| IDEAS |
|
(Indian Disability
Evaluation and Assessment Scale) A Scale for measuring and quantifying
disability in mental disorders |
| Developed
by |
| The
Rehabilitation Committee of the |
| INDIAN
PSYCHIATRIC SOCIETY - 2002 |
| DESCRIPTION OF
"IDEAS" |
| General guidelines : |
| IDEAS is suited best for
the purpose of measuring and certifying Disability. |
| It is therefore a brief and
simple instrument, which can be used, even in busy clinical settings. |
| Some training is required
in the use of IDEAS. |
| This is to be used only on
outpatients and those living in the community. Not appropriate for in
patients. |
| Rating should be done only
based on interviews of the Primary Care Givers. Case records and
patients interviews can be used to supplement information. |
| Only in rare instances when
no primary care giver is available should the rating be based only on
patient interview. This should then be documented. |
| The gender specification
"he" has been used for convenience and refers to both genders. |
| Probe question help to
guide one through the interview and to help identify dysfunction in one
or more activities. |
| Diagnostic categories: |
| Patients with only the
following diagnoses as per ICD or DSM criteria are eligible for
disability benefits. |
| Schizophrenia |
| Bipolar Disorder |
| Dementia |
| Obsessive Compulsive
Disorder |
| Duration of Illness: |
| The total duration of
illness should be at least two years. For the purpose of scoring, the
number of months the patient was symptomatic in the last two years (MI
2Y-months of illness in the last two years) should be determined. |
| Who does the assessment? |
| Diagnosis and certification
can be done only by the Psychiatrist. Administration of IDEAS can be
done by trained' social workers, psychologists, or occupational
therapists. |
| Frequency of
Re-certification |
| Psychiatric Disability will
be reassessed every two years and re-certified. |
| The feasibility of doing
this in the rural areas will however have to be examined. |
| Items |
| I. Self Care: |
| Includes taking care of
body hygiene, grooming, health including bathing, toileting, dressing,
eating and taking care of one's health. |
| II. Interpersonal
Activities (Social Relationships): |
| Includes initiating and
maintaining interactions with others in a contextual and socially
appropriate manner. |
| III. Communication and
Understanding : |
| Includes communication and
conversation with others by producing and comprehending spoken / written
/ nonverbal messages. |
| IV. Work : Three areas are
: Employment / Housework / Education. Measures any one aspect. |
| 1. Performing in Work / Job
: Performing in Work/employment (Paid) employment / self employment /
family concern or otherwise. Measure ability to perform tasks at
employment completely and efficiently and in proper time. includes
seeking employment. |
| 2. Performing in Housework
: Maintaining household including cooking, caring for other people at
home, taking care of belongings etc. Measures ability to take
responsibility for and perform household tasks completely and
efficiently and in proper time. |
| 3. Performing in school /
college : Measures performance in education related tasks. |
| Score for each item: |
| 0-NO
- disability (none,
absent, negligible) |
| 1-MILD - disability
(slight, low) |
| 2- MODERATE
- disability
(medium, fair) |
| 3- SEVERE
- disability
(high, extreme) |
| 4- PROFOUND - disability
(total, cannot do) |
| TOTAL SCORE (range : 0-20)
Add scores of the 4 items and obtain a total score |
| MI
2Y- Months of illness in
the last two years. Interview with informant and case notes if available
should be used to determine for how many months in the last two years
the patient exhibited symptoms. (range: 1-4) |
| MI 2Y: < 6 months:
add 1 |
|
7-12 months : add 2 |
|
13-18 months : add 3 |
|
> 18 months : add 4 |
| GLOBAL DISABILITY : |
| Total Disability score + MI
2Y score = Global Disability score (range : 1-20) |
| Percentages : |
| For the purpose of welfare
benefits, 40% will be the cut-off point. The scores above 40% have been categorized
as Moderate, Severe and Profound based on the Global
Disability score. This grading will be used to measure change over time. |
| Score of 0 - No Disability
= 0% |
| 1-7 - Mild Disability
= < 40% 8 and above > 40% |
| 8-13 = Moderate
Disability; 14-19 = Severe Disability; 20= Profound Disability) |
| MANUAL FOR
"IDEAS" |
| In order to score this
instrument, information from all possible sources should be obtained.
