In 2005 the federal agency responsible for oversight of developmental disabilities conducted an audit of services in the State of Colorado. The audit findings indicated a need to have a statewide, standardized process to identify the support needs of people receiving services. In response to this audit the State of Colorado Division for Developmental Disabilities (DDD) adopted the Supports Intensity Scale (SIS) for use.

The SIS was developed over a five-year period time by a group from the American Association on Intellectual and Developmental Disabilities (formerly AAMR) and is currently used in 12 states. The SIS is an assessment that measures the type, intensity and duration of supports needed by an individual to complete particular tasks or participate in particular activities.

The assessment is completed through an informal interview process that includes people (respondents) who can identify supports needed by the individual in a variety of settings. This of course includes the person receiving services; if that person chooses to participate and can accurately identify needed supports. Typically, the interview takes about two hours of time to complete.

All interviewers are required to undergo training and a reliability test in order to pass certification before being allowed to administer the assessment. Each Community Centered Board makes the decision of how many interviewers to train and utilize within the agency.

In addition to using the SIS to identify support needs, DDD is attempting to use the information to try to establish a more standardized approach to funding. Medicaid services are required to have a consistent application, however, historically each Community Centered Board has had its own method for establishing funding levels. Therefore, DDD contracted with two independent agencies to formulate a tiered system of funding that will relate to support needs. The SIS, as a supplement to other information, will be incorporated into the funding mechanisms used by the state to set rates, beginning for comprehensive services in fiscal year 2008 and for SLS services beginning in fiscal year 2009.

Everyone in Medicaid Comprehensive and Medicaid Supported Living Services (SLS) must have a SIS completed. Interviews for people receiving Medicaid comprehensive services were completed between November 2006 and September 2007. Interviews for people in Medicaid SLS services will be completed between November 2007 and September 2008.

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The Supports Intensity Scale (SIS) is an assessment that identifies the type, frequency and duration of supports needed for an individual receiving services in order to complete particular tasks or participate in particular activities. The process used to gather the information is through an informal interview. The interview typically takes about two hours to complete. The following is an overview of the assessment process.

The SIS covers different domains, or categories, of support need: Home Living Activities, Community Living Activities, Lifelong Learning Activities, Employment Activities, Health and Safety Activities, Social Activities. There is a supplemental section with questions about Protection and Advocacy, the purpose of which is to gather information on a systemic basis, and sections that address Exceptional Medical and Behavioral Support Needs.

Each domain has eight questions relating to the title of the particular category. For each question there are three answers that need to be addressed: 1) What type of support would be needed for the activity? 2) How frequently would that support needed? 3) How much time in one given day would that support take? The questions are asked in such a way as to identify the support needed to complete a task in the same way as someone without an identified disability; complete a task “successfully” is the term used. As an example, one of the questions speaks to getting dressed. The interviewer asks the question, “What type of support would be needed for the person to successfully get dressed? This includes physically getting dressed and choosing clothing appropriate for the weather. Things like putting on clothes, using zippers, snaps, buttons, etc.”. Then the question of frequency will be addressed, “How frequently would that support be needed?”. Last is the question, “How much time on a daily basis would that support take?”.

Responses to the questions are chosen from the rating key of the assessment.

Rating Key

Type of Support : “What type of support would be needed.” 0 = none 1 = monitoring 2 = verbal/gesture prompting 3 = partial physical assistance 4 = full physical support. Frequency: “How frequently would that support be needed?” 0 = none or less than monthly 1 = at least once a month but not once a week 2 = at least once a week but not once a day 3 = at least once a day but not once an hour 4 = hourly or more frequently Daily Support Time: “How much time in any given day would that support take?” 0 = none 1 = less than 30 minutes 2 = 30 minutes to less than 2 hours 3 = 2 hours to less than 4 hours 4 = 4 hours or more

The interview form, upon which answers are recorded, has only a small description of each question. The interviewer has been trained to expand on each item to explain the intent and scope of the question. Only three questions of the assessment encompass transportation needs. The interviewer will clearly identify those questions for which transportation is taken into consideration.

Since there are two or more respondents during the interview consensus for each rating is to be reached. If there are differences of opinion, the interviewer will ask clarifying questions to assist the group to come to consensus. Specific examples are very helpful in this. It is important to keep in mind that questions relate to overall support needs for a particular task or activity, not to each specific step of the task.

DDD FAQs

Click here for SIS FAQs on the Division for Developmental Disabilities website.   DDD contact: Gail Bernstein 303.866.7143

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