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3月社區居住工作坊講義(中英文)
 

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

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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  • 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.

3月社區居住工作坊講義(中英文) 3月社區居住工作坊講義(中英文) Presentation Transcript

  • Person centered supports Methodologically Enhancing Quality of Life of People with Intellectual Disabilities Jos van Loon, Stichting Arduin en Vakgroep Orthopedagogiek, Gent Februari 2011
  • 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
  • Developments in vision
    • Human rights! (…U.N.Convention).
    • Changing definitions and opinions on what is an intellectual disability (AAIDD…).
    • Quality of Life: inclusion, selfdetermination, empowerment
    • Supports-paradigm from care to supports
    • Outcome-based ánd Evidence-based thinking
  • 願景的發展
    • 人權 ! (… 世界人權宣言 ).
    • 對智能障礙定義與看法的改變 (AAIDD…).
    • 生活品質 : 融合、自我決策、賦權
    • 支持 - 典範 從照顧轉移到支持
    • 以成果與證據為基礎的思考
  • Demands of the Environment Personal Competence GAP
  • 環境的需求 個人的能力 差距
  • Demands of the Environment Individualized Supports Closes the GAP Personal Competence
  • 環境的需求 個別化支持 彌合 差距 個人的能力
  • Personal Competence Types of life activities Types of Settings Behavioral support needs Medical support needs PATTERN & INTENSITY OF SUPPORT NEEDS
  • 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
  • The Supports Model is actually very simple:
    • People live where they want to live and work where they want to work, and one offers the support that the person needs.
    • If someone needs a lot of support, that is what he gets.
    • If someone needs little support, then little support is what he gets.
    • If someone needs 24 hours support a day, that is what he gets.
    • If someone needs 1 hour support per week, to help arranging finances, that is what he gets.
  • 支持模式其實非常簡單 :
    • 讓人們住他想住的地方 , 做想做的工作 , 並給所需的支持
    • 有些人 需要 很 多支持的 , 就 得到大量的支持
    • 支持 需求 不多的人 , 就提供少量的支持
    • 如果某人 需要一天 24 小時支持的人 , 那就是 他 得到的 支持
    • 如果某人 一星期 需要 一小時 協助管理財務 , 就給他一小時的支持
  • What do you need to know if you want to support a person in a good way?
    • … ..
    • …… ..
    • …… ..
    • …… ..
    • …… .
    • …… ..
  • 如果你想要以好的方式來支持一個人,你需要知道些什麼 ?
    • … ..
    • …… ..
    • …… ..
    • …… ..
    • …… .
    • …… ..
  • Ánd…What should be the outcome of the support you offer a person?
    • … ..
    • … ..
    • …… .
    • …… .
    • ……
  • 然後…你提供支持的成果應該是什麼 ?
    • … ..
    • … ..
    • …… .
    • …… .
    • ……
  • Quality of Life (Schalock, 2007):
      • a multidimensional concept
      • influenced by personal and environmental factors and the interactions between them
      • evaluating on the base of subjective and objective indicators
      • the quality of life for people with handicaps/ disabilities involves the same factors and relations that are important to everyone,
      • quality of life is enhanced by enabling people to participate in decisions that concern their own existence,
      • accepting people in their own local community and integrating them totally enhances quality of life.
  • 生活品質 (Schalock, 2007):
      • 是多 層 面向的概念
      • 受個人與環境因素 , 以及兩者之間互動的影響
      • 可從客觀與主觀指標來評量
      • 障礙者的生活品質要素與關聯性對 所有的 人而言是同樣重要的
      • 生活品質可藉由讓個人參與所關注的決定而提升
      • 接納並完全的統合於所屬的社區則 可提升 生活品質
  • Dimensions of Quality of Life (Schalock & Verdugo, 2002):
    • Emotional well-being
    • Interpersonal relations
    • Material well-being
    • Personal development
    • Physical well-being
    • Self-determination
    • Social inclusion
    • Rights
  • 生活品質面向 (Schalock & Verdugo, 2002):
    • 情緒福祉
    • 人際關係
    • 物質福祉
    • 個人發展
    • 生理 福祉
    • 自我決策
    • 社會融合
    • 權利
  • Three factors in Quality of Life (Schalock, 2007)
    • Independence
      • Personal Development
      • Self-determination
    • Social Participation
      • Interpersonal Relations
      • Social Inclusion
      • Rights
    • Well-being
      • Emotional Well-being
      • Fysical Well-being
      • Material Well-being
  • 生活品質三要素 (Schalock, 2007)
    • 獨立
      • 個人發展
      • 自我決策
    • 社會參與
      • 人際關係
      • 社會融合
      • 權利
    • 福祉
      • 情緒福祉
      • 生理福祉
      • 物質福祉
  • 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
  • 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
  • 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.
