Introduction

The Independent Skills Assessment Scale is designed to assess the independent living skills of adolescents and adults in 11 major skill areas. It is not specific to any disability or age group and, when completed, will provide a comprehensive profile of an individual's skills and identify areas in which further training is indicated. The Scale is particularly useful for

a) Evaluating whether an individual is a candidate for living conditions where 24-hour assistance is not available (e.g. semi-independent living services),

b) Identifying what specific services the individual may need to ensure remaining in a less restrictive community setting, and

c) Measuring changes in an individual's performance over time.

History of the Scale

Versions of the Independent Skills Assessment Scale have been used by many agencies throughout the United States since Walter A. Baldus developed the original in 1976. Thousands of individuals receiving services from these agencies in a variety of communities and settings have regularly been assessed using previous versions of this instrument. Technology, theory and design in service delivery have changed dramatically over the years, and the 2002 revision reflects those changes as we interpret them.

Two additional, specialized inventories are included in this scale:

The Community Integration Profile consists of a number of items intended to assess the extent to which the individual has already established important support systems in the community. It was designed to sensitize service providers, and those making decisions about services, to the fact that an individual's ability to be successful in semi-independent or independent living is not simply the sum of the skills the individual brings to the situation. The higher the percentage on the Community Integration Scale, the better the individual is integrated into the community.

The Community Support Profile focuses on the community's potential to support that individual in independent or semi-independent living. It is generally understood that fewer services from a professional service provider or family may be needed when the community has substantial, generic services available. The strength and quality of the support system in the community cannot, however, be measured effectively, unless measured for a specific individual, with a very unique repertoire of strengths and needs. The higher the percentage score on the Community Support Scale, the better the community is at offering services relevant to supporting an individual in an independent or semi-independent status.

Administration

Assessment should be done using a combination of direct observation and interview. If the person doing the assessment cannot directly observe a situation, efforts should be made to contrive a close approximation to the situation or, at least, interview one or more persons who may have observed the behavior in the past. The author recommends a team of persons actively involved with the individual being assessed carry out the assessment.

There are four major scoring categories in the main body of the Scale. These four categories follow the usual hierarchy of prompts recognized by trainers and educators and permit the scorer to identify the specific type of assistance typically needed when the individual is determined not to be independent in the skill. Guidelines for scoring categories are as follows:

Independent: Mark the box designated “Independent" only if the individual would generally initiate and exhibit the behavior without monitoring or assistance of any kind. If performance of the skill is sufficiently inconsistent to interfere with the production of that skill, then the item should not be scored as independent.

Assistance Needed: The item should be scored in this category when the individual is not capable of performing the skill independently and cannot appropriately be scored as either “Functionally Incapable" or "Not Applicable" as described below. Whenever the Assistance Needed category is scored, the scorer should indicate the level of assistance that most often represents the kind of assistance needed for the individual to perform the skill.

Verbal Prompt (V): The individual requires verbal instructions or cueing to successfully perform the task.

Gestural Prompt (G): The individual requires gestures or pointing to indicate direction, location, or action to be taken in responding. This is generally paired with a verbal prompt.

Physical Assistance (P): The individual requires a tap, touch, or actual physical guidance in order to complete the skill. This is generally paired with a verbal prompt:

Refusal (R): The individual resists all attempts made to elicit the response or is capable of performing the behavior but refuses to perform a significant percentage of the time. The team will need to decide whether the rate of refusal because of motivation, depression or behavioral problems is sufficient enough to be problematic. (e.g. A 20% refusal rate may not be significant if the issue is making one's bed, but a 10% refusal rate could be a very significant issue if the skill being assessed was “Cooperating with prescribed medical recommendations").

Functionally Incapable (Fl) This category should be scored if the individual is unable to respond or perform for such reasons as physical disability, severe emotional disturbance, or extremely low cognitive ability, and only for reason s which are permanent in nature. The Functionally Incapable category identifies those areas where future training is not expected to result in acquisition of the skill, and those skills that relate to services that, because of the individual's inability to respond or perform adequately, must be provided by either a professional or family caregiver. Such areas must be identified in this category, rather than N/A, in order to avoid skewing the percentages when determining independence levels in the various categories.

