For discussion on

Size: px

Start display at page:

Download "For discussion on"

耐悬毛
7 years ago
Views:

1 For discussion on 14 June 2004 Paper No. CB(2)2695/03-04(03) LEGCO PANEL ON WELFARE SERVICES Progress Report on the Standardized Needs Assessment Tool for Admission to Residential Homes for People with Disabilities PURPOSE A discussion paper on the standardized needs assessment tool for admission to residential homes for people with disabilities by Social Welfare Department (SWD) was submitted to Members for the meeting on 5 January This paper updates Members on the latest position on the development of the tool and the application details. BACKGROUND 2. In view of the growing demand for residential places albeit a significant increase in provision in the past ten years, SWD set up a multi-disciplinary Steering Group on Admission Procedures for Residential Care Homes for People with Disabilities (the Steering Group) in 2001 to steer a review on admission criteria and process of residential homes for persons with disabilities (PWDs). Upon the insights gained from a survey in 2002, the Steering Group formed a Task Group comprising parents and various professionals to devise a standardized assessment tool to identify those PWDs with genuine need for residential service and match them with appropriate types of residential homes. 3. The Assessment Tool covers the following four domains: (a) Nursing Care. A range of nursing activities commonly performed - 1 -

2 in existing hostels/homes for PWDs, including skin care, feeding, drug administration, bowel control, epilepsy, oxygen treatment, suction and bedridden care are included. (b) (c) (d) Functional Impairment. The domain measures a PWD s ability to manage the activities in daily living and how much assistance he/she requires from others. The assessment items include bathing, dressing, body transfer, toileting, eating and drinking. Challenging Behaviour. The aim of this domain is to identify PWDs with challenging behaviour and match their needs with suitable types of residential service. Assessment is based on major typical challenging behaviours including aggression toward others, self-harm, destruction of property and inappropriate behaviours. Family Coping. This domain assesses the main carers coping capacity, the PWDs relationship with their families and their risk of abuse and neglect by others. Factors for consideration include carer s age and health condition, emotional and psychiatric status, whether the carer has to look after other disabled family members, etc. 4. The four domains will determine the needs of PWDs under assessment. The needs so identified will then be considered against the supportive network of family and community resources available to the PWDs. The guiding principle is that family support, community service and day training should first be considered and mobilized to provide support to PWDs and their families before residential services are considered. 5. In addition to determining the needs of individuals receiving assessment, the Assessment Tool also provides indication as to how a PWD s needs could be matched with appropriate types of residential services

3 LATEST POSITION Implication on Applicants 6. Various consultations were made with the Steering Group and parents associations on the application of the Assessment Tool to the waiting list applicants and existing service users of residential homes. It was generally agreed that all PWDs applying for residential care, including those already on the waiting list, must be assessed by this Assessment Tool to confirm their residential care needs and appropriate type of matching residential care services before their admission to the Homes. To take into consideration the PWDs on the waiting list and receiving residential care before implementation of the Assessment Tool, the following arrangements were also generally agreed. (a) (b) (c) New applicants. New applicants assessed to have no residential care need can consider day training programmes or community support services. When there is significant change in their family situations or care required, they can apply for re-assessment to confirm their residential care need. Applicants already on the waiting list upon implementation of the Tool. Applicants on the waiting list assessed to have no residential care need should leave the waiting list and the social workers concerned will formulate care plans with them and their families in which day training programmes or community support services may be considered. However, their names will be put on a separate list, and in case future re-assessment upon significant change of their respective circumstances confirms their residential care need, they can return to the waiting list retaining their original application date. Residents of the subvented residential homes. Residents of the subvented residential homes are not required to undergo the assessment by the Assessment Tool. In case a resident s residential care need has changed due to improvement or deterioration of functioning, he/she will then undergo an assessment by the Tool to determine on the change of types of residential care service

