Integrating Support Intensity Scale (SIS) Information into Individual Support Plans
Robert L. Schalock, Ph.D.
AAIDD Pre-Conference Workshop on Translating Person-Centered Planning and The Supports Intensity
Scale into Meaningful Individual Support Plans June 18, 2012
Overview
Five Best Practice Strategies to Integrate SIS Information into Individual Support Plans 1. Select Important Support Needs
2. Align Support Needs to An Individual Supports Plan Format 3. Align Support Needs to Specific Support Strategies
4. Specify a Specific Support Objective for Each Support Strategy 5. Develop the Individual Supports Plan
Strategy # 1: Select Important Support Needs
Identifying support need areas that are important to the individual is based on the individual’s goals, desires, and preferences. These need to be incorporated into the ISP to ensure that the individual’s supports plan is the person’s plan, and thus is meaningful to the individual. This inclusion ensures the
individual’s motivation, buy in, and commitment to being part of the Plan’s successful implementation.
Identifying support need areas that are important for the individual is based on: (a) high support need scores in the most relevant life activity areas; (b) needed supports in health and safety; and (c) interventions prescribed by a professional.
Exhibit 1
Example of Needed Supports Based on What Is Important To and For the Individual ________________________________________________________________________ Important To the Individual (Based on Personal Goals and Preferences):
“ I want a job”
“ I want an apartment” “I want more friends”
Important For the Individual (Based on Assessed Support Needs):
Home Living: Bathing and taking care of personal hygiene and grooming needs
Employment: Accessing/receiving job/task accommodation Health-Safety: Taking medications
Protection and Advocacy: Protecting self from exploitation Medical: Seizure management and control
Strategy # 2: Align Support Needs to an Individual Supports Plan Format
Table 1
Matrix of Quality of Life Domains and Support Intensity Scale Support Areas ________________________________________________________________________
QOL Domain SIS Support Areas
Personal Development Toileting (A1) Taking care of clothes (A 2) Eating food (A 4) Preparing food (A 3)
Dressing (A 6) Bathing-person. hygiene (A7) House keeping and cleaning (A 5)
Operating home appliances (A 8)
Interacting with others in learning activities (C 1) Participating in training/education decisions (C 2) Learning and using problem solving strategies (C 3) Using technology for learning (C 4)
Accessing training/educational settings (C 5) Learning functional academics (C 6)
Managing money and personal finances (P & A 2) Self-Determination Learning self-determination skills (C 8)
Advocating for self (P & A 1)
Belonging to/participating in self advocacy group (P & A 5)
Making choices and decisions (P & A 7) Interpersonal Relations Going to visit family and friends (B 4)
Interacting with community members (B 7) Interacting with co-workers (D 3)
Interacting with supervisors/job coaches (D 4) Socializing within the household (F 1)
Participating in recreation/leisure/others (F 2) Socializing outside the household (F 3)
Making and keeping friends (F 4)
Communicating about personal needs (F 5) Using appropriate social skills (F 6)
Engaging in loving and intimate relationships (F 7) Social Inclusion Transportation (B 1)
Participation in recreation/leisure activities- community (B 2)
Social Inclusion (continued) Participating-preferred community activities (B 5) Shopping and purchasing goods and services (B 6) Accessing public building/settings (B 8)
Engaging in volunteer work (F 8)
Rights Protecting self from exploitation (P & A 3) Exercising legal responsibilities (P & A 4) Obtaining legal services (P & A 6)
Advocating for others (P & A 8)
Emotional Well-Being Learning self-management strategies (C 9) Maintains emotional well-being (E 8)
Exceptional behavioral support needs (Section 3 B) Physical Well-Being Learning health and physical education skills (C 7)
Taking medications (E 1)
Avoiding health and safety hazards (E 2) Obtaining health care services (E 3) Ambulating and moving about (E 4)
Learning how to access emergency services (E 5) Maintaining a nutritious diet (E 6)
Maintaining physical health and fitness (E 7) Exceptional medical support needs (Section 3 A) Material Well-Being Accessing/receiving job/task accommodation (D 1)
Learning and using specific job skills (D 2) Completing work-related tasks with acceptable speed (D 5)
Completing work-related tasks with acceptable quality (D 6)
Changing job assignments (D 7)
Seeking information and assistance from an employer (D 8)
Exhibit 2
Example of Support Needs Aligned with Quality of Life Domains
________________________________________________________________________ Quality of Life Domain Assessed Support Needs
Personal Development Bathing-person hygiene (A 7) Learning functional academics (C 6) Self-Determination Learning self-determination skills (C 8)
Advocating for self (P & A 1) Interpersonal Relations Making and keeping friends (F 4)
Socializing within the household (F 1) Social Inclusion Transportation (B 1)
