Evaluating Imagine!’s SmartHome

Editor's Notes

• #2: Beth-We would like to thank the Colorado Technical Vitality Council under the University Funding Program for supporting our research.-Elizabeth Woodruff – recent graduate from the University of Colorado with a Master’s Degree in Political Science-Dannette Muselman – a graduate student at the University of Colorado working towards her Master’s Degree in Counseling Psychology-Yvonne Kellar-Guenther – our research mentor for this grant
• #3: Beth-I know a few of you have visited the SmartHome or were lucky enough to hear Greg speak last week. So this is quick overview of the SmartHome and its features. -Imagine! staff is in attendance today and I’m sure they will be happy to answer any questions you may have about the SmartHomes. -A SmartHome incorporates state-of-the-art residential technologies to enhance the quality of life for clients, augment the effectiveness of staff as caregivers, and provide cost and energy savings for direct care provider organizations. There are currently two SmartHomes in operation: the Bob & Judy Charles SmartHome in Boulder and the Charles Family SmartHome in Longmont. Our research involves the 8 residents of the Boulder SmartHome. -Imagine! has long been recognized as a leader in the state of Colorado and the nation in providing innovative services for people with cognitive disabilities. Theses SmartHomes represent the next step in creating new and unique opportunities for the people we serve to engage actively in their homes and communities.-As the first such homes in the nation, the SmartHomes will serve as demonstration models for the future of residential care for people with cognitive disabilities.-Technologies – The handout each of you has is a layout of the Boulder SmartHome and highlights the IT, green technology and assistive technology devices located throughout the home. -A few we specifically looked at. AbleLink Task PrompterMotorized adjustable kitchensink and induction rangeR.F.I.D. Location Badges for consumers and staff
• #4: Beth-These research questions were developed by Imagine! And Colorado WIN Partners in December of 2008.-4 research areas were discussed. The research question that elicited the biggest interest to Imagine! & Colorado WIN Partners was how to Enhance the quality of life for consumers. -The following is a list of the areas WIN Partners addressed in our data collection and analysis.
• #5: Dannette
• #6: Dannette-Do research with residents---not really done in the literature -5Days==engage residents and empower them to be part of research project through being directly surveyedNCI (a quality of life scale) for persons with Developmental Disabilities and open-ended questions designed to capture what the resident valued and their comfort with technologySIS for an individual receiving services in order to complete particular tasks or participate in particular activities.
• #7: DannetteCore Indicators= items that intended to measure central features of QoL through service delivery for persons with DDNCI Is nationally recognized!!Used the :Consumer Survey----Questions obtain expressions of satisfaction and opinions from each individual
• #8: Dannette9 subscales, 46 itemsMeasures residents perceptions
• #9: Beth-SIS identifies the type, frequency and duration of support needed for the individual receiving services in order to complete particular tasks or participate in particular activities.-Supports refer to an array of resources and strategies including individuals, agencies, money, assistive devices or environments with developmental disabilities live in typical community settings. “Rather than mold individuals into pre-existing diagnostic categories and force them into existing models of service, the supports approach evaluates the specific needs of the individual and then suggests strategies, services and supports that will optimize individual functioning.”-SIS was created to be used for the creation of measuring and planning supports and services with developmental disabilities. Can be used to develop Individualized Service Plans and to track the decrease or increase in support needs over time.
