身心障礙鑑定與需求評估分析－分立？或整合？

Disability evaluation and needs assessment of International Classification of Functioning, Disability and Health in Taiwan: separated or integrated?

10.6288/TJPH.202202_41(1).110136

姚奮志(Fen Zhi Yao)

身心障礙功能鑑定 ； 身心障礙需求評估 ； 身心障礙鑑定 ； functioning disability evaluation scale ； Taiwan ICF needs assessment scale ； disability evaluation

台灣公共衛生雜誌

41卷1期（2022 / 02 / 25）

81 - 95

繁體中文

目標：本研究主要了解身心障礙鑑定評估兩階段工具，「身心障礙鑑定功能量表」與「福利與服務需求評估訪談表」的關聯性與差異性，並討論對身心障礙者評估結果的影響。方法：運用衛生福利部身心障礙功能鑑定資料庫與需求評估資料庫2015年至2019年的有效資料共59,787筆，針對兩份工具的評估結果運用等級相關、卡方適合度考驗與單因子變異數分析進行比對。結果：根據各項數據，兩份工具是同一個ICF理念但各自表述；身障者社會參與環境因素在整體鑑定過程中難以評量；身障者的障礙認定有受到區域性的差異對待。結論：制度規劃應整合鑑定評估流程、加強環境因素的考量與應用、強化以身障者為核心的互動和參與。整體鑑定評估流程呈現分立式、區隔化、差異性的特徵，影響身障者評估權益。

Objectives: This study was conducted to understand the correlation and differences between the two-stage tools for disability evaluation-the Functioning Scale of the Disability Evaluation System and the Needs Assessment of Welfare Services for Persons with Disabilities-and to discuss their impact on disability evaluation result. Methods: A total of 59,787 pieces of valid data from the disability evaluation database and needs assessment database of the Ministry of Health and Welfare (MOHW) for the period from 2015 to 2019 were used for the analysis. The results of the two tools were compared through rank correlation, chi-square distribution, and one-way analysis of variance. Results: The data indicated that the two tools were expressed separately by the same ICF ideal. The evaluation of environmental factors was difficult in the overall system. The evaluation of the disabled was subject to regional differences. Conclusions: The system should integrate the evaluation process, reinforce the consideration and application of environmental factors, and facilitate the interaction with and participation of the disabled. The overall evaluation process is characterized by a separated, compartmentalized, and difference approach that undermines the implementation of disability evaluation rights.

