Abstract
Competency assessment of adults with cognitive impairment or mental illness is a complex process that have significant impact on their autonomy and civil rights. Health and social services professionals faced with this question have the responsibility to ensure the protection of these persons, but they must consider the issues surrounding the loss of their rights and autonomy. How can they assure their role as evaluator, while protecting the rights of these people ? How can they stay person-centered and consider the opinion and values of the person and his family throughout the process? Health and social services professionals may then find themselves in an ethical dilemma. To support them in this process, a decision-making tool has been developed to support the competency assessment process by interdisciplinary teams, the Competency Assessment Tool (CAT). This innovative tool integrates both a rigorous evaluation process but also an ethical decision-making process centered on the person. Four studies were carried out to validate the CAT. Thus, a first study was conducted among healthcare and social services professionals. To do this, a focus group with seven participants was conducted. Then, a Delphi study was conducted with 33 health and social services professionals. A validation study with older people, caregivers and members of people's rights protection agencies was conducted through five focus groups. Finally, ten individual interviews were conducted with lawyers. The results demonstrate that the CAT is an innovative, relevant and comprehensive tool that ensures a rigorous assessment and support a person-centered decision making process based on ethical deliberation involving all interdisciplinary team members. Moreover, the CAT is a versatile tool that can be used in different practice contexts. The use of the CAT by the entire interdisciplinary team allows a more comprehensive assessment, a more efficient information sharing and assure a more comprehensive view of the situation of the person.