3月社區居住工作坊講義(中英文)
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2011年3月23-25日社區居住工作坊,邀請Arduin執行長Jos van Loon主講
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3月社區居住工作坊講義(中英文)
- 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
- 2. 以個人為中心的支持 提升智能障礙者生活品質的方法論 Jos van Loon, Stichting Arduin en Vakgroep Orthopedagogiek, Gent Februari 2011
- 5. Demands of the Environment Personal Competence GAP
- 7. Demands of the Environment Individualized Supports Closes the GAP Personal Competence
- 8. 環境的需求 個別化支持 彌合 差距 個人的能力
- 9. Personal Competence Types of life activities Types of Settings Behavioral support needs Medical support needs PATTERN & INTENSITY OF SUPPORT NEEDS
- 10. 個人能力 日常活動 的種類 設施環境 的種類 行為支持需求 醫療 支持需求 支持需求型態與強度 從衡量個人能力來推論支持需求可能是錯誤的
- 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
- 24. 生活品質要素 生活品質領域 生活品質指標範例 獨立 個人發展 自我決策 教育狀態 , 個人技能 , 適應行為 (ADLs IADLs) 選擇 / 決定 , 自治 , 個人掌控 , 個人目標 社會參與 人際關係 社會融合 權利 社交網絡 , 友誼 , 社交活動 , 互動 , 關係 社區 統合 / 參與 , 社區角色 , 支持 人道 ( 尊重 , 尊嚴 , 平等 ) 法律 ( 法律支持 , 正當程序 ) 福祉 情緒福祉 生理 福祉 物質福祉 安全 & 保障 , 正向經驗 , 滿足 , 自我概念 , 免於壓力 健康狀態 營養狀態 娛樂 / 體力消耗 經濟狀態 , 就業情況 , 居住狀態 , 擁有物
- 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.
- 26. 自我決策的作法 支持顧客的重要原則是 : “ ( 在個人助理的支持下 ) 每個人對他 / 她的生活都可以做重要的決定 “ 居住的選擇 : 住宅局 工作的選擇 : 職缺銀行 個人發展的作法 從經驗中學習 : 參與在社區中 生活品質學院 : 著重在解放與自我決策 融合的作法 : 為所有的顧客在社區中提供一般的房舍 , 而非群聚在一起 ! 為兒童提供寄養家庭 工作的公司行號或是日間活動中心是在社區的中央 支持的做法 : 人們住在他們想住的地方 , 做想做的工作 , 並獲得所需的支持 .
- 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
- 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:
- 44. 0 不需要或一個月不到一次 1 一個月至少一次 2 一星期至少一次 3 一天至少一次 4 每個小時或更頻繁 1. 頻率 2. 每日支持時間 0 不需要 1 低於 30 分鐘 2 30 分鐘至 2 小時之間 3 2 小時到 4 小時之間 4 4 小時以上 3. 支持型態 0 不需要 1 監督陪同 2 口頭 / 手勢的提示 3 部分肢體協助 4 完全肢體協助 衡量支持強度 : 每個題項 :
- 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
- 46. 最後 , 是依據支持需求指數來決定支持強度層級 , 這指數是從支持強度量表第一大部分的六個分量表所獲得的標準分數產生的聚集 .
- 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).
- 48. 所以 : 每個人應有機會參與所提供的活動 , 如果有需要應提供最大的支持 ( 從支持的型態、每日支持時間量與頻率 ).
- 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
- 68. 自我報告 1. 你可以自己 進食 、起床、使用廁所與穿衣嗎？ 一般都可獨立完成 需要一些協助 自己無法做到 2. 你可以自己準備餐食、持家隨意行走與服藥 嗎？ 一般都可獨立完成 需要一些協助 自己無法做到 3. 你 有在學習一些技能是能讓你可以做多些事 情 ，或是遵循課程 / 上某些教 育課程 嗎？ 很多 一些 如果有，很少 4. 你有機會可以表現你的技能 嗎？ 常常 有時 從來沒有 5. 你有管道獲得你有興趣的資訊嗎 : 例如報紙、雜誌 / 刊物、網路、圖書館 ？ 相當多 有些 偶爾或從來 沒有 6. 你有 使用電腦、手機或是計算機嗎 ？ 常常 有時 偶爾或從來沒有
- 70. 自我報告 1. 有提供你選擇嗎 ( 例如穿什麼、吃什麼、去哪裡 ) ？ 常常 有時 偶爾或從來沒有 2. 如果提供你選擇，你有做選擇嗎？ 常常 有時 偶爾或從來沒有 3. 你可以決定不做某些要求你的事情嗎？ 常常 有時 偶爾或從來沒有 4. 人們有認真看待你的決定嗎？ 常常 有時 從來沒有 5. 對你自己的錢，你至少有些掌控？ 相當多的掌控 有些掌控 沒有掌控 6. 你有機會表達你的意見例如比較喜歡做什麼、穿什麼、去哪、吃什麼嗎？ 常常 有時 偶爾或從來沒有
- 72. 直接觀察 1. 覺得個人可以遵循每日生活活動、自己吃喝進食、起床、使用廁所與穿衣嗎 ？ 一都可以獨立 需要一些協助 無法自己做到 2. 你覺得個人可以遵循操作例行生活活動 : 準備餐食、持家、隨意行走與服藥嗎 ？ 一都可以獨立 需要一些協助 無法自己做到 3. 你 覺得在過去 6~12 個月，個人所學的技能或是教育的經驗如何 ？ 很多 一些 如果有，很少 4. 個人有機會可以表現他 / 她的技能 嗎？ 常常 有時 偶爾或 從來沒有 5. 個人有管道獲得他 / 她有興趣的資訊嗎 ( 例如報紙、雜誌 / 刊物、網路、圖書館 ) ？ 相當多 有些 偶爾或從來沒有 6. 個人有使用支持輔具嗎 ？ 常常 有時 偶爾或從來沒有
- 74. 直接觀察 1. 個人對自己穿什麼、吃什麼、去哪裡等能有所掌控嗎 ？ 相當多 有時 很少或沒有 2. 當提供選擇時，個人可以落實選擇嗎 ？ 常常 有時 偶爾或從來沒有 3. 個人可以決定對他 / 她重要的事—或甚至可能是他人不希望的事嗎 ？ 相當多 有時 偶爾或從來沒有 4. 個人所下的決定有被尊重 嗎 ( 無論什麼決定 ) ？ 非常地被尊重與遵循 有些被尊重 沒被尊重 5. 對自己至少一定比例的錢，個人有掌控權嗎 ？ 相當多 的掌控 有些 掌控 沒有掌控 6. 個人有機會表達他 / 她的想望嗎 ？ 常常 有時 偶爾或從來沒有
- 75. More about the Personal Outcomes Scale: incl. Manual with data on reliability and validity www.poswebsite.org
- 76. 更多有關個人成果量表 (POS) 的資訊 : 包含信效度數據的手冊 請上網查詢 www.poswebsite.org
- 79. Example of a POS Profile for an organisation
- 81. Example of a POS Profile for a location
- 83. Example of a POS Profile for a client
- 87. Thank you very much for your attention! [email_address]
Notas do Editor
- 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.