障礙功能概念之探討－以新制身心障礙需求評估申覆案為例

身心障礙者是一個動態且多樣的交疊過程，「需求」會依據身體功能與結構、活動參與和環境等因素的不同而不同，側重個人生理、心理及社會三層面交流互動下產生的功能限制及健康狀況之全貌，必須從障礙者本身為基礎出發進行需求評估。在2012年實施「新制身心障礙鑑定與需求評估」，即增設了社政端需求評估制度，著重在ICF「活動及參與」的部分，透過評估過程，深入瞭解其生活經驗、執行日常生活困難程度，作為福利服務資格審查與分配的機制，改變原先有手冊就可以直接取得福利資格的方式。然而，至今已實施八年的時間，最初的核心目標是為讓福利資源達到有效的分配，把服務留給有需求的身心障礙者，但，經常發現家屬與身心障礙者，爭相申覆分流一「行動不便」與「必要陪伴者」的福利資格，造成申覆案量逐漸攀升。在這樣的情況下，存在著主觀與客觀認定議題，探討需要哪些資訊或資源協助評估員的判定，評估表設計是否能夠幫助其判斷，以及如何做出決策，評估背後又是什麼樣子的評估邏輯概念，採取何種因應策略方式，才能在最佳利益需求下回應案主的福利需求，讓每個介入與評估都具有積極的意義，是值得探究的議題。因此，本研究以半結構質性訪談方式為主，訪談8位南部曾經擔任或現任需求評估社工人員，以了解需求評估實際操作上，需要蒐集哪些資訊、參考哪些環境因素，以及遇到哪些最適決策之議題。研究結果分析包含一、「功能障礙狀態的影響因素」；二、「與環境互動下的功能限制」、三、「需求評估決策面臨的困難」。最後，研究結論與建議，主要討論議題有：「ICF觀點分析需求內涵」、「需求的最適決策」、「角色兩難，幫助弱勢v.s把關福利資格」、「社會參與的侷限—環境阻礙、移動限制」以及「從社工生態系統，反思需求評估」的意涵來做建議，才具有積極的意義。

關鍵字

ICF ；需求評估；功能障礙限制；申覆案

並列摘要

The mentally and physically disabled experience a dynamic and diverse overlapping process. The "needs" will vary in factors such as physical function and structure, activity participation and environment, focusing on the functional limitations arising from three levels of physical, psychological and social personal interactions and the overall picture of the health status, and the needs assessment must be made based on the disabled themselves. In 2012, the implementation of the "New System of Identification and Needs Assessment for persons with disabilities " means that the social and political needs assessment system was added, focusing on the "Activity and Participation" part of the concepts of ICF. Through the assessment process, we can gain insights into their life experience and the degree of difficulty in performing daily life , which is also a mechanism for the review and distribution of welfare service, changing the way that the disabled with the original manual can directly obtain welfare qualifications. It has been implemented for eight years. The original goal is to achieve effective distribution of welfare resources and leave services to the persons with disabled in need. However, it is often found that family members and the disabled himself are competing for the distributary welfare qualifications of "impaired persons" and "necessary companions" which causes the number of applications to gradually increase. Under such circumstances, with subjective and objective identification issues, discussing what information or resources are needed to assist the assessorss in the assessment, whether the design of the assessment forms can help the assessment, and how to make a decision, and what logic is behind the assessment concept, what kind of responsive strategies can be adopted to respond to the welfare needs of the client for their best interest so that each intervention and evaluation has a positive meaning, a topic worth exploring. Therefore, this research interviewed eight former or current needs assessment social workers in the south to understand what information needs to be collected, which environmental factors are referred to, and which are most suitable issues decision-making. The research results include 1. "Influencing factors of dysfunction state"; 2. "Functional limitations under interaction with the environment"; 3. "Difficulties when facing needs assessment and decision-making". The final part are the research conclusions and recommendations. The Discussion topics include: "ICF perspective analysis needs connotation", "optimal decision-making for needs", "role dilemma, helping the disadvantaged vs. guarding welfare", "limitations of social participation—environmental obstacles, mobility restrictions" and "social work ecosystems, reflections on needs assessment". Only when the above-mentioned are considered can the suggestions we made be of great significance.