Self Sufficiency Matrix

Transcription

1 Self Sufficiency Matrix Marc Delsing Praktikon, Radboud University Nijmegen The Netherlands Ans Dekker YoukéYouthCare

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3 Introduction Self sufficiency is the realization of an acceptable level of functioning across a number of life domains (e.g., housing, social support, mental health), either by oneself or by adequately organizing care Self sufficiency matrix is tool with which practitioners, policy makers, and researchers in (public) health care, social services and related fields can easily and comprehensively asses clients level of self sufficiency To be used at different phases of support/care: intake, intermediate evaluations, post-treatment

4 Self Sufficiency Matrix (SSM-D) As of 2015, an increasing number of local governments throughout the Netherlands will expect (youth) care institutions to use the SSM-D for: Screening Formulation of treatment goals Monitoring and evaluating client progress

5 SSM (Dutch version) The Dutch version of the Self Sufficiency Matrix (SSM-D) distinguishes 5 levels of self sufficiency (columns) Acute problems, Not, Barely, Adequately, Completely The SSM-D assesses a persons level of self sufficiency on 11 domains (rows) Income, Day-time activities, Housing, Domestic relations, Mental health, Physical health, Addiction, Daily life skills, Social network, Community participation, Judiciary For each level of self sufficiency, domain-specific criteria are specified (cells)

6 SSM-D To be filled in by practitioner working with the client Sources of information Client Administrative sources: Communal registration, client account records, insurance data Colleagues

7 Development Pearce et al. (1996): Economic self sufficiency standard The Snohomish county self sufficiency taskforce (2004): First SSM based on ROMA outcomes standards Arizona and Utah (a.o.) (2006): State-specific adaptations of SSM Adaptations of the SSM vary in number of domains Number of levels of self sufficiency and formulation of domain-specific criteria remains consistent Public Health Service Amsterdam (2010): First Dutch adaptation of SSM (SSM-D) The SSM-D was developed with feedback and input from professionals, policymakers, and researchers from the field of public mental health care

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10 Parenting Domains

11 Previous Research FassaertT, LauriksS, van de WeerdS, de Wit M, Buster M (2013) Ontwikkelingen betrouwbaarheid van de Zelfredzaamheid-Matrix. Tijdschrift voor Gezondheidswetenschappen 91(3): Fassaert, T, Lauriks, S., van de Weerd, S., Theunissen, J., Kikkert, M., Dekker, J., Buster, M., & de Wit, M. (2013). Psychometric Properties of the Dutch Version of the Self-Sufficiency Matrix (SSM-D). Community Mental Health Journal. Study 1 (N = 81; Assertive Community Treatment (ACT) teams, average age 21,2 yrs.): Team-based comprehensive and flexible treatment/support for individuals with serious mental illness Study 2 (N = 107; Chronic psychiatric patients, average age 49,2 yrs.) PCA: 1 factor Reliability: alpha.85 and.87, respectively Correlations as expected with HoNOS(measures different aspects of mental health) and CANSAS (measures functioning on 22 life domains)

12 Limitations Previous Research Research scarce Small samples Do findings generalize to other (e.g., youth care) settings? Cross-sectional data (1 measurement time-point): Sensitivity to change? Given its rapidly increasing popularity: Research highly needed!

13 Research Questions Psychometric Properties SSM-D Factor structure Reliability Convergent validity Sensitivity to change Do T1 SSM-D results match expected problems of target group? To what extent do clients show improvement on self sufficiency domains?

14 Method: Respondents Supported accommodation N = 164 Improve skills aimed at self sufficiency 24-7; 6-12 months Individual coaching, group discussions, additional training (practical, social, institutions, financial) Residential care N = 143 Crisis intervention for homeless youth Improve skills aimed at self sufficiency; income & health insurance, arrange appropriate care by 3 rd party 24-7; max. 12 weeks Total N = 307 Age yrs. M = 168; F = 139

15 Method: Measures SSM-D Adult Self Report (ASR) Adaptive Functioning Scales:Friends; Spouse/Partner; Family; Job; Education, Personal Strengths Syndrome Scales:Anxious/Depressed; Withdrawn; Somatic Complaints; Thought Problems; Attention Problems; Aggressive Behavior; Rule-breaking Behavior, and Intrusive Youth Self Report (YSR) Syndromes Scales: Anxious/Depressed, Withdrawn/Depressed, Somatic Complaints, Social Problems, Thought Problems, Attention Problems, Rule-Breaking Behavior, Aggressive Behavior

16 CATPCA Component Loadings Income.677 Day-time act..764 Housing.651 Domestic rel..427 Mental health.533 Physical health.506 Addiction.665 Daily life skills.614 Social network.588 Community participation.789 Judiciary.553

17 Reliability Reliability Statistics Cronbach's Alpha N of Items

18 Convergent validity Significant correlations with ASR (N = 106) Income Thought problems -.21* Attention problems -.23* Rule-breaking behavior -.27** Day-time activities Job.30** Education.26* Rule-breaking behavior -.42** Housing Domestic relations

19 Convergent validity Significant correlations with ASR Mental health Friends 0.24* Personal strengths 0.19* Withdrawn -0.27** Aggressive behavior -0.21* Physical health Domestic relations 0.24* Somatic complaints -0.22* Aggressive behavior -0.23*

20 Convergent validity Significant correlations with ASR Addiction Job 0.23* Aggressive behavior -0.22* Rule-breaking behavior -0.43** Daily life skills Social network Domestic relations 0.29** Personal strengths 0.26** Withdrawn -0.26** Thought problems -0.21* Aggressive behavior -0.29**

21 Convergent validity Significant correlations with ASR Community participation Rule-breaking behavior -0.24* Judiciary Job 0.29** Rule-breaking behavior -0.31** SSM-D Total Personal strengths 0.24* Withdrawn -0.26** Thought problems -0.20* Aggressive behavior -0.25** Rule-breaking behavior -0.31** Intrusive behavior -0.21*

22 Convergent validity Similar pattern of associations with regard to YSR syndrome scales (N = 25)

23 Beginning of Treatment (%) 100% 90% 80% 70% 60% 50% 40% 30% 20% Completely self sufficient Adequately self sufficient Barely self sufficient Not self sufficient Acute problems 10% 0%

24 Beginning of Treatment (%): Residential Care (N=143) 100% 90% 80% 70% 60% 50% 40% 30% 20% Completely self sufficient Adequately self sufficient Barely self sufficient Not self sufficient Acute problems 10% 0%

25 100% Tracking Client Progress: SSM-D Scores at Beginning and End of Treatment 90% 80% 70% 60% 50% 40% 30% Completely self sufficient Adequately self sufficient Barely self sufficient Not self sufficient Acute problem 20% 10% 0%

26 Change: Number of clients improving, stable, and deteriorating ** n.s. n.s. ** ** ** ** * ** ** ** Improved: level 1, 2 3, 4, 5 Stable Deteriorated: level 3, 4, 5 1, 2 0 * p<.05; ** p<.01

27 Conclusions Psychometric properties 1 underlying dimension Reliable sum score Support for validity of domain scores Sensitive to change T1 SSM-D results match expected problems of target group Clients show improvement on most self sufficiency domains In sum: The SSM-D appears to be a promising instrument to evaluate individuals' functioning and progress on a broad range of relevant life domains

28 Future Directions Research with 2013-version Self-report version Adolescent (young adult) version: Focus on fulfillment of developmental tasks Inter-rater reliability Norms (total score) Theoretical foundation

29 Thank you! Marc Delsing Praktikon, Radboud University Nijmegen The Netherlands Ans Dekker YoukéYouth Care