• #10: Beth-SIS covers different domains, or categories, of support needed: Home Living ActivitiesCommunity Living ActivitiesLifelong Learning ActivitiesEmployment ActivitiesHealth and Safety ActivitiesSocial Activities-Each domain has 8-9 questions. For each question there are three answers that need to be addressed. Responses to the questions are chosen from the rating key of the assessment. What type of support would be needed for that activity? 0=none1=monitoring2=verbal/gesture prompting3=partial physical assistance4=full physical supportHow frequently would that support be needed? 0=none or less than monthly1=at least once a month but not once a week2=at least once a week but not once a day3=at least once a day but not once an hour4=hourly or more frequentlyHow much time in one given day would that support take? 0=none1=less than 30 minutes2=30 minutes to less than 2 hours3=2 hours to less than 4 hours4=4 hours or more
• #11: DannettePart of Qualitative researchReported preliminary results to Imagine! in October and sought clarification on questions (member checking)
• #12: BETH
• #13: DANNETTE
• #14: DannetteSample size of 8 very small, and cannot obtain significant statistical findings with such low samplenot all subscales had a sample of 8 because lack in composite scores. Composite scores were not made because of missing data.When refer to “6” residents, it is not that we left out 2 residents but that we did not have complete data for all 8Explain outliers: person a— t1=0, t2=0, vs. person b– t1=0, t2=10…mean would be 5, but does not tell you much about how the scores greatly increased for one person and stayed same for the other
• #15: Dannette*Example of one of the subscales that had interesting findings as relates to QOLMeasures the level of which resident has control in choosing , for example where to work and where to liveRange of scores: Can change by dropping 5 points, 0=no change, or increase by 4 points5 resident’s mean scores stayed the same or increased2 resident’s mean scores increased by one point1 resident’s mean scores increased by two points2 resident’s mean scores increased by 4 points1 resident’s mean scores decreased by 3 points
• #16: DannetteRemember to say “their perception” when reported resident call dataIncrease=5Same=1Decrease=2
• #17: DANNETTE5/6= more in control of lives (choices and decision making)3/6= safer in home/hood, more respected by those around them (work, home, day programs), more personal caring rlxls with pple beyond staff
• #18: DANNETTE4/5= better access to resources (i.e. transportation), while last person reported no changeLittle change=community involvement
• #19: DannetteSLOW DOWN SLOW DOWNDecrease in service coordination and knowing service coordinatorNot what we expectedDuring membercheck with Imagine! found out that residents may now only have to turn to staff in home for service, rather than multiple service providers within communityImagine! expected this finding as it decreases costs in services
• #20: DannetteInteresting results for these two open ended questionsDo we report Day 1 and 2?
• #21: DannetteT1= 4 resident say work as most interesting thing they did. By T2, this response expanded to include the startup of the coffee grinding business that the residents are working on together.Use of computers: T1=4 & T2=6, and use for personal interests.However, we expected to hear all residents say that they have access to and use computers in T2.This is not what we foundWe learned= what you don’t hear that you expect to is valuable and important in the research process…not always about just understanding what you see/hear, but research is also thinking about the meaning of what it not heard.
• #22: BETH
• #23: Beth-The Support Needs Index indicates the overall level of supports needed for the individual. This is done by taking the raw scores of each Activity Subscale as ranked during the interview. Then using Standard Scores and Percentiles established in the SIS appendices. -These graph shows the overall support needs of each individual from Round 1 which was administered prior to the residents moving into the SmartHome (Range from 2006-2008) and Round 2 which was administered August 2010, 1 year after moving into the SmartHome. -2 stayed the same-5 decreased (3 had dramatic drops)-1 increased-The increase and the lack of change for 2 of the individuals didn’t quite fit with what we expected to see. Since these percentiles show the support needs as a whole we decided to look at the subscales of the SIS to get a better understanding of where support needs were specifically increasing and decreasing and then hopefully being able to better understand the results we are seeing.
• #24: Beth-This chart includes the 6 subscales that we used in our research and lists out the areas of decreasing support needs, no change and increasing support needs. -In general we are seeing a high decrease in support needs in almost all areas. Although there are still areas which have increased. Why? -This still didn’t give us an adequate understanding of why the support needs were increasing or decreasing so I decided to look at specific questions of from the SIS in an attempt to better understand why we are seeing increasing and decreasing scores-The next three slides featured focus on specific questions in the SIS Interview
• #25: Beth-Part A: Home Living Activities; Q3 – Preparing food-Technology in the Kitchen:AbleLink Computer Prompting System – allows the individual to see and hear prompts on how to make spaghetti. From what to grab from the pantry, wash hands, boil water, heat sauce, etc. As the individual needs less support the prompts can become more broad.Motorized adjustable kitchen sink, induction stovetop and work surface – allow individuals in wheelchairs/different heights to be able to use the devices at their comfort level. Induction stovetop – provides for a safer cooking experience. Heat is generated directly in the cooking vessel (pot, pan) rather than generated from electrical coils or burning gas. Induction heating significantly reduces the possibility of burn injury. -3 remained high which can be understood through the nature of their disability-Did see a decrease in two individuals down to 0 zero supports needed – meaning they need no support to engage in this activity. An area of independence we understand as a predictor of quality of life. -The most interesting is the fact that two individuals raised from 0 support needs in Time 1 to scores of 7 & 5 in Time 2. Seemed incorrect to us, or possibly flawed data. When talking with Imagine! we discovered that these two individuals, prior to the SmartHome, lived in “independent” or non-supported living situations where preparation of meals constituted a staff member making food once a week and freezing it so the individual could reheat it in the microwave. So of course an individual who is now empowered to be able to make their own meals when they never were before will have an increase in support needs in order to learn a new activity. -If a person was just to look at the numbers they would see an increase and understand it as a negative effect. But when taking a closer look at the question and understanding the nature of the SmartHome we consider a raise in support needs to be an indicator of improved quality of life.
