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Assessing levels of functioning

Functional assessments help identify the level of support, supervision and resources a person needs. They can be used to determine eligibility, care planning and assessing outcomes.

What functional assessment covers

Functional assessment practices consider differences in cognition, communication, sensory abilities (sight, hearing) and mobility.

Rather than simply asking people questions about their educational history or contact with disability-related support services, or whether they can perform a specific skill related to cognitive functioning, it's better to ask them to demonstrate a particular skill. In other words, you assess what a person 'does do', rather than what they 'can do'.

Functional assessment shifts the focus from the cause of disability or cognitive impairment to the impact of the condition. It's important to distinguish between capacity limitations that result directly from a person's health status and those limitations in which a person's participation is restricted due to environmental factors, including their physical environment and social circumstances (World Health Organization 2003).

The World Health Organization lists a number of activity and participation domains in its Checklist for International Classification of Functioning, Disability and Health (World Health Organization 2003) that should be considered in functional assessments.

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Functional assessment domains


DomainSkills

Learning and applying knowledge

Watching
Listening
Reading
Writing
Arithmetic
Solving problems

Communication

Receiving and producing spoken message
Receiving or producing non-verbal messages
Conversation

Domestic life and mobility

Shopping
Preparing meals
Self-care/hygiene
Housework
Using transport
Simple exercise (taking stairs, walking short distances)

Interpersonal interactions and relationships

Forming and maintaining intimate relationships
Forming and maintaining social relationships with family and friends
Relating to strangers

A person's functioning in the context of their environment also needs to be considered, including available supports such as family, health and support services, medication, and aids for communication and memory.

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Examples of functional assessment tools

The I-CAN (Instrument for Classification and Assessment of Support Needs) was developed to assess and classify the support needs of adults (16 years plus) with diverse disabilities in residential and respite settings, but its use has been expanded to mental health and rehabilitation programs. It emphasises support needs rather than deficits and considers health, wellbeing and activities of daily life. The assessment produces a written psychological report which can be used to inform, guide and improve the individual support plan. Where an intellectual disability has been identified, the tool takes approximately 70 minutes to administer, but applications in mental health settings show a shorter length of time, and Version 5 (currently under development) will include a brief version which is being trialled at 30 minutes. Training in the I-CAN is required, and is available through the Centre for Disability Studies, University of Sydney (www.i-can.org.au).The cost to an organisation is $550 sign-up fee plus $22 per assessment.

The Scales of Independent Behaviour - Revised (SIB-R) is a comprehensive, norm-referenced assessment of adaptive and maladaptive behaviour designed to establish the type and amount of special assistance needed by people with cognitive disabilities. The short form acts as a brief screening tool and can be administered in 15-20 minutes, and an Individual Plan Recommendation provides a plan for and tracks an individual's support and service needs and goals. The tool, including the manual, interview handbook and 25 forms, can be purchased from ACER for $559 (www.shop.acer.edu.au).

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Find out more

NADA (Network of Alcohol and Drug Agencies) (2013b) Brief Guide to Cognitive Impairment Screening and Assessment Tools, NADA: Sydney.

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