Implementing disability evaluation and welfare services based on the framework of the international classification of functioning, disability and health: experiences in Taiwan

Wen-Ta Chiu,Sue-Wen Teng,Kwang-Hwa Chang,Chia-Feng Yen,Wen-Chou Chi,Hua-Fang Liao,Tsan-Hon Liou,Yen-Ho Wang

doi:10.1186/1472-6963-13-416

Abstract

BackgroundBefore 2007, the disability evaluation was based on the medical model in Taiwan. According to the People with Disabilities Rights Protection Act, from 2012 the assessment of a person’s eligibility for disability benefits has to be determined based on the International Classification of Functioning, Disability, and Health (ICF) framework nationwide. The purposes of this study were to: 1) design the evaluation tools for disability eligibility system based on the ICF/ICF-Children and Youth; 2) compare the differences of grades of disability between the old and new evaluation systems; 3) analyse the outcome of the new disability evaluation system.MethodsTo develop evaluation tools and procedure for disability determination, we formed an implementation taskforce, including 199 professional experts, and conducted a small-scale field trial to examine the feasibility of evaluation tools in Phase I. To refine the evaluation tools and process and to compare the difference of the grades of disability between new and old systems, 7,329 persons with disabilities were randomly recruited in a national population-based study in Phase II. To implement the new system smoothly and understand the impact of the new system, the collaboration mechanism was established and data of 168,052 persons who applied for the disability benefits was extracted from the information system and analysed in Phase III.ResultsThe measures of the 43 categories for body function/structure components, the Functioning Scale of Disability Evaluation System for activities/participation components, and the needs assessment have been developed and used in the field after several revisions. In Phase II, there was 49.7% agreement of disability grades between the old and new systems. In Phase III, 110,667 persons with a disability received their welfare services through the new system. Among them, 77% received basic social welfare support, 89% financial support, 24% allowance for assistive technology, 7% caregiver support, 8% nursing care and rehabilitation services at home, and 47% were issued parking permits for persons with disability.ConclusionThis study demonstrated that disability evaluation system based on the ICF could provide a common language between disability assessment, needs assessment and welfare services. However, the proposed assessment protocol and tools require additional testing and validation.

Highlights

Before 2007, the disability evaluation was based on the medical model in Taiwan
The specific aims of this study were to: 1) design the evaluation tools for disability eligibility system based on the International classification of functioning (ICF) and ICF-child and youth (ICFCY); 2) compare the differences of disability grades between the old and new systems; 3) analyse the outcome of the new disability evaluation system
Development of the measures of the core set for disability evaluation This study used Delphi technique to develop the b/s core set for the disability assessment [17,18,19]. (Figure 4) Forty-three b/s categories were included in the core set

Summary

Introduction

According to the People with Disabilities Rights Protection Act, from 2012 the assessment of a person’s eligibility for disability benefits has to be determined based on the International Classification of Functioning, Disability, and Health (ICF) framework nationwide. Disability had been narrowly equated with the health condition, impairment, or capacity limitations of people This overly medicalized view fails to address the social factors, discrimination, prejudice, and barrier of environmental factors that prevent the full participation of people with disabilities, and unable to describe the factors, such as assistive technology, that contribute to the overall disability experience [4,5]. The ICF framework assists in examining an individual functioning at the physical, personal, and societal levels, and provides definitions to conduct operational assessments. The ICF framework was used in the Multi-Country Survey Study conducted by the WHO between 2000 and 2001, and the World Health Survey Program of 2002 and 2003, to measure the health status of general populations in 71 countries [4]

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Discussion

Conclusion