Generalization and Sustainability in Positive Behavior Support

In Katherine’s story there are several types of measures that are used to evaluate outcomes. However, at the end of the day, the most critical outcome is whether Katherine’s quality of life improved. There are many ways to assess quality of life. For example, in Katherine’s case, one measure used was parent ratings. However, there are many others measures that can be collected.

Quality of life can change in dramatic ways over time with some domains becoming more important and others decreasing in importance. An assertive community treatment, wraparound, or person-centered plan will include gathering information that will help a child or adult and team members consider what measures are most important during a time in someone's life.

For example, a quality of life domain addressing the rights a person experiences, prompts us to consider whether the degree to which a person's life includes privacy, basic freedoms, the ability to vote, and obtain legal supports. These issues are naturally different for a young child in a family setting compared a young adult. Domains often shift across the lifespan as a person's life changes over time. The events in a person's life can shift suddenly leading to the need for measures that will help a person better understand how to achieve an optimal sense of well-being.

Quality of Life Domains in the Disability Field and in Mental Health

Assessing Quality of Life and Across People

SAMHSA’s Eight Dimensions of Wellness

• Social – Developing a support system/feeling connected to others
• Emotional - Skills to cope with stress and negative life outcomes
• Spiritual – Search for meaning/sense of purpose
• Intellectual – Knowing one’s strengths and expanding wisdom and skills
• Physical – Basic needs related to sleep, physical activity, and diet
• Environmental – Living in positive settings that support well being
• Financial – Satisfaction with current finances and future plan
• Occupational – Obtaining a sense of positive meaning from one’s work

Quality of Life and IDD

• Emotional Wellbeing – Feelings of happiness or contentment, feeling comfortable and safe at home and in the community
• Interpersonal Relationships –Receiving affection and love at home and in the community, connecting with others
• Material Wellbeing –Being able to purchase items that one wants or needs, owning items or property
• Personal Development – Learning and evolving as a person in education and life
• Physical Wellbeing – Maintaining optimal health and mobility
• Self-Determination –Making one’s own important life decisions and life goals
• Social Inclusion –Feeling included as part of a community and building meaningful connections with others
• Rights – Being able to have one’s right to privacy and freedom and access to legal support, to vote and engage in civic responsibilities

Quality of Life Indicators of Quality of Life

Many Different Kinds of Measures for Quality of Life: Indicators Measures

Emotional Well-Being	Enjoyment of Life Self-Concept Stress Levels
Interpersonal Relations	Quality/Number of Interactions with Others Quality/Number of Relationships with Others Informal and Formal Supports for Relationships
Material Well-Being	Financial Status Type and Preference for Employment Quality of Housing
Personal Development	Educational Opportunities Personal Competence at Home/School/Work/Community Performance in Important Activities
Physical Well-Being	Health Status Activities to Encourage Exercise, Stimulation, and Relaxation Leisure Activities: Quality and Number
Self-Determination	Autonomy: Extent to Which Person Has Control Over Important Life Experiences Opportunities for Choice Making Every Day Goals and Personal Values Acknowledged, Followed and Respected by Others
Social Inclusion	Community Integration and Participation Community Roles That Bring Respect and Social Equity Social Supports Necessary for Community Involvement
Rights	Extent to Which Person Experience Fair and Equitable Treatment in the Home and Community Extent to Which Legal Supports Are Available