國際健康功能與障礙分類（ICF）系統專業團隊評估模式應用：分類一致性探討

The Evaluation Consistency of Professionals for People with Disabilities: International Classification of Functioning, Disability and Health Practical Applications

王國羽(Kuo-Yu Wang) ； 嚴嘉楓(Chia-Feng Yen)

《身心障礙研究季刊》 9卷4期 (2011/12) Pp. 207-227

https://doi.org/10.30072/JDR.201112.0001

摘要

2007年我國公佈「身心障礙者權益保障法」，第五條揭示身心障礙人口的鑑定分類將在2012年有大幅度的改變，該分類架構將依據世界衛生組織「國際健康功能與身心障礙分類（ICF）」的身體功能及構造章節為基礎。第六及第七條進一步規定所有的鑑定及需求評估都必須是以「專業團隊」模式進行。本研究主要目是欲探討鑑定與需求評估過程中，「專業團隊」成員的專業組成對相同個案的評估差異。研究方法：本研究分為兩階段進行，第一階段主要以專家－德菲術方式進行，研究工具為ICF編碼工具書，以及國內相關團體或個人提供之五個案例背景描述。研究對象為專科醫師、社工師、特殊教育教師、早期療育管理員等七位之專業人員，以ICF編碼定義為依據，針對五個案例給予開放編碼。第二階段則模擬身心障礙者鑑定及需求評估專業團隊之方式，以相同案例分別進行討論，收集物理治療、職能治療及社會工作三類專業人員之編碼結果，此階段共計24人。本研究歸納此三類專業人員對同一個案例的評估結果，進一步分析第一階段及第二階段之專家意見，比較組間與組內差異（within＆between different）。結果：本研究結果發現專科醫師在「身體功能及構造」面向的敏感度及一致性較高，但在其他面向的判定上，專科醫師的判定結果大多停留在ICF第二層。而社工師及其他領域專家在相同個案的判定結果差異性較大，編碼結果較傾向至第三及第四層的描述，並認為個案在活動及參與面向應該陳述細緻，專科醫師則認為在評估選擇涵蓋性較大的編碼即可，不需要過於細緻；這顯示各專業領域間對同一位個案解讀與認知差異較大，若沒有透過適當協商與討論機制，評估結果在各專業團體間必定會有極大的落差，而其後續的福利資源連結及配置，所造成的衝擊勢必更大。

關鍵字

身心障礙者鑑定 ； 專業團隊評估 ； 國際健康功能與障礙分類（ICF）

並列摘要

Base on People with Disabilities Rights Protection Act 5 and Act 6, the identification system for people with disability will be changed significantly in 2012. The new verification and needs assessment system which include assessment tools, assessment process, and plan of training trainer for new identification system are developing from 2007 by our government. All the assessment process will be practiced by professional team-work. Purpose: To evaluate the consistency of outcomes for professionals of every variety. Method: There are two stages to collect data in the present study. The first stage was collecting the ICF-coding for five cases of 7 professionals (specialties, social workers, special education teachers, the experts of early intervention) by Delphi-method. The second stage was by professional team-work (OT, PT, social workers: total 24 persons) with the same cases. To compare and analysis the differences of coding outcomes to the same cases within and between the professionals. Results: High consistency of specialties in body function and structure and significant differences of total coding outcome between social workers and other professionals. The gap with coding outcome of within and between the professionals are both significantly different. The communicative and discussion mechanism are important for verification system to people with disabilities in the future.

並列關鍵字

Group evaluation of professionals ； identify for people with disabilities ； International Classification of Functioning Disability and Health (ICF)

參考文獻

內政部(2010) 。身心障礙權益保障法2007 公布。

王國羽()。,未出版。

Andriesse, H.,Hägglund, G.,Jarnlo, G. B.(2005).The clubfoot assessment protocol (CAP): description and reliability of a structured multi-level instrument follow-up.BMC Musculoskeletal Disorders.6,40.

Bensoussan, L.,Viton, J. M.,Barotsis, N.,Delarque, A.(2008).Evaluation of patients with gait abnormalities in physical and rehabilitation medicine settings.Journal of Rehabilitation Medicine.40,497-507.

Cieza, A.,Ewert, T.,Üstün, T. B.,Chatterji, S.,Kostanjsek, N.,Stucki, G.(2004).Development of ICF Core Sets for patients with chronic conditions.Journal of Rehabilitation Medicine.36,9-11.