Introduction

1. Using the ICF for assessing assistive products and enabling environmental needs in persons with disabilities THE WORLD REPORT ON DISABILITY: IMPLICATIONS FOR ASIA AND THE PACIFIC 5-7 December 2011Sydney, Australia Saichon Kloyiam, Theeraporn Chaimala, Articha Naravorawat, Wachara Riewpaiboon Abstract Purpose: To examine whether the assistive products and enabling environmental modification services mentioned in the current relevant Thailand’s national and local laws would be well covered by the ICF codes in Chapter e1 (products and technology) and to develop a need assessment questionnaire based on the ICF selected for care plan, service management and resource allocation. Method: the ICF codes in Chapter 1 were scrutinized and selected based on its relevance for developing a need assessment questionnaire. The developed questionnaire was then tested by pilot need surveys in communities of eight provinces within three regions. Individual care and service management plans were conducted for resource allocation. The functional performances and social participation of related PWDs were monitored. Results: Twelve ICF codes in Chapter 1 were identified. Eight ICF codes corresponded to the national Act while five codes to those provided by the local fund. Only nine codes were selected for the need assessment questionnaire. The service provision process has been running from September through December 2011. The outcome monitoring has been done in parallel. CONCLUSIONS: Needs for assistive products and enabling environmental modifications could be determined by the developed ICF-based questionnaire. The functional outcome of the services could also be monitored. It would be better if the need assessment questionnaire for assistive devices and enabling environmental modifications is used together with other dimensions of need surveys particularly participation in specific meaningful life areas of each PWD. Introduction Results Twelve ICF codes in Chapter 1 were identified. Eight ICF codes corresponded to the Thai Act, 2007 while five codes to those provided by the Provincial Authority Office (PAO) in one pilot province. Only nine codes were selected for the need assessment questionnaire. The unit of assessment was performed with persons with disability living in their houses and household contexts. General demographic data, number of family members especially children and elderly, functioning information, availability of assistive device, individual utilizing spaces, barriers in everyday life, adjusted home modifications, needs for modifications with reasons and affordability were also asked. Some of the data are shown in table 2. The United Nation Convention on Right of Persons with Disabilities (UNCRPD), 2008 has addressed the importance of assistive products and environmental modifications in article 4, 9, 20, 21, 24, 26, 29, and 32. Measures relevant are stated in additional 17 articles. It entitles beneficiaries with rights to assistive product and environmental modification services to full and enjoyment of all human rights (Borg, Lindstrom, & Larsson, 2009). Although Thailand has the Person with Disability’s Quality of Life Promotion Act 2007 (replacing the Rehabilitation for Persons with Disability Act 1991) which conforms well to the UNCRPD, issues of inappropriate assistive products and environmental barriers that limit independent living and social participation have been evident. In order to make the right a reality, the question of how to deliver the services of appropriate devices and environmental modifications is crucial. Linking national to local implementing mechanism needs to be developed. To enhance independent living and increase the opportunity for social participation of persons with disability, enabling environments are required. Assistive devices would fill the gap between individual’s personal capability and environmental demand. So, only devices might be useless in many places for everyday living if the surrounding environments are still inaccessible. The major constraints of making enabling environments include affordability, competing priority, availability of appropriate technology and knowledge, and cultural differences (WHO. The World Report on Disability. 2011). The International Classification of Functioning, Disability and Health (ICF) is considered conceptually consistent with the UNCRPD. It could serve as a conceptual framework for developing a need assessment tool. The obtained information would address personal context-related needs in assistive products and environmental modifications. Personal care plan and service delivery, as well as community development plan to make environments more enabling could be formed by utilizing such the information. Self modified handrail Standard handrail Standard toilet chair self designed toilet chair Table 1: Correspondences among ICF, Act, PMRF and questionnaire Pictures of standards for urban settings and local adjusted designs focused on toilets Regarding the Act 2007, needs for assistive devices could be assessed and provided personally by many providers including physicians, special educators, and social workers. Additionally mass delivery by charitable organizations or politicians could also be often observed. Standard wheelchairs and mobility aids e.g. cane and walker were most common since persons with mobility difficulties were most prevalent. While campaigns and movements on accessibility in public buildings, transportation, and information access have long been conducted, the right of household modifications to enhance independent living has just been realized and piloted in 10 provinces with limited budget of 20,000 THB/ person in 2011. Three national level leading agencies including the National Office for Empowerment of Persons with Disability (NEP), the Association of Siamese Architects under the Royal Patronage of His Majesty the King, and the Institute of Health Promotion for Persons with Disability have been collaborating, regionally joined by faculties of Architecture of local universities, and provincially by at least four alternatives of service managers including the Provincial Authority Office, non-government organizations working for persons with disability, Disable People Organizations and Provincial Office for Empowerment Persons with Disability. Major functions of local service management mechanism included case finding and screening, consultation for need assessment and design, resource mobilization, and reconstruction management. Further outcome monitoring would be done after finishing the constructions and a short period of living in new enabling environment will be examined. Objective Table 2: General demographic data • To examine whether the assistive products and the enabling environmental modification services stated in Thailand’s laws and relevant ministerial regulations could be covered by the ICF codes in Chapter 1 Products and Technology (e1) • To develop a need assessment questionnaire for care plans, service management and resource allocation Why? & How is the enabling environment for person with mental disability? Methods & Materials Conclusions The ICF codes in Chapter 1: Products and Technology relevant to assistive products and environmental modifications were practically applied to the corresponding categories stated in Thailand’s national and local laws. Individual’s needs for assistive products and environmental modifications could be determined by the developed ICF-based questionnaire. The functioning and participation profile could be revealed for later outcome monitoring. It was found that poverty causing un-affordability came to the first rank among the constraints of making enabling environment of individuals. Standard environmental modifications were not always appropriate for local PWD’s lifestyles. Cultural differences in house constructions and ways of everyday living reflected needs for context-based or contemporary standards for each particular community. Additionally, disability attitude might make PWD unaware of their rights. For an effective and efficient implementation process, local leading agencies played important roles to ensure sustainability of service delivery system. Further research is needed to evaluate the effects of assistive products and environmental modifications on participation in specific meaningful life areas of each PWD and cost-effectiveness analysis is required to inform policymakers and funders. The Person with Disability’s Quality of Life Promotion Act 2007 and the Provincial Medical Rehabilitation Fund in Thailand (PMRF) related to provision of assistive products and environmental modification services were reviewed. ICF codes in Chapter 1 (e1: Products and Technology) were linked to the content with relevant laws. ICF codes covering assistive products and environmental modification services supported by the laws were selected and used to develop a need assessment questionnaire for assistive products and environmental modifications A service delivery mechanism in eight provinces within three regions of Thailand was collaboratively developed. A 50 case pilot work using the developed questionnaire has been being conducted (Figure 1). Pre-environmental modification assessment data was analyzed. Figure 1: Pilot sites in three regions and no. of study cases Collaborative Agencies Local household design and constructtoenable PWD