Approaches to Health Care Cole, M. & Tufano, R. (2008). Applied theories in occupational therapy. Thorofare, NJ: Slack.

Overview Medical Model Approach vs. Social vs. Biopsychosocial World Health Organization Approach & ICF Health Promotion First compare mm to cc and then explore the WHO approach which tries to address both

Medical vs. Social vs. Biopsychosocial Different names for each side, but basically one sees the client as the problem and the other see the client as having challenges, usually due to societal barriers

Comparison of Terminology Medical Client Centered (Social & Biopsychosocial) Patient Health is absence of disease Disease Diagnosis Prescription Treatment Client Health is well being Health condition Disability Enablement Intervention What other words would you use to describe a visit to a physician?

Approaches to Health Medical Behavioral or Social Biopsychosocial Client-Centered! Medical Behavioral or Social Biopsychosocial Target Strategies health problems- no target here poverty, hx of exclusion, no access to pools inability to swim none teach children to swim personal empowerment, community organization, grant funding for inner city and rural pools run by community members The fatal drowning rate of African American children ages 5 to 14 is 3.1 times that of white children in the same age range. Among racial groups, African Americans reported the most limited swimming ability. Behavioral approach may blame the victim

Client-centered Biopsychosocial Occupation Person Environment Client choice Respect for diversity Collaborative partnership Enable occupation by empowerment Situation congruent interventions Client is individual and unique Situation congruent- the intervention targets what the client needs at the time according to their situation

WHO and the ICF

World Health Organization Created by the United Nations in 1948 Provides leadership and accountability for world health Publishes: the ICD (International Classification of Diseases) now on version 11 Classification of Functioning, Disability and Health (ICF) Why would we all need to use the same definitions? Why do we care?

ICF Systems model Provides an organized list of everything that impacts health Very similar to our practice framework except OTPF provides much more detail on occupations (performance patterns etc.) See page 54 of Willard and Spackman for graphic

Conceptual Model of Functioning “Disability and functioning are viewed as outcomes of interactions between health conditions and contextual factors” p. 10 Body Functions are physiological functions of body systems (including psychological functions). Body Structures are anatomical parts of the body such as organs, limbs and their components. Impairments are problems in body function or structure such as a significant deviation or loss. Activity is the execution of a task or action by an individual. Participation is involvement in a life situation. Activity Limitations are difficulties an individual may have in executing activities. Participation Restrictions are problems an individual may experience in involvement in life situations. Environmental Factors make up the physical, socal and attitudinal environment in which people live and conduct their lives.. WHO, 2002

Body Structure: Function: Structure of the Nervous System The Eye, Ear and Related Structures Structures Involved in Voice and Speech Structure of the Cardiovascular, Immunological and Respiratory Systems Structures Related to the Digestive, Metabolic and Endocrine Systems Structure Related to Genitourinary and Reproductive Systems Structure Related to Movement Skin and Related Structures Function: Mental Functions Sensory Functions and Pain Voice and Speech Functions Functions of the Cardiovascular, Haematological, Immunological and Respiratory Systems Functions of the Digestive, Metabolic, Endocrine Systems Genitourinary and Reproductive Functions Neuromusculoskeletal and Movement-Related Functions Functions af the Skin and Related Structures WHO, 2002

Activities and Participation 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 WHO, 2002

Environmental Factors Products and Technology Natural Environment and Human-Made Changes to Environment Support and Relationships Attitudes Services, Systems and Policies WHO, 2002

Example of four levels of disability Health Condition Impairment Activity Limitation Participation Restriction Spinal Injury Paralysis Incapable of public transport Lack of accommodation leads to no participation in religious activities Juvenile diabetes Pancreatic dysfunction None 2nd to medication Doesn’t go to school because of bullying Four levels of functioning are health, body function and structure, activity and participation WHO, 2002

WHO Disability Assessment Schedule 2.0 A generic assessment instrument for health and disability Used across all diseases, including mental, neurological and addictive disorders Short, simple and easy to administer (5 to 20 minutes) Applicable in both clinical and general population settings A tool to produce standardized disability levels and profiles Applicable across cultures, in all adult populations Directly linked at the level of the concepts to the International Classification of Functioning, Disability and Health (ICF) www.who.int/classifications/icf/whodasii/en/ 12 item and 36 item versions, excellent psychometric properties and norm referenced

WHODAS 2.0 Domains of Functioning Cognition – understanding & communicating Mobility– moving & getting around Self-care– hygiene, dressing, eating & staying alone Getting along– interacting with other people Life activities– domestic responsibilities, leisure, work & school Participation– joining in community activities www.who.int/classifications/icf/whodasii/en/

Health Promotion

Occupational Justice

Health People 2020 Healthypeople.gov Office of Disease Prevention and Health Promotion Info graphics Charts and data on leading health indicators and health disparities Program planning tools Evidence based resources

References WHO (2002). Towards a common language for functioning, disability and Health: ICF. Geneva, Switzerland: Author.