Examples of individual supported living for adults with intellectual disability.

BACKGROUND: This article provides a qualitative account of four models of support for adults with intellectual disability in individual supported living (ISL) arrangements. MATERIALS AND METHODS: Completion of the first 50 evaluations of 150 arrangements for the third phase of the ISL project provided the examples. RESULTS: Four approaches are described: living alone, co-residency, relationship and host family. Within each type, wide variations occur particularly based on security of tenure, formal and informal support and management variations. CONCLUSION: Fifty evaluations so far illustrated a wide range of approaches to ISL, providing evidence of the critical importance of the formal and informal support environment and reinforcing the contention that ISL is appropriate for people with high support needs.

Development of a fidelity measure for community integration programmes for people with acquired brain injury.

OBJECTIVE: The paper describes development of the Assessment of Community Integration Programme Attributes (ACIPA) measure based on a descriptive community integration framework. The purpose of this measure is to allow evaluation of community integration programmes for adults with acquired brain injury (ABI). METHODS: The Community Integration Framework (CIF) was used to design a fidelity evaluation measure through consultation with 37 participants from five stakeholder groups (practitioners, researchers, policy-makers, people with ABI and family members of people with ABI) using semi-structured interviews, focus groups, iterative surveys and a multi-attribute utility (MAU) method. RESULTS: The resultant measure included seven themes and 21 attributes. Each attribute included indicators and probing questions. Weights were assigned to each theme and constituent attributes. CONCLUSION: Programme evaluation commonly focuses on outcomes, often overlooking analysis of programme processes. Although it requires further psychometric (reliability and validity) development, the Assessment of Community Integration Programme Attributes may be used to assess the relationship between programme processes and specific outcomes and also to inform the development of programmes aiming to enhance community integration for adults with ABI.

Exploring the experiences of people with the dual diagnosis of acquired brain injury and mental illness.

PRIMARY OBJECTIVE: People with the dual diagnosis of acquired brain injury and mental illness (ABI/MI) are vulnerable to a range of negative life experiences, which has received limited attention in the literature. The objective of the project described in this paper was to identify and describe these experiences in order to distinguish barriers and facilitators to successful rehabilitation and recovery. RESEARCH DESIGN: The project used qualitative methodologies. METHODS AND PROCEDURES: The 15 participants were eight people with ABI/MI, two family members and five support workers. Nineteen interviews were conducted. Analysis of these interviews produced a set of five key themes, with each theme elaborated by a set of descriptive issues. MAIN OUTCOMES AND RESULTS: The five themes were loss, personal development, occupation, family and services. The experiences of people with ABI/MI were strongly negative. They faced more barriers than facilitators to recovery. Current policies and practices were inadequate. CONCLUSIONS: Enhanced stakeholder collaboration and co-ordination and a more individualized, long-term perspective on the needs of people with ABI/MI are recommended to guide future policy and practice. Future research on quality-of-life, wellbeing, community inclusion and participation in ordinary life was recommended.

Framework for describing community integration for people with acquired brain injury.

BACKGROUND/AIM: Community integration is the ultimate goal of rehabilitation of adults with acquired brain injury which has a high incidence in the Australian population. The literature shows a need for a more comprehensive framework for community integration. This study developed a descriptive community integration framework drawn from views of five stakeholder groups and was compared with four similar frameworks. METHODS: Thirty-seven experts in acquired brain injury, including practitioners, researchers, policy makers, people with acquired brain injury and family members participated. Using a Delphi method, an iterative process of surveys, interviews, and focus groups sought their views on community integration. Responses were analysed in three stages systematically to reduce a large quantity of raw data into a core set of descriptive themes. A final member checking process rated participants' agreement with the importance of each theme. RESULTS: Seven themes were identified and described: Relationships, Community Access, Acceptance, Occupation, Being at Home, Picking up Life Again, and Heightened Risks and Vulnerability. Themes were congruent with elements of the frameworks from the literature. CONCLUSIONS: Rich data came from the diverse stakeholders in the participant groups. Two unique themes reflected the importance of re-integration and recovering important aspects of previous lives, and identifying risks and vulnerabilities and providing safeguards. The framework reflected emphases that may be specific to acquired brain injury. It can be used as a basis for development of community integration programmes and outcome measures.

Evaluation of an employment program for people with mental illness using the Supported Employment Fidelity Scale.

BACKGROUND: The Individual Placement and Support (IPS) model aims to achieve open employment for people with mental illness. The Supported Employment Fidelity Scale (SEFS) is a 15-item instrument that evaluates the extent to which a service follows the IPS principles of best practice. This paper describes the IPS model and an evaluation of a specialist employment program for people with mental illness using the SEFS. METHODS: The SEFS enabled a quantitative assessment of service provision against the criteria of evidence-based practice principles. Data were collected from multiple sources. In addition, a literature review was conducted, and personnel engaged in implementation of the IPS model at other Australian employment programs were consulted. RESULTS: The program achieved a score of 59 of a possible 75 on the SEFS, which is described as fair supported employment. DISCUSSION: Analysis of the 15-scale items resulted in the identification of strengths, areas for further development, and a set of recommendations. CONCLUSIONS: The program was operating substantially in line with evidence-based practice principles and had considerable scope for further development. Issues arising from the evaluation, areas of applicability of the SEFS and the underlying literature, and implications for occupational therapy are highlighted.