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?

姚奮志(Fen Zhi Yao)

《台灣公共衛生雜誌》 41卷1期 (2022/02) Pp. 81-95

https://doi.org/10.6288/TJPH.202202_41(1).110136

摘要

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。

關鍵字

身心障礙功能鑑定 ； 身心障礙需求評估 ； 身心障礙鑑定

並列摘要

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.

並列關鍵字

functioning disability evaluation scale ； Taiwan ICF needs assessment scale ； disability evaluation

參考文獻

賴俊帆：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 2018；8：87-118。doi:10.3966/222372402018100802003。 Lai CF. The needs assessment and service delivery image of disability in Taiwan: the effect of institutionalization in the context. J Community Work Community Studies 2018;8:87-118. doi:10.3966/222372402018100802003. [In Chinese: English abstract]

廖華芳、嚴嘉楓、黃靄雯等：身心障礙鑑定功能量表之運用。台灣醫學 2013；17：317-31。doi:10.6320/FJM.2013.17(3).13。 Liao HF, Yen CF, Hwang AW, et al. Application of the functioning scale of the disability evaluation system. Formosan J Med 2013;17:317-31. doi:10.6320/FJM.2013.17(3).13. [In Chinese: English abstract]

梁美榮、姚奮志：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2019；9：113-60。doi:10.3966/222372402019100902003。 Liang MJ, Yao FZ. A study on the integration of legal needs assessment and case management services for the disabled. J Community Work Community Studies 2019;9:113-60. doi:10.3966/222372402019100902003. [In Chinese: English abstract]

邱大昕：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 2011；15：187-213。doi:10.6785/SPSW.201112.0189。 Chiu TS. Who are the disabled: an examination of the application of ICF in light of the history of disability evaluations in Taiwan. Soc Policy Soc Work 2011;15:187-213. doi:10.6785/SPSW.201112.0189. [In Chinese: English abstract]

周月清、王育瑜、林昭文：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 2009；(6)：38-78。doi:10.29814/TSW.200901.0002。 Chou YC, Wang YY, Lin ZW. Impacts of Local Government Act on social welfare services at central and local level: the case of disability welfare services. Taiwanese Soc Work 2009;(6):38-78. doi:10.29814/TSW.200901.0002. [In Chinese: English abstract]