MENTAL HANDICAP VOL. 19 DECEMBER 1991

The Huddersfield Abilities Scale

A Brief Scale for Assessing the Abilities of People with Learning Difficulties

__________

Simon Whitaker Paul Weaver

There are an increasing number of registers for individuals with learning difficulties. This paper briefly summarises the need for and require- ment of such registers. An account is given of the development of a new set of assessment scales which are hopefully well suited as a basis for gathering information for use in a computerised local learning difficulty register.

Introduction Over the last 10 years there has been an increase

in the number of registers kept on people with learning difficulties (Souter, 1990; Cubbon, 1985). The main purpose of these registers is to keep basic information on people with learning difficulties to assist in service planning (Cubbon, 1984). The type of questions that information from the register will be required to answer are as follows:

(i) How much and what type of day care will be required in 5 years’ time?

The information that could be provided in order to help answer this, would be the number of children, between the ages of 16 and 19, whose level of abilities is such that some sort of day care provision will be necessary.

(ii) How much physiotherapy time should be provided?

In order to answer this question it may be necessary to know how many people there are in the district who are unable to walk.

(iii) How much short term care should be provided?

The sort of information that may be necessary here, is of how many people there are, cared for by relatives, who are dependent for basic self care.

In order to answer these questions it is necessary to have a measure of the individual’s abilities, either generally or in some specfie area, such as walking or self help. Since the information required from the register will be, in the main, anonymous statistical information on groups of people, rather than detailed information on a specific person, the measure of abilities need not be detailed on individuals. However, the information will be required to be accurate and easily updated.

Although there are a number of scales of adaptive behaviour available for assessing levels of ability of people with learning difficulties, these are often not suitable for use on a computerised register. This is either because it takes some time to complete an assessment or because the way the information is presented is not compatible with having a simple print-out of a person’s abilities together with other information. In the past many registers have made use of the Wessex Behaviour Rating Scale (Kushlick, Blunden and Cox, 1973) which is quick to complete and puts people in one of five levels of dependency. However, this scale has been found, in a survey of registers, to be unsatisfactory as it will assign people with very different needs to the same category (Cubbon, 1985).

This paper describes the development of the Huddersfield Abilities Scale (HAS), a scale for assessing the abilities of people with learning difficulties, for use in a computerised register.

The Huddersfield Abilities Scale (HAS>

HAS was designed to meet the following require-

0 It should cover the full range of abilities in

ments:

people with learning difficulties.

SIMON WHITAKER is a Principal Clinical Psychologist, PAUL WEAVER is a Psychology Assistant. Both work at the Greenhead Resource Unit, Princess Royal Community Hcalth Centre, Greenhead Road, Huddersfield HD1 4EW.

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Untrained staff should be able to complete an assessment on an individual with learning difficulties in a few minutes. (If this requirement was not fulfilled it was felt that the register would not be updated regularly.)

It should be reliable, i.e. if two assessors were to complete HAS on the same individual, then the results that each assessor obtained should be essentially the same.

It should be valid in the sense of producing a result that truly reflects the abilities of the individual who has been assessed.

The information should be able to be presented on a computer print-out in a simple and easily understood form so that it can be quickly checked for accuracy.

An initial draft HAS was produced with 15 separate scales, as in the left hand column of Figure 1. Each of these scales, with the exception of “Communication System”, is divided into three levels of ability. For each of these levels there is a paragraph outlining the sort of abilities the individuals should demonstrate to be marked at the particular level. In addition to this paragraph, each level has a one or two word description corresponding to it. As well as these three categories there is an additional “Not Known” category for each scale. Figure 2 shows the “Dress- ing Scale” as an example. The individual filling in the scale is required to circle the description corresponding to the ability level that most closely describes the person they are assessing. In the case of “Communication System” they are required to circle the system of communication used by that person.

Once this information has been placed on a database, it is possible to program the computer to

Toileting Independent Feeding Independent Dressing Help Needed Washing Help Needed Language Production Partial Language System Makaton Language Receptive Partial Writing None Number None Sight Partial Hearing Not Known Locomotor Walks Independence Dependent Cooking Dependent Domestic Help Needed

FIGURE 1

Independent Will completely dress and undress self, choosing appropriate clothes for weather or occasion. Can be left to dress self, though may need help with difficult fastenings and in choosing what clothes to wear. Has to be dressed or help given with getting some clothes on that do not involve difficult fastenings.

Help Needed

Dependent

Not K n o w n

FIGURE 2. Dressing Scale

produce a simple print-out of the data as shown in Figure 1, with each scale having words describing the level of the ability printed next to them. This enables the data to be checked quickly by staff who known the individual and have some familiarity with HAS.

