What's in a SIS score? User experiences of the Supports Intensity Scale
As the Supports Intensity Scale continues to be widely used, users are curious about how other professionals are using the Scale and assessment scores to develop plans for clients with intellectual disabilities. Here we talk to three users of the Supports Intensity Scale who share different, yet valuable uses of SIS assessments.
New Horizons Inc.
New Horizons Inc., located in Poughkeepsie, NY, is an early user of the Supports Intensity Scale. When Executive Director Regis Obijiski first introduced SIS to his staff in 2004, he saw right away that SIS established an objective measure to discuss service needs of his clients. Obijiski explains that interviews with an individual and his or her circle of support often do not get too far beyond anecdotes in a few highlighted areas of a person's life. “Too often, that which is obvious to family members may be overlooked in a discussion with providers of supports. The SIS encourages the key stakeholders to examine home, health, medical, behavioral, social, employment, community, advocacy, and protection in a comprehensive manner. The SIS provides an easy-to-read and clear set of expectations for those involved with providing supports.”
New Horizons Inc. uses the Supports Intensity Scale with all residential clients taken in by the organization. SIS scores are typically used to justify and explain the residential habilitation plan, a master document on each client’s needs. Sandra Swan, Service Coordination Supervisor explains, “If a valued goal for a client is to connect with the community and if the person needs to schedule transportation to pursue an interest in the community, Section 1, Part B of SIS (Community Living Activities) is used to determine the frequency, daily support time, and type of support needed to achieve this goal. Hence, SIS allows for a realistic plan for the daily lives of consumers…the scores reflect a service that needs to be justified and explained in the client's habilitation plan.”
Apart from quantifying service needs, Sandra sees another benefit in using SIS—establishing staffing patterns. “The SIS has clarified the role of staff in supporting people with developmental disabilities in a variety of settings. The SIS scores justify a certain staffing pattern for an individual.” Currently, New Horizons Inc. has 11 service coordinators involved with administering SIS.
State of Georgia
From a service provider, we turn to a state setting, where the long-term goal with the Supports Intensity Scale is to use the tool for resource allocation purposes, i.e., to determine funding for services to each client based on scores obtained from a SIS assessment. Louisiana and Georgia, two of the three states that have adopted SIS so far, are awaiting an analysis of SIS results to make a determination on how to proceed with resource allocation.
In the interim, SIS is serving as an instrument of change in the state of Georgia, points out Greg Kirk, President of the PCPS. “Using the SIS is a dynamic shift in thinking for providers and coordinators as well as people receiving services. It forces everyone to look at the supports needed to help the person with a disability to be as successful as the average American. This is a dynamic change and a giant step in the right direction!” For Johnathon Crumley, Regional Supervisor with Middle Georgia Behavioral Services in Georgia, “The result of using SIS with clients is really much more precise, effective Individualized Service Plans.” He explains, “Largely the SIS will tell you exactly the way your ISP needs to be written. For example, a person may not need a lot of support getting into the community but may need extensive support in socializing appropriately while in the community. As you can see, this helps the coordinator isolate the actual areas of need(s) thus resulting in more effective, life impacting plans.”
The best news about SIS for Michelle Schwartz, Executive Director of Creative Consulting Services, the agency that is responsible for the state-wide administration of SIS in Georgia, is that “The SIS is not deficits-based and that the information obtained from interviews is actually being used on a practical basis” for citizens with developmental disabilities served by the state.
Private consultant and psychologist, Joan Nyala Cooper’s use of the Supports Intensity Scale is slightly different. In Joan’s case, SIS is being used as part of a bigger assessment process, a Whole Person Assessment for residents at several state developmental centers in California. The assessments were designed to meet the contract requirements proposed in an announcement by the South Central Los Angeles Regional Center to assist in directing their resource development for community placement planning. Joan is the founder of AFRI-PSYCH Consultants operating in California and Nevada, and in 2005, she organized a team that included a nurse, an occupational therapist, and a nutritionist to conduct 2-day assessments to determine what supports consumers living in Developmental Centers would need to live in a community setting. The SIS was part of a multi-step undertaking including a thorough evaluation of each person’s medical and behavioral records, and analyses of areas such as cultural concerns, community living strengths, work-related behavior, nutritional needs, and in-depth client observations and interviews.
Joan relied on the Supports Intensity Scale to support key evidence revealed in the preparation of the Whole Person Assessment for each client. “For me, SIS is most helpful in quantifying the support needs of a person in relation to others, nationally. It gives you an objective measure to use to talk about needs and services required for a person.” For example, one of Joan’s clients obtained a Support Needs Index of 107, which placed the person in the 68th percentile range when compared to others with cognitive disabilities living in the community. However, an analysis of exceptional behavioral and medical support needs as well as protection and advocacy needs along with a reported history of assault and explosive behavior required that direct care be at the most intensive level on a 24-hour basis. The SIS assessment also revealed that more than 4 hours of constant monitoring would be needed. Guidance for daily living, educational, social, and vocational areas highlighted challenges toward community placement for this client. Joan is careful to emphasize that in her case, the SIS results were carefully considered in the context of several other steps taken to carefully evaluate the person.
For Joan, the findings on the SIS profile form (p.8 of the interview form) is a great opportunity to offer a narrative analysis of client needs, especially for those clients who have a number of highs and lows in the graphic plot (deviations from the mean). In one instance, a client scored very low for home living activities, but very high on employment. The client had several behavioral problems and autistic traits, which called for high supervision in employment settings. The client however was very comfortable at home and needed much less support there.
SIS Trainer Colleen McLaughlin points out that the information recorded in the Profile form also serves as a helpful historical record of how the support needs of the client have changed over time. Colleen explains, “Often, if supports are provided and learning occurs/the individuals own skills increase as a result of these supports and a SIS could be administered a year or so following (depending on the person and agency requirements) and a decrease in support need could occur.” Colleen is careful to point out, “It’s important to keep in mind that you’re not evaluating the supports that are provided. Remember that the person should be evaluated without regard to the supports currently provided.”
Irrespective of scores and profiles, all users agree that the Supports Intensity Scale is a great conversation catalyst. From her experience administering the Scale, Colleen points out, “The assessment really does open up the possibilities for people and you’d be surprised at the ideas that come up for supporting the person in leading a better life. Much of the time this information might never have been thought of if a plan were written without use of the SIS.
The Supports Intensity Scale User’s Manual has detailed instructions on how to score and interpret SIS. In addition, there is a section on using SIS to create person-centered plans using three case studies of persons with different levels of support needs. To access the Melvin Thurber case study, visit http://www.siswebsite.org/site/pdf/SISInterform&casestudy.pdf
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