Bridging professional decision making and policy formulation – construction and use of the Functional efficiency scale BSM for intensity of support assessment

Social reforms in Serbia have focused on improving accountability of social protection system. In order to support evidence-based decision-making and person-cantered planning in determining the level of intensity and type of... [ view full abstract ]

Social reforms in Serbia have focused on improving accountability of social protection system. In order to support evidence-based decision-making and person-cantered planning in determining the level of intensity and type of support needed for independent life, the FES-BSM scale was developed. Scientific approach was used in operationalization of bylaws with goal to create reliable and short, multidimensional assessment scale which is universal for all beneficiaries.
The aim of this study was to examine psychometric properties of FAS-BSM as precondition for use of the scale in individual decision making, resource allocation and get deeper understanding in use of FAS-BSM for policy planning. Study was conducted on the sample of 304 beneficiaries of system of social care in Serbia, from five subgroups: children without parental care, children with behavioural problems, persons with disability, mentally ill persons and elderly.
During first phase factor structure and interrater reliability was assessed. Each participant was rated by two independent ratters. In second phase feasibility of scale for evidence based planning of services for elderly was assessed on the sample of all users of social care services for elderly in one municipality.
Exploratory factor analysis (WLSMV) suggest that 4 – factor solution is adequate: activities of daily living, instrumental activities of daily living, social skills and mobility (RMSEA=.06, SRMR=.02, CFI=.99 and TLI=.99). Interrater reliability of subscales and instrument was good with kappa in range from .78 to .83. Scale was useful in planning of services and two areas of unmet needs of elderly was identified as well as imbalance in currents structure of support where increasing severity of functional limitations was fallowed with increasing family participation as care providers and decreasing use of services.
Research provides evidence that FES-BSM have very good psychometric properties and can be used for individual assessment, allocation planning and policy formulation.