An Introduction to the Inter RAI IDD Assessment

An Introduction to the Inter. RAI I/DD Assessment System Mary L James inter. RAI Fellow Associate Research Scientist University of Michigan Alaska Governor’s Council on Disabilities & Special Education July 13, 2016 ©inter. RAI 2014– Do not duplicate or distribute 1 www. interrai. org

Agenda • • inter. RAI and the inter. RAI “Suite” Uses of inter. RAI data Frequently Asked Questions Discussion ©inter. RAI 2014– Do not duplicate or distribute 2 www. interrai. org

What is inter. RAI? • Research collaborative: 87 members/35 nations • Non-profit corporation • Key interests • Science (e. g. , cross-national comparisons, outcomes research) • Instrument development • Support implementation in other nations • Holds copyright to inter. RAI assessment instruments • Grants royalty-free licenses to governments/care providers in exchange for data • Licenses software vendors around the world ©inter. RAI 2014– Do not duplicate or distribute 3 www. interrai. org

inter. RAI Members and Activities Europe North America Canada, USA, Mexico, Belize Iceland, Norway, Sweden, Denmark, Finland, Netherlands, Germany, UK, Switzerland, France, Poland, Italy, Spain, Belgium, Estonia, Lithuania, Czech Republic, Russia, Austria, Portugal, Ireland Middle East/Asia Israel, India, Qatar, Lebanon, Egypt Africa South Africa, Ghana (WHO) South America Chile, Brazil, Peru Far East/Pacific Rim Japan, South Korea, Taiwan, Australia, China, Hong Kong, New Zealand, Singapore ©inter. RAI 2014– Do not duplicate or distribute www. interrai. org

inter. RAI “Suite” • • • Wellness Community Health Home Care Assisted Living LTC Facility Post-acute Care Palliative Care Pediatric ID, MH ©inter. RAI 2014– Do not duplicate or distribute • Acute Care • Inpatient Mental Health • Forensic supplement • Correctional Facilities • Community Mental Health • Developmental/Intellectual Disabilities • Self-Report Quality of Life www. interrai. org

Brant E. Fries and Mary L. James US States Using inter. RAI Instruments April 2016 Statewide: –HC/CHA – MDS-HC –MH –CMH –SQo. L –I/DD –Children ID/DD –Children MH –Children HC Open symbol for Regional/Managed Care, shaded for planned ©inter. RAI 2015 – Do not duplicate or distribute without permission www. interrai. org

Instead of …. .

Design of Data Collection Form • “Domains” • Each domain has specific “items” • “Items” ARE NOT “questions” • Items identify specific information to be gathered • Interview with person only one possible information source • • Direct observations Staff Family/friends Records ©inter. RAI 2014– Do not duplicate or distribute 9 www. interrai. org

Four “Super-Domains” Social Life/ Inclusion Cognition/ Behavior Community/ Communication/ Social Involvement Vision (G) (C) Cognition (H) Strengths/ Relationships/ Supports (D) Mood/ Behavior (L) ©inter. RAI 2014– Do not duplicate or distribute Everyday Living Lifestyle (E) Clinical Health Conditions (I) Environment (F) Independence in Oral/ Nutritional Everyday Activities Status (K) (J) Services and Supports (N) Medications (M) www. interrai. org

Item Construction Each item has four components: Intent: Why information is sought Definition: What exactly is to be recorded Process: How to collect information – strategy/approaches Coding: How to record ©inter. RAI 2014– Do not duplicate or distribute 11 www. interrai. org

Brant E. Fries & Mary L. James I/DD AC ©inter. RAI 2014 – Do not duplicate or distribute without permission www. interrai. org

inter. RAI HC and inter. RAI I/DD HC 128 Core Items 121 Items ID 123 Items 69 Other Shared Items 441 Items Total

inter. RAI CMH and inter. RAI I/DD 108 Core Items ID CMH 117 Items 169 Items 106 Other Shared Items 500 Items Total

Applications of inter. RAI Data ©inter. RAI 2014– Do not duplicate or distribute 15 www. interrai. org

Applications of inter. RAI Data Care Planning Policy Case-Mix ASSESSMENT Screening ©inter. RAI 2014– Do not duplicate or distribute Quality 16 www. interrai. org

What people want Person prefers change 100 90 80 70 60 50 40 30 20 10 0 Living arrangements Paid employment Recreational activities All Religious activities Community Daily routine Relationships Institution Note: Approximately 60% of the sample responded (70% in community and Supports and services

Scales Embedded in DD Instrument • • • ADL Hierarchy Aggressive Behavior Cognitive Performance Communication Depression IADL Capacity IADL Performance Pain Social Withdrawal ©inter. RAI 2014– Do not duplicate or distribute 18 www. interrai. org

Functioning: Cognition Cognitive Performance Scale 25 20 15 10 5 0 0 1 All 2 Community 3 Institution 4 5 6

Functioning: Self-care skills Activities of Daily Living Hierarchy 25 20 15 10 5 0 0 1 All 2 Community 3 Institution 4 5 6

ID CAPs • • Social Relationships Meaningful Activities Communication Continence Injurious Behavior Mental Illness Abuse ©inter. RAI 2014– Do not duplicate or distribute 21 www. interrai. org

Sample Clinical Assessment Protocols (CAPs) Manual ©inter. RAI 2014– Do not duplicate or distribute 22 www. interrai. org

Collaborative Action Plan Triggers Source: Arkansas statewide profile, 2013 • Average 3 CAPs triggered • 4% triggered 0 CAPs • 11% triggered 1 CAP • 85% triggered 2+ CAPs • 0% triggered all 7 CAPs 70% Community Institution 60% 50% 40% 30% 20% 10% 0% Abuse Communication Continence Injurious Behaviour Meaningful Activities Mental Illness Social Relationships

Frequently Asked Questions • Where is……. . ? • It’s a MINIMUM data set • Software can enable notes • Additional items can be added • Why aren’t there more items about …. ? • Don’t need to “load” everything onto single item, ask many questions about particular issue • Ex: “bathing” excludes hair washing but “upper body dressing” stands in to indicate likely need for assistance with hair • What are you supposed to do if………? • Separate assessor skills from the data collection form • What is your agency’s current standard practice? ©inter. RAI 2014– Do not duplicate or distribute 24 www. interrai. org

What DD Tool Does Not Do ØHarm the relationship between the provider agency, the person, and his/her support network ØDictate what must be addressed ØDictate how needs should be addressed ØNegate the importance of individual choice ©inter. RAI 2014– Do not duplicate or distribute 25 www. interrai. org

What inter. RAI DD Does • Helps guide planning process • Highlights potential areas of need • Highlights strengths – person and network • Helps with planning supports and services: • Individual items inform on what supports and services may be needed • Scales inform on: • The person’s current status • The rate of change in status over time (person or group) • Outcomes of supports or interventions ©inter. RAI 2014– Do not duplicate or distribute 26 www. interrai. org