1. Supports Intensity Scale (SIS) Presentation for Day Services Providers
February 22, 2018
Hosted by Pulford Community Living Services

2. Assessing Needs Supports Needs Index Rating – Supports needed to be successful
Talk about dominant support, not what is current and to be successful. Looking at the support – not the activity. Not a can or can’t do assessment.

3. Assessing Needs History and Development of the SIS approach by AAIDD
The SIS is a valid and reliable assessment tool, specifically designed to measure the type, frequency and intensity of support an individual needs to participate in community life.
The SIS was developed over a five-year period by a team of experts from the AAIDD. This team included self-advocates, family members and professionals in the field of developmental disabilities.
The SIS measures support needs in the areas of home living, community living, lifelong learning, employment, health, and safety and social activities. It also looks at how an individual protects and advocates for themselves, and extra support needed to deal with exceptional medical and behavioral needs.
CLDS originally identified the need for a new assessment process during a comprehensive review of the program (Funding Model Review). The new assessment tool needed to support person centered planning and provide information for cost effective and equitable distribution of funding.
During this time (as well as more recently leading up to the selection of the assessment tool) a number of assessment tools were extensively researched (Inventory of Client and Agency Planning or ICAP, Scales of Independent Living, Service Needs Assessment Profile or SNAP to name a few) and through this process the SIS was considered the most promising for Manitoba.

4. Assessing Needs What We do with SIS – Many Uses for Participants Benefits
It can be used in combination with other assessment tools as determined necessary.
It can help to identify areas on which to concentrate:
Developing a transition plan in school.
Help agencies when developing program proposals.
Communicate support needs within CLDS and within agencies (changing staff).
Identify goals and support needs prior to an IP meeting.
Inform Resource Coordinators about support needs.
Help guide SIL plans.
Provide information for SDM hearing.
Inform a support needs based funding model to be more equitable in the way services are provided.

5. Assessing Needs What SIS is not
SIS is not a:
Test – a participant is not asked if they can or can’t do things, no demonstration of skill or competencies during the assessment.
Diagnostic evaluation or psychological evaluation.
Planning meeting, but a collection of information to inform planning.
SIS does not:
Provide a diagnosis or determination of CLDS program eligibility.
Tell us what to do – it helps inform decision making.
There is no right or wrong answer – answers are based on discussion and agreed upon by consensus.

6. Assessing Needs Training is required for CLDS to administer the tool
In order to ensure the integrity of the tool, inter-rater reliability and overall consistency, AAIDD requires that individuals administering the tool are fully trained by certified SIS trainers.
To date, 10 CLDS staff have received SIS training and have been certified to conduct SIS assessments.
SIS Facilitators are observed conducting assessments by a provincial SIS trainer on an ongoing basis to ensure consistency and accuracy of the tool as well to ensure the principles of the assessment are followed.

7. Support Budgets

8. Determining Supports History and Development
CLDS has contracted with Human Services Research Institute (HSRI) to inform development of a supports budget model for adults with intellectual and developmental disabilities.
HSRI is a non-profit organization established in 1976, providing leading research, policy development and consultation in the area of intellectual disabilities.
HSRI is considered the leading expert in helping jurisdictions establish a supports budget framework informed by a standardized assessment tool.

9. Determining Supports The SIS and Supports Budget Framework
All individuals receiving CLDS services have/will participate in a SIS assessment. One purpose of participating in a SIS assessment is to allow an individual to be assigned to a support level.
Low
High
Support Needs 1 2 4 5
Modest support needs & increased but not extraordinary behavioral support needs
Extraordinary Medical support need
Extraordinary Behavioral support need 3 6 7
Low Need
Less Budget
More Budget
High Need 1 2 3 4 5 6 7
Support levels are used later to determine the support budget amount that an individual will receive. The SIS is a measure of general support needs and includes medical and behavioral supports.
To obtain additional information regarding support needs, CLDS has adopted the use of Supplemental Questions (SQs) in addition to the SIS assessment.
When the SIS is administered, certain responses require that Supplemental Questions be asked. Responses help to clarify supports which are needed to ensure the safety and wellbeing of an individual with extraordinary medical or behavioral support needs.
A Verification process has been developed to confirm whether an individual has exceptional medical and behavioral support levels.
The Supplemental Questions are not part of the SIS instrument, but are asked during the SIS interview for some individuals when triggered by responses to items related to medical and behavioural support needs (Section 3A and 3B of the SIS).

