Experiences of ICF/ICF-CY Implementation in Taiwan Hua-Fang (Lily) Liao 1,2 , Tsan-Hon Liou 2,3 , Chia-Feng Yen 2 , Ai-Wen Hwang 2,4 , Wen-Chou Chi 2 , Tien-Fang Wu 2 , Yi-Ling Pan 5 1 School and Graduate Institue of Physical Therapy, College of Medicine, National Taiwan University, Taipeiu, Taiwan 2 Taiwan ICF Reasearch Team 3 Institute of Injury Prevention & Control, Taipei medical University, Taipeiu, Taiwan 4 Graduate Institute of Early Intervention, Chang-Gung University, Kweishan, Taoyuan, Taiwan 5 Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, NTU, Taipei CBR: practice and evidence-building in diverse locations, University of Sydney, Oct 5-6 2011 1
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Experiences of ICF/ICF-CY Implementation in Taiwan
1School and Graduate Institue of Physical Therapy, College of Medicine, National Taiwan University, Taipeiu, Taiwan 2Taiwan ICF Reasearch Team 3Institute of Injury Prevention & Control, Taipei medical University, Taipeiu, Taiwan 4Graduate Institute of Early Intervention, Chang-Gung University, Kweishan, Taoyuan, Taiwan 5Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, NTU, Taipei
CBR: practice and evidence-building in diverse locations, University of Sydney, Oct 5-6 2011
1
Implementation of ICF/ICF-CY in Taiwan since 2002
• Policy design The People with Disabilities Rights Protection Act (2007) Changes in the disability eligibility system and services (2012-)
• Clinical practice and education Professionals
Assessment, documentation, and service delivery (2004 -) Education in different disciplines (2002 -)
Participation of the public, especially people with disabilities Attending and organizing workshops (2008 -) Implementation of ICF in the eligibility system (2012-)
Taiwan Society of International Classification of Functioning, Disability and Health (TSICF) (2009-)
• Research and publication Understanding of ICF/ICF-CY, classification, clinical application,
etc.. (2002-)
Health Condition
Body Functions & Structures
Activities Participation
Environmental Factors
Personal Factors
2
Application of ICF/ICF-CY in the disability eligibility system in Taiwan, July 2012
• The health authority Evaluation reports after the medical
examination (b,s) and functional assessment (d,e)
• The social welfare system Needs Assessment (e)
• The county (city) authorities Issue the disability
identifications Provide the mandatorily related
welfare and services
Medical Examination
Functional Assessment
Needs Assessment
Disability Identifications & Providing Services 3
Task force on functioning assessment of disability eligibility system, Taiwan ICF research team Article 6: Qualification of the disability assessment professionals, the
categories and grades of disability, assessment items and standards, assessment methods, instruments, operation and others are prescribed by the central competent authorities in charge of health (Department of Health) to design content of eligibility assessment to conduct pilot studies to examine its
reliability and validity Article 6: Local health authorities shall assemble assessment
teams to render the assessment services and complete appraising and ascertaining/verification reports on the disability. to design and provide training courses for
assessment teams 4
5
Need Assessment
(Social welfare system)
Change assessment content, Assessing 13000 persons with disabilities in 25 cities and counties
Training testers, Assessing 500 persons in 4 cities
Task force for developing the eligibility system based on ICF in Taiwan
Part 1: Functioning and Disability
Part 2: Contextual Factors
Personal Factors
Measuring tool
5
Measuring tool Year2008
2009
2010 2011
ICF
Body Functions and Structures
(b, s codes)
Activities and Participation
(d codes)
Environmental Factors
(e codes)
5
Comparisons between old and new eligibility systems
Correlation coefficients between d4 and scores of WHO DAS in stroke patents (n=110) (2010 ICF Trial study)
WHODAS Whole score
d4-capacity 0.89
d4-performance 0.92
d450-capacity 0.82
d450-performance 0.83
(Liao, Hwang, Liou, Yen, et al., 2011, unpublished data)
all values with P<0.01 (two tailed)
