Implementing SIS at clinical level Exploring the discrepancies between support needs and support provided Luigi Croce, Roberta Speziale, Marco Lombardi, Antonio Caserta Reaserch group on Quality of Life, Anffas Onlus roberta.s@anffas.net Gent, March, 22, 2018

The paradigm of support affects the concept of support need and substantiates the construct of support itself. Supports are sets of resources and strategies aimed to promote development, education, interests and well being of a person (Schalock, 2014). On the two premises: Is it possible to configure a set of supports as a system of measurable variables? Such a concept of support, as it is used in SIS, might be usefully implemented to define supports as a system of variables? SIS provides a personal profile of all the needs of support; is it possible to have a personal profile of the support provided to the same person at any time of the ISP development? We propose that the discrepancy between a specific need of support and the support provided at any time, might be a very powerful indicator to define new support objectives and strategies and a very precise process indicator of support provision development towards a better satisfaction to the same need of support.

How to develop a ISP with ecological and supports matrices? The person and his/her supports in the community: steps forward the ISP Administration SIS-A: SIS-A as it is completed on matrici electronic platform; Classification and validation of actual supports: we have implemented a new ecological variables in assessment. Actual supports are the supports wich are available for the person at the moment of the evaluation. One of the aims of support providing is implement and align new supports to those available at the moment of the first evalutation Ecological matrix: a map and a table by which it is possible to visualize all the relevant information relating to what is important to, what is important for, the description of the functioning of the person, the support needed and the actual QoL profile in just one paper. This process permits to track and modify every variable whenever a change is present and leads to an integrated definition of support objectives. The matrix is not completed if it is not considered as a crucial ecological variable, the actual support provided to the person.

4. Matrix of supports: at the end of the ecological matrix, the support objective are defined and declined in the specific QoL domains. The end of this process is composed by a report: a file called the Support Matrix or Support Plan where all the different support activities are defined in a QoL domain and related on the basis of the supposed Outcome that have to be reached. The result should be ‘‘an unambiguous, individualized plan that specifies (a) the settings for and activities in which a person is likely to engage during a typical week, and (b) the types and intensity of support that will be provided (and by whom)’’ (Thompson et al., 2004, p. 81). The plan then should be implemented by the different support providers, formal and informal, as a case manager/support coordinator, the direct support staff, the family members, the volunteers of the community.

The discrepancy beetwen supports need and supports provided The discrepancies between the support needs profile and the provided supports is a very strong indicator on the way to identify critical areas where to plan new supports, particularly if we integrate such information with personal desires/preferences and Qol profiles. The evolution of the discrepancies along time is also a good indicator to monitor the progress in support providing while the ISP is developed. In the meantime we have the “saturation index”, which means the percentage of support provided versus the need of support, that measures the efficacy of support delivery during ISP devolpment.

Conclusions: It is possible to profile supports needs It is possible to begin to profile support provided It is possible to qualify and quantify discrepancies It is possible to integrate discrepancies with QoL profiles and personal wishes and preferences in order to define specific support objectives and plan desired and appropriate supports It is possible to increase QoL and adaptive behavior with personal and contextual supports

Valutazione multidimensionale Desideri e aspettative Funzionamento (ICF) Diagnosi (ICD10 e DSM 5) Intensità dei sostegni necessari (SIS) Qualità della Vita (POS, San Martin, altri strumenti) Set di ulteriori strumenti (es. Barthel, ADI, ADL, etc)

Valutazione multidimensionale

Valutazione multidimensionale

Raccolta del contributo sanitario, educativo, abilitativo/riabilitativo, psico-sociale, assistenziale, contestuale

Descrizione e classificazione dei sostegni in atto nel tempo e loro confronto con i sostegni necessari

Descrizione e classificazione dei sostegni in atto nel tempo e loro confronto con i sostegni necessari

Descrizione e classificazione dei sostegni in atto nel tempo e loro confronto con i sostegni necessari

Classificazione e documentazione del lavoro di rete e community care

Definizione di obiettivi di sostegno (grazie alle lettura in una matrice ecologica, dei risultati dell’assessment e della valutazione multidimensionale)

progettazione, pianificazione, programmazione e coordinamento dei sostegni (stesura e monitoraggio del piano individualizzato dei sostegni)

realizzazione del bugdet analitico di progetto (o di vita, o di salute) e la sua gestione nel tempo

Individuazione dei livelli di efficienza ed efficacia dei sostegni pianificati ed erogati in relazione agli esiti

Stesura e stampa automatica di report (per esempio progetto individuale esteso e ridotto)