10. Determining Supports Supports Budget Levels
The SIS allows for scale scores to be calculated related to various sections. The table shows the criteria used to assign individuals to one of seven levels with the following information.
Level Assignment Criteria
Support Levels
Sum ABE
3A (Medical)
3B (Behavioral) 1
Least Support Needs
0 to 22
0 to 6 2
Mild or Moderate Support Needs
23 or 30 3
Mild to Moderate Support Needs & Moderate Behavioral Challenges
0 to 30
7 to 10 4
Moderate Support Needs & Mild to Moderate Behavioral Challenges
31 to 36
0 to 10 5
High Support Needs & Mild to Above Average Behavioral Challenges
37 to 52 6
Extraordinary Medical Challenges
Any
7 to 32 or Verified Extraordinary medical risk 7
Extraordinary Behavioral Challenges
11 to 26 or Verified Danger to others or Extreme self-injury risk

11. Determining Supports How Final Level Assignments Work - Supports Budget Level Assignment
Using the SIS, the sum of the standard, not “raw,” scale scores in Parts A, B, and E in Section 1. These include scales on Home Living Activities, Community Living Activities and Health and Safety Activities.
Scale scores associated with Exceptional Medical and Behavioral Needs Section Part A on Medical Needs (scored 0-32) and Part B on Behavioral Needs (scored 0-26).
Responses to Supplemental Questions and verification determinations described above are used to assign individuals to Level 6 or 7.
Why are the cut offs set where they are? Why a score of 22? For Level 1, why not 21? Or 23? Why just ABE? Why isn’t the SNI used in total? Why just these supplemental questions? There are others we can think of. How is verification managed? Who does verification? What are their qualifications? What records are reviewed? Why just 7 levels? We think there should be 8. Or 9. What services go with what level? Why? Who says?  Yes, Level 1 could have been set at 21 or 18 or 24. Ditto with the other level. YES, we might have used SNI. Yes, we could add more SQs. Yes we could have 6 levels or 14. Yes, the service mix by level is an arguable topic. CLDS will complete a Levels assignment validation study to ensure that the level assignments are accurate and not missing anyone or groups of individuals.

12. Determining Supports How Final Level Assignments Work - Supports Budget Level Assignment
In this example, this individual would be assigned into Supports Budget Level 4 with a total standard score in SUM ABE of 34. Need to also consider response to the Supplemental Questions related to Exceptional Medical and/or Behavioural sections.

13. What if the support budget level doesn’t look right?
It is possible that not all information was shared with the SIS Facilitator at the time of the assessment.
This could be that the right people were not invited to the assessment or people were shy in providing the information.
We are asking everyone’s help to let us know of sensitive topic areas or if there is a need for follow up and private conversations to ensure the right information is provided to ensure an accurate assessment.
We ask that we limit the attendees to the SIS to 5 people to prevent people from feeling overwhelmed and then not sharing or feeling put on the spot.
The assessment might be out of date.

14. What Can I do?
Talk with the CSW to request a referral to update the assessment or to determine if a new assessment needs to be done.
Sometimes a change of 1 or 2 scores won’t have an impact on the overall support budget level. It may also be a situation where an ‘Exceptions Review” would be more helpful. They will be able to help facilitate this process.
Let the CSW know of any special accommodations that need to be made to ensure that everyone is comfortable and is willing to contribute information.

15. Determining Supports Exceptions Review Process – How it Works
The exceptions review process is a way to address the needs of people who are genuinely outliers in whatever level they are assigned. This may apply to people who have needs above and beyond those addressed in the support level or they just have unique needs which are not captured and addressed within the level’s service package.
CLDS eligible individuals are assigned to one of seven levels of need based on the SIS assessment. These levels, as well as an Individual’s living situation, determine the individualized budget that an individual will receive.
CLDS recognizes that in any level-based funding system a small percentage of individuals will have extraordinary support needs that are beyond their assigned budget and service package. As a result, CLDS has developed policy and procedures to guide the process for identifying and reviewing these cases.
If the assessment "misses" people should be able to request an "exceptions review". Nothing is perfect. 