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d4 subscale scores were significantly correlated with WHODAS score
Items in Scale Interrater reliability Test-retest reliability
d5 Self-care d510 washing oneself 0.90** 0.60**
d520 caring for body part 0.74** 0.45**
d530 toileting 0.80** 0.51**
d540 dressing 0.81** 0.74**
d6 domestic life d630 preparing meals 0.82** 0.79**
d640 doing housework 1** 0.68**
d650 caring for household objects 1** 1**
Inter-rater and Test-retest Reliability (Kappa value ) of disability score of 「ICF Activities of Daily Living Scale - Adult version」for Adults with Stroke (2010 Taiwan ICF trial)
**p<0.01 (Wu, et al., 2011, submitted) 11
d5 and d6 subscales of the eligibility measures showed acceptable inter-rater and test-retest reliabilities
Convergent Validity of Qualifiers of Subscales of「ICF Activities of Daily Living Scale - Adult version」for Adults with Stroke (2010 Taiwan ICF trial) (n=50)
* The level of disability is administered by the disability registration system, Department of Social Affairs, Ministry of the Interior in Taiwan
(Yen, Liou, 2011, unpublished data)
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Significant differences of WHODAS scores among 4 severity levels
Functional assessment for eligibility determination for adults (≧18 yrs) in 2011 trial
• Performance part, 6 domains Designed based on WHODAS 2.0 Modify the 36-item version (interviewer
administered and proxy-administered) according to the culture and language of Taiwan
• Additional parts, designed by the team Capacity part of 6 domains by interview Domain e (environment) by interview Domain d4 (capacities by direct testing and
performance by interview)
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Assessment content (d, e) design in 2011 • Five revisions of adults-version (April to Sept.) 14 expert meetings Based on WHO DAS II Suggestion by medical staffs and specialists in the
training courses Start to collect data in this Oct
• First draft of children-version Translated and revised from Child and Family
Follow-up Survey (CFFS) (Bedell, 2004) for eligibility determination use since July. 3 expert meetings Start training course in Oct. 2011 17
Training courses for testers for data collection
• 25 training courses (21 for adults-form and 4 for children-form) , more than1500 professionals trained, from June to Oct. 2011
• 13000 persons with disabilities randomly stratified and selected in Taiwan will receive assessments
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Summary • Time pressure in preparation
• Purposes of the ICF research team To examine the clinical feasibility and to choose
appropriate cut-off points If the measure can clearly describe the characteristics and
needs of people with disabilities • Pilot testing in 2010
Four sites, totally 500 subjects with variety of disabilities
• Pilot study in 2011 Whole country, totally 13000 subjects with variety of disabilities
• The government system, nongovernment organization and academic society worked as a team
• Several unresolved issues Cutoff point for severity of disability
b/s categories are set as gatekeepers The distribution of resources
Balance between needs and limited budget 19
Conclusions • The concept of ICF/ICF-CY has widespread in
Taiwan in recent years; including policy design, clinical practice, research and education.
•
• For the successful implementation of the policy, carefully designed programs, based on evidence; trainings of personnel as well as education for the public to facilitate the understanding of ICF/ICF-CY should be prepared in advance.
•
• Promotion of international communication and cooperation are needed to speed the usage of ICF/ICF-CY as a common language.
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Acknowledgements • This study is supported by the Department of
Health, Taiwan (No. 98M8178, 99M4080, and 99M4073).
• We also thank all the advisors who participated in the meetings. Taiwan ICF Team leaders include Yen-Nan Chiu, Tien-Chen Liu, Lu Lu, Shyh-Dye Lee, Fu-Sung Lo, Tai-Lung Cha, Yen-Ho Wang, Ben-Sheng Chang, Shu-Jen Lu, Ting-Fang Wu, Ti-Li Kao, Kuo-Lung Lee, Min-Huei Lin, Leang-Yang Lai, Man-Yen Chiu, Kuo-Yu Wang, Wan-I Lin, Lin-Ju Kan, Wei-Chang Chen, Shu-Jen Lun, etc…