Predicting support needs for people with psychiatric and intellectual disabilities.

Over the last 30 years there has been a paradigmatic shift in the field of disabilities towards assessing individual support needs in relation to social and environmental context rather than individual deficits. The capacity of existing assessment instruments to assess support needs is limited because most were designed to assess individual deficits and thereby determine eligibility for funding and/or services. Some instruments have been designed to assess support needs but there are several problems associated with these instruments including, suitability for use in only one disability type, susceptibility to rater bias, and failure to account for variations in support needs over time. This thesis attempted to contribute to addressing these deficiencies by examining the characteristics that are most predictive of support needs for people with psychiatric and intellectual disabilities and the methods by which changes in such support needs could be predicted. Two studies were used to address these aims. The first considered samples of people with primary psychiatric disabilities (N= 561) and intellectual disabilities (N =168), who lived in Supported Residential Facilities. These participants were assessed in regards not only to standard demographic and disability characteristics, and also personal characteristics, including functional abilities, and support needs. The data were analysed using ordinal logistic regression to determine which better predicted support needs and, accordingly, which characteristics were most important to include in the assessment of support needs. Analysis showed that personal characteristics, such as functional abilities such as showering/bathing and budgeting explained much more variance in support needs than either demographics or disability characteristics. This suggests that, for support needs assessments to be accurately assessed, they should include evaluations of these personal characteristics even though they may require more time and resources to obtain than demographic and disability data. The second study in this thesis aimed to investigate whether caregivers could predict changes in support needs over six-month periods accurately. Residents in supported accommodation with a primary psychiatric disability (N = 60; although some attrition among those with psychiatric disabilities), or primary intellectual disability (N = 57) and their caregivers were involved in this study. Caregivers were interviewed on three occasions at six-monthly intervals and asked to estimate any changes that they expected to occur in the next six months or that they believed had occurred in the preceding six months. Caregivers were also asked to complete two functional assessments for each resident at the three points in time. The functional assessments were used as the benchmark against which the accuracy of caregivers’ estimates was examined. Analysis found that caregivers were unable to predict accurately prospective changes in overall or specific support needs, nor were they able to report accurately such changes retrospectively. The results of this thesis contribute to the body of knowledge in the relatively new area of support needs assessment in terms of possible predictors of support needs and the assessment of changes in support needs. Recommendations for further research include; investigating some of the personal characteristics found to be predictors of support needs in greater detail and among other disability types, replication of these findings in other samples, and investigating ways to improve caregivers’ capacity to predict changes in support needs accurately.Thesis (Ph.D.) -- University of Adelaide, School of Psychology, 200