DIDD Provider Training: THE SIS® Assessment

DIDD Provider Training: THE SIS® Assessment

DIDD Provider Training: THE SIS Assessment 1 Presented by Ascend Management Innovations & DIDD Training Objectives 2 Discuss philosophy and history of SIS Define provider roles and responsibilities

Explain how to read and use the SIS Summary Report What is the SIS ? 3 SIS stands for SUPPORTS

INTENSITY SCALE The SIS was created by AAIDD 4 Who is AAIDD?

American Association on Intellectual and Developmental Disabilities Publishers of the SIS assessment Introduction to the SIS 5

A standardized assessment A semi-structured interview Consists of 86 questions in 3 sections Introduction to the SIS 6

Represents a paradigm shift in the field of developmental disabilities successbased versus deficiency-based Do WITH instead of Do FOR a person How is the SIS different? 7

Emphasizes supports rather than deficits Leads to person-centered rather than program-centered thinking Highlights success potential rather than status quo services How is the SIS different? 8

Measures what it would take to live a life of inclusion in the community rather than inclusion in segregated settings Explores a full range of everyday life activities rather than limiting expectations about an individuals potential. Fundamental Principle of the SIS 9

People with disabilities deserve to: Experience the same rights and responsibilities, Explore dreams and expectations, and to Discover and access opportunities that are available to other adults in their community. Participate as part of a larger community rather than in a segregated setting.

What the SIS Measures 10 Success The SIS measures the support that is needed to help the person with a disability:

Engage in activities like other same-aged adults Participate as fully in the activity as possible Participate as often as other adults in the community 11 What affects our support needs? 12 Thinking about SUCCESS

13 ICAP vs. SIS 14 ICAP vs. SIS 15 -- Measures adaptive behaviors -- Measures nature of support & functional limitations

needed to be successful -- Not very effective in measuring day-to-day support needs -- Easily used for day-to-day planning purposes -- Does not capture planning -- Very helpful for discussions of discussions on how to help the natural supports and person- individual live an everyday life centered goals

ICAP vs. SIS 16 --Multiple separate --One interview all interviews together --20 to 30 minutes to -- 1 to 2 hours to complete complete

--Once every -- Once every 2 years 3 years Sections of the SIS 17 There are 3 Sections of the SIS

Section 1 The Support Needs Scale Section 2 Supplemental Protection & Advocacy Scale Section 3 Exceptional Medical & Behavioral Support Needs Section 1 Support Needs Scale 18

Section 1 is comprised of 6 domains covering all life areas. 1A Home Living 1B Community Living

1C Lifelong Learning 1D Employment 1E Health & Safety 1F Social Activities It is the only section of the SIS that is standardized. Section 1A Home Living 19 Home living:

Dressing and personal hygiene Caring for clothes Tidying around the home Preparing and eating meals Using home electronics Section 1B- Community Living 20

Community living: Transportation Accessing public settings

Running errands and using community services Shopping Visiting friends and family Interacting with community members Engaging in recreation and leisure activities Section 1C Lifelong Learning 21 Lifelong Learning

Comprised of 2 sub-sections Formal (Classroom) Learning Planning for and selecting

classes Accessing and participating in adult education Using technology to promote learning Informal (Everyday) Learning Problem solving Using functional academics Staying healthy, safe

and fit Exercising selfdetermination and selfmanagement Section 1D - Employment 22 Employment

Learning job skills Accessing job accommodations Interacting with coworkers and supervisors Maintaining quality and productivity Adapting to changes Obtaining information from the employer Section1E Health & Safety 23

Health & Safety Taking medications Accessing healthcare services Avoiding health and safety hazards Ambulating safely Accessing emergency services

Maintaining proper nutrition and exercise Maintaining emotional well-being Section1F Social Activities 24 Social Activities

Socializing at home and within the community Participating cooperatively with others Using appropriate social skills Communicating effectively Making and keeping friends Engaging in loving and intimate relationships Engaging in volunteer work Section 2 Protection & Advocacy 25

Because it was not normed, it is not standardized no standardized score on the summary report Covers more broad-based themes

Advocating for self and others Managing money and personal finances Protecting self from exploitation Exercising legal/civic responsibilities Obtaining legal services Making choices and decisions Participating in advocacy groups 26 Section 3 Exceptional Medical & Behavioral Support Needs

Not standardized no standardized score. 29 exceptional medical and behavioral support needs. Recommended as the starting point for the SIS assessment, rather than the last section. Information identified here often threads

throughout the assessment. 27 Section 3 Exceptional Medical & Behavioral Support Needs There are many ways to measure medical and behavioral needs, and the SIS cant capture everything. What the medical and behavioral sections

do is give a good red flag that there may be exceptional needs happening. How Supports are Measured 28 Sections 1 and 2