• #26: BethPart C: Lifelong Learning Activities ; Q4 – Using technology for learningAbleLink Computer Prompting System – Found in Kitchen/Dining Room and each persons bedroom. Includes weather prompt (allowing the individual to be better prepared for their day with appropriate attire), newspaper prompt (speak out loud, customize to interests), journal, internet, iTunes, email, games, movies, etc., different for each resident based on their priorities. -2 stayed the same-5 decreased -1 increased-Due to the technology aspect of the SmartHome we expected to see support needs decrease. -What we found most interesting was the resident whose support needs increased. This resident is writing a monthly diary entry for the Imagine! website, and in phone calls and a visit at the SmartHome expressed to me how much fun she is having learning how to make journal entries, write emails and is even talking about the possibility of writing a book. Impressive skills being learned to make this all happen. Can understand why here support needs would increase. As she uses the computer more and absorbs new skills and wants to attempt new things she will need help in the learning process. Don’t we all when it comes to technology and computers.
• #27: Beth-Final pattern we found interesting when looking more closely at the SIS data. Part E: Health & Safety Activities; Q4 – Ambulating and moving about -The SmartHome has 3 individuals who use power wheelchairs, Mandy-joystick, Donna-joystick and Gerald-head switch. -It is expected that these individuals will always have higher support needs due to the nature of their disability. -Due to the layout of the home and the tech involved in helping encourage mobility these 3 individuals all saw a decrease in their support needs.
• #28: Beth-Overall we saw a decrease in support needs for the residents which was what we expected. Meaning the levels of independence for these residents is increasing which is one of the predictors of quality of life. -But the overall numbers didn’t create an adequate understanding of how living in the SmartHome has effected their quality of life. -Looking at the specific questions of the SIS interview and piecing them together with the stories I have collected in my visits and phone calls with the residents we were able to better understand specific ways these residents lives are improving. -The point of SIS is create tailored to the individual service plans in order to help improve the quality of life of the individual. When looking at the specific questions and linking them with technologies in the SmartHome we were able to create a much richer picture of understanding the improved quality of life of the 8 residents.
• #29: Dannette
• #30: DannetteDuring member checking with Imagine! they asked about how the two data sets might be relatedSubjective=NCI b/c it is resident’s perceptions of their QoL and collected directly form them-Objective= SIS b/c it is done by family members, staff members who have different perspective on the resident’s livesNew Research Direction---is there a RELATIONSHIP?
• #31: Dannette(+) correlation does not mean it is of better value---just change in same directionNCI Access (+) correlated with SIS Employment and SIS Social-Residents who perceive better access to supports (e.g. transportation) and people to help them also increases in the support needed for employment and social activities. - Alternatively, those who perceive less access to these supports were viewed as needing less supports around employment and social activities. 1. Possible that those who have greater access to services (i.e. transportation) are in need of more support in their job and social settings, which makes sense as they may have a need for support in traveling to see others in the community. Residents notice they need more support in doing these activities.2. Possible that those who have less access to services (i.e. transportation) are in less need of support in social settings and employment settings because perhaps more independent and are able to get out into community and socialize with others on their own. Residents who feel they do not have this access are viewed as not needing it.ALMOST PERFECT CORRELATION Perhaps the most interesting finding is that the SIS social subscale and the NCI access subscale are almost perfectly correlated.
