Indian Disability Evaluation and Assessment Scale

Indian Disability Evaluation and Assessment Scale (IDEAS) is a scale for measuring and quantifying disability in mental disorders.

Items –

I. Self Care: Includes taking care of body hygiene, grooming, health including bathing, toileting, dressing, eating, taking care of one’s health.

II. Interpersonal Activities (Social Relationships): Includes initiating and maintaining interactions with others in contextual and social appropriate manner.

III. Communication and Understanding: Includes communication and conversation with others by producing and comprehending spoken/written/non-verbal messages.

IV. Work: Three areas are Employment/Housework/ Education Measures on any aspect.

  Performing in Work/Job: Performing in work/employment (paid) employment/selfemployment/ family concern or otherwise. Measure ability to perform tasks at employment completely and
efficiently and in proper time. Includes seeking employment.

  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.

  Performing in school/college: Measures performance education related tasks.
Scores for each item:

NO disability (none, absent, negligible) MILD disability (slight, low) MODERATE disability (medium, fair) SEVERE disability (high, extreme) PROFOUND disability (total cannot do)

. 0  :

. 1  :

. 2  :

. 3  :

. 4  :

TOTAL SCORE: Add scores of the 4 items and obtain a total score

Weight age for Duration of illness (DOI):

  < 2 years

  2-5years

  6-10 years

  10years

:  score to be added is 1

:  add2

:  add 3

:  add4

Global Disability

Total Disability score + DOI score = Global Disability Score Percentages: 0 : No Disability = 0%
1-6 : Mild Disability = < 40 %
7-13 : Moderate Disability = 40 – 70 %

14-19 : Severe Disability = 71-99% 20 : Profound Disability = l00% Cut off for welfare measures = 40 %

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 given and case notes when available.

I. SELF CARE

This should be regarded as activity guided by social norms and conventions. Guiding Questions:

. a)  Maintenance of personal hygiene and physical health.

. b)  Eating habits

. c)  Maintenance of personal belongings and living space

. d)  Does he look after himself, wash his clothes regularly, take a bath and brush his teeth?

. e)  DOES he have regular meals?

. f)  Does he take food of right quality and quantity?

. g)  What about his table manners?

. h)  Does he take care of his personal belongings with reasonable standard of cleanliness and
orderliness?

Scoring:

  0 = No disability
Patient’s level and pattern of self-care are normal, within the social cultural and economic context.

  1= Mild disability
Mild deterioration in self-care and appearance (not bathing. shaving, changing clothes for the occasion as expected). Does not have adverse consequences such as hazards to his health. No embarrassment to family.

  2= Moderate disability
Lack of concern for self-care should be clearly established such as mild deterioration of physical health, obesity, tooth decay &, body odours.

  3= Severe disability
Decline in self-care should be marked in all areas. Patient wearing torn clothes would only wash if made to and would only cat ift6ld. Evidence of serious hazards to physical health. (Malnutrition. infection. patient unacceptable in public).

  4= Profound disability
Total or near total lack of self-care (Example: risk to physical survival, needs feeding, washing, putting on clothes etc., Constant supervision necessary)

II. INTER PERSONAL ACTIVITIES

Includes patient’s response to questions, requests and demands of others, activities or regulating emotions, activities of initiating, maintaining and terminating interactions and activities of engaging in physical intimacy.

Guiding Questions:

. a)  What is his behaviour with others?

. b)  Is he polite?

. c)  Does he respond to questions!

. d)  Is he able to regulate verbal and physical aggression?

. e)  Is he able to act independently in social interactions?

. f)  How does he behave with strangers?

. g)  Is he able to maintain friendship?

. h)  Does he show physical expression of affection and desire?

Scoring:

  0= No disability
Patient gets along reasonably well with people, personal relationships No friction in interpersonal relationships.

  1= Mild disability
Some friction on isolated occasions. Patient known to be nervous or irritable but generally tolerated by others.

  2= Moderate disability
Factual evidence that pattern of response to people is unhealthy. May be seen or more than few
occasions. Could isolate himself from others and avoid company.

  3= Severe disability
Behaviour in social situations is undesirable and generalized. Causes serious problems in daily
living/or work. Patient is socially ostracized.

  4= Profound disability
Patient in serious and lasting conflict, serious danger to problems of others. Family afraid of potential consequences.
III. COMMUNICATION AND UNDERSTANDING
Understanding spoken messages as well as written and non-verbal messages and ability to reduce messages in order to communicate with others.
Guiding Questions:

. a)  Does he avoid talking to people?

. b)  When people come home what does he do?

. c)  Does he ever visit others?

. d)  Is he able to start, maintain and end a conversation?

. e)  Does he understand body language and emotions of others such as smiling, crying,

. f)  screaming, etc.,

. g)  Does he indulge in reading and writing?

. h)  Do you encourage him to be more sociable?

Scoring:

  0 = No disability
Patient mixes, talks and generally interacts with people as much as can be expected in his socio- cultural context. No evidence of avoiding people.

  1= Mild
Patient described as uncommunicative or solitary in social situations. Signs of social anxiety might be reported.

  2= Moderate
A very narrow range of social contacts, evidence of active avoidance of people on some occasions and interference with performance of social rules causes concern to family.

  3= Severe
Evidence of more generalized, active avoidance of contact with people (leave the room when visitors arrive and would not answer the door or phone).

  4= Profound
Hardly has any contacts and actively avoids people nearly all the time. Eg : may lock himself inside the room. Verbal communication is nil or a bare minimum.
IV. WORK
This includes employment, housework and educational performance. Score only one category in case of an overlap.
Guiding Questions:

. a)  Is he employed/unemployed?

. b)  If employed, does he go to work regularly?

. c)  Does he like his job and coping well with it?

. d)  Can you rely on him financially?

. e)  If unemployed, does he make efforts to find job?

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 cope 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.
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 a 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.

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