In 2020, Options Autism Adult Services began implementing the San Martin Scale, a recognised quality of life goal attainment scale for the people in our care.

It is an important step in further supporting the adults who live in our services to increase their independence and work towards attaining a better quality of life. This person-centred approach ensures that we decide targets based on information gathered from the opinions and desires of the people we support, in addition to assessments that are more formal.

There are numerous quality of life instruments in the field of intellectual disabilities, however, most of them focus on those people with the highest levels of functioning, while only a few are suitable for people with more profound intellectual disabilities. People with a severe learning disability are often extremely dependent on third parties when it comes to the satisfaction of their needs, thus their quality of life also depends greatly on those who support them. The San Martin Scale enables professionals to identify areas where service delivery could be improved upon, based on evidence through the assessment of individuals and related to their own view of their quality of life.

Measurable goals help us:

  • Pinpoint priorities for the development and maintenance of quality of life for the people we support
  • Provide an evidence-based means of monitoring and evaluating their progress
  • Support in the identification and development of appropriate interventions
  • Support defensible evidence-based practice, which in turn supports good outcomes for the people we support

How do we Set Goals?

Three priority goals are identified for each person, based upon a Quality of Life Framework, which:

  1. must be a relevant area of focus for the person we support
  2. must be observable and measurable
  3. must be agreed on by the person and all involved in the person’s care

So far we have run a trial of the San Martin Scale in a small number of services. Initial feedback is very positive and we have received some heartening evidence of progress.

What next?

During 2021 we rolled out the San Martin Scale to more of our adult services, and this roll out continues during 2022 so that more people can benefit. With each cycle of assessment and goal setting, we are starting to see clear evidence that people’s quality of life is improving with the use of this tool. We look forward to providing more updates in the coming months.

The San Martin Scale is based on the eight dimensional model of Verugo and Schalock (2014) and as such is divided into 8 domains: Self-Determination; Rights; Emotional Wellbeing; Social Inclusion; Personal Development; Interpersonal Relationships; Material Wellbeing; and Physical Wellbeing. Each domain targets a specific area, known to be correlated with people’s rating of quality of life, and has been identified through revision of the literature over the last two decades. 

The scale is a 95-item Likert scale questionnaire that should be completed by a third-party respondent who knows the adult well. In Options services, the assessment is currently completed by the Assistant Psychologists and care staff, usually the House Manager or Team Leader. The rater is asked to answer the questions with a ‘never’, ‘sometimes’, ‘often’ or ‘always’ response for the adult they are supporting. Following the completion of the assessment, a report is shared with the service and the person’s family where appropriate. Goals are then selected and developed in collaboration with the relevant clinician.  Each adult’s assessment will be reviewed and re-administered annually to allow for flexibility in the goals and approach.