International Classification of Functioning, Disability and Health (ICF)

1. International Classification of Functioning, Disability and Health (ICF) KNR 365

2. WHO • Who is WHO? • World Health Organization • United Nations’ agency • Established in 1948 • Objective is attainment by all peoples of the highest level of health (not just absence of disease)

3. WHO Family of International Classifications • International Classification of Diseases (ICD-10) • Codes diagnoses and mortality causes • International Classification of Functioning, Disability and Health (ICF) • Classification system of functioning • Over 1,400 classifications • International Classification of Health Intervention (ICHI) • Currently being developed • Different professions developed own (our text)

4. International Classification of Functioning, Disability and Health (ICF) • Provides standard language & framework for description of health & disability • Across disciplines, service delivery settings, countries, disabilities • TR will need to learn the content & language of ICF to talk/work with other professions • Interventions • Outcomes

5. ICF • 1st version was 1980 • Focused on impairment, disability & handicap • Revised in 2001 • Focuses on health & functioning vs. disability • Endorsed by 191 nations including US • Endorsed by PT, OT, TR and other healthcare organization

6. ICF • Classification of health and health-related domains, that help to describe: • Changes in body function and structure • What a person can do in a standard environment (level of capacity) • What a person can do in their usual environment (level of performance)

7. ICF Applications (Individual level) • For the assessment of individuals: What is the person's level of functioning? • For individual treatment planning: What treatments or interventions can maximize functioning? • For the evaluation of treatment and other interventions: What are the outcomes of the treatment? How useful were the interventions? • For communication among physicians, nurses, physiotherapists, and other health works, social service works and community agencies • For self-evaluation by consumers: How would I rate my capacity in mobility or communication?

8. Conceptual Models of Disability • What is the Medical Model? • Views disability as feature of person • Disability is directly caused by disease, trauma, or other health conditions • Requires medical care provided by professionals • Call for medical treatment or intervention to “correct” the problem

9. Conceptual Models of Disability • What is the Social Model? • Views disability as a socially created problem • It is not just an attribute of a person • Disability demands a political response • Problems are created by unaccommodating physical environment brought about by attitudes & other features of the social environment

10. Conceptual Models of Disability • What is the Biopsychosocial Model? • ICF based on this model • Integration of medical & social models • Disability and function viewed as outcomes of interaction between health conditions (disease, disorders, injuries) and contextual factors

11. Conceptual Models of Disability • Contextual factors • External environmental factors • Social attitudes, architectural barriers, legal & social structures, climate, etc. • Internal personal factors • Gender, age, coping skills, social background, education, past & present experiences, etc. • Factors that influence how disability is experienced by the individual

12. Biopsychosocial Model: ICF Interactions

13. Key ICF Definitions • Body functions: physiological functions of body systems • Body structures: anatomical parts of the body • Impairments: problems in body function or structure • Activity: execution of a task or action • Participation: involvement in a life situation • Participation restrictions: problems in involvement in life situations • Environmental factors: make up the physical, social and attitudinal environment in which people live.

14. Conceptual Model of ICF Part 1. Functioning and Disability (a) Body Functions and Structures - Changes in body functions (physiological) - Changes on body structures (anatomical) (b) Activities and Participation - Capacity: Executing tasks in a standard environment - Performance: Executing tasks in the current environment

15. Conceptual Model of ICF Part 2. Contextual Factors (c) Environmental factors - Facilitating or hindering impact of features of the physical, social, and attitudinal world (d) Personal factors - Impact of attributes of person See Porter & burlingame, p. 4

16. Body Functions (b – many TR scope)(relates to function in isolation) • Mental functions • Sensory functions and pain • Voice and speech functions • Functions of cardiovascular, hematological, immunological and respiratory systems • Functions of the digestive, metabolic and endocrine systems • Genitourinary and reproductive functions • Neuromusculoskeletal and movement related functions • Functions of skin and related structures

17. Body Structures (s – doctor score) • Structures of the nervous system • Eye, ear and related structures • Structures involved in voice and speech • Structures of the cardiovascular, immunological and respiratory systems • Structures related to the digestive, metabolic and endocrine systems • Structures related to the genitourinary and reproductive system • Structures related to movement • Skin and related structures

18. Activities and Participation (d – TR scope)(relates to ability to do an activity) • Learning and applying knowledge • General tasks and demands • Communication • Mobility • Self-care • Domestic life • Interpersonal interactions and relationships • Major life areas • Community, social and civic life

19. Environmental Factors (e – TR scope) • Products and technology • Natural environment and human-made changes to environment • Support and relationships • Attitudes • Services, systems and policies

20. Personal Factors • Not coded in ICF because of wide international variability • Still included because of importance to understanding functioning & disability

21. ICF Coding Example

22. ICF Qualifiers • ICF domain becomes a classification when qualifiers are used • Qualifiers record presence and severity of a problem in functioning at the body, person, and societal levels • 1 or 2 qualifiers may apply per ICF domain

23. ICF Qualifiers (cont.)

24. ICF Qualifiers (cont.)

25. ICF Qualifiers (cont.)

26. ICF Qualifiers (cont.)

27. ICF Qualifiers (cont.)

28. ICF Core Sets • Brain injury rehabilitation • Breast cancer • Cardiopulmonary conditions • Depression • Multiple Sclerosis • Stroke • Etc. • Also ICF-CY (children)

29. ICF TR Resources • Howard, D., Browning, C., & Lee, Y. (2007). The International Classification of Functioning, Disability, and Health: Therapeutic recreation code sets and salient diagnostic core sets. Therapeutic Recreation Journal, 41(1), 61-81. • Porter, H. R., & VanPuymbroeck, M. (2007). Utilization of the International Classification of Functioning, Disability, and Health within therapeutic recreation practice. Therapeutic Recreation Journal, 41(1), 47-60.