In a few weeks, AAMR will launch SIS Online, the world’s first web-based
scoring and reporting system dedicated uniquely to assessing support needs of
persons with mental retardation and developmental disabilities. John Ashbaugh,
State Policy Consultant to AAMR and Vice President of Danic Technology Inc.,
talks to AAMR about what makes the Supports Intensity Scale (SIS) and the new
enterprise system unique.
AAMR: You have been talking to states and agencies about SIS
over the past year. What in your opinion distinguishes SIS from existing assessment
tools?
Ashbaugh: SIS requires the direct assessment of needs as opposed
to having the needs statistically inferred based on historical correlations of
need and adaptive
maladaptive behavior scores. The support needs decision is made on the front
lines rather than back room.
AAMR: Can you elaborate on that last thought? You pointed out
in a recent interview that SIS avoids the error inherent in inferring support
needs indirectly through
statistical measurements.
Ashbaugh: The SIS requires the Interviewer and respondents to
make the assessment of support needs directly for or with the individual. The
Inventory for Client
and Agency Planning (ICAP), Developmental Disabilities Profile (DDP), and other
traditional instruments are used to assess adaptive and maladaptive behaviors.
The assessment of support needs is subsequently done through statistical inference.
The inferred needs are derived by researchers using a combination of expert judgment
and the analysis of historical data to identify statistically significant correlations
between levels of adaptive and problem behaviors (and other limiting conditions)
and levels of service and support use. Used supports are assumed to be needed
supports. The correlations are then used to define a continuum of composite scores
each with a corresponding level of need for support and supervision. The composite
scores are typically combined into a manageable number of groups for purposes
of level-of-care determination, resource allocation and payment. An individual’s
support needs are then determined by the score set (group) in which his or her
scores happen to fall.
AAMR: And what is inconsistent with that picture?
Ashbaugh: There are two critical errors introduced with the
statistical approach to needs assessment used by the ICAP. The first lies in
treating "used" supports
as "needed" supports. Used supports are a function of supply, which
varies from area to area owing as much if not more to resource availability and
program philosophy as to "need." The second error is known as the ecological
fallacy where the researcher makes an inference about an individual based on
aggregate data for a group when in fact the inference—in this case, type(s)
and level(s) of needed supports—is unlikely to make sense for every member
of the group.
AAMR: So what you are saying is that SIS reports directly on
the unique needs
of each individual such that there is no second guessing required.
Ashbaugh: Yes.
AAMR: You also said recently, "SIS is enriching the planning process." Could
you elaborate?
Ashbaugh: Yes. Early feedback on the SIS is indeed that SIS
is enriching the planning process by sparking discussion and ideas on how the
individual might
grow and flourish in ways not before considered. At the same time, SIS is taking
longer than expected to complete. What isn’t yet known is whether, the
extra time requirement will be ongoing, will evaporate with the learning curve,
or something in between.
AAMR: Talking about the learning curve, AAMR recently launched
the first SIS Train the Trainer seminar. AAMR will have a cadre of professional
trainers available
to educate end users of SIS. What role do you see for training in the acceptance
of SIS?
Ashbaugh: The emphasis currently in the DD field is on training
and recognition, and that professional degrees do not necessarily distinguish
the best support
workers. It’s good to see that AAMR is following the same path with the
SIS. Good training will be essential to the success of SIS, training that deals
as much with actively engaging individuals, families and significant others in
supports planning as with the completion and scoring of the SIS.
AAMR: Many professionals in the developmental disability arena
are excited about using SIS as a potential solution to distributing resources
in a manner that
meets the needs of that person in the amount and intensity required. Can you
comment on that?
Ashbaugh: You’re right. A number of states have, or are now developing
individual budget amounts pegged to individual characteristics and situational
factors that have been shown to be statistically significant predictors of costs.
Central to these budget models is the association of support needs and related
costs with individual characteristics. To-date, the ICAP has been the source
of choice for the individual characteristics given its wide use and the consequent
availability of ICAP data. However, as the SIS gauges support needs directly,
rather than indirectly (via association with individual characteristics), it
should prove a superior tool for purposes of individual budget determination.
Hopefully, we will be able to demonstrate this before long. We’re expecting
final approval on our first state SIS-based individual budgeting project within
the week.
AAMR: So it looks like there is considerable interest in SIS the state circle.
However, things are slow in moving. Why?
Ashbaugh: States use needs assessment instruments for eligibility
determination,
level of
care determination, system assessments and resource allocation/payment. States
typically make heavy investments in system design, development and training particularly
in the case of resource allocation / payment systems. States must also expend
considerable time and political capital getting these systems adopted. It is
always difficult to institute new systems that affect the bottom lines of providers,
consumers/families and State.
AAMR: As you know, we will launch SIS Online, the world’s
first entirely web-based scoring and reporting system dedicated to gauging support
needs of
people with MR/DD. The idea of creating a web-based application accessible by
all was essentially yours. What prompted you to suggest that AAMR move in this
direction?
Ashbaugh: I work for Danic Technology, Inc. Danic provides database
management systems to human service agencies in North America, principally to
developmental
disabilities agencies in the U.S. Over the years, Danic has moved:
from Personal Computer (PC) systems where software, data and processing all rest
in a single PC or group of locally networked PC’s
to Client/Server systems where software, data and processing are distributed
among office PCs (clients) and servers (central computers), and most recently
to web-based systems. These systems allow any authorized user with an Internet
browser to access the software, data and processing power of servers over the
Internet. Data can be shared across different software applications and operating
systems.
Borrowing from Danic’s experience, I could see that the web-based application
of SIS made sense. It would address several problems that have historically limited
the application and use of individual assessments, chief among which is:
Access. The PC-based scoring software that typically comes with paper assessment
instruments is accessible only to those who purchase and load the software onto
their PCs. Moreover, in order to be used by state DD authorities, the assessments
and/or summary scores must be manually reentered into the state’s database.
By establishing a SIS database on-line, any authorized user can score the SIS
and access the results. Moreover, the entries or summary scores need be entered
only once into the SIS on-line system. Where states have web-based systems, the
entries and analyses can be done through their systems. Where they don’t,
the SIS On-line can effectively serve as their database. Because the SIS On-Line
can accept other data as well, it can serve as quite an expansive, low-cost,
ready-built alternative to states developing their own web-based consumer information
systems.
AAMR: And you commented in a recent article that state information
systems, like
the
SIS Online system, are increasingly web-based applications.
Ashbaugh: Yes, they [web-based applications] permit wider user
access—anyone
with an Internet browser can access them—at a lower cost (over the Internet)
and can more easily communicate one with another.
AAMR: Ultimately, the aim of AAMR, like all other disability
groups and professionals is to enhance the quality of life of people with developmental
disabilities.
How do you see SIS contributing to these efforts?
Ashbaugh: Historically, the exclusive reliance on traditional
assessment instruments with their inherent focus on individual deficiencies,
has helped lead "case
managers" to approach clients and families more as doctor than guidance
counselor. More time is devoted to the careful documenting of individual skill,
behavioral and physical deficits than to the understanding of the individual’s
life, interests and aptitudes. Hopefully, introducing the SIS into the mix will
help shift the focus. And I will repeat what I said before, good training will
be key, training that deals as much with actively engaging individuals, families
and significant others in supports planning as with the completion and scoring
of the SIS.
John Ashbaugh can be contacted at jashbaugh@danic.com
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