The type of support to help the individual be fully engaged How often the support is needed to fully involve the individual in the process How much cumulative active support time is needed in the course of a typical day Rate on a scale from 0-4 Section 3

Consider if the absence of support would pose an important health or safety risk to the individual or others Rate on a scale from 0-2 The SIS is a Robust Instrument 29

Studies have proven the SIS, when done correctly, is a valid, reliable assessment of support needs. The SIS can be used to guide as well as reinforce a persons ISP plan. It provides a starting place for identifying needs, along with a persons goals and preferences. Ascend and the SIS 30

Ascend has had their SIS data analyzed by a third party, who showed their assessments to be 100% reliable, better than anyone in the nation. SIS Assessors go through extensive training and testing to become certified. Assessors are observed regularly by a trainer to ensure adherence to protocol.

Ascend and the SIS 31 You see this: The assessor must consider these factors: What the SIS Does NOT Do 32

The SIS does not: Diagnose intellectual developmental disabilities Determine eligibility for needed services and supports

Does not, in isolation, change the services a person receives Both an ICAP and a SIS ? 33 Yes, some individuals will be getting both an ICAP and a SIS within a several

month period. A pilot of 500 individuals was randomly chosen to have both assessments so that DIDD could take a look and see how they compare. Transition from ICAP to SIS 34

The ICAP will be phased out from use no later than June 2013. Many individuals have already begun receiving SIS assessments in place of ICAP assessments. People chosen for the pilot will have both an ICAP and a SIS within a few months.

The SIS Process- How It Works 35 Assessors receive information regarding an individuals SIS, such as provider agencies. Assessors will contact the lead agency first. Agency Hierarchy:

Residential Provider Day Provider PA Provider The SIS - Role of the ISC 36

ISCs may be asked to assist with scheduling when a person has transitioned agencies and the assessor is having difficulty locating him or her. ISCs may attend or be a respondent. ISCs are the liaison to the family to let them know about the SIS. The SIS - Individual Participation

37 Individual participation is highly encouraged. The person can stay for all or part of the process. The person is not required to attend the SIS, but the assessor must be able to

meet the person for the assessment to be valid. Respondents 38 AAIDD has established specific criteria as to who qualifies as a SIS respondent. The person must: Have

known the individual being assessed for at least 3 months. Be able to speak knowledgably about support needs across a variety of everyday settings. Ascend must have at least TWO valid respondents to conduct the SIS assessment. How do we choose respondents? 39 Role of the respondents

40 As respondents, YOU are the experts on describing the person being assessed. Your job is to paint a picture of what supports are needed for success. Role of the assessor 41

The assessors job is to explain what the questions are asking. He or she will help the team talk through the item and come to a consensus for each rating. However, the assessor will keep in mind AAIDDs rules for scoring.

The SIS is transparent 42 For every question, the assessor will let you know what they are marking as a rating.

The assessor will also let you know what notes they are taking about the person. Your assessor may use a computer or paper for the assessment. Professional Judgment 43 You will hear the assessor ask questions about the ratings you choose. This is not because they doubt you, but because they are ensuring that the question is

rated according to the authors intentions. Professional Judgment 44 The SIS publishers emphasize that the assessor use: Understanding of the SIS Synthesis of respondent information Observations of the individual Professional training/experience

Critical thinking Together these will determine the final rating. Can I appeal the SIS score? 45 Reconsiderations:

With ICAP, a phone interview could be conducted to provide additional information when disputing scores. This will not be done for SIS. Reason the ICAP consisted of multiple interviews, so reconsideration was simply adding an interview. With SIS being a group interview where respondents reach a consensus, that environment cannot be recreated with a phone call. Can I appeal the SIS score? 46

Appeals Scores for the SIS are not appealable. Therefore, in order to have the opportunity to contribute your knowledge of an individual, you must attend the assessment. Redos must be approved by DIDD when or if a change of status occurs. The SIS - What happens

next? 47 All SIS assessments receive a thorough Quality Audit after the interview is completed. Clinicians look for missed ratings, errors, or incongruencies in scoring.

Final report will be sent to providers following QA completion this may take a few weeks. Regional Office Intake Process 48 Intake will no longer complete ICAPs after full

transition to the SIS. DIDD is not considering SIS as an Intake tool, as there will not always be knowledgeable respondents available for an interview. Intake will determine an initial rate based on review of medical records, family interview, interviews of other professionals and observation of the person. What do I DO with the SIS ? 49

A valuable asset to the COS/Planning Team. Activities assessed are directly related to the ISP. EXCELLENT TOOL when looking to transition individuals to competitive employment. SIS discussions often lead to planning objectives. How do I read the SIS Summary Report? 50

The SIS Summary Report 51 The SIS Summary ReportPage 1 52

Page One is the demographics page. Please let us know if any demographic information on the reports you receive from us is incorrect or needs updating. On this sample, DOB, ID number, and address were deleted for HIPAA compliance. The SIS Summary Report 53 The SIS Summary Report- Page 1

54 The report you receive will show the respondents names. Please always inform the person who calls to schedule if there is a conservator involved. Conservators are always invited and encouraged to attend, but they may choose

whether or not to participate. The SIS Summary Report 55 The SIS Summary Report 56 The SIS Summary Support Needs Ratings 57

Raw scores are converted to standard and percentile scores to determine an overall Support Needs Index The higher a Support Needs Index, the more intense the individuals support needs. Both scores define how each individual compares to other adults with disabilities that were part of the norming sample.

