Technical Meeting on INCLUSIVE SOCIAL PROTECTION FOR PERSONS

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Technical Meeting on “INCLUSIVE SOCIAL PROTECTION FOR PERSONS WITH DISABILITIES” organized by ILO and

Technical Meeting on “INCLUSIVE SOCIAL PROTECTION FOR PERSONS WITH DISABILITIES” organized by ILO and IDA Geneva, Switzerland, 22 -23 January 2015 Disability Assessment & International Classification of Functioning, Disability and Health (ICF) Nenad Kostanjsek (WHO), Alarcos Cieza (WHO), Aleksandra Posarac (World Bank) 1 | ICF and Disability Assessment | Technical Mtg on “Social Protection for Persons with Disabilities” | Geneva, Switzerland, 22 -23 January 2015

Overview l Disability assessment and evaluation – Definition, purpose and scope – Traditional approaches

Overview l Disability assessment and evaluation – Definition, purpose and scope – Traditional approaches l Moving towards an ICF based approach – What is the ICF? – Rationale for use – Implementation issues 2 | ICF and Disability Assessment | Technical Mtg on “Social Protection for Persons with Disabilities” | Geneva, Switzerland, 22 -23 January 2015

Disability assessment and evaluation l Disability assessment is the process of making an authoritative

Disability assessment and evaluation l Disability assessment is the process of making an authoritative determination about the kind and extent of disability a person has, as part of a larger administrative process usually called disability evaluation or disability determination. l Disability evaluation, which includes disability assessment as a component, determines the eligibility of an individual claimant for some social benefit, service or protection. l Scope of benefits and services varies according to country’s disability policy: – – – health & rehab services incl. access to assistive technology social or income security & pensions health and social insurance benefits short and long term sick leaves general social benefits incl. income support and access to transportation, housing or education services, – employment-related benefits incl. workers’ compensation, vocational rehabilitation 3 | ICF and Disability Assessment | Technical Mtg on “Social Protection for Persons with Disabilities” | Geneva, Switzerland, 22 -23 January 2015

”Traditional” Disability Assessment approaches Approach Impairment based Conception of ‘disability’ Tools Criteria Medical Impairment

”Traditional” Disability Assessment approaches Approach Impairment based Conception of ‘disability’ Tools Criteria Medical Impairment guidelines ‘Baremas’ criteria Health condition problems with body functions and structures Functional Capacity Assessment Informal assessment 4 | (e. g. AMA Guidelines for the Evaluation of Permanent Impairments) Problems or Functional limitations in basic (In)Capacity activities Evaluation (FCE) Determined by assessor (often medical) ICF and Disability Assessment | Technical Mtg on “Social Protection for Persons with Disabilities” | Geneva, Switzerland, 22 -23 January 2015 Determined by assessor body level impairment is used as indicator of ‘whole person’s disability ADL/IADL criteria limitation in basic activity is used as indicator of ‘disability rating Determined by assessor

Problems with ”traditional” Disability Assessment approaches l Indirect assessment of functioning: Inferences are made

Problems with ”traditional” Disability Assessment approaches l Indirect assessment of functioning: Inferences are made from – health condition & impairment type/degree -> whole person disability – health condition & impairment type/degree -> ADLs/IADLs – Specific ADLs/IADLs -> work capacity l Comparability problems: – how to quantitatively rate loss of limb with depression in terms of disability? – same impairment may have different impacts in terms persons functioning l Assessment ignores the impact of environmental factors (barriers/facilitators) on the persons functioning l No linkage with classification: no or limited possibilities to compare and aggregate data l Validity, reliability, transparency and standardization of the assessment are often compromised by policy objectives or legal rules that govern the evaluation procedure 5 | ICF and Disability Assessment | Technical Mtg on “Social Protection for Persons with Disabilities” | Geneva, Switzerland, 22 -23 January 2015

What is the ICF? l Classification & metrics for organizing & reporting health and

What is the ICF? l Classification & metrics for organizing & reporting health and disability data l Conceptual model for understanding health and disability 6 | ICF and Disability Assessment | Technical Mtg on “Social Protection for Persons with Disabilities” | Geneva, Switzerland, 22 -23 January 2015

The structure and codes of the classification ICF Contextual factors Functioning and Disability Body