Participation in recreation/leisure activities (B 2) Rights Protecting self from exploitation (P & A 3)
Obtaining legal services (P & A 6)
Emotional Well-Being Learning self-management strategies (C 9) Prevention of non-aggressive but inappropriate behavior (3 B # 8)
Physical Well-Being Taking medication (E 1)
Seizure management ( 3 A # 11)
Material Well-Being Learning and using specific job skills (D 2) Completing work-related tasks with acceptable speed (D 5)
Strategy # 3: Align Support Needs to Specific Support Strategies Table 2
Elements and Components of a System of Supports
________________________________________________________________________
Element Component/Specific Support Strategies
Natural Supports Support networks (e.g. family, friends, colleagues, generic agencies) advocacy, befriending, community
involvement, social engagement, and interactions
Cognitive Assistive and information technology (e.g. communication devices, cell phones, iPads, medication dispensing devices, med alert monitors, speech recognition devices Prosthetics Sensory aides and motoric assistance devices
Skills and Knowledge Task analysis, applied behavior analysis, information availability, functional/real-life learning opportunities, education and training strategies such as Universal Design for Learning
Environmental Ramps, brail, push buttons, modified counters and work Accommodation spaces, modified transportation, secure and predictable
environments, adapted texts and signs, environments that are conducive to learning, matching tasks to an
individual’s relative strengths and interests
Incentives Role status involvement, recognition, appreciation, money, personal goal setting, empowerment, self-directed ISP, community participation
Personal Characteristics Choice making, decision making, interests, motivation, skills and knowledge, positive attitudes and expectations, self-management program
Professional Services Physical Therapy, Occupational Therapy, Speech Therapy, Medical, Psychological, Psychiatric, Nursing
Positive Behavior Supports Functional assessment of problem behavior and focusing on altering the environment before a problem behavior occurs and teaching appropriate behaviors
Policies and Practices Aligning staff and professionals’ work, increasing staff (Organizational) involvement, providing needed transportation, reducing
turnover and continual change of direct support staff, establishing a reference person for each client, partnering with universities and other research and training centers Policies and Practices Resource allocation patterns, interagency networks, public (Societal) relations campaigns, information services
Exhibit 3
Example of Assessed Support Needs Aligned to Specific Support Strategies
________________________________________________________________________ Assessed Support Need Specific Support Strategy
Bathing-personal hygiene Incentive program
Learning functional skills Universal design for learning
Learning self-determination skills Opportunities for choice-decision making Shopping and purchasing goods Pictorial shopping guide
Making and keeping friends Support network Socializing within the household Incentive program
Transportation Modified transportation
Participation in recreation/leisure activities Interests and motivation
Engaging in loving and intimate Social engagement and interactions relationships
Accessing training/education settings Transportation
Learning self management strategies Self management program Prevention of non-aggressive by
inappropriate behavior Applied behavior analysis Taking medication Medicationl dispensing device
Seizure management Med alert device
Learning and using specific job skills Supported employment Completing work-related tasks with Supported employment acceptable speed
Strategy # 4: Specify a Specific Support Objective for Each Support Strategy
Table 3
Exemplary Support Objectives
________________________________________________________________________ Use personal goal setting to promote social inclusion
Provide a behavior support plan to increase incentives
Implement computer and video-based instruction on food preparation and safety skills
Implement a positive behavior support program to reduce self injurious behavior
Use local self-help advocacy group and iPhone to increase community involvement
Use Facebook or other social media to communicate with friends Use video-based instruction to increase functional skills
Use a med alert device and mobile support team to allow semi-independent living
Use a computer-based augmentative communication system to increase expressive language
Advocate for community-based environmental accommodation to increase mobility access
Develop on-line communities to increase social interaction and community participation
Network with community-based self help groups to increase social inclusion Use Facebook to recruit allies within the community
Access community and neighborhood support groups to facilitation successful community living
Strategy # 5: Develop the Individual Supports Plan Table 4
Individual Supports Plan Development Principles
________________________________________________________________________ 1. The client and the client’s family are actively involved in the plan’s development
and implementation.