This will include interview of patient, the care giver and case notes
when available. |
| 1. SELF CARE |
| This should be regarded as
activity guided by social norms and conventions. the broad areas covered
are : |
| a. Maintenance of personal
hygiene and physical health |
| b. Eating habits. |
| c. Maintenance
of personal
belongings and living space |
| Guiding Questions |
| a. Does he look after
himself, wash his clothes regularly, take a bath and brush his teeth? |
| b. Does he have regular
meals ? |
| c. Does he take food of
right quality and quantity ? |
| d. Does he dress
appropriately (weather conditions, over dressing) ? |
| e. Does he take care of his
personal belongings with reasonable standard of cleanliness and
orderliness ? |
| f. Does he seek treatment
for health conditions and comply with advice? |
| Scoring of Disability -
0=No disability |
| Patients level and pattern
of self-care are normal, within the socio-cultural and economic context. |
| 1 = Mild : Mild
deterioration in self-care and appearance (not bathing, shaving,
changing cloths for the occasion as expected). Does not have
adverse consequences such as hazards to his health. No embarrassment to
family. |
| 2 = Moderate : Lack
of concern for self-care should be clearly established such as
deterioration of physical health, obesity, tooth decay & body odors |
| 3 = Severe : Decline
in self-care should be marked in all areas. Patient wearing torn cloths,
would only wash if made to and would only eat if told. Evidence of
serious hazards to physical health. (Malnutrition, infection, patient
unacceptable in public). |
| 4 = Profound : Total
or near total lack of self-care (Example : risk to physical survival,
needs feeding, washing, putting on clothes etc. Constant supervision
necessary). |
| Not attempts at
engaging in any kind of social interaction. Family afraid of potential
consequences. |
| III.
COMMUNICATION AND UNDERSTANDING |
| Understanding
spoken messages as well as written and nonverbal massages. Ability to
produce meaningful messages in order to communicate with others. Ability
to converse in groups (such as chatting and discussing) |
| Use of
communication devices such as telephone, e-mail, internet etc. |
| Any
reduction/excess of these behaviours should be considered. |
| All modes of
communication should be considered. |
| 1. Questions |
| a. Does he
avoid talking to people/ talk excessively at times? |
| b. Is he able
to start, maintain and end a conversation? |
| c. Does he
indulge in reading, writing and other communication devices such as
telephone, e-mail etc.? |
| d. Is he able
to comprehend verbal/ non-verbal communication? |
| e. Axe others
able to comprehend his communication? |
| f. Do you need
to encourage him to be more communicative? |
| Scoring : 0 =
No disability |
| Patient
communicates with people as much as can be expected in his
socio-cultural context. No difficulty in comprehension. |
| 1 = Mild
:Patient described as uncommunicative. communication inappropriate (as
in excitement). No active avoidance, but speaks only when spoken to.
Could have some difficulty in comprehension. |
| 2 = Moderate
:A
narrow range of communication. communication can be too brief/in excess,
incomplete or incomprehensible. |
| 3 = Severe
:Evidence of more generalized, active avoidances of any kind of
communication. Serious difficulty in comprehension. |
| 4 = Profound
:All communication is nil or a bare minimum. communication totally incomprehensible. |
| IV. WORK |
| This includes
employment, housework and educational performance. Score only one
category in case of an overlap. |
| Guiding
Questions |
| a. Is he/she
employed/unemployed/housewife/student? |
| b. If employed,
does he got to work regularly? |
| c. Does he like
his job and is he coping well with it? |
| d. How is his
competence at work? |
| Scoring : 0 =
No disability |
| Patient goes to
work regularly and his output and quality of work performance are within
acceptable levels for the job. |
| 1 = Mild :
Noticeable decline in patient's ability to work, to cop with it and meet
the demands of work. May threaten to quit. |
| 2 = Moderate :
Declining work performance, frequent absences, lack of concern about all
this. Financial difficulties foreseen. |
| 3 = Severe :
Marked decline in work performance, disruptive at work, unwilling to
adhere to disciplines of work. Threat of losing his job. |
| 4 = Profound
:Has been largely absent from work, termination imminent. Unemployed,
and making no efforts to find jobs. |
| House-wives |
| In similar
ways, housewives should be rated on the amount, regularity and
efficiency in which tasks in the following areas are completed. Consider
the amount of help required completing these. |
| Acquiring daily
necessities, making, storing and serving of food, cleaning the house,