1. 周月清, YC,王育瑜, YY,林昭文, ZW(2009)。地方制度法施行對中央與地方社會福利制度的影響：以身心障礙福利為例。台灣社會工作學刊，6，38-78。
   連結：
2. 周月清, YC,張恆豪, HH(2017)。新制身心障礙鑑定與需求評估（ICF）執行之探討：身心障礙服務使用者觀點。東吳社會工作學報，32，1-34。
   連結：
3. 周宇翔, YH,李淑貞, SJ,何季蓉, CJ,張聿淳, YC,劉旻宜, MY(2013)。從理念到落實─ICF在台灣的實踐經驗：以身心障礙者福利與服務需求評估訪談表為例。身心障礙研究，11，249-261。
   連結：
4. 邱大昕, TS(2011)。誰是身心障礙者：從身心障礙鑑定的演變看「國際健康功能與身心障礙分類系統」（ICF）的實施。社會政策與社會工作學刊，15，187-213。
   連結：
5. 全國法規資料庫：身心障礙者鑑定與需求評估作業併同辦理實施辦法。https://law.moj.gov.tw/LawClass/LawSingle.aspx?pcode=D0050184&flno=6。引用2022/02/01。 Laws & Regulations Database of the Republic of China. Regulations of evaluation and needs assessment of people with disabilities are combined for processing. Available at: https://law.moj.gov.tw/LawClass/LawSingle.aspx?pcode=D0050184&flno=6. Accessed Accessed February 1, 2022. [In Chinese]
6. Allan, CM,Campbell, WN,Guptill, CA,Stephenson, FF,Campbell, KE(2006).A conceptual model for interprofessional education: the international classification of functioning, disability and health (ICF).J Interprof Care,20,235-245.
7. Brandt, DE,Ho, PS,Chan, L,Rasch, EK(2014).Conceptualizing disability in US national surveys: application of the World Health Organization’s (WHO) International Classification of Functioning, Disability and Health (ICF) framework.Qual Life Res,23,2663-2671.
8. Caisse nationale de Solidarité Pour l’autonomie (CNSA). Manuel D’accompagnement du GEVA (Guide d’évaluation des besoins de compensation de la personne handicapée), 2008. Available at: https://www.cnsa.fr/documentation-et-donnees/formulaires/version-graphique-du-geva-et-son-manuel. Accessed February 1, 2022
9. Chiu, WT,Yen, CF,Teng, SW(2013).Implementing disability evaluation and welfare services based on the framework of the international classification of functioning, disability and health: experiences in Taiwan.BMC Health Serv Res,13,416-425.
10. Chou, YC,Kröger, T(2017).Application of the ICF in Taiwan - victory of the medical model?.Disabil Soc,32,1043-1064.
11. Day, AM,Theurer, JA,Dykstra, AD,Doyle, PC(2012).Nature and the natural environment as health facilitators: the need to reconceptualize the ICF environmental factors.Disabil Rehabil,34,2281-2290.
12. Denermark, B,Granberg, S,Kramer, SE,Selb, M,Möller, C(2013).The creation of a comprehensive and a brief core set for hearing loss using the international classification of functioning, disability and health.Am J Audiol,22,323-328.
13. Fresk, M,Brodin, N,Grooten, WJ,Joseph, C,Kiessling, A(2019).Mapping a measure of physical ability for persons with long-term musculoskeletal pain to the ICF and ICF Core Sets.Eur J Public Health,29,286-291.
14. Grill, E,Furman, JM,Alghwiri, AA,Müller, M,Whitney, SL(2013).Using core sets of the international classification of functioning, disability and health (ICF) to measure disability in vestibular disorders: study protocol.J Vestib Res,23,297-303.
15. Heerkens, YF,de Brouwer, CPM,Engels, JA,van der Gulden, JWJ,Kant, I(2017).Elaboration of the contextual factors of the ICF for Occupational Health Care.Work,57,187-204.
16. Hoefsmit, N,Houkes, I,Nijhuis, F(2014).Environmental and personal factors that support early return-to-work: a qualitative study using the ICF as a framework.Work,48,203-215.
17. Hoyle, P(2017).Integrated categories for integrated care - the importance of patient centred categories.Int J Integrated Care,17,A16.
18. Linden, M(2017).Definition and assessment of disability in mental disorders under the perspective of the International Classification of Functioning Disability and Health (ICF).Behav Sci Law,35,124-134.
19. McDougall, J,Wright, V,Rosenbaum, P(2010).The ICF model of functioning and disability: incorporating quality of life and human development.Dev Neurorehabil,13,204-211.
20. Piškur, B,Daniëls, R,Jongmans, MJ(2014).Participation and social participation: are they distinct concepts?.Clin Rehabil,28,211-220.
21. Prodinger, B,Salzberger, T,Stucki, G,Stamm, T,Cieza, A(2011).Measuring functioning in people with fibromyalgia (FM) based on the international classification of functioning, disability and health (ICF) -- a psychometric analysis.Pain Pract,12,255-265.
22. Regione del Veneto Aziende ULSS. della Scheda di Valutazione Multidimensionale della Disabilità, 2014. Available at: https://bur.regione.veneto.it. Accessed December 9, 2021
23. Rosa, D,MacDermid, J,Klubowicz, D(2021).A comparative performance analysis of the International Classification of Functioning|Disability and Health and the Item-Perspective Classification framework for classifying the content of patient reported outcome measures.Health Qual Life Outcomes,19,132.