Not Applicable (N/A): When the individual would have absolutely no use for the skill being assessed, the choice of "Not Applicable" should be used. An example of when N/A might be appropriate might be; ~Cleans and maintains personal corrective devices~, when the individual does not require eyeglasses, hearing aids, or any other personal corrective device. The N/A items are separated from the item totals for each category when determining independence levels.

Discretionary Boxes and Lines: There is a discretionary box on each line, to the far right of the page. No specific use is assigned, but the possibilities for use include: identify current goals and objectives; targeting immediate need areas; or noting behaviors that have not been directly observed. If the box is used, it is the responsibility of the rater to code or label the top of each page for the specific use and then clearly define the code somewhere on the assessment

An extra line has been provided at the end of each section. It is to be used at the discretion of the assessment team to add specific skills for individuals, not covered adequately by those listed

Use of Comment Space

There is a comment space provided to the right of each item. This space is provided to note specific problems, percentages, or qualifying statements that relate to the specific item. The comment section following each section is to be used for remarks relating to problems or barriers related either to an individual skill or the corresponding set of skills.

Scoring

The purpose of the Scale is to determine a gross measure of independence for both individual skill areas and for overall independence in the represented skills. These scores are intended to be used to compare previous results using the same scale on the same individual. To determine the level of independence on individual sections or for the entire scale, tally the number of items marked as independent in the section, and divide that amount by the total number of items minus the number of items marked "Non Applicable" .

EXAMPLE:

# of items scored "Independent

--------------------------------------------------------------------------- = % Independence

Total # of items -minus- # of items scored “Not Applicable”

The percentages for the other responses may be done in the same manner, substituting whichever category you wish to determine for the number of items scored "Independent" in the equation.

We caution you not to equate any two items or any two sections of the scale. If experience has taught us anything over the years, it is that development of any one of the skills represented can result in an increase in independence, personal control, and certainly self-esteem for the individual. It is in the Coping Skills and Behavior section however, where we find the components that will likely predict success in living independently in the community. Unlike any of the other subsets, a failure to acquire any one of the represented skills in that section could seriously jeopardize the individual's safety, or the safety of others. We recommend that each assessment team look more closely at that section than any other in the Scale.

Acknowledgments the authors would like to thank the many staff of the Woodvale agencies without whose assistance the construction of this instrument would not have been possible. We also thank Mike Maas Ph.D. who contributed to the content of the scale.

Other Assessments Available

• The “Assessment of Personal Strengths and Needs" is a simpler, shorter alternative to the ISAS that profiles the physical, sensory, and communicative abilities, coping skills, as well as performance skills in various areas for individuals who are more severely challenged. It is especially useful as a pre-screening device during the referral or intake process.

• For further assessment of socio/sexuality skills it is recommended that you supplement this assessment with the "Sexuality Assessment". It contains 100 items that specifically address a wide range of sexuality issues, including body awareness and hygiene, relationships, social responsibility, victimization, and sexual activity. It is coordinated with a training package that uses charts, visual devices and other materials that can be used with staff and individuals in your programs.

• Several conditions common to individuals with developmental disabilities and other physical disabilities can interfere with nutrition and general health and well-being. The "Assessment of Nutritional Needs" is designed to help the caregiver determine nutritional needs and adaptations, and plan for appropriate assistance.

• “Assessment of Clinical Nursing Care Needs”

A critical need for agencies providing services to individuals with special need is the determination of the levels of nursing services necessary to insure adequate care and observation is being provided. The scale assists in determining the level of Clinical Nursing Services necessary and suggests a number of Clinical Nursing hours (RN or LPN) that will need to be provided to individual consumers. This will prove especially useful in working with individuals, guardians, case managers and administrative staff in determining the financial commitments necessary.

For further information on these assessments, purchasing information, or training in administering individual assessments call or write:

Janet Baldus

Bald Eagle Assessments Fax 507-437 2074

111 11th Ave. N. E.

Austin, MN 55912 Telephone inquiries: 507-437 2074