Organizational Structure and reviewing Process
The Knowledge Library is an application filled with knowledge on support strategies and interventions that is searchable via different routes. As such this creates an interesting way to knowledge on demand.
In writing an Individual Support Plan or ISP the goals (as anticipated effects), Quality of Life domains ( in which area we want to work) and the components of supports ( which components of supports are for this individual preferable) can serve as entrance for an wealth of knowledge, which in our view keeps on expanding.
Important for the Knowledge Library is that it is built within a well-defined model for the use of support strategies, methods and interventions, in which values, general factors as pedagogical climate and the relation between client and professional, methodical considerations, environmental conditions, and evidence are important criteria. This means that support strategies that are incorporated in the library should not only meet demands regarding content, and be evidence-based, but also be applicable within the demands of the Model for use in the Knowledge Library. We first describe the Model for the use of support strategies, methods and interventions.
In our view (Van Loon, Bonham, Peterson, Schalock, Claes & Decramer, 2012; van Loon, 2015) a support methodology has four phases: an input-, throughput-, output- and outcome phase. For the input phase, an evidence-based tool to measure the support needs, the Supports Intensity Scale (SIS, Thompson et al., 2004), is used. For the measurement of outcomes also an evidence-based tool is used, the Personal Outcomes Scale (POS, van Loon et al. 2008). However, the question what evidence-based interventions can best be deployed in the throughput phase, what works and what works less or not, deserves more attention.
Considerations regarding a model for use in the Knowledge Library
For the use of support strategies, methods and interventions
Enhancing Quality of Life (QOL), supporting people, working with methods and interventions takes place within a framework. The vision from where we work, the values that we adhere to, the pedagogical climate, the attitude, conditions, environmental factors: these are all factors within which the concrete support is provided, within which methods are used.
The UN Convention and the QOL domains.
The Articles of the UN Convention on the Rights of People with Disabilities (CRPD) and the QOL domains set the values for this framework, within which interventions and methods should take place. Themes such as human dignity, participation / inclusion and accessibility of society, equality and equal opportunities, autonomy and self-determination, empowerment and physical, emotional and material well-being are here important. Verdugo, Navas, Gomez and Schalock (2012) found a close relationship between the QOL domains and the Convention Articles; these Articles thus can be evaluated assessing indicators associated with the eight QOL domains.
What are effective factors?
There is also the question of the effectiveness of interventions in general. What we find in literature is that instead of specific forms of therapy, more general factors seem to have a stronger influence (Yperen, van der Steege, Addink and Boendermaker, 2010; Lambert and Ogles, 2004) . Well-known examples of these factors are:
- Fit the motivation of the client;
- Good quality of the relationship client-therapist;
- proper structuring of the intervention (clear objective, planning and phasing);
- a good ‘fit’ of the approach to the problem and the demand for assistance;
- implementation of the intervention as it should be performed;
- professionalism (good education and training) of the practitioner;
- good working conditions of the treatment (as bearable caseload, good support, rescuer safety).
As van Yperen et al. (2010) state, there is also increasing evidence in the literature that routine monitoring of the effectiveness of the treatment during the execution leads to better results.
Jongepier, Struijk & van der Helm (2010) speak, according to Kok (who speaks of the importance of a good first line strategy) about the importance of an open pedagogical climate.
Methodical considerations .
There are also methodical considerations that are important in developing a framework for interventions. Here one can think of following the methodical cycle, person-centeredness, and following the program-logic model . Lombardi, Croce, Claes Vandevelde & Schalock (2016) argue that the emphasis should be on providing support that is tailored to the specific domain of quality of life, and on the basis of the support needs of the individual person. The support process should be person centered and based on personal needs and goals.
Also environmental circumstances are important in enhancing Quality of Life. Schalock (2017) in this regard speaks of the importance of focusing on creating environments instead of focusing on services, as main task of an organization. A study by Claes, Van Hove, Vandevelde, van Loon & Schalock (2012 shows that environmental factors (living independently, a regular job or having volunteer job) were related to a higher QOL. Also Lombardi et al. (2016) found that it is clear that people who live in smaller residential settings and participate in community activities, such as a regular job and / or a volunteer job, have a better quality of life.
Evidence-based supports and interventions
The specific (therapeutic) interventions and methodologies which are used in the context of a support plan, must be evidence-based.
Alignment with QOL
Schalock (2017) gives an overview of the various components of a system of supports. Schalock (2015) also aligns Quality of Life Domains to Potential Support Strategies and Anticipated Effects. We combined this across the eight QOL domains to come to an overview which can be of help in deciding which support strategies potentially can be used in developing individual support plans. In Table 1 we give an example for two domains. Of course the support strategies mentioned in Table 1 are exemplary. It will be necessary to elaborate on these.
|Table 1. Interventions aligned tot the QOL domains|
|QOL domain||Related Components of a system of supports||Exemplary Support Strategies||Anticipated Effects|
Access/interface with natural supports
Ensuring physical accessibility of buildings, transport, and work spaces; creating secure and predictable environments; and providing physical and other accommodations that allow individuals to negotiate their environment and carry out daily tasks
Use of social media
Use prosthetics (sensory or motor devices)
-Increased community access, participation, and involvement
Enhanced personal development, community living, integrated employment
Increased social inclusion, interpersonal relations, social-emotional well-being
Make sure that people who need support have the chance to be fully involved in their lives and receive the right range and level of support to be
Dignity and respect
Building and maintaining support networks
Provide safe and predictable environments
Access professional services
Maximize incentives (e.g. rewards, opportunities to be successful)
Use positive behavioral supports
Enhancing social role status through community involvement, equal opportunity, recognition, appreciation, financial security, honors, personal goal setting, empowerment, and control of an individual supports plan.
-Reduce fear and anxiety
-Increase motivation and satisfaction
-Reduce challenging behaviors and increase positive interactions
-Maximize mental/ behavioral health
Increased motivation and achievement
Safety, security, engagement, being unconditionally valued
A model for evidence-based supports and interventions in a support methodology
If we take the above considerations together, the following model for evidence-based supports and interventions in a support methodology can be sketched.
- The values, based on the UN Convention and the QOL domains, and
- evidence based general factors regarding the efficacy of interventions set the framework, within which interventions and methods should take place.
- In this framework there are also methodological and substantive conditions for which interventions and methods to use.
- Then there are (evidence-based) environmental conditions
- There are specific interventions which should comply with the criterion to be called evidence-based: a firm relation should be demonstrated between the
specific interventions and measured outcomes.
- There should be an alignment to QOL and a system of supports.
Using the Knowledge Library
The knowledge library is in the first place meant for staff who are responsible for the development of an ISP. If they are in dialogue with the person, and use the SIS (Thompson et al. 2004), they know what the person wants in his / her life, what his / her goals in life are, and they know about the support needs of the person. And if they use an outcome measurement like the POS (van Loon et al. 2008) they know about the person’s quality of life. But what support to give to enhance the QOL of the person? The application we are developing permits the user to search for support strategies within QOL domains, within the components of the system of supports, and aligned to the anticipated effects (goals to and for the person). An important feature here is the framing of these support strategies in the model for evidence-based supports and interventions in a support methodology we outlined above, which makes this library more than a mere overview of methods and interventions.
The system interface offers the user to search the library on a search phrase, anticipated effect, system of support, and QOL domain by filtering. This means that every search result can be refined using these 4 parameters.
The explanatory notes shown by the search results offer the ability to determine the usability of the support strategy, by recognizing the stated values as important to the individual and the environmental conditions that need to be in place.