24. Smart, JF(2005).The promise of the International Classification of Functioning, Disability, and Health (ICF).Rehabil Educ,19,191-199.
25. Teng, SW,Yen, CF,Liao, HF(2013).Evolution of system for disability assessment based on the international classification of functioning, disability, and health: a Taiwanese study.J Formos Med Assoc,112,691-698.
26. Tucker, CA,Cieza, A,Riley, AW(2014).Concept analysis of the patient reported outcomes measurement information system (PROMIS®) and the International Classification of Functioning, Disability and Health (ICF).Qual Life Res,23,1677-1686.
27. Ustun, TB,Kostanjesek, N,Chatterji, S,Rehm, J,WHO(2010).Measuring Health and Disability: Manual for WHO Disability Assessment Schedule (WHODAS 2.0).Geneva:WHO.
28. van Ierssel, J,Sveistrup, H,Marshall, S(2018).Identifying the concepts contained within health-related quality of life outcome measures in concussion research using the International Classification of Functioning, Disability, and Health as a reference: a systematic review.Qual Life Res,27,3071-3086.
29. Verdonschot, MM,de Witte, LP,Reichrath, E,Buntinx, WH,Curfs, LM(2009).Impact of environmental factors on community participation of persons with an intellectual disability: a systematic review.J Intellect Disabil Res,53,54-64.
30. WHO(2002).Towards a Common Language for Functioning, Disability and Health (ICF).Geneva:WHO.
31. WHO(2001).International Classification of Functioning, Disability and Health (ICF).Geneva:WHO.
32. 王國羽, KY(2012)。世界衛生組織分類系統與障礙測量議題。障礙研究：理論與政策應用，高雄=Kaohsiung:
33. 台灣國際功能身心障礙與健康分類系統研究學會：身心障礙鑑定人員訓練—Q&A 2019。http://www.icf.org.tw/QAList.asp。引用2021/09/01。 Taiwan Society of International Classification of Functioning, Disability and Health. Training for disability identification personnel -- Q&A 2019. Available at: http://www.icf.org.tw/QAList.asp. Accessed September 1, 2021. [In Chinese]
34. 李淑貞, SJ,陳政智, CC,謝東儒, TR,郭婉盈, WY,張聿淳, YC,周宇翔, YH(2014).我國身心障礙者福利與服務需求評估指標、工具、流程與實務操作模式之驗證修正.台北=Taipei:衛生福利部=Ministry of Health and Welfare, R.O.C. (Taiwan).
35. 周宇翔, YH,李淑貞, SJ,謝東儒, TR,張聿淳, YC(2013)。ICF架構下的身心障礙者需求評估制度現況與挑戰。社區發展季刊，150，40-57。
36. 林萬億, WY(2010)。,台北=Taipei:內政部=Ministry of the Interior, R.O.C. (Taiwan)。
37. 邱佳盈, JY(2014)。花蓮=Hualien，慈濟大學公共衛生學系=Deaprtment of Public Health, Tzu Chi University。
38. 姚奮志, FZ(2016)。身心障礙者個案管理及生涯轉銜服務：現況分析檢討與發展。台灣社區工作與社區研究學刊，6，77-138。
39. 姚奮志, FZ,李淑貞, SJ,梁美榮, MJ(2021)。,台北=Taipei:衛生福利部=Ministry of Health and Welfare, R.O.C. (Taiwan)。
40. 張光華, KH,林靖瑛, YC,王淑真, SJ(2015)。新制身心障礙鑑定制度實施後身心障礙者的看法與期許。社區發展季刊，150，110-122。
41. 梁美榮, MJ,姚奮志, FZ(2019)。身心障礙法定需求評估與個案管理服務整合之研究。台灣社區工作與社區研究學刊，9，113-160。
42. 廖華芳, HF,嚴嘉楓, CF,黃靄雯, AW(2013)。身心障礙鑑定功能量表之運用。台灣醫學，17，317-331。
43. 廖華芳, HF,嚴嘉楓, JF,黃靄雯, AW,劉燦宏, CH,紀彣宙, WC(2015)。身心障礙鑑定功能量表之發展與應用。社區發展季刊，150，77-98。
44. 監察院：糾正案文109內正0011字號。https://www.cy.gov.tw/CyBsBoxContent.aspx?s=17016。引用2021/08/20 The Control Yuan, R.O.C. (Taiwan). Control Yuan No. 109 Internal 0011 Corrective Measures Document. Available at: https://www.cy.gov.tw/CyBsBoxContent.aspx?s=17016. Accessed August 20, 2021. [In Chinese]
45. 衛生福利部：身心障礙者人數按類別及縣市別分。https://dep.mohw.gov.tw/DOS/cp-5224-62359-113.html。引用2022/01/29。 Ministry of Health and Welfare, R.O.C. (Taiwan). The disabled population by classification and locality. Available at: https://dep.mohw.gov.tw/DOS/cp-5224-62359-113.html. Accessed January 29, 2022. [In Chinese]
46. 衛生福利部, R.O.C. (Taiwan)(2016).身心障礙鑑定功能量表8.0版操作手冊.台北=Taipei:衛生福利部=Ministry of Health and Welfare, R.O.C. (Taiwan).
47. 衛生福利部, R.O.C. (Taiwan)(2010).身心障礙權益保障白皮書.台北=Taipei:衛生福利部=Ministry of Health and Welfare, R.O.C. (Taiwan).
48. 衛生福利部：身心障礙者福利與服務需求評估及證明核發辦法。https://law.moj.gov.tw/LawClass/LawAll.aspx?pcode=D0050050。引用2022/02/01。 Ministry of Health and Welfare, R.O.C. (Taiwan). Welfare and service needs assessment of the people with disabilities and the certification method. Available at: https://law.moj.gov.tw/LawClass/LawAll.aspx?pcode=D0050050. Accessed February 1, 2022. [In Chinese]
49. 衛生福利部護理及健康照護司：各縣市併同辦理醫院名冊1101208。https://dep.mohw.gov.tw/donahc/cp-1038-5219-104.html。引用2022/02/1。 Department of Nursing and Health Care, Ministry of Health and Welfare, R.O.C. (Taiwan). All counties and cities also handle the hospital register (1101208). Available at: https://dep.mohw.gov.tw/donahc/cp-1038-5219-104.html. Accessed February 1, 2022. [In Chinese]
50. 賴俊帆, CF(2018)。台灣身心障礙需求評估與服務輸送圖像：脈絡中的制度化效果。台灣社區工作與社區研究學刊，8，87-118。