SPECIAL APPLICATIONS
Independent Living
Chapter 8
TIMBERS ASSESSMENT OF CONCEPTS OF INDEPENDENT LIVING
Harold D. Converse and Janet B. Thompson
TABLE OF CONTENTS
I. | Abstract |
II. | Introduction |
III. | The Development of the Tacil |
IV. | Test Standardization |
V. | Methodology |
VI. | Results of the Reliability Study |
VII. | Discussion |
I. ABSTRACT
The Timbers Assessment of Concepts of Independent Living (TACIL) is a self-assessment of the concepts of independence of adults with physical or neurological disabilities. Responding to positive statements, individuals rate their awareness, organization, or management abilities relating to seven domains of adult community living. Studies have found the TACIL to be a valid self-rating with reliable correspondence between self-rating and staff rating. Not seen as a prediction, the TACIL rates the individualās ability to manage those tasks he or she is unable to perform.
II. INTRODUCTION
TACIL was developed out of a need to identify the capability of individuals with severe physical or neurological disabilities to live independently. The Timbers is a residential facility sponsored by Cerebral Palsy Research Foundation of Kansas for adults with physical or neurological disabilities. In addition to accessible apartments, the Timbers, through the Program Services Department, offers support services such as attendant care, transportation, and independent living skill training. Assessment of the individualās ability to live independently is a critical component of skill training; however, an adequate assessment for individuals with severe physical or neurological disabilities was not available. Indeed, the definition of āindependentā was debatable. Is independence defined as being able to function without assistance? Because the residents of the Timbers are severely physically or neurologically disabled, the definition of independence needed to focus on the individualās control of the decision-making process, not the functional skill. The Program Services Department staff identified the need for an assessment of the individualās ability to be in control of daily living activities.
A search was initiated for such an instrument. Most of the independent living assessments found were functional assessments which penalized physically disabled individuals who could not perform the tasks. Other assessments were the āon-offā variety, i.e., the client either was fully independent or not at all. In addition, most assessments were third party; a case manager, helper, or parent assessed the ability of the disabled person to perform. The Program Services Department staff refined the paremeters of their needed assessment:
1. It must assess the disabled individualās ability to exert control over the activities of adult daily living (ADL). How does the disabled individual perceive independence? What is the individualās concept of independence?
2. It must be a self-assessment. No third party can truly assess an individualās concept of independence.
3. It must identify how individuals function in different domains or areas of life at differing levels of independence. Skill acquisition is progressive and individuals living in a ālearningā environment progress at individual rates and for different reasons.
III. THE DEVELOPMENT OF THE TACIL
Over a 3-year period, ideas for the assessment were collected from the Program Services Department staff and from residents of the Timbers. Items were written, tried out, and rewritten. One of the main goals was to create an assessment that the individual could complete independently. This required that it be written in a language easily understood and commonly used. The Timbers residents are, for the most part, developmentally disabled. Their educational history is varied, but many were not included in public education under Public Law (PL) 94ā142, The Education for All Children Act.
In addition to being easily understood, the assessment was developed to include following premises:
1. A self-assessment, rather than a third-party assessment, would provide a truer picture of the individualās ability to control activities.
2. The domains to be assessed should be drawn from experiences common to persons with disabilities living independently.
3. The assessment must reflect varying degrees or levels of independence to reflect changes over time and to allow for comparison of strength and needs within and between domains.
4. The assessment should be easily understood and easily administered to make it accessible for the widest possible use.
An instrument was developed which would assess the disabled individualās concept of his or her own ability to function in five major domains: adult daily living (ADL), management of finance (MF), legal rights (LR), health and attendant care (H/AC), and lesiure time (LT). Questions were presented as āIā statements, and individuals were asked to rate their response to the statements on a scale of 1 to 4, from ānot like meā to ājust like meā. The statements were designed to reflect one of three levels of independence: awareness, organizational, and management. The awareness level indicates that the individual is aware that something needs to be done, but has difficulty organizing steps to accomplish the task. The organizational level indicates the individual is aware of the task and has some ability to organize the necessary steps, but is unable to provide the follow-through independently. The management level indicates assimilation and accommodation: the individual is aware of the task, can organize steps for its completion, and can manage to carry them out.
The first trial instrument was administered to ten residents at the Timbers who were picked at random. The residents were asked to rate the instrument itself, specifically the language used, the content of the statements, and their personal response to assessing their own skills. Results of this first testing, although highly informal, were extremely useful. First, there was general agreement between the self-ratersā assessment and the staffsā opinion of their functioning. Residentsā response to the language, the content, and the testing experience prompted changes. Items were rewritten, further simplifying or clarifying the language. Statements were restated, putting them more within the context of the residentsā experience. In addition, two more domains were added, vocational (V) and mobility (M). The assessment was again administered and reviewed for corrections.
The results of this 3-year development is the TACIL. The TACIL is a 60-item assessment in which adults with disabilities respond to āIā statements related to seven domains of adult community living. These domains are ADL, MF, LR, H/AC, LT, V, and M. The TACIL is a self-assessment designed to determine whether the self-raterās concept of his or her independence is at an awareness level, an organizational level, or a management level. The three levels relate to the categories of residential programs defined in the Kansas Rehabilitation Information System, an interagency...