What to Expect in a ReBAR Assessment

Interview

Orientation for CDDP, County, and Provider Staff participating

in assessment interviews

3-10-09

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What Will You Learn Today? • Why Oregon is doing assessments

• What the SIS assessment is and who created it

• Who will get an assessment

• What the assessment measures

• What the assessment interview will be like

• Examples of assessment questions and ratings

• How Oregon will use the information

• How YOU can prepare for an interview

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ReBAR: Restructuring Budgets, Assessments & Rates

ReBAR is a project to restructure DD Comprehensive Services rates to make them more:

Sensible: understandable to all and directly related to a consumer’s support needs

Portable: consumers can carry their level of need assessment and an appropriate budget as they move or change providers or settings

Fair: Allocations are uniformly determined – individuals with similar needs get similar budgets

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ReBAR Changes Start With . .

“A” for an Assessment

for each individual consumer

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Why does the Statewant to do assessments?

Because Oregon wants a fair way to measure everyone’s support needs.

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Over the next 5 years…

All adults living in or moving into DD group homes or Supported Living programs…

…will get a ReBAR assessment.

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What do you need?

The ReBAR Assessment is an Interview

Asking the consumer and participants like YOU some questions.

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The list of questions will come from a tool called the SIS

SIS®Supports Intensity Scale…or SIS

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The group that wrote the interview questions is AAIDD:

American Association on Intellectual and Developmental Disabilities

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AAIDD

is the largest association in the world for people with developmental disabilities.

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What Does “Supports” Mean in the SIS Assessment?

SupportsIntensity Scale

SIS®

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“Supports” means the assistance the consumer needs to do something successfully.

“Success” means a level of performance, involvement, and participation in an activity that is comparable to that of typical adults without disabilities.

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What Does “Intensity” Meanin the SIS Assessment?

SIS®SupportsIntensity Scale

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Intensity is the level of support a consumer needs.

• Lots of support.

• Some support.

• A little support.

SUPPORT

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What Does “Scale” Meanin the SIS Assessment?

SIS®SupportsIntensity Scale

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“Scale ” means a standardized way to measure support needs

Score = 1-2-3-4-5-6-

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The SIS assessment measures support needs to find out:what type of support is

needed how often support is needed how much support is needed

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What will an Interview be like?

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Who will be at the interview?The Interviewer and

• Consumer • Case Manager• Guardian or

Family member• 1-2 staff from

home • 1-2 staff from day

or work

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Each person at the interview:

• Should have known the consumer for at least 3 months.

•Should know about supports needed

•Should be prepared and feel free to share information when asked

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Together, the group meets with the interviewer.

This will take about 3 hours.

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During the interview-YOU and others should:

Answer all the questions even if they don’t seem to apply to the consumer now or in the future.

Be ready to describe supports if asked. This is what makes the assessment picture complete and person- centered.

Fill out a survey at the end of the interview about what worked and didn’t work in the assessment process.

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What if YOU know any topics that may:

• make the consumer feel uncomfortable or

• trigger uncomfortable responses

Help the consumer tell the interviewer orTell the interviewer yourself, before the interview starts if possible

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Who is the interviewer?An experienced person who is trained

to do SIS assessments will ask the questions.

Training NotebookSPD Interviewer

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What will the interviewer do?

Explain the interview process.

Ask you the interview questions.

Write down your answers on a computer.

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The Interviewer will work with the group to reach agreement about

supports needed, because…• Not everyone sees the

consumer the same way or doing the same things

• Some items have many parts

• Consumers need different supports in different settings

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What Kind of Questions Will Be Asked at the Interview?

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The interviewer will ask about:

All parts of a consumer’s everyday life Some areas that are very personal

Things that may not be happening now but could happen in the future

Let’s look at sample questions in each section of the SIS

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Section 1: Activity Domains

Home Living Community Living Lifelong Learning Employment Social Activities Health & Safety

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Bathing-Personal Grooming:(Showering, bathing, shaving, menstrual cycle)

•Does___ need support for personal grooming?•If so, what type of support is needed?•How often is it needed?•How much time does the support take each day?

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Example: In Home Living, a question you will be asked about is:

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Transportation:(Getting from place to place in the community - going shopping, to the bank, to leisure activities)

•Does___ need support for transportation?•If so, what type of support is needed?•How often is it needed?•How much time does the support take on a day it occurs?

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Example: In Community Living, a question you will be asked about is:

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Learning Functional Academics:(Using a watch, keeping a schedule)

•Does___ need support to follow a schedule?•If so, what type of support is needed?•How often is it needed?•How much time does the support take?

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Example: In Life Long Learning, a question you will be asked about is:

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Changing Job Assignments:(Difficulty in adapting to changes in work tasks, supports for job transition)•Does___ need support at times of change?•If so, what type of support is needed?•How often is it needed?• When needed, how much time does the support take?

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Example: In Employment, a question you will be asked about is:

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Socializing in the home:(Social interaction with roommates)

•Does___ need support to socialize?•If so, what type of support is needed?•How often is it needed?•How much time does the support take?

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Example: In Social Activity, a question you will be asked about is:

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Example: In Health & Safety, a question you will be asked about is:

Taking medication:(At the correct time and prescribed level)

• How often is medication taken each day?• How much support is needed to take medication?• How long does it take someone to help with daily

medication?

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Section 2: Protection and Advocacy

Advocating for Self Managing Money - Finances Protecting Self -Exploitation Participating Self-Advocacy Obtaining Legal Services Exercising Responsibilities Making Choices Decisions Advocating For Others

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Advocating For Self:(Expressing personal preferences including

wants and needs, understanding choices and decisions)

• What type of support is needed in advocacy?• How often is it needed? • How much daily support time is needed?