The original draft was circulated to senior staff working with people with learning difficulties in Health, Social Services, Education and the Voluntary Sector within Huddersfield. Comments were invited regarding the choice of scales used, the description of the ability levels and how credible the scale looked to them, to other staff and to parents. In the light of comments received, appropriate changes were made to HAS.

The scale was assessed for reliability. This was done by selecting 10 people with learning difficulties representing a wide range of age and ability. Two people who were very familiar with the person being assessed were then asked to complete HAS independently. The percentage of agreement was then calculated by dividing the number of scales on which the two raters had agreed, (130) by the total number of scales used on all 10 subjects (150), and then multiplying by 100. This produced a reliability estimate of 86.6%.

The validity of the scale was assessed by compar- ing the results of an assessment on HAS with that of an assessment on a highly standardised scale for assessing abilities in people with learning difficulties; Part 1 of the Adaptive Behaviour Scale (Nihira, Foster, Shellhaas and Leland, 1974). This was done by taking a different sample of 20 people with learning difficulties selected to be representative with respect to age, physical ability and level of learning ability and assessing them both on HAS and Part 1 of the Adaptive Behaviour Scale. The Pearson Product Moment Correlation Co-efficient was then used to see to what extent two scales produced the same result on the people assessed.

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The results of this showed a very close relationship with the correlation co-efficient of r = 0.94.

It should be noted that although these measures of reliability and validity are high, they are based on a small sample with a large range of abilities. It is possible that had the sample been more restricted, the levels of reliability and validity we would obtain would be less than those cited.

In addition to the formal data on the reliability and validity it was apparent that HAS fulfilled other criteria. Staff who were unfamiliar with the scale were able to complete an assessment within a few minutes and felt that the scale was giving an accurate reflection of the individual with learning difficulties.

Another measure that is often included on regis- ters that would be useful for planning is that of a person’s level of challenging behaviour. Although we are now working on a separate measure of challenging behaviour, we did not feel it would be appropriate to combine the two. Challenging behaviour is a much more controversial area than level of skills and it is also proving to be much more difficult to measure accurately.

The scale has now been adapted as part of the Huddersfield Register of People with Learning Difficulties which has been set up using a microcom- puter and a standard database system, Dataflex. It should therefore be easily incorporated into other registers. If any readers would like to use the scale or require further information they should write to the first author.

Limitations of HAS A note of caution should be sounded at this point.

One of the functions of many registers is to prompt and monitor a regular review system of all

information held on the register. This is increasingly taking the form of an Individual Programme Plan (IPP) for each person, whose strengths and needs are considered and appropriate goals set for meeting these needs within a given time period. In order for this to be done an accurate assessment has to be carried out including the measurement of skills and abilities. For this type of assessment, HAS would be quite unsuitable since it does not provide nearly enough detail and is designed to be used on a large group of people with very different abilities. The authors feel that the assessment used to look at a person for an IPP meeting should be specially chosen to suit individual skills and abilities and provide an appropriate amount of detail on them. The interested reader is advised to look at Kiernan (1987) for further details of these assessments.

REFERENCES Cubbon, J. (1984) The emergence of mental handicap

registers. Mental Handicap 12:4, 137-138. Cubbon, J . (1985) Integrating mental handicap

registers with service provision. Mental Handicap 13:2, 60-61.

Kiernan, C. (1987) Criterion-referenced tests. In J. Hogg and N. V. Raynes Assessment in Mental HarLdicap: A Guide to Assessment Practices Tests and Checklists, 158-189, Beckenham: Croom Helm.

Kushlik, A., Blunden, R. and Cox, G. (1973) A method of rating behaviour characteristics for use in large scale surveys of mental handicap. Psychol. Med. 3, 466-478.

Nihara, K., Foster, R., Shellhaas, M. and Leland, H. (1974) AAMD Adaptive Behaviour Scale, 1974 Revision. Washington DC: American Association on Mental Deficiency.

Souter, R. (1990) Severe learning difficulties: The need to plan for the future. Yorkshire Medicine 2 3 , 13.

BIMH Publications Someone to turn to: the social worker’s role and the role of front line staff in relation to people with mental handicaps Dorothy Atkinson

An account of the roles and relationships at the “front line” of services for people with mental handicaps. Part 1 - Research findings, roles, and relationships is based on the findings of a follow-up study of people discharged from hospital to independent living situations in the community; Part 2 - Implications of research findings for front line staff looks at the roles, both formal and informal, that staff adopt in the lives of people with mental handicaps as service users and the relationships that develop between them. 1989 104 pages ISBN 0 906054 66 4 Pbk f6.95 plus p&p

Orders and sales enquiries to: BIMH Publications, Bank House, 8A Hill Road, Clevedon, Avon BS217HH Tel. (0275) 876519

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