Type of Project: In-house project
Development of a List of Indicators Suitable for Assessing Prognosis for Reintegration and Rehabilitative Needs in Mentally III Persons Applying for Disability Pension (IREPRO)

Objective: A tool for determining the rehabilitative needs and the prognosis for reintegration in persons applying for disability pension is developed. This tool is to be used during medical examinations in the course of expert testimonies. It is thought as a list of indicators. The list of indicators: - shall allow to determine the prognosis for regaining the full or at least part-time functional capacity to work. - shall also differentiate between claimants with low, moderate and good chances to improve through rehabilitative measures offered by the statuary pension insurance. It will also describe which treatments or rehabilitative measures outside the responsibility of the statuary pension insurance are necessary for improvement. The indicator list will refer to the International Classification of Functioning (WHO). Background: Background of this project is a lack of unified principles in assessing the prognosis for mentally ill persons applying for a disability pension. Often the options for rehabilitative treatment are not systematically discussed. These shortcomings became obvious during an analysis of expert testimonies (Hesse 2001). Due to changes in law, which now allow partial disability pensions, the improvement of functional working capacity to a part-time level becomes a possible target for rehabilitative measures and has to be considered in the expert testimony. Besides the new SGB IX clearly stresses the precedence of checking the need of rehabilitation in claimants of disability pensions. Method: Considering the available evidence and practical experience indicators are identified, operationalized and ranked by a small group of experts. (They are employed by the statuary pension insurance or rehabilitative facilities). Each indicator of prognosis is (as far as possible) matched with a suitable rehabilitative measure or treatment. At several times during the development the results of the small group are mirrored to a larger group of experts, who are asked to comment the results and express their degree of consent (Delphi-Method). These responses will be taken into consideration by the small group. In a final consensus-conference with all experts (small and big group) the indicator list will be confirmed. Finally the indicator list will be used in a field trial to judge practicability and benefit. Results: A manual was developed, which describes 10 indicators out of three categories (functioning, course of disease and treatment, ressources). The rating for each indicator is visualised in a profile and connected with treatment options. Case studies are added to illustrate the application rules. The manual in pdf-format is available on request.