Development and validation of the ICF-CY-Based Functioning Scale of the Disability Evaluation System--Child Version in Taiwan.

BACKGROUND/PURPOSE: The International Classification of Functioning, Disability, and Health-Children and Youth version (ICF-CY) depicts human functioning [body functions (b), structures (s), and activities and participation (d) components] as the product of the interaction between health conditions and contextual factors [environmental factors (e) and personal factors]. In Taiwan, testers use the Functioning Scale of the Disability Evaluation System-Child version (FUNDES-Child) to collect information related to b, d, and e for children aged 6.0-17.9 years in the Disability Eligibility System (DES). The purpose of this study was to examine the content and construct validity of the FUNDES-Child. METHODS: We developed the FUNDES-Child through translating the existing questionnaires, cross-cultural adaptation, expert consensus, and field tests. Consensus meetings were conducted to link items from the FUNDES-Child to ICF-CY codes. To investigate construct validity, we examined associations among scores from the FUNDES-Child that reflected ICF-CY chapter-linked components. RESULTS: The FUNDES-Child items were successfully linked to all nine d-, five b-, and four e-chapters of the ICF-CY. Moderate correlations were found between scores that were expected to be related to specific chapters in the b, d, and e components. The scores of the b-chapters had stronger relationships with the d independence scores, while attitudes of others (e4) had stronger relationships with the d participation frequency scores. CONCLUSION: The FUNDES-Child had acceptable content validity and construct validity in the DES. The associations found among the ICF-CY chapter scores provided a model for investigating the impact of body functions and environmental factors on children's activities and participation.

Measuring disability and its predicting factors in a large database in Taiwan using the World Health Organization Disability Assessment Schedule 2.0.

The definition of disability had been unclear until the International Classification of Functioning, Disability, and Health was promulgated in 2001 by the World Health Organization (WHO). Disability is a critical but relatively neglected public-health concern. We conducted this study to measure disabilities by using the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) and identify the factors that contribute to disabilities. We obtained and analyzed the data on people who applied to Taiwan's disability registration system between September 2012 and August 2013. A total of 158,174 cases were selected for this study. Among the people included in this study, 53% were male, and the females were on average 3 years older than the males. More males than females were of a low socioeconomic status, but the rate of employment was higher among the males than among the females. Age, sex, place of residence, and types and severity of impairment were all determined to be factors that independently contributed to disability. This study has demonstrated that disability can be measured and compared using WHODAS 2.0. Increasing the public-health attention devoted to disability and identifying the factors associated with disability can promote independence and social participation in people with disabilities.

Does the planned long-term care policy in Taiwan meet the needs of people with disabilities?

The long-term care (LTC) insurance policy will be enacted in Taiwan. Under the proposed policy, people with disabilities will have priority in receiving insurance. The aim of this study was to compare the functional statuses of 3 disability groups and to investigate the coverage provided by the planned LTC insurance in Taiwan. A cross-sectional study was conducted in this study to fulfill this research goal. There were 3239 subjects with physical, sensory, or intellectual disabilities from the Disability Eligibility System during September 2011 and July 2012. The World Health Organization Disability Assessment Schedule 2.0 - 36-item version (WHODAS 2.0)--traditional Chinese version was used to assess their functional statuses. Significant differences in all of the domain scores and summary scores of the WHODAS 2.0 were determined after adjusting for age among the 3 groups. People with physical or sensory disabilities exhibited the most drastic differences in the domain of daily living, and people with intellectual disabilities exhibited major differences in the cognition domain. After matching the planned coverage services, we determined that the planned LTC insurance does not meet the diverse needs of people with disabilities. In particular, social participation and a sense of security and satisfaction regarding the psychological aspects of having a disability must be considered in LTC insurance policies.

Implementing disability evaluation and welfare services based on the framework of the International Classification of Functioning, Disability and Health: experiences in Taiwan.

BACKGROUND: Before 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. METHODS: To 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. RESULTS: The 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. CONCLUSION: This 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.

Evolution of system for disability assessment based on the International Classification of Functioning, Disability, and Health: A Taiwanese study.

BACKGROUND/PURPOSE: The criteria for disability were mainly based on the medical model, and the candidates for disability benefits were identified by physicians mainly depending on their degree of bodily impairment, but without sufficient evaluation of their activity, participation, and environment in Taiwan. According to the People with Disabilities Rights Protection Act, the assessment of a person's eligibility for disability benefits was required to be based on the International Classification of Functioning, Disability, and Health (ICF) framework since July 11, 2012. This study investigated a proposed system to assess patients' eligibility for disability in Taiwan, based on the ICF. METHODS: We have initiated a national decision-making process involving members of Taiwan's ICF Team. We facilitated 16 group discussions on the ICF coding system, in which 199 professionals participated. In each group, one member led the group discussion until a consensus was reached. RESULTS: We have developed a process to determine the eligibility of people with disabilities. This study set up the standards, tools, and practice manuals for each category. We have also developed a core set for disability assessment. CONCLUSION: We implemented a new system to assess patients' eligibility for disability. The proposed assessment protocol and tools require further validation.

Developing a disability determination model using a decision support system in Taiwan: a pilot study.

BACKGROUND/PURPOSE: The aims of our study were to: (1) develop the Disability Grading Decision Support System (DGDSS) and to (2) compare the new International Classification of Functioning, Disability, and Health (ICF)-based disability determination tool (ICF-DDT) with the diagnosis-based disability determination tool (D-DDT). METHODS: A total of 9357 patients recruited from 236 accredited institutions were evaluated using the ICF-DDT and the D-DDT, and the presence, severity, and category of the disability identified using the two determination tools were compared. In the DGDSS, the ICF-DDT consisted of four models comprising nine modules to determine the presence and the severity of the disability. The differences between models (modules) are the different combinations of World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) and Scale of Body Functions and Structures. RESULTS: Compared with the D-DDT, more patients were determined to be disability-free when using the ICF-DDT. Module 1-1 had the highest profoundly severe rate, and module 2-2 had the highest mild and moderate disability rates. Module 2-1 had the highest severe disability rate. Module 1-1 resulted in the smallest difference, and module 3-1 resulted in the largest difference, compared with the D-DDT. Feedback from users suggested that the DGDSS is a robust system if the original data are accurate. CONCLUSION: The presence, severity, and category of the disability determined using the ICF-DDT and the D-DDT were significantly different. The results of the DGDSS provide information for policymakers to determine the optimal allocation of social welfare and medical resources for people with disabilities.