working with those helping with domestic duties such as maids, cooks
etc., looking after possessions and valuable in the house. |
| Students |
| Assess the
score on performance in school/college, regularity, discipline, interest
in future studies, behaviour at the educational institution. Those who
had to discontinue education on account of mental disability and
unable to continue further should be given a score of 4. |
| IDEAS (Indian
Disability Evaluation and Assessment Scale) |
| SCORING SHEET |
| ITEMS |
0 |
1 |
2 |
3 |
4 |
| 1. Self Care |
|
|
|
|
|
| II. Interpersonal Activities |
|
|
|
|
|
| III.Communication &
Understanding |
|
|
|
|
|
| IV. Work |
|
|
|
|
|
| A. TOTAL SCORE (1+II+III+IV)
(Range 0-16) |
|
| B. MI 2Y SCORE (Range 1-4) |
|
| GLOBAL SCORE (A+ B) (Range
1-20) |
| Percentage of disability |
|
| RESULTS OF
FIELD STUDIES |
| The sample was
drawn from 8 centres all over the country. They were a good mix of
patients attending mental hospitals, outpatient clinics of psychiatry in
general hospitals and rehabilititation centres. The four diagnostic
groups were also included. Total number of cases included in the field
study = 1078 |
| Center wise
Distribution: |
| Bangalore (RFS)
|
= 103 |
| Kolkata (Antara)
|
= 110 |
| Chennai: |
|
| IMH
|
= 160 |
| SCARF |
= 260 |
| Lucknow (KGM) |
= 100 |
| Thrissur (GH) |
= 135 |
| Trivandrum (GGM) |
= 100 |
| Vellore CMC) |
= 110 |
| Gender and age
distribution: |
|
| Males |
= 665 (61.6%) |
| Females |
= 413 |
| Mean Age of
patients |
= 37.4 +_ 11.53 |
| Mean duration of
illness |
= 8.61 +_ 6.55
years |
| This was the
total duration of illness and not MI 2Y |
| Schizophrenia |
= 560 |
| Schizoaffective |
= 13 |
| Mood disorders:-
Depression |
= 97 |
| Mania |
= 116 |
| Bipolar disorder |
= 198 |
| Dementia |
= 21 |
| OCD |
= 59 |
| Others |
= 14 |
| Table 1 |
|
| Mean Scores of
Items N= 1078 |
|
| Items |
Mean Scores |
Range |
| Self Care |
0.94 +_ 1.13 |
0-4 |
| Interpersonal
Activities |
1.54 +_ 1.15 |
0-4 |
| Communication
& Understanding |
1.46 +_ 1.18 |
0-4 |
| Work |
2.11 +_ 1.42 |
0-4 |
| A. TOTAL SCORE
(Range 0-16) |
Mean = 6.05 +_
4.13 |
| B. Total
Duration (Range 1-4)* |
Mean - 2.88 +_
1.07 years |
| GLOBAL SCORE (A
+ B) |
Mean = 8.93 +_
439 |
| (Range 1-20) |
|
| *Please note
that experience during field trails showed that it was rather difficult
to compute total duration of illness in certain episodic illnesses. It
was also felt that equating the duration of c disorders and chronic
disorders would not be the right thing to do. Hence this has now been
changed to months of illness during the last two years. (MY 2Y). |
| Reliability |
| Due to logistic
reasons, it was not possible to conduct interacentre reliability exercises.
Interacentre reliability was done in a few centres between two raters.
The kappa vale was 0.76 revealing the need for some training in the use
of IDEAS. |
| Internal
consistency was calculated. The alpha value was 0.8682 indicating good
international consistency between the items. |
| Validity: Face
validity: The draft instrument was circulated among a team of mental
health and disability professionals. Their opinions were sought as to
whether at face value, the instrument appeared to be measuring the
desired qualities. There was a general consensus on the 4 items of the
instrument. |
| Content
validity: During the work of some Indian centres on the ICIDH, several
focus group discussions were held. More were held in SCARF for the
purpose of this study. The group members consisting of patients,
families, and professionals also felt that the items of the schedule
were critical in the measurement of this disability. |
| Criterion
validity was established by comparing IDEAS with SAPD (Schedule for the
Assessment of Psychiatric Disability), which has been standardized in
India. Both these instruments were administered on 223 care givers at
SCARF and also scored independently by two raters, Correlation for all
the 4items was good. |
| CONCLUSIONS : |
|
We now have a
simple, but comprehensive instrument developed and standardized in
India. It is primarily meant for measuring disability for the purpose of
certification and therefore produces values, which can be converted into
percentages similar to what is practiced for other disabilities. It can
be used on the field and in busy clinical settings. It is largely
dependent on the information provided by the primary care giver. Since
it is on a 5-point scale, any changes occurring during re-assessments
can be picked up. For any clarification or more information, please
contact:
|
| Dr. R. Thara |
| Director,
Schizophrenia Research Foundation (SCARF) R/7A, North Main Road, West
Anna Nagar Extension |
| Chennai -600101 |
| INDIA Tel :
6263970, 6207073. |
| E-mail: scarf@
vsnl.com |
|
|
