Development of an instrument for the evaluation of independent living skills in adults with disabilities
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In the United States, community based services for individuals with disabilities have received a huge impetus since the Olmsted decision in 1999. While the states have been developing programs and waivers to support community based living, there are no scientific protocols to determine if an individual is capable of living in the community. The purpose of this study was to develop and test an instrument, the Independent Living Skills Assessment (ILSA) which was conceptualized using the biopsychosocial framework. Study participants included adults with disabilities, living in nursing homes or in the community across four states. A concurrent nested design involving both quantitative and qualitative methods was used. During the first phase of the study, the Independent Living Skills Questionnaire (ILSQ) was created and the content validity and inter-rater reliability was established by using seven experts in the field of independent living. The content validity index for individual items and the complete scale for independent living were all above .86. Inter-rater reliability for items in the questionnaire was between .98 and 1.00. Phase II involved creating the ILSA based on the ILS-Q and establishing its psychometric properties. Rasch analysis resulted in identifying two subscales, Personal Management and Resource Management. The fit statistics and the rating scale structure were examined for each subscale and were found to be satisfactory. Convergent and discriminant validity were measured by correlation coefficients. Correlation of the ILSA with the OARS-IADL scale (convergent validity) was .82 (p<.000) and correlation with the FIM(TM) (discriminant validity) was .544 (p<.000). Internal consistency of the subscales as measured by Cronbach's alpha was found to be .81 for the Personal Management subscale and .86 for the Resource Management subscale. At the end of Phase II, the ILSQ was revised and redundant and misfitting items removed. In phase III, the responsiveness of the ILSA and its ability to identify differences between the nursing home and community residents, was tested and found to be satisfactory. The findings from the initial testing of the ILSA indicate sound psychometric properties. The ILSA can be valuable tool in determining a person's ability to remain in the community.