Enhancing Rehabilitation Services with ICF Application in Hong Kong

1. HKSR 60th Anniversary Symposium and Workshops “New Perspectives on Holistic Rehabilitation and Social Inclusion towards 2030” 28 - 29 March 2019 Application of ICF in Rehabilitation Services in Hong Kong Professor Chetwyn CHAN Chair Professor, The Hong Kong Polytechnic University Vice-Chairperson, Executive CommitteeTheHong Kong Society for Rehabilitation Please cite this PowerPoint as Chan, C. (2019). Application of ICF in Rehabilitation Services in Hong Kong [PowerPoint slides]. Retrieved from https://www.rehabsociety.org.hk/wp-content/uploads/2019/05/8_Keynote-IV_Prof.-Chetwyn-CHAN.pdf

2. Application of ICF in Rehabilitation Services in Hong Kong Prof. Chetwyn CHAN Chair Professor, The Hong Kong Polytechnic University Vice-Chairperson, Executive Committee The Hong Kong Society for Rehabilitation HKSR 60th Anniversary Symposium and Workshops on “New Perspectives on Holistic Rehabilitation and Social Inclusion towards 2030” on 28 March 2019, Hong Kong

3. International Classification of Functioning, Disability and Health (ICF) • A WHO framework for measuring health and disability established in 2001 • A Bio-Psycho-Social Model • Widely applied in various types of clinical and community rehabilitation service (e.g. stroke rehabilitation, vocational rehabilitation) Health Condition 健康狀況 Body Functions & Structure 身體功能和結構 Activity 活動 Participation 參與 Environmental Factors 環境因素 Personal Factors 個人因素 (Kostanjsek, 2004) (www.who.int/classification/icf)

4. Key Available ICF Tools • ICF Framework • ICF Checklist • ICF Coding System and ICF Core Sets • ICF-based Tools • WHO Disability Schedule 2.0 (WHODAS 2.0) • Monitoring Manual and Menu (MM&M) for CBR and other community-based disability inclusive development programs

5. Finger et al. (2012) Conclusion: The expert opinion and evidence-based Core Set could serve as an international standard for what to measure and report concerning functioning of individuals in vocational rehabilitation.

6. ICF Core Set – V R

7. ICF Brief Core Set – V R

8. Leung et al. (2011) Conclusion: Deficits in social and motor functioning, and attention-deficit hyperactivity disorder-related symptoms, are important determinants of activity and participation in preschoolers with DD. One may consider targeting these specific areas to enhance activity and participation amongst these children.

9. Leung et al. (2011)Classifying Clinical Tests

10. Conclusion: ICF was found to: (1) standardize rehabilitative procedures; (2) facilitate flow of congruent and updated information from the hospital to outpatient facilities, relatives, and care givers; (3) address organizational issues; (4) serve as a benchmark for professionals who have limited specific expertise in rehabilitation of comorbid obese patients.

11. Brunani et al. (2015)

12. (Brunani et al., 2015)

13. Chen et al. (2016) Conclusion: Clinical experience in post-stroke rehabilitation enhances inter-rater reliability of ICF assessment. Knowledge of patient’s functional capability, such as conducting common clinical tests in post-stroke rehabilitation, is useful for improving assessment validity.

14. Local Experience of Application of ICF in Rehabilitation Services The Spastics Association of Hong Kong The Hong Kong Society forRehabilitation Fu Hong Society

15. Assessment for Service Planning Using ICF By Fu Hong Society

16. Description of Initiative WHY Current assessment was not sensitive enough to detect service need of users with intelligent disability To adopt (1) ICF Assessment and (2) Functioning Scale of the Disability Evaluation System (FUNDES) in the assessment flow HOW EXPECTED OUTCOME • To better reflect users’ wish during the service planning • To enhance the service to be more person-centred • To build a common language and enhance the multi disciplinary communication

17. Individual Functional Profile by FUNDES FUNDES measures users’ performance (with assistance) and capacity (without activity) in 8 domains of activity, participation and environmental factors • Remarks: • First 6 domains measured by 36-item WHO Disability Assessment Schedule 2.0 • Last 2 domains measured by 15 additional items

18. ICF Assessment Form 服務使用者/家屬角度 身體功能及結構(損傷) 活動及 參與 (活動局限/參與限制) • Describe users’ functional profile using text by relevant professionals • Professionals conduct their conventional assessment as usual • Highlight users’ strength, interest and wish 專業人員觀點 環境因素 個人因素

