1. Person centered supports Methodologically Enhancing Quality of Life of People with Intellectual Disabilities Jos van Loon, Stichting Arduin en Vakgroep Orthopedagogiek, Gent Februari 2011
23. QOL Factor QOL Domain Exemplary QOL Indicators Independence Personal Development Self-Determination Education status, personal skills, adaptive behavior (ADLs IADLs) Choices/decisions, autonomy, personal control, personal goals Social Participation Interpersonal Relations Social Inclusion Rights Social networks, friendships, social activities, interactions, relationships Community integration/participation, community roles, supports Human (respect, dignity, equality) Legal (legal access, due process) Well-Being Emotional Well-Being Physical Well-Being Material Well-Being Safety & security, positive experiences, contentment, self-concept, lack of stress Health Status Nutritional Status Recreation/Physical Exertion Financial status, employment status, housing status, possessions
25. System thinking (Meso-level): Focus on QOL The practice of self- determination Everyone can make important decisions in his / her life (with the support of a personal assistant) Option of accommodation : the housing bureau Option of work : the vacancy bank The practice of personal development Learning by experience: Participating in the community Academy on QOL: Focused on emancipation and self-determination The practice of inclusion: Normal houses for all clients Foster families for children Work or daily activities in companies and daycentres in the community The practice of supports: People live in an house where they want to live themselves and work where they want to work themselves and get the supports they subsequently need.
27. Input Througput Output The goals and perspectives of a person, His or her support needs (SIS) and The quality of his / her life at a certain moment in time An Individual Supports Plan Based on wishes, goals, perspectives and support needs Which supports are to be given on which QOL-domains Which supports are to be given on which QOL-related support areas Quality of Life. This QOL therefore should be measured as a personal outcome of supports. Personal Outcomes Scale . Right to left thinking And now to the micro level: A person centered support system
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43. 0 None or less than monthly 1 Monthly 2 Weekly 3 Daily 4 Hourly or more frequent 1. Frequency 2. Daily support time 0 None 1 Under 30 minutes 2 30 minutes to less than 2 hours 3 2 hours to less than 4 hours 4 4 hours or more 3. Type of supports 0 None 1 Monitoring 2 Verbal/gestural prompting 3 Partial physical assistance 4 Full physical assistance Measuring Supports Intensity: per item:
45. Finally, a Supports Intensity Level is determined based on the Total Support Needs Index which is a standard score generated from scores on the 6 subscales of the Support Needs Scale
47. So: Every person should have the opportunity to participate in the given activity, if necessary with maximum support (in terms of Frequency, Daily Support Time, and Type of Support).
61. Personal Outcomes Scale A Scale to Assess an Individual’s Quality of Life Dr. Jos van Loon Prof.dr. Geert van Hove Prof.dr. Robert Schalock Lic. Claudia Claes 2008
62. 個人成果量表 (POS) 評估個人生活品質的量表 Dr. Jos van Loon Prof.dr. Geert van Hove Prof.dr. Robert Schalock Lic. Claudia Claes 2008
Elementen in de visie van Arduin, die is gebaseerd op de Rechten van de Mens, zijn onder andere de kritiek op instituutszorg door de jaren heen, veranderde opvattingen over de aard van een verstandelijke beperking en met name internationaal erkende en gevalideerde inzichten over kwaliteit van bestaan. Dit alles heeft geleid tot het inzicht dat we van denken in termen van zorg moesten switchen naar denken in termen van ondersteuning!
Elementen in de visie van Arduin, die is gebaseerd op de Rechten van de Mens, zijn onder andere de kritiek op instituutszorg door de jaren heen, veranderde opvattingen over de aard van een verstandelijke beperking en met name internationaal erkende en gevalideerde inzichten over kwaliteit van bestaan. Dit alles heeft geleid tot het inzicht dat we van denken in termen van zorg moesten switchen naar denken in termen van ondersteuning!
The constructs of personal competence and support needs are related, but are not the same thing. Five major influences on the support needs of people with intellectual disabilities are shown this Figure 1.1. One of these influences is level of personal competence. It is likely that the greater an individual’s level of personal competence, the less the intensity of support needs. Conversely, likely the lower a person’s level of personal competence, the greater the support needs. Four other major influences on the intensity of a person’s support needs are also shown in the figure: exceptional medical support needs (the greater the medical needs the greater the support needs) , exceptional behavior support needs (again, the greater the behavioral considerations, the greater the support needs); the number and complexity of the settings in which a person participates (the more complex, the greater the support needs – moving about a small town requires less support than moving around a large cit); and the number and complexity of the life activities in which an person participates (e.g., the more complex the job, the greater the need for support). Inferring a person’s pattern and intensity of support needs from traditional measures of personal competence is unlikely to result in specific and practically useful conclusions because IQ scores and adaptive behavior measures do not provide a complete measure of personal competence, nor do they account for the other four influences on support needs shown in this figure.
The constructs of personal competence and support needs are related, but are not the same thing. Five major influences on the support needs of people with intellectual disabilities are shown this Figure 1.1. One of these influences is level of personal competence. It is likely that the greater an individual’s level of personal competence, the less the intensity of support needs. Conversely, likely the lower a person’s level of personal competence, the greater the support needs. Four other major influences on the intensity of a person’s support needs are also shown in the figure: exceptional medical support needs (the greater the medical needs the greater the support needs) , exceptional behavior support needs (again, the greater the behavioral considerations, the greater the support needs); the number and complexity of the settings in which a person participates (the more complex, the greater the support needs – moving about a small town requires less support than moving around a large cit); and the number and complexity of the life activities in which an person participates (e.g., the more complex the job, the greater the need for support). Inferring a person’s pattern and intensity of support needs from traditional measures of personal competence is unlikely to result in specific and practically useful conclusions because IQ scores and adaptive behavior measures do not provide a complete measure of personal competence, nor do they account for the other four influences on support needs shown in this figure.
En eigenlijk is het ondersteuningsdenken heel simpel. Je laat mensen wonen in een huis waar zij zelf willen wonen en werken daar waar men wil werken, en je biedt vervolgens de ondersteuning die iemand nodig heeft. Op het moment dat iemand veel ondersteuning nodig heeft, dan biedt je veel ondersteuning. Indien een persoon weinig ondersteuning nodig heeft, dan biedt je weinig ondersteuning. Als iemand 24 uur per dag iemand in de buurt nodig heeft, dan is dat de ondersteuning. Als iemand 1 uur per week iemand nodig heeft, die langs komt voor zijn financiële papieren te regelen, dan wordt die ondersteuning geboden.
En eigenlijk is het ondersteuningsdenken heel simpel. Je laat mensen wonen in een huis waar zij zelf willen wonen en werken daar waar men wil werken, en je biedt vervolgens de ondersteuning die iemand nodig heeft. Op het moment dat iemand veel ondersteuning nodig heeft, dan biedt je veel ondersteuning. Indien een persoon weinig ondersteuning nodig heeft, dan biedt je weinig ondersteuning. Als iemand 24 uur per dag iemand in de buurt nodig heeft, dan is dat de ondersteuning. Als iemand 1 uur per week iemand nodig heeft, die langs komt voor zijn financiële papieren te regelen, dan wordt die ondersteuning geboden.