SRS Frequently Asked Questions

1. How would you rate the SRS if the patient or significant other is your only source of information?
2. What do you do if there are discrepancies between subjects and informants?
3. Can the SRS be abstracted from a medical chart?
4. Can the SRS be collected from a phone interview?
5. How would you rate an individual who is incarcerated?
6. How does the SRS rate an individual who needs full-time supervision but can direct their own care?
7. For the SRS scale, does it matter why an individual needs supervision?
8. How do you rate instances where an individual is getting more supervision than they need (ie an overprotective caregiver)?
9. Are there standard questions to ask? What other scales, if any, would be helpful in determining the SRS score?
10. How do you rate someone who should be supervised during the day, but isn't because no one is available?
11. How do you rate someone in barbituate coma? What if an individual is placed in a barbituate coma so the treating staff doesn't have to restrain him/her?
12. What if someone is living with someone else, but could live independently?
13. Is there a way to extrapolate cost information from this scale?

1. How would you rate the SRS if the patient or significant other is your only source of information?

Since the SRS tries to measure the level of supervision actually received, having only one source should not be a serious problem as long as the source is reliable. One advantage of having both patient and S.O. as sources is that it allows cross-checking. Even if only one source is available, cross-checking is still possible if the SRS rating is implied by the patient's living situation (e.g., the patient is living independently). However, having only one source could lead to an invalid SRS rating if the source is responding invalidly, such as a patient or S.O. in denial or a S.O. who is not sufficiently familiar with the patient's living situation. In these circumstances, the rater should take routine steps to improve data quality, such as contacting a S.O. who might be a better informant.

2. What do you do if there are discrepancies between subjects and informants?

In my experience, this occurs more often when sources report how much supervision they think is needed, instead of reporting factually how much supervision is received. It is important to emphasize to sources that the rater is interested in factual information. Holding joint and separate interviews with the subject and informat may help. For example, if one source reports that the subject has been alone overnight and the other source denies this ever happened, the rater can ask about specific events (e.g., when was the last time the subject was unsupervised overnight?) in order to decide which report is true. Another technique is for the rater to ask the source to report the level of supervision that the source feels is needed and also the level of supervision that the source knows is being received. Sometimes, asking for both reports helps the source to distinguish between these two viewpoints.

3. Can the SRS be abstracted from a medical chart?

SRS ratings must be rated based on someone's direct observation of how much supervision the individual receives. However, it is sometimes possible to rate the SRS from records if the records indicate a living situation that strongly implies a specific level of supervision. For example, this is true if the records indicate that the patient lives alone or independently, lives in a nursing home, or lives in a facility in which the rater knows the level of supervision.

4. Can the SRS be collected from a phone interview?

Yes.

5. How would you rate an individual who is incarcerated?

If the individual is incarcerated in a locked facility, the SRS rating would generally be 11 (closed facility). It is possible that ratings of 12 (1:1 supervision within a closed facility) and 13 (physical restraints) would apply in some cases. Raters should be cautious in using the SRS with individuals in minimum security facilities, some of whom are allowed to travel unsupervised to jobs or on brief passes.

6. How does the SRS rate an individual who needs full-time supervision but can direct their own care?

As a general rule, the SRS rates only the frequency and intensity of supervision being provided. The SRS does not take into account who is responsible for providing the supervision. This should not create a serious problem if the SRS is used with individuals with brain injury, since in this population it is expected that relatively few of those who receive full-time supervision would also be responsible for directing this supervision. However, if the SRS were used with individuals who do not have cognitive limitations (e.g., spinal cord injury), it might be important to clarify that the scale was being used to measure supervision only in the physical sense of the term.

7. For the SRS scale, does it matter why an individual needs supervision?

It needs to be emphasized that the SRS rates how much supervision an individual receives, and not why this is needed. An advantage of this procedure is that level of supervision, as rated by the SRS, should represent the cumulative impact of different impairments and disabilities, in terms of the amount of help received directly from other persons.

8. How do you rate instances where an individual is getting more supervision than they need (ie an overprotective caregiver)?

The rater should follow standard procedure and rate the amount of supervision that the individual actually receives, even if this is more than needed. By following this procedure, the SRS should be sensitive to reductions in the individual's supervision level that might, for example, result if the individual moves to a less restrictive living situation. If this procedure were violated, as would happen if the rating was based on the amount of supervision that the rater felt was needed by the individual, then the SRS might lose sensitivity to change.

9. Are there standard questions to ask? What other scales, if any, would be helpful in determining the SRS score?

If the SRS is administered as an interview, the simplest procedure is for the rater to use the same question that appears in the written instructions: How much time is someone else responsible for being with the patient. If necessary, the rater can use the anchor statements as additional questions (e.g., Does the person ever leave the home alone? Does the person have someone else with him all the time?).

The SRS was designed to be rated without the help of other scales. However, if other scales that measure assistance or supervision in (e.g., FIM) are administered, then the information obtained may be usable in rating the SRS, and vice versa. Therefore, it may be helpful to administer these scales during the same part of the interview.

10. How do you rate someone who should be supervised during the day, but isn't because no one is available?

It is important for the rater to follow standard procedure, which requires the rater to rate the amount of supervision actually received by the person, even if this is less than needed. In this circumstance, the rater should ask whether the person is receiving indirect supervision, for example being checked on occasionally by neighbors during the day.

12. How do you rate someone in barbituate coma? What if an individual is placed in a barbituate coma so the treating staff doesn't have to restrain him/her?

Normally, this would be a patient in the intensive care unit (ICU) of a hospital, which would correspond to a rating of 10 (full-time direct supervision). Note that if physical restraints are used, as is often the case in intubated patients, then the rating could be 13.

If the individual is placed in a barbituate coma so that staff do not have to restarain them, it would probably involve an ICU patient, as in the previous example, and should correspond to a rating of 10.

13. What if someone is living with someone else, but could live independently?

Again, it needs to be emphasized that the SRS is rated based on the level of supervision received and not on the amount that could be received in a less restrictive setting, even if the less restrictive setting would be more appropriate than the actual living situation.

14. Is there a way to extrapolate cost information from this scale?

This is an interesting possibility being studied at our center (TIRR). For example, in the case of a person with brain injury who is receiving supervision from family members, but without having to pay for it, it might be possible to calculate what it would cost to reimburse someone (e.g., personal attendant) for providing the same amount of supervision time.