Example: In Protection and Advocacy, a question you will beasked about is:

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Section 3: Exceptional Medical and Behavioral Supports

Exceptional Medical Support Needs• Respiratory Care• Feeding Assistance• Skin Care• Other Exceptional

Medical Care

Exceptional Behavioral Support Needs• Externally directed

destructiveness - Injury to Others

• Self-directed destructiveness - Injury to Self

• Sexual Issues

• Other Exceptional Behavioral Support

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Skin Care:(Turning or positioning: is assistance needed to reposition

in chair or bed?)

If “YES” What is the level of support needed?The scale changes to: • No Support• Some Support• Extensive Support 39

Example: In Exceptional Medical Supports, a question you will be asked about is:

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Externally-Directed Destructiveness:(Aggression against others, stealing, arson, etc.)

If “YES” What is the level of support needed?The scale changes to: • No Support• Some Support• Extensive Support 40

Example: In Exceptional Behavior Supports, a question you will be asked about is:

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ReBAR Assessment Supplemental Questions

Oregon has added selected additional questions to the assessment to obtain more information about specific support needs related to:

Exceptional Medical Support Needs

Exceptional Behavioral Support Needs

The interviewer will ask these questions if indicated.

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Now let’s practice by meeting a real consumer and see how the Questions and Ratings work!

Meet Carolyn.

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We will use an example from the Home Living Domain:

• Item: Eating Food: (ingesting food, chewing, swallowing)

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The interviewer will ask Carolyn:

Question: What type of support do you need when you eat?

.. . and then he or she will ask YOU to provide this information also.

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Answer: During meals, Carolyn needs someone to stay close by to observe and make sure she does not eat too fast.

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Which of the following ratings fit Carolyn’s Type of Support ?

0 None1 Monitoring 2 Verbal/Gesture Prompting3 Partial Physical Assist4 Full Physical Assist

Answer: “Staying Close By & Observing”#1 = Monitoring

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The interviewer will also ask Carolyn:

Question: How Often do you need support when you eat ?

. . . and then he or she will ask YOU to provide this information also.

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Answer: Carolyn eats 4 meals each day and needs to be observed every time she eats.

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Which of the following ratings fit Carolyn’s Frequency of Support?

0 None to less than 1 time per month 1 at least 1 time per month, but not 1 time per week2 at least 1 time per week, but not 1 time per day3 at least 1 time per day, but not 1 time per hour4 hourly or more frequently

Answer: “4 meals a day”#3 = at least 1 time per day, but not 1 time

per hour

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The interviewer will ask Carolyn:

Question: How much support time do you need when you eat?

. . and then he or she will ask YOU to provide this information also.

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Answer: Carolyn spends about 30 minutes eating each meal.

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4 half-hour meals totals 2 hours each day.

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Which of the following ratings fit Carolyn’s Daily Support Time ?

0 None 1 less than 30 minutes 2 30 minutes to < 2 hours3 2 hours to < 4 hours4 4 hours or moreAnswer: “4 meals x 30 minutes each totals 2 hours” #3 = 2 hours to < 4 hours

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The interviewer will enter the following into the computer for Carolyn:

Type of Support: 1 = monitoring Frequency of Support: 3 = at least 1 x day but not 1 x per hourDaily Support Time: 3 = 2 hours to < 4 hours

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If the interview sounds hard

Remember,it’s not a test. There are no right or wrong answers . . . and YOU are there because YOU know this consumer well.

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What happens to the SIS Information?

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SPD will use what is learned about the consumer from the assessment to:

Match the consumer’s needs to a level of support, from lowest (called “Tier 1”) to highest (called “Tier 6”).

Set an “Individual Budget Amount” (IBA) designed to support that level of need.

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The Individual Budget Amount (IBA)• The “Individual Budget Amount” (IBA) is

the amount of funding authorized by SPD for the consumer for a service.

• Right now, only DD50 residential services will be affected. However, the information from this same SIS assessment will be used later for DD54 employment/day services. That is why it is important for day program staff to participate now.

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A Summary of the SIS results with information helpful for person-centered planning and the ISP.

Notification of the designated funding Tier and IBA

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Counties, Providers, Guardians, and Consumers will get:

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OK- What more can I do to get ready for an interview?

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Be Prepared !• Review information about the consumer

Know, (but don’t bring) essential information• Individual Support Plan (ISP)• Risk Tracking Record (RTR)• Behavior Support Plan or Nursing Care Plan

• Talk about the consumer with other staff who may have a different perspective on specific support needs based on their work on other days or shifts.

• Learn more about the SIS through websites listed at the end of this power point

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Watch a Video called “Conducting the Assessment”

* Produced by Washington Division of Developmental Disabilities

Review the video on the ReBAR Website

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Go to Websites to Learn More• SIS: General SIS reading, information, and

completed SIS samples http://www.siswebsite.org/cs/root/main/supports_and_sis.

• ReBAR Program http://www.oregon.gov/dhs/dd/rebar/

• Oregon Council on Developmental Disabilities for SIS Consumer and Family Orientation Information l www.ocdd.org/SISorientation.htm

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This presentation was developed using : • A presentation designed by self advocates at the

Pennsylvania Training Partnership for People with Disabilities and their Families at Temple University

• Picture Communication Symbols ©1981-2009 by DynaVox Mayer-Johnson. All Rights Reserved Worldwide. Used with permission

Adapted for Oregon: for consumers and families by the Oregon Council

on Developmental Disabilities for counties and providers, by ReBAR Program staff in

the SPD, Office of DD Services

Thank you!For being a part of these important

Assessment Interviews !!The ReBAR Team