annually as part of the planning process A new SIS is not necessary when an individual moves from one living situation in the community or type to another. Supports for an individual should remain the same regardless of where the person lives or works. Instructor Notes: 4/3/09

A new SIS™ is needed when: An individual is new to the Waiver moves from a long term medical environment (e.g. Nursing Facility) medical or psychological condition changes, Providers would use the current SIS or assessment for the initial period (per your regulatory requirements). 4/3/09

The SIS™ Interview Site Interviews may occur anywhere that allows for uninterrupted privacy The individual and interview team should agree on a location where everyone will feel comfortable The location should be chosen to help facilitate participation by the individual Interviews may occur at these or other locations: The individual’s or a family member’s home The individual’s day service location, provider meeting room, community meeting room. Support Coordinator/CM Offices 4/3/09

Things To Know About the Interview SIS™ is not a test. There are no “right” or “wrong” answers - just a guided conversation with all participants It's important for all participants to give their input & be as accurate as possible Since SIS is a standardized assessment, we must answer all the questions even if they don't seem to relate to the consumer now or even in the future 4/3/09

Things to Tell the Interviewer Before the Interview… How the individual prefers to participate and communicate If any topics of discussion may "trigger" uncomfortable responses from the individual and how to best accommodate how information is gathered Any accommodations which may be needed for any participant 4/3/09

SIS Interview Participants An Invitee is called a “Respondent” and is any person designated to answer questions about the support needs of the individual: Should know the person for at least 3 months Should have regular (preferably daily) interaction with them in settings where support is needed Should be prepared to provide responses that accurately reflect the support need. 4/3/09

SIS Interview Respondents The right respondents can make all the difference in capturing an accurate picture of an individual’s support needs As mentioned earlier, an interview may include: The individual Guardian or family member if appropriate One or two staff from day program provider One or two staff from residential provider Support coordinator Interviewer 4/3/09

SIS Respondents: Direct Support Staff Agencies should designate staff from each of the residential and day/employment services to serve as respondents. Information from both residential and day services is essential. To be prepared, designated respondents should review information from the ISP, “Essential Information” & other relevant information prior to the interview. 4/3/09

SIS Respondent: The Individual The individual should participate in at least part of the interview, and use their communication devices, if needed In unique situations the individual may be unable or decide not to be interviewed. If so, The individual or team should identify who will represent them (family member, advocate, or support coordinator) The Interviewer should try to meet the individual at some point before the interview or prior to finalizing the report to explain about the meeting. 4/3/09

Roles and Responsibilities of Case Managers/Interviewers of SIS™ Support for Team Members/Standardization of Administration Help Team Members Understand the Score and Interpret their responses Help Team Members Develop Outcomes in the Person-Centered Planning Process Follow Up and Monitor Plan 4/3/09

The Individual and Identification of Other Respondents “The interview is about the individual’s life. It is not the family's or provider’s interview.” AAIDD 2008 Respondents should be given the opportunity to express their opinions about individuals invited to the SIS interview, & their preferences considered along with those of others putting the interview team together. 4/3/09

Identification of Other Respondents cont. An individual may assist in identifying a family member and/or an advocate to participate This is similar to the process used for ISP meeting. 4/3/09

SIS™ Respondents: Service Providers How Many Staff Can Attend? In most cases, each service agency would select one respondent who knows and works with the individual on a daily basis. One additional staff respondent from each of services area may attend if a more thorough understanding of the supports an individual needs can be provided. 4/3/09

SIS™ Respondent: Support Coordinator/CM If the Support Coordinator/CM is familiar with the individual’s support needs, they will participate as a respondent. If the Support Coordinator does not meet the criteria as a respondent, they might participate as an observer if they are not the interviewer. 4/3/09

When a SIS™ is completed -Respondents may.. Give input to the Interviewer and will use the SIS instead of their current assessments for any individual they support once a SIS is completed. Use current process until a SIS is completed (during the phase in). Receive on-line print outs of the reports which are distributed after SIS is completed prior to development of the annual plan. 4/3/09

Team meetings….. Team meeting might look different when completed in a person-centered way. The SIS™ is best completed by the team prior to the annual gathering with review and use during the Person-Centered process. 4/3/09

Level Of Care/LOF Information on the SIS™ should be consistent with the information from the LOF 4/3/09

One Team Assessment/One plan/Shared outcomes SIS™/ISP Framework One Team Assessment/One plan/Shared outcomes Partners/Circles of support Self-direction Health and safety Regulatory compliance Person-Centered Practices Leadership Team 5 4/3/09

Changes in Language Client/Consumer = Individual Case Manager = Support Coordinator Service Plan = Support Plan Training = Learning Assistance = Supports Specialized Supervision = Safety Supports Interventions/Strategies = Support Instructions 4/3/09

The Person-Centered Plan Focuses on the individual and what he/she wants in life Contains the balance of important “TO” and “FOR” that leads to the individual’s desired outcomes. Describes the details of how supports will be provided to achieve the outcomes. 4/3/09

Before planning During planning After planning Instructor Notes: This slide represents the phases of the team process. After planning 4/3/09

The Modules of the ISP: 1. Essential information 2. Personal Profile 3. Shared planning 4. Agreements 5. Support Plans 4/3/09

I. Essential Information List of Components….. 4/3/09

Risk assessment SIS 4/3/09

II. Personal Profile Considers “a good life”/ talents and contributions 4/3/09

II. Personal Profile Considers what’s WORKING AND NOT WORKING 4/3/09

III. Shared Planning Considers what’s IMPORTANT TO the individual 4/3/09

III. Shared Planning …And FOR the individual’s life 4/3/09

III. Shared Planning Planning is evaluated for success 4/3/09

IV. Shared Agreements 4/3/09

IV. Shared Agreements 4/3/09

Part V: Plan for Supports Optional format This begins the part of the plan that is optional. 4/3/09

Person-centered descriptions V. Plan for Supports Supports tailored to individual preferences Person-centered descriptions 4/3/09

V. Plan for Supports Schedule to meet agreements 4/3/09

V. Plan for Supports Keeping track ISP CHECKLIST BLANK COPY - (OPTIONAL for WAIVER PROVIDERS) Currently resolving issues such as -- Signing in and out of day support, hourly services Addressing specialized supervision 4/3/09

Ongoing notes and learning V. Plan for Supports Ongoing notes and learning LEARNING LOG (OPTIONAL for WAIVER PROVIDERS) 1 per person M. Smull 4/3/09

What? V. Plan for Supports Ongoing review and improvements Completed quarterly. 4/3/09

The PC Process Tells Us The Individual’s: Health and safety issues Description of the good life What’s working and not working Desired outcomes Supports to reach those outcomes 4/3/09

AND THE SIS™ TELLS YOU….. What type of supports a person will need….. The intensity of those supports….. The frequency of supports….. 4/3/09

4/3/09

Questions? More info: www.dmhmrsas.virginia.gov MR/IDS web pages www.AAIDD.org Supports Intensity Scale™ 4/3/09

Thank you! The Picture Communication Symbols ©1981–2008 by Mayer-Johnson LLC. All Rights Reserved Worldwide. Used with permission. Thanks also to The Pennsylvania Training Partnership for People with Disabilities and Families and the Oregon Office of Developmental Disabilities for the use of their slide presentations which were adapted for Virginia. 4/3/09 89