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The Care Dependency Grant (CDG) provides income support for children with severe intellectual or physical disabilities who require permanent care. It is designed to replace the loss of income for parents or caregivers who provide such care. Currently the application process involves an assessment by a medical practitioner to determine whether the child has a disability that results in permanent or full-time care needs.
Since the early 2000s, the Department of Social Development (DSD) has been aware of the need to revise the assessment tool which is used to determine eligibility for the CDG. The intention has been to move towards a more holistic and uniform assessment process that is broader than a medically-based determination of disability, and that supports a more objective measure of ‘care need’.
The new assessment tool was drafted after wide-range input from stakeholders, such as consultative workshops with the disability and children’s sectors, and input made at the Taylor Committee of Inquiry into a Comprehensive System for Social Security for South Africa in 2002. Last year, the Children’s Institute was commissioned to pilot the revised assessment tool, in particular, to:
- assess the effectiveness of the tool to determine eligibility for the CDG accurately;
- assess the functionality of the tool; and
- revise the tool and make recommendations for its implementation.
The pilot study took place in a rural district in Limpopo, a metropolitan area in the Eastern Cape, and an urban area in KwaZulu-Natal. The research team conducted initial site visits to make contact with key stakeholders, including DSD, South African Social Security Agency (SASSA) and Department of Health officials, as well as with local non-governmental organisations providing services to children with disabilities. Once health facilities were selected at each site, personnel who were to be involved in the piloting (doctors, therapists and SASSA officials) were trained on the rationale and practical use of the new tool.
Piloting started thereafter, targeting applicants bringing children for assessments for the CDG, who were asked to participate in a second assessment, using the new tool. (The piloting process was additional to, and did not replace, the existing assessment process.) Fieldworkers observed the assessments, and interviews were conducted both with applicants and with assessors. A total of 80 complete assessments were conducted using the new tool.
Data analysis of the completed assessments focused on the profile of children and applicants, as well as on the different components of the assessment (i.e. health condition, functional assessment, care needs and decision-making). Semi-structured interviews were analysed thematically, as was feedback from participants during the training process.
The analyses suggested that the length, format and complexity of the tool undermined the ability of assessors to complete it accurately. Based on the findings, and by working closely with the designers of the tool, the research team undertook major revisions to the assessment tool. Key changes included:
- removing numerous, repetitive questions (which resulted in extraneous information);
- improving its format to facilitate easier use;
- simplifying the care-needs scoring system; and
- allowing for children without functional limitations to be assessed for care needs, and therefore to be eligible for the CDG.
The research team has also made recommendations on the implementation of the tool to the DSD. These addressed issues of inter-sectoral collaboration, training and logistics, including staffing, venues and administrative procedures.
The research team is currently awaiting feedback on the draft report from the DSD. The revised tool and recommendations are not available for circulation as they may be subject to further revisions.