Key concerns raised by experts about particular assessment tools
|
|
|
|
|
Vineland 3
|
Children aged 7—17
Adults (18+)
|
-
Intended to measure adaptive behaviour, not functional capacity, and is used for diagnosis and treatment planning
-
Designed and validated for people with specific disabilities (e.g. intellectual and developmental disabilities and autism), not other disability types, including psychosocial disability and degenerative conditions
-
Results may be variable depending on the day administered and fluctuating functionality
-
Insufficient empirical evidence supports Vineland's use with people with psychosocial disability and psychotic disorders
-
Because Vineland-3 is a semi-structured interview, the skills and experience of the professionals administering the scale and interpreting responses could be potential sources of variability
-
Requires a support person to speak about individuals' functional impairments, not the individual themselves, which may be inappropriate or cause distress (e.g. in family violence situations, or in circumstances where people may not have close support people)
-
A thorough Vineland assessment may often take as long as ten hours, and much longer if a person has complex needs
-
Not appropriate for use in remote Aboriginal communities because of complexity of wording for people for whom English is a second language, and because some concepts may be culturally inappropriate (e.g. questions about a child taking their shoes off before entering the house or whether they wash fruit before eating it)
-
Contains questions that may be difficult for someone with low literacy, English as a second language or unfamiliarity with overseas terms to understand
-
Questions about employment are not suitable for adults who developed their disability in adulthood (e.g. if they held a job 20 years ago, they would score as having no issues with employment)
-
The generated report compares the adult to their age equivalent (e.g. to a two year old child) and so may be perceived as belittling
-
Some may consider the nature of the questions to be confronting
|
|
Participation and Environment Measure for Children and Youth (PEM-CY)
|
Children aged 7—17
|
-
Very limited research exists on the psychometric properties of this tool
-
Does not measure specific impacts of disability directly, such as incontinence, but can be utilised to measure it indirectly, depending on the assessor's knowledge, skills and experience
|
|
Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT)
|
Children aged 7—17
|
-
Developed specifically for young people with an autism diagnosis
-
Questions exist about its reliability and validity
-
May be 'psychometrically unsound', with research suggesting that it does not measure what it is supposed to measure
|
|
Lower Extremity Function Scale (LEFS)
|
Adults (18+)
|
-
Originally designed to assess lower limb function of people with lower-extremity musculoskeletal dysfunction
-
Used as a clinical tool for monitoring progress in rehabilitation
-
Not designed to be completed by or be administered to a proxy (if, for example, the person has an intellectual disability and is unable to self-report answers themselves)
-
Asks questions based on people's capacity today (e.g. 'Today, do you or would you have any difficulty at all with…'), which may not take into account the positive impacts of existing supports or fluctuating, episodic or degenerative disability
|
|
Craig Hospital Inventory of Environmental Factors (CHIEF)
|
Adults (18+)
|
-
Intended to measure environmental factors, not functional capacity
-
Insufficient empirical evidence supports its use with people with psychosocial disability
-
May not effectively record information about how, for example, vision impacts functional capacity
-
Asks individuals to self-rate the impact of their disability over 12 months, with some individuals not being able to accurately recall the impact of their disability over extended timeframes (e.g. those with acquired brain injuries and short-term memory issues)
-
Not designed to be completed by a proxy
-
May be discrepancies in scoring between individuals scoring themselves and carers/support people scoring on their behalf
-
Some inter-rater reliability statistics are lower than what is considered acceptable—that is, two different assessors may rate the same applicant differently
|
|
World Health Organisation Disability Assessment Schedule (WHO-DAS) 2.0 36
|
Adults (18+)
|
-
Can be used across all disability cohorts, but is not a functional capacity assessment
-
Designed as a pre- and post-test to measure the effectiveness of interventions
-
Concerns exist about its length
-
Designed for answers based on the past 30 days, which may not capture episodic, fluctuating or degenerative disabilities and may be difficult for some people with intellectual disabilities
-
Not appropriate for use in remote Aboriginal communities
-
May not deliver a clear picture of a young person in residential aged care because questions will not accurately uncover the person's situation (e.g. they may not be able to make a cup of coffee because they do not have accessible facilities to do so)
-
Research indicates that people self-rate their functioning higher than their clinicians do—e.g., some research suggests that the WHODAS-2.0 has classified the functioning of psychiatric patients as significantly less impaired than experienced clinicians do, and that the WHODAS correctly classified the functioning of psychiatric patients in only 44% of cases
-
Unsuitable as a stand-alone assessment tool for people with significant psychosocial disability, with many items not being relevant for assessing psychosocial disability, and some domains that would be relevant for psychosocial disability not being sufficiently assessed
-
Does not comprehensively assess functional capacity to engage in self-care activities (e.g. to wash, get dressed etc.)