The SIS - Section 1A - Support Needs Profile 58 This is a visual representation of percentile ranking in each domain assessed. The SIS Support Index scores are graphed to show the persons overall profile when considered across all

domains. The SIS Summary Report 59 The SIS - Section 2 Supplemental Protection & Advocacy Scale 60

This section was not norm referenced and is not used to determine the SIS Support Needs Index. Items are ranked from highest to lowest score. The four highest ranked items should be considered when developing ISPs, as these are areas where the person may be most vulnerable and in need of support. The SIS Summary Report 61

Medical and Behavioral Support Needs 62 Scores are added to determine the subtotals for both Exceptional Medical and Exceptional Behavior Support Needs. The persons COS/Planning Team is recommended to review needed supports if:

Either section has a total score greater than 5 A two is circled for any sub-item The SIS Summary Report 63 64 The SIS Summary Report - Introduction 65

This page shows the rating scale that respondents use when determining appropriate scores for each sub-item. This rating scale is used when assessing Sections 1 - A, B, C, D, E, F and Section 2 Detailed Response 1A 66

The SIS - Section 1, Part A 67 Type of Support- all 3s (partial physical assistance, help through doing) except one score of 4 (full

physical assistance, doing for). Frequency all 3s (at least 7 days/week)with one score of 2 (at least once a week up to 6 days a week) Daily Support Time mostly scored 2 (30 minutes to < 2hours), with three 3s (2 to 4 hours) The SIS Summary Report - Section Notes 68

Each section allows space for assessors to note additional/qualifying information respondents felt needed to be captured to understand the person. These notes can be used to facilitate dialogue among the COS/Planning Team when completing the ISP. The SIS Summary Report - Section 1, Part A 69

Section notes provide information to the reader of the report to better understand what a persons support needs might look like. Important To/Important For does not affect the SIS score is for the planning team. Both kinds of information are vital to person centered planning. Detailed Response 1D

70 The SIS - Section 1, Part D 71 Type of Support all 3s (partial physical assistance, help through doing) except two scores of 4 (full physical assistance, doing for).

Frequency all 2s (at least once a week up to 6 days a week), with one score of 1 (at least once a month but not every week) Daily Support Time Scores of 4, 2, and 1 The SIS - Section 1, Part D 72 Section notes - Indicate that competitive employment would likely be very challenging, as

the support person would need to do the entire job. Respondents noted Nothing in the Important To/ Important For Section consider Would he enjoy having some spending money? Is it important to him to find ways to feel competent while being productive? Detailed Response Section 2 73

Supplemental Protection and Advocacy Scale 74 Rating scale (Type of Support, Frequency, and Daily Support Time are same as Section 1). Again, this section is not included when

determining the Support Need Index as it is not norm referenced. It is vital information when planning supports. 75 Detailed Response 3A 76 Detailed Response 3B 77 The SIS - Section 3 - Exceptional Medical

and Behavioral Supports Needs 78 Uses a single 0 2 rating scale. This section is not included when determining the Support Needs Index as it is not norm referenced. However, high scores in these two areas may be reflected in the intensity of needed

supports throughout the assessment. Most Important To the Individual 79 Most Important For the Individual 80 How do I use SIS with my ISP? 81

82 83 Identifying potential outcomes and supports 84 Maslows hierarchy of needs: 85 Citation: Schop, Cory. "Maslow's Hierarchy of Needs- What Are Man's Needs According to Maslow." Safety Needs. 22 July 2009. Web. 25 Apr. 2012. .

Increasing independence 86 If an individual scores a 4 on an item (full physical assistance), the individual may not be able to increase their engagement in the task. If an individual scores a 0 on an item (independent), the individual has already mastered the task.

Increasing independence 87 For items that are rated a 3 for teamwork could a goal be to move that item to a 2 be able to coach them through it? For items that are rated a 2 for coaching

could a goal be to move that item to a 1 be able to just give reminders or monitoring? When doing planning 88 Consider where the individual is in the hierarchy of needs.

Consider what items can an individual get traction on where can we make a difference? 89 Questions & Answers 90

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