基于ICF职业康复核心分类组合的职业康复个案管理OA北大核心
Case management based on the ICF vocational rehabilitation core set
目的 基于《国际功能、残疾和健康分类》(ICF)职业康复核心分类(VR-CS)构建系统性的个案管理模式,探索其在职业康复中的应用路径和成效,将VR-CS的13个核心类目运用于职业康复的个案管理实践中,基于全面的功能评估,设计并且实施系统化和个性化的个案管理方案,从而提升个体的职业独立性、社会参与度以及整体生活质量. 方法 采用理论研究与实证个案分析相结合的方法,基于VR-CS的13个核心类目,从身体功能与结构、活动与参与以及环境因素3个层面,对全面职业评估、制定并实施整体化和个性化职业康复计划以及动态监测进行理论分析.通过3类典型职业康复个案,即重性抑郁症、高功能孤独症和轻度认知障碍个体的职业康复说明基于VR-CS的个案管理相关证据和效果. 结果 基于VR-CS的个案管理方法,采用ICF的生物-心理-社会的功能模式,构建了整体性与个性化的个案管理系统,融合了评估与分析职业康复需求、设定目标与制定计划、实施多学科团队协作干预和个性化干预、过程监测与动态调整、重返职业活动与长期跟踪服务等环节.基于VR-CS构建的个案管理模式在促进个案职业独立性与社会参与度方面表现出显著且系统性的成效.本研究围绕VR-CS的13个核心类目,设计并实施个案管理的主要方法和步骤进行了详细的分析,并在3个案例中阐释了该模式在实际职业康复中的方法.在身体功能与结构层面,个案管理涵盖精力和驱力功能评估(b130)、高水平认知功能训练(b164)和运动耐受性提升(b455).自初始评估阶段起,个案管理即围绕功能限制与需求设定短期和长期目标,并在干预过程中持续动态监测,适时调整干预措施.提升了个体的身体耐受力与认知功能,改善了在复杂职业环境中的持续工作能力.在活动与参与层面,聚焦于职业技能掌握(d155)、应激管理与心理调适(d240)以及复杂人际交往能力培养(d720).个体通过定期参与专业技能培训、角色扮演和实际工作模拟等干预措施,逐步强化职业适应能力和社会互动技能.个体掌握了实用技能,在多样化社交环境中逐步提升自我效能感与职业自信心,推动社会角色的重塑.在环境因素与个人因素层面,个案管理路径涉及直系亲属家庭的积极参与(e310)、社会态度的积极转变(e460)以及卫生和就业政策资源的合理运用(e580,e590),通过全面整合社会与社区资源,为个体创造包容性更强、支持性更高的康复环境.通过设计并且实施系统的个案管理方案,个体心理状态、职业适应性和社会互动能力均显著改善,大多数个案在干预结束后实现稳定就业或持续参与社会活动. 结论 VR-CS提供了一种系统化、多维度且以个体为中心的个案管理架构,该架构采用生物-心理-社会模式,从个体的身体功能、心理状态和环境因素等角度出发,系统分析个体的主要功能障碍和职业康复需求,在此基础上,设计实施系统性、针对性和整体性的个案管理方案.基于VR-CS的个案管理方案,不仅可以提升个体的职业能力,也有助于改善个体的整体生活质量和社会适应能力.
Objective To develop a systematic case management model based on the International Classification of Functioning,Disability and Health(ICF)Vocational Rehabilitation Core Set(VR-CS)and explore its application pathways and efficacy in vocational rehabilitation.The 13 core categories of VR-CS are applied in vocational rehabilitation case management practices,utilizing comprehensive functional assessments to design and implement structured and individualized case management plans.This,in turn,seeks to enhance individuals'vocational independence,social participation and overall quality of life. Methods This study adopted a combined approach of theoretical research and empirical case analysis.Based on the 13 core categories of VR-CS,a comprehensive vocational assessment was conducted across three dimensions:body function and structure,activities and participation,and environmental factors.The study theoretically analyzed how to develop and implement holistic and individualized vocational rehabilitation plans,along with dynamic monitoring processes.Three types of typical vocational rehabilitation cases were examined,including individuals with major depressive disorder,high-functioning autism and mild cognitive impairment,to illustrate the evidence and effectiveness of VR-CS-based case management. Results The VR-CS-based case management method,grounded in the ICF bio-psycho-social model,constructed an inte-grated and individualized case management system.This system combined the assessment and analysis of voca-tional rehabilitation needs,goal setting and planning,multidisciplinary team intervention,individualized interven-tions,process monitoring and dynamic adjustments,return-to-work activities,and long-term follow-up services.The case management model developed through VR-CS demonstrated significant and systematic efficacy in pro-moting vocational independence and social participation.This study provided a detailed analysis of the primary methods and steps involved in designing and implementing case management and elaborates on the practical ap-plications of this model from the three representative cases.At the body function and structure level,case man-agement included the evaluation of energy and drive functions(b130),high-level cognitive training(b164),and the enhancement of exercise tolerance(b455).Case management focused on accurately setting short-and long-term goals around functional limitations and needs.Dynamic monitoring during interventions ensured timely ad-justments to intervention measures.This process improved physical endurance and cognitive function,enhanced sustained work capacity in complex vocational environments.At the activities and participation level,the focus was on skill acquisition(d155),stress management and psychological adjustment(d240),and the cultivation of complex interpersonal communication abilities(d720).Individuals engaged in regular professional skills training,role-playing and simulated work scenarios to progressively enhance vocational adaptability and social interaction skills.Through this process,individuals acquired practical skills,gradually boosting self-efficacy and vocational confidence,thereby facilitating the reshaping of their social roles.At the environmental and personal factors lev-el,case management pathways involved active participation from immediate family(e310),positive shifts in soci-etal attitudes(e460),and the effective utilization of health and employment policy resources(e580,e590).By in-tegrating social and community resources comprehensively,the program created a more inclusive and supportive rehabilitation environment.By designing and implementing systematic case management programs,individuals showed significant improvements in psychological well-being,vocational adaptability and social interaction skills.The majority of cases achieved stable employment or continued participation in social activities following the intervention. Conclusion VR-CS provides a systematic,multidimensional and person-centered case management framework.This framework applies the bio-psycho-social model,analyzing individuals'primary functional impairments and voca-tional rehabilitation needs from the perspectives of body functions,psychological states and environmental fac-tors.On this basis,a comprehensive,targeted and holistic case management plan is developed and implemented.The VR-CS-based case management approach not only enhances vocational capabilities but also improves over-all quality of life and social adaptability.
胡志活;吴孟杰;陈芷莹;杨亚茹
扶康会,中国香港 999077扶康会,中国香港 999077扶康会,中国香港 999077世界卫生组织国际分类家族中国合作中心,北京市 100068||华东师范大学体育与健康学院,上海市 200241
临床医学
职业康复核心分类组合个案管理
vocational rehabilitationcore setcase management
《中国康复理论与实践》 2025 (2)
209-217,9
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