-
Does not address a person's capacity for work and study, if the person is not already engaged in these activities
-
Has limitations for use with people with deafblindness (e.g. most questions use flashcards to remind the respondent of key information), and does not capture the extra time that activities may take for a person with disability and deafblindness in particular (e.g. it may take the person hours to do the vacuuming)
-
Scores do not indicate, for example, whether difficulties are because of particular disabilities, and do not include further details on why a person may have difficulty completing a task and what help they need to do it
-
Does not record whether the person has existing supports in place that help them tocomplete a task
-
Without using input from family, carers, support workers and other health professionals, risks underestimating the full impact of a person's disability on their day-to-day life—for example, if the person lacks insight or is unaware that they are only able to complete activities with significant support from others
-
No established thresholds exist for interpreting the global or domain-specific scores related to the criterion of clinically significant impairment
-
Contains potentially sensitive questions, e.g. about difficulties with sexual activity
-
Wording of some questions may cause distress (e.g. 'how much of a problem does your family have because of your health problems?')
-
Scores between clinicians who know the person and those who did not previously know the person may vary widely, because of additional clarifying information the former may be able to ask on the basis of their existing knowledge
|
Source: Enable Plus, Submission 1, pp. 18–23, 26; Council for Intellectual Disability, Submission 43, p. 2; Physical Disability Council of NSW, Submission 56, p. 19; Eastern Health—Mental Health, Submission 100, [p. 3]; Ms Carolyn Fitzgibbon, Submission 108, [pp. 1–3, 6, 7]; Uniting NSW ACT, Submission 129, p. 9; Australian Clinical Psychology Association, Submission 150, p. 4; Occupational Therapy Australia, Submission 159, pp. 17, 18, 36, 38; Marninwarntikura Women's Resource Centre and The University of Sydney, Submission 164, pp. 5–6 and Supplementary to submission 158, [pp. 1–2]; Name Withheld, Submission 185, p. 2; Name Withheld, Submission 186, [p. 2]; Autism Spectrum Australia, Submission 206, p. 7; South West Autism Network (SWAN), Submission 221, p. 3; Name Withheld, Submission 256, p. 5; MOTivations Warragul, Submission 273, p. 3; Ms Muriel Cummins, Submission 278, pp. 16, 27, 29, 36, 38; Name Withheld, Submission 288, p. 2; St Vincent's Hospital Melbourne—Mental Health, Submission 313, p. 9; ME/CFS Australia, Submission 317, pp. 29, 30; Name Withheld, Submission 320, [p. 1]; ME/CFS & the NDIS Facebook Group, Submission 332, pp. 11, 13; Ms Tania Nicholls, NDIS Program Lead, St Vincent's Mental Health, St Vincent's Hospital Melbourne, Proof Committee Hansard, 23 April 2021, p. 51; Mr Patrick McGee, National Manager, Policy, Advocacy and Research, Australian Federation of Disability Organisations, Proof Committee Hansard, 18 May 2021, p. 13; Continence Foundation of Australia, Submission 220, p. 4; Scope (Aust) Ltd, Submission 214, pp. 4–8; Dr Lauren Rice, Research Fellow, University of Sydney, Proof Committee Hansard, 27 April 2021, pp. 11, 12; Uniting NSW ACT, Submission 129, p. 8; Centre of Research Excellence in Disability and Health, Submission 197, p. 5; Brain Injury SA, Submission 104, p. 10; Name Withheld, Submission 178, [p. 4]; Vision 2020 Australia, Submission 296, p. 16; Western Australia Association for Mental Health, Submission 10, [p. 3]; Spinal Life Australia, Submission 15, [p. 7]; Deafblind West Australians, Submission 55, [pp. 19–20]; Ms Jenny Spiers, Submission 110, [p. 3]; National Mental Health Consumer and Carer Forum, Submission 130, p. 8; Young People in Nursing Homes National Alliance, Submission 161, p. 16; Exceptional Bonds, Submission 215, p. 4; Mental Health Australia, Community Mental Health Australia & Mental Illness Fellowship of Australia, Submission 240, pp. 4, 5; Muscular Dystrophy Foundation Australia, Muscular Dystrophy NSW, Muscular Dystrophy Qld, Muscular Dystrophy WA, Muscular Dystrophy Tasmania and Capital Region Muscular Dystrophy, Submission 249, p. 6; Valid, Submission 309, p. 25; Able Australia et al., Submission 318, [pp. 16–17]; Occupational Therapy Australia, answer to a question on notice, 6 May 2021 (received 21 May 2021), p. 2.