16. Planning for Results Person-Centred Planning
-the section… “Important to” also creates a link to what was identified as valuable “to” the person during the SIS assessment.
-the section focuses on preferences, rituals, interests, hobbies or relationshps that the person can identify as important “TO” them.
-this is usually the section that creates the most conversation and buzz and we’ve encouraged people to be open about their preferences as it is important for people in their life to know. Examples can include, that family is really important to someone, Or ensuring that they have their quota of xbox or youtube time in during a day or making sure I sleep-in on the weekend.
-the structure of their day and how people like to be supported is something that is also identified… can formally identify personality traits that one values in those that support them.
These items were identified what is important “To” the individual as they were recognized by the person and referenced with in the SIS assessment.
At times, important “To” can reference an individuals preference in support needs (e.g. routine), but can also highlight desired interests, hobbies or relationships.

17. Planning for Results Person-Centred Planning
From SIS to a Person Centred Plan
We’ll go through some of the tool now to give you an idea of what it looks like… here’s an example of what can be included in the “Important for” section:
-focuses on items that are required for one to remain safe and healthy. These are items that are consistently present within one’s SIS assessment and predominantly in sections ABE as well. These items are traditionally idenitified as “Support Needs” in other planning tools and can be referenced again further in the document when creating a plan to achieve goals.
-I have noted in my experiences so far that this has been more of a conversation where “actions” have been identified and supports needs are discussed in a greater context of community living.
These items were identified as important “For” the individual because they were recognized by the support team members and had emerged from the SIS assessment ratings as significant support needs.
These items can also be used for any other “Supports Needs” section of another planning process.
These items can be listed as “Goals” for skill development if desired to achieve a greater level of independence.

18. Planning for Results Person-Centred Planning
These items were identified as “What could be improved” because they were identified by the program participant during the person-centred planning session and referenced within the SIS assessment.
This may be an area to identify “support gaps” or opportunities to promote more independence, skill building, and self directed life.
-What could be improved…
This section encourages focus on areas where things going so well all the time.
-so maybe someone does not have the appropriate supports to go to the gym and they enjoy activities like swimming – those activities aren’t happening enough.
-maybe they are frusterated in not making good progress of being more with meal prep or have communicated a lack of meaningful relationships.
-this area may indicated “service or support” gaps ---- I have seen examples where maybe pursuing respite services was not a focus of case management support when it could have been.

19. Planning for Results Person-Centred Planning
Here are some examples of an individual goal within Person-Centred Planning and how it can be supported by others in the person’s life.
-The “what can be improved section” can help inform a person’s daily support goals and identify opportunities to address service/support gaps by creating a meaningful plan (steps, who is responsible and time frames to make progress).
-This example is reflective of the goals that many people that I have met with in the last year who simply wish to do the activities that they enjoy more often.
-Other examples have included applying more support to personal care and hygiene routines (e.g. young guys and shaving), and meal preparation (e.g. looking at recipes, using social media or youtube (areas of interest) – tying things together and identifying the “imporant for and to sections to ensure that appropriate supports are in-place”

20. Planning for Results Person-Centred Planning
Here are some examples of an individual goal within Person-Centred Planning and how it can be supported by someone in the person’s life.
-You’ll see a similar framework in a the Learning and Skill building section where one would like to increase independence by learning skills to prepare meals for themselve.
-I have also observed situations where an individual identified a goal to get their drivers licese and a plan was supported to work toward that goal in utilizing family supports (to study for written test) and self managed respite services to practice driving.

21. What happens after the SIS interview is completed?
The SIS is reviewed and edited to ensure that all information provided in the assessment makes sense.
A report is generated which calculates all of the raw scores (adding up all of the numbers we’ve rated), and determines the standard scores for each section.
The report also includes a list of what was identified as important to and important for an individual. This information can be used for planning.
HSRI and CLdS use the scores from this report to determine a support budget level.
This process can take up to a month to complete.
In some rare cases, a program participant has asked us not to share the report with a supporting agency.

22. Getting the support budget level
For new program entrants, the report and the support budget level will be reviewed by a CSW with the program participant and their circle of support. The CSW will use this information to assist individuals to make plans for services, also considering non paid activities and life goals.
For program participants who are already receiving services, the CSW is able to provide the support budget level if it is requested as a support budget may not be applied to them at this time.
Agencies will be provided with the Supports Budget Levels either by the individual or the assigned CSW.

23. Further Questions Please contact: Meredith Daun SIS Program Manager
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