Application and Benefits of Using ICF Core Set in Vocational Rehabilitation Valentina Brecelj, University Rehabilitation Institute, Republic of Slovenia

I have no potential conflicts of interests to report

Goal  development of an efficient, applicable in practice and user-friendly description of functioning and disability. Important for coordinated VR process, with the aim of successfully solving unemployment issues of service users. ICF Core Set facilitates the description of functioning by providing lists of categories that are relevant for specific health conditions and health care contexts. These ICF categories were selected from the entire ICF following a scientific approach based on preliminary studies and with the involvement of experts. Project 2015 and 2016: Development of the ICF Core Set for VR Development Center for Vocational Rehabilitation at University Rehabilitation Institute Republic of Slovenia Project 2015 and 2016: Development of the ICF Core Set for VR

Vocational Rehabilitation and Employment of PwD Act  To acquire status of PwD the following criteria have to be met: - permanent physical and mental impairments and diseases, - difficulties with employability, - obstacles in inclusion in the working environment, as defined by ICF. Rules on criteria and procedure to acquire the status of a PwD and the right to VR and to assess employment opportunities of PwD and on activities of rehabilitation commissions  In the process of assessment to acquire the status of PwD, ICF is used for assessing physical and mental functions. Standards of VR services  Service – assessment phase (in final report) -Aside from other measures, also ICF is used in the assessment of the difficulties and obstacles related to disability -ICF is a base for planning further VR services Legal basis - Slovenia

International Classification of Functioning Disability and Health ICF The International Classification of Functioning Disability and Health – ICF has two aspects:  It is a philosophy which helps you to understand disability and health  It is a classification system to assess everyday life of people with disabilities ICF consists of four domains  Body Functions  Body Functions (including mental functions)  Body Structures  Activities and Participation  Environmental Factors We do not only need to know the name of a disability, but also about the individual impact of it.

The basis for the development of the ICF Core Set for VR -VR aims to facilitate the return-to-work process  ICF is needed for a universal description of functioning for persons who participate in VR. -ICF not only describes health deficits but also looks at the individual problems in everyday life performance. -The focus is not only on deficits, but also on resources. -We should be able to communicate about complex interactions with other professionals and employees of the other institutions

The basis for development of the ICF Core Set for VR -Using only of the first part of the ICF (Body Functions) is not sufficient for the purpose of the VR process – it does not cover all areas, which are important for the life and employment of individual service user  non-medical factors are not taken into account -Aside from disability, employability is influenced also by activities and participation of any individual and by environmental and personal factors.

The basis for development of the ICF Core Set for VR -ICF is used only in the first, assessment phase of the VR process  reduces the purpose of the ICF application (goal setting in the Individual Rehabilitation Plan, guiding and evaluation of the VR process)

Overall 1400 ICF categories  time consuming, ineffective We can prepare our own list of relevant ICF categories! useful and practical tool multidimesional common language for describing health and health-related states in order to improve communication between different stakeholders assessment of functional status is clear and structured enable assesment of the needs  clear, specific goal of treatment  enable planning of the activities/services General rule: 20% categories explain 80% versions from practice General rule: 20% categories explain 80% versions from practice Why use ICF core set?

What did we do? – Development Methodology consensus driven approach A consensus driven approach has been used to define the ICF Core Set for VR: 1.group of eight VR professionals developed a draft of the ICF Core Set covering all potentially relevant employment aspects doctor – occupational health medical practitioners, social worker, psychologist, specialist for adult education, occupational therapist, sociologist, special educational needs teacher

Development Methodology systematic literature review 2.a systematic literature review was conducted  positive impact of ICF Core Sets application on the reha processes selected cases from VR 3.the use of the entire ICF and of the WHO‘s Comprehensive ICF Core Set for VR on the selected cases from VR selection of the cases was made on the basis of the most frequent diagnoses (ICD: mental and behavioural disorders; disease of muscosceletal system and connective tissue; d. of the nervous system; d. of eye and adnexa) 4.appropriateness of already developed WHO Core Sets for VR was checked we decided which ICF categories are to be included in the core set following a multi-stage, well-established decision-making and consensus process  we decided which ICF categories are to be included in the core set following a multi-stage, well-established decision-making and consensus process

Development Methodology 5.a wider group of VR professionals tested the draft of ICF Core Set (10 focus groups with 72 participants – VR professionals) 6.pilot study – all VR providers are using the ICF Core Set in their own cases in practice (app. 100–150 cases)  inter-observer agreement (i.e. Cohen‘s kappa and related methods)  final consensus ICF Core Set for VR in Slovenia

Vocational rehabilitation is a process which enables persons with functional, psychological, developmental, cognitive and emotional impairments or health disabilities to overcome barriers to accessing, maintaining or returning to employment or other useful occupation.

ENVIRONMENTAL FACTORS Products and technology for improving the functioning of a PwD (e110–e135): personal consumption, personal use in daily living, indoor and outdoor mobility and transportation, education, employment Support and relationships (e315 – e340): practical physical or emotional support by family and friends Attitudes (e410 – e430, e498): influence on individual behaviour and social life at all levels Transportation services (e540)

Further activities ICF Core Set for VR Further activities

Goal Setting (Individual Rehabilitation Plan) on the basis of the ICF Core Set for VR Rehabilitaton process: further activities 1.Assessment  Service B 2.Goal Setting (on the basis of the Core Set)  -Linking specific ICF categories with the VR services -Individual Rehabilitation Plan 3.Providing the services  VR services 4.Acting  VR services – adapting to the needs 5.Evaluation of goal achievement  -at the end of the VR -Evaluation of the VR process with the ICF Core Set reassessment at the end of the VR proces ICF Core Set for VR

IRP on the basis of the ICF Core Set for VR