4 Case Review 7. The Assessment Tool is a comprehensive assessment comprising different care needs and social aspects of the PWD concerned. As the care needs and support systems of the PWDs may change over time, social workers/parents can call for a review anytime when necessary such as significant change in demand for nursing or personal care; increase or decrease in challenging behaviour or uncontrollable behaviour; significant change in family circumstances etc. Checklists would be developed for the reference of social workers and parents on identification of changes calling for review. Appeal Mechanism 8. PWDs or their family members may file an appeal against the assessment results to a central registry set up in SWD either directly or through their social workers. A pre-appeal mediation team comprising social worker, physiotherapist, occupational therapist, and registered nurse from SWD would look into the case, explore any factors that may have affected the assessment and discuss with relevant parties with a view to resolving the disagreement. The case would be brought up to the Appeal Board if the disagreement could not be resolved. 9. The Appeal Board will consist of one member from SWD, one member from the welfare sector, one from the health sector and one from other stakeholders such as parents. It will recommend a most suitable service plan for the PWDs concerned. Pilot Study 10. To establish the applicability, reliability and validity of the Assessment Tool, a two-phase pilot study was introduced. Phase One Pilot Study 11. The phase one pilot study was conducted from October 2003 to March The aim of phase one was to collect empirical data for the purpose of improving the practicality and utility of the draft Assessment Tool, to test the administration process and to enhance the user-friendliness of the draft Assessor Manual. 13 assessors were recruited from family service centres, medical social service units, special schools and - 4 -

5 rehabilitation units to conduct assessment sessions for 39 cases. Information on the assessment process was collected through the assessors feedback questionnaires, third-party on-site observation and phone interview reports. 12. The findings from this phase one study indicated that the Tool, with its content, structure and procedures, could on the whole be conducted smoothly by registered social workers. On average one assessment session was normally completed within 60 minutes. Most assessors found it easy to apply the Tool. However, clarification and liaison with other concerned parties such as school, other social workers, nurses was sometimes necessary in order to gather information which the informants themselves could not provide or to verify information. Almost all assessors in the pilot study indicated that the content of the Tool was comprehensible and the Assessor Manual was useful. Most assessors indicated that the scorings systems were user friendly save the section on nursing care need and functional impairment which needed to be modified to make it more consistent with that of other sections. All assessors found the half-day training session provided to them in the pilot study useful in assisting them to apply the Tool but extension to a one-day training was suggested to give more time for practice and case discussion. In sum, result from this phase one pilot study supported the use of the draft Assessment Tool, Assessor Manual and administration procedures as a provisional blueprint for further development. 13. The draft Assessment Tool and the Assessor Manual are enclosed at Annex I and Annex II (both in Chinese) respectively. Phase Two Pilot Study 14. The phase two pilot study commenced from April till July The purpose of the phase two pilot study was to collect reliability and validity data on the draft Assessment Tool. 40 assessors were recruited to work in pairs to conduct 160 assessments to test the inter-rater reliability. Feedbacks from the PWDs and their families were also collected after the assessment sessions to explore their views on the participation process. Analyses of data collected from 40 assessors indicated that the overall inter-rater reliability of the Assessment Tool was very satisfactory. Feedbacks from the PWDs and their families suggested that they found it easy to understand the content of the Assessment Tool and could participate in the assessment process comfortably

6 15. For the validity data, a multi-disciplinary professional group comprising social workers, clinical psychologist, psychiatrist, medical officer, registered nurse and occupational therapist, blind to the draft Assessment Tool, was formed to examine in depth ten cases selected from the 160 assessments mentioned above and make recommendation on their residential needs and the types of appropriate placements basing on the background information of the case instead of the details of the assessment conducted by the assessors. The recommendation of the professional group was to be compared against the assessment result from the Assessment Tool to improve the Tool s validity. This part of the pilot study would complete in July Implementation 16. Based on the outcome of phase two pilot study, the Assessment Tool would be further refined for implementation. To prepare for the implementation of the Tool, tentatively in January 2005, training sessions for social workers on the conduction of assessments using the Assessment Tool and briefing sessions on the operation procedures of the Assessment Tool to other stakeholders including social workers, rehabilitation service units, parents, etc. to strengthen their understanding about the new assessment and referral procedures would be organized. Consultation 17. SWD will further consult the Steering Group, the Rehabilitation Advisory Committee (RAC), the parents associations and other stakeholders before implementation of the Assessment Tool. FINANCIAL IMPLICATION 18. The implementation of the Assessment Tool would not bear any additional cost on existing rehabilitation service. Rather, due to rationalization of applicants service need and re-prioritization of community support, day training and residential services in service matching, it is expected that only those with genuine need for residential service would remain on the waiting list and the waiting time would be reduced. Also, the percentage of applicants declining residential services will drop and public resources would be more effectively utilized. On the other hand, the cost for development of Assessment Tool and the Assessor Manual, the provision of staff - 6 -