  • 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 .
  • 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
  • 以 個人為中心的支持系統 輸入 過程 輸出
    • 個人的目標與觀點 ,
    • 個人所需的支持 , 及
    • 特定 階段的生活品質
    個別化支持計畫 , 是 以期待與目標為基礎 , 以生活品質領域來提供支持 , 並要相符
    • 生活品質 .
    • 因此 以 生活品質作為個人 支持 成果的 衡量 .
    • 個人成果量表
    微視層級 : 由右到左的思考
  • What do we mean with an ISP / Individual Support Plan?
    • The ISP is composed of Instructions (and if possible goals for learning) regarding the desirable and needed support of the client.
    • These instructions are written to give the client a quality of life that is as good as possible. Therefore the instructions are written within the framework of the eight domains of QOL: per domain of QOL it is considered which instructions are needed for this domain.
    • The instructions have to give an answer to the desired life experiences and goals of the person, ánd to which supports he / she needs. Therefore the personal assistant writes the ISP as an answer to the desired life experiences and goals of the person ánd as an answer to the items of the Supports Intensity Scale on which the person needs support. Per domain are the desired life experiences and goals reflected as well as the items of the SIS, which are connected to this domain.
  • ISP / 個別化支持計畫是什麼 ?
    • ISP 是有關顧客想望與所需支持的教學撰寫 ( 可能的話是學習的目標 ) .
    • 這些指導說明是為了盡可能提供顧客良好的生活品質 . 因此是以生活品質領域為架構來書寫 : 依每個生活品質領域來思考各領域所需提供的指導 .
    • 這些指導說明應該要回應個人想望的生活經驗 , 與他 / 她所需的支持 . 因此 , 個人助理所書寫的 ISP 要回應個人想望的生活經驗與目標 , 並回應個人在支持強度量表 (SIS) 題項所需的支持 . 每個領域反映出個人期待的生活經驗與目標 , 且跟這領域所對應的 SIS 題項相連結 .
  • The ISP
    • Eight domains,
    • and within each domain
    • the corresponding desired life experiences and goals ánd
    • the support needs
    • are the framework for an ISP.
  • ISP
    • 八大領域 ,
    • 然後在每個領域
    • 有相對應想望的生活經驗與目標 , 及
    • 支持需求
    • 這是 ISP 的架構 .
  • Input
    • Which wishes (dreams) and personal aspirations does the person have?
    • Then measuring the type and intensity of the support-needs is necessary to come to this better QOL
    • This can be done with the Supports Intensity Scale.
    • This scale is intended to map as objectively as possible the intensity of the supports as needed by the person with an ID.
  • 輸入
    • 個人有哪些希望 ( 夢想 ) 與個人抱負 ?
    • 然後衡量為了有較好的生活品質所需的必要支持型態與強度
    • 可運用支持強度量表 (SIS) .
    • 這份量表是希望盡可能客觀地描繪出智能障礙者所需的支持強度 .
  • The perspectives, wishes and goals the person has in his / her life.
    • Establishing wishes, dreams, personal aspirations, goals by an ongoing dialogue with the client and his or her family, or other people who know the person well.
    • With as guide for this dialogue
      • The nine support areas as mentioned in the Supports Intensity Scale (Home living, Community living, Lifelong learning, Employment, Health and safety, Social activities, Protection and Advocacy Activities, Exceptional Medical Needs and Exceptional Behavioral Support Needs)
      • This dialogue is methodologically operationalised in a semi-structured interview
  • 個人生活的觀點、希望與目標 .