2. The support team that develops and implements the ISP is composed of agency staff who know the individual well and will be involved in the plan’s
implementation and monitoring.
3. Priority is given to those outcome areas that reflect the person’ goals, relevant major life activity areas, and exceptional medial and behavioral support needs. 4. An outcomes-focused framework is used to aggregate support strategies and
objectives to person-referenced outcomes that are either important to or important for the individual.
5. Support objectives are referenced to specific support strategies composing a system of supports and not to person-specific attitudes or behaviors.
6. The ISP is implemented via multiple entities including the service recipient, one or more family members, direct support staff, and a case manager/supports coordinator.
7. The ISP format should be user friendly and easy to communicate so as to facilitate effective implementation.
________________________________________________________________________ Table 5
Sequential Steps in ISP Development
________________________________________________________________________ 1. Identify the individual’s primary support needs based on: (a) what is important to
the individual (i.e. the individual’s goals and preferences); and (b) what is important for the individual (i.e. assessed support needs in relevant major life activity areas, exceptional medical and behavior support needs, and professional recommendations. (Strategy # 1)
2. Aggregate the support needs into the respective quality of life domains (or other organizing framework). Best practices require a holistic approach that reflects the multidimensionality of human behavior. (Strategy # 2)
3. Align the targeted support needs with specific support strategies. (Strategy # 3). 4. Specify a specific support objective for each support strategy. (Strategy # 4) 5. Identify who is responsible for implementing each support objective.
Alignment Framework
QOL Domains (Table 1)
Important/Relevant Assessed Support Needs
(Table 2) Specific Support Strategy (Table 3) Support Objective (Table 4) Responsible Entity Personal Development Bathing-personal hygiene
Learning functional academics
Incentive program Universal design for
learning
Implement an incentive program
Use universal design for learning
Self-Determination Learning self-determination skills
Shopping and purchasing goods
Opportunities for choice-decision making Pictorial shopping guide
Provide opportunities for choice-decision making Develop and use a pictorial
shopping guide Interpersonal
Relations
Making and keeping friends Socializing within the
household
Support network Incentive program
Expand support network Implement an incentive
program Social Inclusion Transportation
Participation in
recreation/leisure activities
Modified transportation Interests and motivation
Provide modified transportation Increase interests and
motivation through highly valued activities
Rights Engaging in loving and
intimate relationships Accessing training/education
settings
Social engagement and interactions Transportation Demonstrate/pattern social engagement and interactions Provide frequent transportation Emotional Well-Being Learning self-management
strategies
Self-management program Implement an IT-based and monitored
self-Prevention of nonaggressive but inappropriate behavior
Applied behavior analysis
management program Apply applied behavior
analysis Physical Well-Being Taking medication
Seizure management
Medication dispensing device
Med alert device
Procure and use medication dispensing device
Procure and use med alert device
Material Well-Being Learning and using specific job skills
Completing work-related tasks with acceptable speed
Supported employment Supported employment Enroll in supported employment Enroll in supported employment Exhibit 4. Individual Supports Plan Alignment Framework