7 training and the information technology support would be absorbed by SWD and no additional resource would be required. ADVICE SOUGHT 19. Members are invited to note and comment on the progress of the development of the proposed Assessment Tool. Social Welfare Department June

8 附件 I Annex I I. 1. ( ) ( ) 2. () () () ( ) L/M( ) in RP 3/3/220/( ) 5. 埗 6. II

9 / DRAFT III ii i ii iii - 2 -

10 / DRAFT IV. iv A A1. A2. A A A A3. A2.1 A2.3 A2 A1 A3 B B1. B2. B * B * B3. B3.1 B3.2 B2.1 B2.2 B2 B * B * * B3 B1 B3 iv (a)(b) (c) (d) - 3 -

11 / DRAFT V. A B B C C C D 1 2. / 0 1 D. 0 1 E. A1, B1, C1 D 1 E 0 1 A1, B1, C1 D A2, B2, B3 C2 * * 0 E * - 4 -

12 / DRAFT VI. A. 1. (a) (b) (c) (a) 60 (b) (c) (d) (e) (f) (g) (h) B C

13 / DRAFT VII. A. 1. III 2. 0 B1 1 * * B. 1. IV C1 1 * 1 * C. 1. V D1 1 * 1 * D. 1. VI * 1 * * - 6 -

14 / DRAFT E. 1. A D (HMMH) (HSMH) (HSPH) (C&A/SD)

15 附件 II I Annex II

16 A % % B nursing care need functional impairment challenging behaviour family coping C. 4. (a) needs risk factors (b) service streaming (c) SWA (d) - 2 -

17 D. 5. E V VI

18 F. 14. I II

19 E [self-financing hostel] [supported hostel SHOS] 23. 况 * * * - 5 -

20 G. I II III. (a) (b) VII

21 Digoxin

23 , 4-9 -

25 IV (a) (b) (c) (d) 3. A A B A A 0 3 B

26 A B A A A 3 B 4 6 A B 3 6 A B

27 A A2. /

28 A B

29 B2. B B2.2 / /, cut 0 枱

30 B3. B3.1 B3.2 B3.1 + / + + // + / B3.2 刹

31 V. * a b 1. A1 A2 B1 B2 B3 C1 C2 D D A1B1C1 D A2B2B3 C2 2. A2 B2 C2 D VI. C E A1B1C1 D A2B2B3 C2 E * Borthwick-Duffy, S. A. (1994). Prevalence of destructive behaviors. In T. Thompson & D. B. Gray (Eds.), Destructive behavior in developmental disabilities: Diagnosis and treatment (pp. 3-23). Thousand Oaks, CA: Sage

32 VI. A B

33 C

34 VII A D 1 2. A D 2 3. A D 3 4. A D E1 A D 5. E2 6. E3 E3 E1 E2 E1 A D A D

35 (C&A/SD) (HMMH) (HSPH) (HSMH)

36 (C&A/SD) (HSPH)

38 / / / / /

國立中山大學學位論文典藏.PDF

國立中山大學學位論文典藏.PDF I II III The Study of Factors to the Failure or Success of Applying to Holding International Sport Games Abstract For years, holding international sport games has been Taiwan s goal and we are on the way