    • 透過跟顧客、他 / 她的家人或是其他熟識的人之間的持續對話 , 建立想望、夢想、個人抱負與目標 .
    • 這對話的指引
      • 支持強度量表的九個支持領域 ( 居家生活、社區生活、終身學習、就業、健康與安全、社交、保護與倡議、特殊醫療與行為支持需求 )
      • 這對話的操作方法是透過半結構性訪談
  • Determining the support needs
    • Determine the Support Intensities with the Supports Intensity Scale (SIS), regarding the nine support areas:
    • Home living, Community living, Lifelong learning, Employment, Health and safety, Social activities, Protection and Advocacy Activities, Exceptional Medical Needs and Exceptional Behavioral Support Needs
    • An interview with the client and his / her family and the personal assistant
  • 決定支持需求
    • 用支持強度量表 (SIS) 來決定下列九個領域的支持強度 :
    • 居家生活、社區生活、終身學習、就業、健康與安全、社交、保護與倡議、特殊醫療與行為支持需求
    • 訪談顧客、他 / 她家人以及個人助理
  • The Supports Intensity Scale (Thompson et al.,2004) : Important starting points:
    • All people are fundamentally equal to each other .
    • Every person should always be understood in
    • connection with he context in which he / she lives.
    • Supports have to make sure that people with disabilities get and hold access to the social, political and economic resources of the society.
    • Every person needs to get the opportunity to participate in the given activity, if necessary with maximum support (in terms of type of support, the daily support time, and frequency).
    • The SIS is meant to use in combination with a individualized person-centered support plan and is intended to create a better connection between the support plan and the needs and choices of people with an intellectual disability.
  • 支持強度量表 (Thompson et al.,2004) : 開始的重要關鍵點 :
    • 根本上每個人都是平等的 .
    • 應當理解每個人的生活環境脈絡 .
    • 支持應當是要確保每位障礙者有管道並取得所需的社會、政治與經濟資源 .
    • 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來看 ).
    • SIS 需要與個別化的以個人為中心的支持計畫一起合併使用 , 且在智能障礙者的支持計畫與其所需與選擇間創造更佳的連結 .
  • The SIS is composed of three sections
    • Section 1, the Support Needs Scale, consists of 49 life
    • activities that are grouped into six subscales
    • Home living
    • Community living
    • Lifelong learning
    • Employment
    • Health and safety
    • Social activities
    • Section 2, consists of 8 items related to
    • Protection and Advocacy Activities
    • Section 3, Exceptional Medical and Behavioral Support Needs,
    • includes 15 medical conditions and 13 problem behaviors that
    • require increased levels of support
  • SIS 包含三大部分
    • 第一大部分 , 支持需求量表 , 包含 49 項生活活動 , 分成六個分量表
    • 居家生活
    • 社區生活
    • 終身學習
    • 就業
    • 健康與安全
    • 社交活動
    • 第二大部分 , 包含 8 題跟保護與
    • 倡議有關的活動
    • 第三大部分 , 特殊醫療與特殊行為支持需求 ,
    • 包含 15 項特殊醫療狀況與 13 種問題行為
    • 需要增加支持需求層級
  • 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:
  • 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 :
  • 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
  • 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 .
  • 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).
  • 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 ).
  • Throughput: ISP : Basis: The QOL Domains and corresponding support areas of the SIS
    • Domains QOL:
    • Emotional wellbeing
    • Interpersonal relations
    • Material wellbeing
    • Personal development
    • Fysical well-being
    • Self-determination
    • Sociale inclusion
    • Rights
    • Support Areas SIS:
    • Exceptional Behavioral Support Needs
    • Social activities
    • Employment
    • Lifelong Learning, home living
    • Health and safety, exceptionals medical support needs
    • Protection and Advocacy: item 1,5,7
    • Community Living,
    • Protection and Advocacy, items 2,3,4,6,8
  • 過程 : ISP : 依據基礎 : 生活品質領域與對應的 SIS 支持領域
    • 生活品質的領域 :
    • 情緒福祉
    • 人際關係
    • 物質福祉
    • 個人發展
    • 生理福祉
    • 自我決策
    • 社會融合
    • 權利
    • SIS 的支持領域 :
    • 特殊行為支持需求
    • 社交活動
    • 就業活動
    • 終身學習、居家生活
    • 健康與安全、特殊醫療支持需求
    • 保護與倡議 : 題項 1,5,7
    • 社區生活
    • 保護與倡議 , 題項 2,3,4,6,8
  • The ISP consists of Instructions (and, if possible, goals on learning) regarding the wanted and needed supports of the person
    • The instructions should give an answer to the wishes and goals of the person, ánd to the supports he needs. The personal assistant writes the ISP as an answer to the wishes and goals the person mentions and as an answer to the items on the SIS on which the person needs support.
