Imagine three active and engaged women; one is a TV anchor, one is a surgeon, and the third is a housewife – all are the same age and have similar socioeconomic status.
What if all the three ladies suffered the same accident that resulted in the amputation of their dominant hand? Now think how will that accident and the disability acquired as an outcome affect them?
According to the Medical or Impairment Model for assessing their acquired disability; all three ladies are now suffering from the same condition and the same impairment – and it is true, medically all three cases are the same, but that is far from the essence and general guidelines directed by the International Classification of Functioning, Disability and Health (ICF) and the World Health Organization in 2001.
Based on this statement, Functioning is defined as “an umbrella term encompassing all body functions, activities, and participation. Similarly, disability serves as an umbrella term for impairments, activity limitations, or participation restrictions.”
The interpretation of this statement identifies the complex nature of disability and how it should be perceived holistically, accordingly diverting the common view to include the impact of the medical condition and its subsequent impairment on the individual’s level of activity, participation, and interaction with the community.
This gradual shift in the mindset, assessment, and classification of individuals with disabilities provides a more complex person-centric view; creating a deeper holistic understanding, therefore emphasizing different needs and interventions that target people with disabilities across the different life domains and disciplines.
Revisiting the original scenario of the three affected women in the article and after following a more functional and holistic approach in assessing their disability, this would capture a different image than the pure medical lens.
Considering that all three examples were managed similarly through medical intervention, prosthesis, and rehabilitation.
The TV anchor would be able to return to work and would be able to perform at a level close to her life before the disability; her actual job doesn’t require a high level of functional utilization of her arm. Moreover, such a disability can pose rather a positive impact on her psychological and social status in the long-term.
The surgeon would not be able to return to her work; as her actual job would be deemed impossible, she therefore requires a drastic shift in her career, accordingly, affecting her income level, social status with a potential impact on her psychological well-being.
Finally, the housewife would require a certain level of support to be able to perform all her duties at the same level, which poses an additional financial or psychological stress on the individual and the household.
Such an example provides a simple yet clear view of the massive difference between medically identical cases regarding the impact, needs, and type of support required an impairment has on an individual if we take into consideration social and environmental aspects.
In theory, it is very clear that the value of shifting the mindset of viewing people with disabilities from form to function is essential to guarantee the activation of a human rights-based perspective, but it is also common to struggle in applying even the most compelling and theoretically sound concept.
However, the International Classification of Functioning has provided a system for describing and organizing information about functioning and disability; accordingly, describing disability as a condition that resulted in an impact on Body Structures and Body functions, led to an Activity Limitation and caused a Participation Restriction all within a Contextual Perception considering both Environmental and Personal factors in the assessment.
Several countries and entities have undergone massive efforts in developing intricate tools to assess an individual’s disability following the ICF instructions, including but not limited to the WHODAS 2.0 developed by the WHO itself, the Washington Group Extended Set Questionnaire, several psychological and behavioral scales, in addition to adapted local assessment tools.
Despite the differences, most assessment tools have a set of commonalities; including but not limited to being weighed, scored, assessing functionality and ability to perform activities of daily living, being validated, and tested for reliability.
Taking into consideration the wide selection of available assessment tools, all developed by experts, one more question still needs to be answered.
Why do countries and governments still work on developing standalone local assessment tools?
The answer is divided into two parts.
The First is Contextuality…
Contextuality with respect to the local variables such as language, tradition, and demographics.
Contextuality, with respect to the purpose or objective of the assessment and the utilization of information that could be extracted from the outcomes of such assessment.
Contextuality, with respect to the available resources and type of support and benefits planned by the government for Persons with Disability.
Which is factored in by developing local (homegrown) assessments to complement international references and tools.
The Second is overcoming shortages…
The answer to this issue is more complex, but after the study of several international assessments and tools, the assessment is done for what it is designed to detect.
Several international tools can be heavily used for research purposes rather than actual disability determinants; others can spot specific disabilities, i.e., Vineland Adaptive Behavior Scale, and others are more sensitive to specific age groups.
The main takeaway is that to ensure a Holistic Assessment is achieved and all ICF recommendations are objectively assessed; the assessment should be designed as a fully integrated process in the following sense; Medical and Impairment Diagnosis which acts as a guidance and reference, followed by a functional assessment of the activities of daily living and an assessment of the feasibility and ability of the applicant to work or resume education.
These steps should be overshadowed by Socioeconomic Household assessment as well as an Assessment of Environmental Factors, which accordingly requires deep cross-integration with National Registries, Household income and expenditure, and other economic surveys, in addition to Service and Geo Mapping efforts.
Finally, and to conclude the discussion, it is safe to say that Theories clearly identify what needs to be done to ensure equity and fairness; moreover, there have been several efforts and resources spent to develop assessment tools that reflect all the Social Theories, Conventions, and Agendas.
However, the success of such efforts lies mainly in the ability to fully integrate, customize, and contextualize implementation as per the local variables and contexts.
Assessing disability is not a one-size-fits-all activity; it is more of a complex joint process that requires specifically designed and tested inputs and efforts.
Discover more from Phoenix
Subscribe to get the latest posts sent to your email.