19. Clinical Reasoning Application of ICF in Adult Service and SCI Service By The Spastics Association of Hong Kong

20. ICF-Based Clinical Reasoning (A Pilot Trial in Community Service for SCI commenced in 2018) Mapping is assisted by making reference to the ICF core set for SCI (long=term care) Key element: Transform rehabilitation into a transdisciplinary and holistic practice

21. Discrepancy Analysis (To translate Assessment Findings into Meaningful Goals) ‘Can-Do’ in standard setting ‘Do-Do’ in real-life setting Participation Activity Environment Body Physical Personality Social

22. Central Source of Comprehensive Information • Cross disciplines web-based curriculum management system • Integrated assessment • Shared assessment results • Computerized data processing and analysis • Unified Integrated Assessment • Different sections administered by different professional disciplines • Standardized assessment tools, procedures and scoring system

23. ICF-Based Comprehensive Post-Stroke Rehabilitation Service By The Hong Kong Society for Rehabilitation

24. ICF-Based Comprehensive Post-Stroke Rehabilitation Service Project Objectives: • Provide activity and participation-oriented rehabilitation service to individuals after stroke in the community • Explore the feasibility of ICF-based case management model • Establish a common language among different professionals

25. Strategies of Applying ICF • ICF-based Screening form • Checklist and Assessment Sheet • ICF Individual Profile • ICF Core Sets for Stroke • Activity and Participation-based Rehabilitation Goal Setting & Service Design • ICF Framework and Goal Attainment Scale Case manager ICF Multi-disciplinary team (PT, OT, ST, RN, SW)

26. Service Flow Initial Assessment (Screening) Intensive Rehab Professional Assessment & Rating on ICF Categorical Profile Multi-disciplinary Meeting & Rehab Plan Setting Service Matching Maintenance and Prevention Internal Service Referral Intervention & Evaluation

27. Major Service Components Service Goal A: Enhancing activity and participation competence INDEPENDENT LIVING TRAINING COGNITIVE TRAINING • Mobility(D4) • Self-care (D5) • Domestic life (D6) • Environmental factors • Learning & applying knowledge (D1) • general Tasks & Demands (D2) (PT, OT & SW) (OT & SW) COMMUNICATION AND SWALLOWING TRAINING PSYCHO-THERAPY • Communication (D3) • Interpersonal Interactions and Relationships (D7) • Personal factors • Handling stress and other psychological demands (D240 of D2) (ST, OT & SW) (SW)

28. Major Service Components Service Goal B: Secondary prevention and long-term maintenance LIFE STYLE MODIFICATION LIFE ROLE RESTORA-TION • Economic life (D860)of Major life areas (D8) • Personal factors (VR) (RN & SW) • Interpersonal Interactions and Relationships (D7) • Community, social & civic life(D9) • Environmental factors CRN SUPPORT GROUPS SELF HELP ORGANIZATIONS • Community, social & civic life (D9) • Environmental factors (SW) (SHO)

29. Independent living training Multi-disciplinary team conference Cognitive training module Communication & swallowing training

30. Preliminary Data (N=12) Service users’ need/performance on activity & participation domains

31. Individual ICF Profile Service User A (only show codes with designated intervention provision) Remark: 0 = No, 1 = Mild, 2 = Moderate, 3 = Severe, 4 = Extremely severe

32. Key Lessons Learned Worked Well • ICFenhances a holistic view on users’ need and design of individualized and comprehensive rehabilitation plans • ICFtools increase quality of multi-disciplinary communication and collaboration • ICFsteers service design to cater users’ activity and participation needs Barriers to Be Overcome • Develop operational definition and improve sensitivity of the qualifier of ICF code • Develop new service protocols for fulfilling the ICF-based assessment results • Needs additional resources for providing the new services https://www.rehabsociety.org.hk/dccs/crn/zh-hant/strokecomrehab/

33. Conclusions • Demonstrate how assessment systems and service provision can adopt ICF • Adoption of core sets particularly the activity and participation, and environment factors as they are the needs of service and drive client satisfaction • Current diagnostic and outcome measures can be mapped to the activity and participation, and environment factors • Integration of clinical measures and ICF Core Set Assessment into client’s rehabilitation goals may better enhance quality and effectiveness of services

34. Recommendations • Develop common terminology and goals in rehabilitation offered by NGOs • Include more NGOs taking lead to develop assessment, goal setting, and service provision model/systems • Conduct studies to explore quality and effectiveness of ICF-based systems • Set up common data-base for individuals with disabilities and special needs – cross-institution and cross-sector referral/transfers

35. Thank You! Chetwyn.chan@polyu.edu.hk