    • Per domain the wishes and goals ánd the corresponding items of the SIS are shown.
  • ISP 是有關顧客想望與所需支持的教學撰寫 ( 可能的話是學習的目標 )
    • 這些指導說明應該要回應個人想望的生活經驗 , 與他所需的支持 . 因此 , 個人助理所書寫的 ISP 要回應個人的想望與目標 , 並回應個人在支持強度量表 (SIS) 題項所需的支持 .
    • 每個領域需反映出個人的想望與目標 , 以及所對應的 SIS 題項 .
  • Goals on Learning
    • Because Personal development is one of the important domains of QOL,we find it important that the personal assistent together with the client, and with them the psychologist, think about goals on learning in het ISP. Especially in view of a future perspective.
  • 學習的目標
    • 因為個人發展是生活品質的重要領域之一 , 我們發現個人助理與顧客還有心理師一起思考有關 ISP 的學習目標是很重要的 . 特別是從未來的觀點 .
  • Person Description
    • The ISP is written as a checklist on the base of the domains of QOL, wishes and goals and support needs. Because it is important that one doesn’t loose touch with the person as a whole, there is also in the Personal Plan a description of the person. A good description should make clear who the person is as a person.
  • 個人描述
    • ISP 是以生活品質領域為撰寫的基礎 , 作為想望、目標與支持需求的檢核清單 . 因為是全人的觀點 , 所以在個人計畫也有個人描述的部分 . 好的個人描述應當清楚描繪出這個人 , 且是一個全人 .
  • Output
    • Support should result in a good QOL, not in the first place in less support needs!
    • A good system of supports should therefore be evaluated by measuring QOL of the persons who get supports. worden
  • 輸出
    • 支持應該導致有良好的生活品質 , 而非先看到支持需求的減少 !
    • 因此 , 一個良好的支持系統應可用衡量個人的生活品質來做評估 .
  • QUALITY OF LIFE MEASUREMENT FRAMEWORK
    • Focus on Personal Outcomes
      • Referenced to Core QOL Domains and Indicators
      • Measured on Basis of Self-Report and Direct Observation of Indicator Items
    • Emphasis on Stakeholder Involvement
      • Indicator Item Selection (Focus Groups, Etic Items)
      • Survey Administration (Consumer-Based)
      • User Friendly Assessment Strategies
    • Quantification of Self-Report and Direct Observation Items
      • Each Indicator Item is Assessed on the Basis of Self-Report and Direct Observation
      • Likert (3-point) Ratings are Used for Both Self-Report and Direct Observation Assessments
  • 生活品質的衡量架構
    • 聚焦在個人成果
      • 參照生活品質領域及指標
      • 以自我報告和直接觀察作為衡量指標項目的基礎
    • 強調利害關係人的參與
      • 指標項目的選擇 ( 焦點團體 , 客位題項 Etic Items)
      • 調查的執行 ( 以顧客為基礎 )
      • 使用者方便的評估策略
    • 自我報告與直接觀察項目的量化
      • 每個指標項目都是以自我報告及直接觀察為評估基礎
      • 皆使用萊特的三分評量法
  • 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
  • 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
  • Ten steps in the Scale’s development
    • The initial item pool was derived from previous research and published literature regarding domain-specific indicator items such as those shown herefore.