The structure and codes of the classification ICF Contextual factors Functioning and Disability Body functions and Structures Body functions Sensory functions b 2 and pain b 4 Personal factors b 21020 Light sensitivity b 210 Seeing functions b 2100 b 21021 Colour vision b 215 b 2101 b 21022 Contrast sensitivity b 220 b 2102 Quality of vision b 229 b 230 b 235 b 240 b 5 b 249 b 6 b 255 b 250 b 260 b 2108 b 21023 Visual picture quality b 21028 Quality of vision, other specified b 21029 Quality of vision, unspecified b 2109 Seeing functions of sensing a minimum amount of light (light minimum), and the minimum difference in intensity (light difference) Inclusion: functions of dark adaptation; impairments such as night blindness b 270 | Technical Mtg on “Social ICF and Disability Assessment (hyposensitivity to light) and b 8 | Geneva, (hypersensitivity to light) b 280 Protection for Persons with Disabilities” photophobia Switzerland, 22 -23 January 2015 b 7 7 | Environmental factors Body structures b 1 b 3 Activities and Participation b 265

ICF = conceptual model of disability Health Condition (disorder/disease) Body function & structure (Impairment)

ICF = conceptual model of disability Health Condition (disorder/disease) Body function & structure (Impairment) Activities (Limitation) Environmental Factors 8 | ICF and Disability Assessment | Technical Mtg on “Social Protection for Persons with Disabilities” | Geneva, Switzerland, 22 -23 January 2015 Participation (Restriction) Personal Factors

Key features of the ICF model 9 | Multi-dimensional not uni-dimensional Universal not minority

Key features of the ICF model 9 | Multi-dimensional not uni-dimensional Universal not minority approach Integrative not medical or social Context inclusive (person & environment) not person alone Etiological neutral not driven by causality Interactive not linear progressive Cultural applicability not western concepts Continuum with Health not Categorical ICF and Disability Assessment | Technical Mtg on “Social Protection for Persons with Disabilities” | Geneva, Switzerland, 22 -23 January 2015

Reasons for using ICF for Disability Assessment l ICF as an optimal reporting structure

Reasons for using ICF for Disability Assessment l ICF as an optimal reporting structure provides a – – state of the art model of disability structure and dimensions of what to measure comprehensive platform to monitor UN-CRPD implementation Rosetta stone for functioning and disability information l ICF as the basis for process legitimacy – – 10 | Fairness Transparency Impartiality Comparability (equity) ICF and Disability Assessment | Technical Mtg on “Social Protection for Persons with Disabilities” | Geneva, Switzerland, 22 -23 January 2015

Ongoing work to enhance data standards for health and disability information systems l Facilitate

Ongoing work to enhance data standards for health and disability information systems l Facilitate joint use of ICF & ICD (International Classification of Disease) – ICD-11 categories incorporate functioning properties l Develop International Classification of Health Interventions (ICHI) – Inclusion of functioning interventions l Digitalize WHO Classifications – Automated information retrieval through formalized knowledge representation & assigning unique IDs for every ICD category CA 11. 3 Acute myocardial infarction, without specification of ST elevation http: //id. who. int/icd/entity/2016376826 11 | ICF and Disability Assessment | Technical Mtg on “Social Protection for Persons with Disabilities” | Geneva, Switzerland, 22 -23 January 2015

Moving towards an ICF based disability evaluation process Implementation issues (1) It entails a

Moving towards an ICF based disability evaluation process Implementation issues (1) It entails a process of institutional and policy reform which requires: – formal regulation and legislation – Implementation through institutional and organizational structures – involvement of a cadre of professionals implementing the rules and in response to legitimate interests of multiple stakeholders – management of a technical and political process – consideration of financial implication (i. e. disability assessment is an important fiscal “gate keeper”) – careful planning and persistent implementation – 12 | ICF and Disability Assessment | Technical Mtg on “Social Protection for Persons with Disabilities” | Geneva, Switzerland, 22 -23 January 2015

Moving towards an ICF based disability evaluation process Implementation issues (2) l Workflow –

Moving towards an ICF based disability evaluation process Implementation issues (2) l Workflow – – Preparation of Evaluation file Interdisciplinary assessment Determination of functioning level & benefits Re-assessment in case of appeal l Protocol & Instrument development – Functioning domain groupings – Scoring l Infrastructure – Interdisciplinary assessment teams – Admin & support staff – Building & equipment l Training & communication 13 | ICF and Disability Assessment | Technical Mtg on “Social Protection for Persons with Disabilities” | Geneva, Switzerland, 22 -23 January 2015

Lessons Learned from developing and implementing an ICF based disability evaluation process l Technical

Lessons Learned from developing and implementing an ICF based disability evaluation process l Technical process l Time consuming l Politically charged l Complex human & digital interaction l Technical capacity for knowledge transfer and international expertise very limited 14 | ICF and Disability Assessment | Technical Mtg on “Social Protection for Persons with Disabilities” | Geneva, Switzerland, 22 -23 January 2015