• #32: Dannette(-) correlation does not mean it is of better value---just change in opposite direction1. SIS Lifelong Learning (-) correlated with NCI Relationships and NCI Satisfaction-As life learning decrease, rlxl and satisfaction increase, or as life learning increase relationships and satisfaction decrease.-Possible those who perceive having more relationships are in less need of support in problem solving & self-management-Possible those who perceive having more satisfaction in work and employment are viewed as needing less self-management and problem solving support.2. NCI Community Inclusion (-) correlated with SIS Employment and SIS Social-As resident’s perception of community inclusion increases= viewed decrease need for support in employment and social activitiesAlternatively, resident’s perception of community inclusion decrease=viewed need for support in employment and social increase -Possible those perceive more involved in community are in need of less support because they are more able to go out to employment and day programs where they can socialize and be with others-Possible those who perceive less community inclusion are those who are in need of more support in their employment and social settings-This finding is expected: those who are viewed as need less support in employment/social settings are more integrated with in community through their physical and social presence at job setting and day programs. 3.  NCI relationships (-) correlate with SIS social -As resident perceives their relationships as increasing, there are viewed as needing less support in social activities,Alternatively, those who perceive relationships decreasing are viewed as needing more supports in socializing -finding is expected-possibility that those who perceive themselves as gaining more friends and time spent with friends/family are more likely to not need as much support in social skills with those individuals because of the nature of such relationships.
• #33: DannetteHolistic approach to understanding the quality of life of the residentsUses resident’s perceptions and staff/family perceptions– comparing multiple viewpoints is interesting because there may be the same or different perceptions of what is going on in the residents lives-makes understanding one set of data more in-depth because you have something to compare it toWould use in the future: important to gain as many different entry points of information on the residents and have that data to make sense out of the bigger picture. The NCI or SIS alone gives only a snippet of that aspect of the residents, but when combined you can see that changes in one area also found to change in the other
• #34: Beth-So enough of all this explanation of data and charts. Onto what we actually learned from this research.
• #35: Beth-The goal of this research project was to determine if living in a group home that utilized smarthome technoloogy increased the quality of life for eight adults with developmental disabilities. -The Predictors of improved quality of life we used to gauge our data were for the residents to:Have more relationshipsHave increased independenceHave greater interaction with their environment. -All those graphs and numbers and explanations we just showed you say that these predictors are being fulfilled for these 8 residents. -This fits with what we expected, and what is the drive for Imagine! in creating these SmartHomes: Those who have greater access and choices will have less need for support and increased independence.
• #36: Beth-So we saw that quality of life for these 8 residents did increase. Due to the subject nature of the data we collected these increases might not be specifically linked to the technology in the SmartHome. -Some of these quality of life increases might be due to the public nature of the SmartHome. During the resident selection process each individual was made aware that their living situation would be of interest to many people and their home would be a show home and their lives would be made aware to the public and of great interest to the public. -In conversations with SmartHome staff they mentioned they were seeing many of the residents coming out of their shells since living in the SmartHome. The residents are introducing themselves to visitors, telling jokes and are excited to share all the cool aspects of their home and what they’ve been up to. -Another interesting factor of how the SmartHome has increased quality of life is that the residents feel empowered that are helping with the development and trialing of this new technology. In a conversation I had with one of the residents she expressed to me that she was proud of the fact that she was learning how to use the computers in the home and trialing new devices because she knows her work will help with development of technology that can be used by all the other Imagine! clients not lucky enough to live in this house. This is significant because we are seeing a group of individuals who have always needed others to help them, and now they are able to help others with their involvement in the SmartHome. -As stated earlier in my discussion of the SIS data, linking decreasing support needs with improved quality of life was not an adequate indicator. Instead it requires us to understand that these individuals are involved in more complex tasks which may require increased support needs. So although some of our data may not numerically allude to improved quality of life, we are overall seeing this improve.
• #37: DannetteDo different: have same person collect T1 and T2 data so that there is nothing missing and do interviews in person so that you can gather all information needed and richer stories of the clients lives can be heard that may be lost over the phoneKeep same: continue to collect data in objective and subjective ways because it helps to make greater sense out of what is going on in the lives of the residents---both are valuable!!Data from residents: good because it is unique in the field of research of people with DD, and this approach helps to have their voice heard---gave them something to engage in, look forward to, and feel empowered that someone is interested in hearing their views and opinions about what their lives are like and how others can assist them to live fuller and more independent lives.
• #38: DannetteAdaptation to technology----what features of technology and characteristics of the individual influence the use and satisfaction with tech?What does staff think about the tech? The are part of the residents lives in providing service, but as employees what does the technology do for their jobs?Collect data in another year to have 3 data points to compare and see if preliminary changes continue in same directionWhat do family members think? What changes do they see in their loved one’s quality of life? How are they able to use technology to connect with and socialize with their loved one in new ways?These possible areas of future research are consistent with the continued mission of Imagine!’ssmarthomes