    • From the beginning our intent was to develop parallel forms of a scale that would allow for the measurement of both subjective and objective indicators. Our intent was operationalized in the Personal Outcomes Scale in the form of a Self Report and a Direct Observation version. For comparability purposes, the content of each item should be (and eventually was) the same for Self Report and Direct Observation .
    • Expert judges in the field evaluated each item in reference to four criteria; (a) reflect what people want in their lives (‘importance’); (b) relate to current an future policy issues (‘relevance’); (c) those that the service/supports provider has some control over (‘feasibility’); and (d) can be used for reporting and quality improvement purposes.
  • 發展量表的十步驟
    • 最初的題項是 先 從已發表的研究與文獻中列出 明確 與領域相關的指標項目 .
    • 我們一開始即想要發展同時包含客觀與主觀指標的評量表 . 透過了個人成果量表 (POS), 這目的得以操作 . 為了比較 , 自我報告與直接觀察的每個題項內容都應當相同 .
    • 這領域的專家從四個標準來評估每個題項 (a) 反映出個人想要的生活 (‘ 重要性’ ); (b) 與現在及未來的政策議題有關 (‘ 相關性’ ); (c) 服務 / 支持提供者有些掌控的 (‘ 可行性’ ); 及 (d) 可用來做報告與品質改善 (‘ 目的性’ ).
    • Focus groups composed of important stakeholders (e.g. professionals, organization personnel, consumers, persons with different diagnoses, and families) evaluated each potential item/indicator in reference to its value and importance to them.
    • A 3-point Likert scale format was developed for the respondent to evaluate each item on two subscales: a Self Report Scale and Direct Observation Scale.
    • A pilot version of the Scale was developed and administered to a representative sample of about 90 clients of the population(s) for whom the Scale will be used.
    • Pilot study data were analyzed to confirm the reliability, core QOL domain loading, robustness, and etic property of the respective item. Items were selected that met the criteria listed in steps 2 and 3.
    • A second pilot version of the Scale was developed and administered to a representative sample of 79 clients of the population(s) for whom the Scale will be used.
    • Pilot study data were analyzed to confirm the reliability, core QOL domain loading, and robustness of the respective item. Final items were selected that met the criteria listed in steps 2 and 3.
    • The assessment instrument was finalized, including administration and scoring instructions.
    • 焦點團體包含了重要的利害關係人 ( 如專家學者 , 組織人員 , 消費者 , 不同診斷的障礙者 , 及家人 ) 來評估可能題項 / 指標的價值與對他們的重要性 .
    • 運用萊特的三分評量法來評估每個題項受訪者的回應 : 包含了自我報告量表與直接觀察量表 .
    • 發展實驗性量表 , 針對未來將使用這份量表的 90 位代表性樣本進行測試 .
    • 收集實驗前測研究的資料並進行分析 , 以實證信度 、 核心生活品質領域的份量 、 健全性 、 每個題項的客位特質 , 選出符合步驟二與三標準的題項 .
    • 再發展第二版的實驗性量表 , 針對未來將使用這份量表的 79 位代表性樣本進行測試 .
    • 再次收集實驗量表的資料並進行分析 , 以實證信度 、 核心生活品質領域的份量 、 健全性 、 每個題項的客位特質 , 依符合步驟二與三的標準選出最終版題項 .
    • 確認最後的 評估工具 , 包含施測與計分指引 .
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  • 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
  •  
  • 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
  •  
  • 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
  •  
  • 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
  • More about the Personal Outcomes Scale: incl. Manual with data on reliability and validity www.poswebsite.org
  • 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
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  • Example of a POS Profile for an organisation
  • 以一個組織為例其個人成果量表側面圖
  • Example of a POS Profile for a location
  • 以一個地點為例其個人成果量表側面圖
  • Example of a POS Profile for a client
  • 以一個顧客為例其個人成果量表側面圖
  • What do you need to be capable of if you want to give good support to a person with ID?
    • ..............
    • ..........
    • ...........
    • .........
    • ........
  • 如果你想為智能障礙者提供好的支持 , 你需要什麼能力 ?
    • ..............
    • ..........
    • ...........
    • .........
    • ........
  • Thank you very much for your attention! [email_address]
  • 非常感謝您的聆聽 ! [email_address]