Wout de Boer, Regina Kunz and very, very many others Development of an ICF based instrument for functional assessment of work capacity in psychiatry Wout de Boer, Regina Kunz and very, very many others

I have no conflicts of interest to report

Organisation University of Basel, Hospital, Swiss academy of insurance medicine Fachhochschule Nordwestschweiz Assessment centres: asim Basel, MEDAS Interlaken, MEDAS Zentralschweiz, ZMB Basel Suva University of Basel, Psychiatrische Kliniken Financing: SNF, BSV, Suva, asim

Background Evaluation for work disability is performed by medical specialists who are not trained for this Evaluation for work disability is subject to criticism: Reliability Transparency A functional approach is recommended «ICF» but not instrumented

ICF ICF is three things ICF is not We provided for that (2010-2016) A concept of disability (thinking) A big pile of relevant items (documenting) A hierarchical classification of these (organising) ICF is not An instruction of how to elicit An instruction of how to document We provided for that (2010-2016)

Aim Develop an instrument that is reliable transparent for functional assessment in psychiatric evaluation of work disability

IFAP 18 Psych. 100 Reports Expertgroup 12 Mental Functions 13 Activ. own work Hotel 50 Psych. 55 Claimants

Current practice From 100 reports, a survey (120 psychiatrists), a survey (55 psychiatrists) we know that: Reporting is very heterogeneous Psychiatrists are ill informed about a claimant’s work Psychiatrists have very different ideas about how suitable work should be conceptualised Psychiatrists are not trained in eliciting a claimant’s functional capacity

Results: Instrument We drafted an instrument to report mental functions (12) activity limitations own work (13) activity limitations suitable work in hotel (same 13) Based on our earlier results and Mini ICF (Linden) Iterative with psychiatrists in training (N=25) Psychiatrists tested in practice (N=25)

Mental functions compared to healthy person (ICF) Functions of temperament and personality Agreeableness Psychic stability Being open towards new experiences Self confidence Mental energy Attention Memory Emotional function Thinking Higher cognitive functions Experience of self and of time Other impairment of mental function:

Activity limitations compared to work (Mini ICF; examples added) (1) adherence to regulations and routines (2) planning and structuring of tasks (3) flexibility and capacity to adapt (4) using professional competences (5) competence to judge and to decide (6) endurance (7) assertiveness (8) contact with others (9) contact within groups (10) intimate relationships (11) non-work activities (12) self care (13) mobility

Scale Function/ Activity (examples added) 0 = no impairment/ no limitation 1 = mild impairment/ slight limitation 2 = moderate impairment/ compensable limitation 3 = severe impairment/ requires adaptation of work 4 = loss of function/ impossible

Eliciting and documenting functional capacity We trained psychiatrists in documenting in IFAP and in functional interviewing Functional interviewing is: Work-capacity- health conditions that set limits Training initially 9 hours Improved training 18 hours

Testing RELY 1: feasibility; reliability trained psychiatrists: diagnose, impairments, limitations, %; RELY 1: adherence to function oriented interview RELY 2: judgment reliability trained psychiatrists: diagnose, impairments, limitations, %; (ongoing) RELY 3: user (claimants, psychiatrists, insurers) satisfaction with IFAP and transparency (ongoing)