ICF World Health Organization Classification Assessment Surveys & Terminology Group as the New Member in the WHO Family of International Classifications Adapted slide presentation for UMINDS class – Sept

Basic Messages ICF has been systematically revised in the last decadeICF has been systematically revised in the last decade –large international and multidisciplinary participation –extensive field testing –guided by scientific principles taxonomic guidelines: logic and terminologytaxonomic guidelines: logic and terminology practical utility: feasibility, ease of use, ethical guidelinespractical utility: feasibility, ease of use, ethical guidelines reliability, validity and comparabilityreliability, validity and comparability When the rubber hits the road...When the rubber hits the road... –ICF can serve as a useful tool for Health Information Systems evaluation: needs, outcomes, costs, quality, satisfactionevaluation: needs, outcomes, costs, quality, satisfaction service provision, social policyservice provision, social policy –Application guidelines, training, tools are needed

World Health Assembly l Endorse and publish ICF l use the ICF in Member States in: Ü research Ü surveillance Ü reporting l Joint use with ICD l Operational subsets: Ü surveys Ü clinical encounters l Periodic revision

Interventions procedures procedures Reasons for encounter ICD-10 ICD-10 International Statistical Classification of Diseases & Related Health Problems ICF International Classification of Functioning, Disability and Health IND Nomenclature of Diseases Speciality adaptation s Primary care adaptations WHO Family of International Classifications Associated Products Main Classifications Adaptations

ICF Publications 1. Main volume with glossary - Full version 9999 cat. - Short version 99 cat. 2. Clinical Descriptions & Assessment Guidelines 3. Assessment Criteria for Research 4. Other versions - Specialty adaptations Children and Youth 5. Dedicated Assessment Tools

Multilingual CD-ROM Browser & Internet Edition classification in its tree structureclassification in its tree structure Two languages at the same timeTwo languages at the same time Advanced search functionAdvanced search function Cross references via hyperlinksCross references via hyperlinks Selects and work on subsetsSelects and work on subsets Internet based upgrading facilitiesInternet based upgrading facilities

Aims to provide a scientific basis for consequences of health conditionsto provide a scientific basis for consequences of health conditions to establish a common language to improve communicationsto establish a common language to improve communications to permit comparison of data across:to permit comparison of data across: – countries – health care disciplines – services – time to provide a systematic coding scheme for health information systemsto provide a systematic coding scheme for health information systems

ICIDH-1 ICF Conceptual transformationConceptual transformation User needsUser needs Advocacy scienceAdvocacy science –Service Outcomes: measure to manage –Health Measures: evidence to inform policy –Causality: multi-linear web

Foundations of ICF Human Functioning - not merely disability Universal Model - not a minority model Integrative Model - not merely medical or social Interactive Model - not linear progressive Parity - not etiological causality Context - inclusive - not person alone Cultural applicability - not western concepts Operational - not theory driven alone Life span coverage - not adult driven

Human Functioning not disability alone Body functionsvs impairmentsBody functionsvs impairments Body StructuresBody Structures Activitiesvs activity limitationActivitiesvs activity limitation 1980 disability 1980 disability Participationvs handicapParticipationvs handicap

Terminology Neutral language “politically correct” “politically correct” cultural sensitive cultural sensitive No terms as No terms as - physically challenged – handicapped – differently abled (adapted by Els N)

Universal Model vs. Minority Model Everyone may have disability ContinuumMulti-dimensional Certain impairment groups CategoricalUni-dimensional

Definition of the term Disability Disability is an umbrella term for impairments, activity limitations or participation restrictions. It denontes the negative aspects of the interaction between an individual (with a health condition) and that individual’s contextual factors (environmental and personal factors). (inserted by Els Nieuwenhuijsen)

Medical versus Social Model PERSONAL problem vs SOCIAL problemPERSONAL problem vs SOCIAL problem medical care vs social integrationmedical care vs social integration individual treatment vs social actionindividual treatment vs social action professional help vsindividual & collective responsibilityprofessional help vsindividual & collective responsibility personal vs environmental adjustment manipulationpersonal vs environmental adjustment manipulation behaviour vsattitudebehaviour vsattitude care vs human rightscare vs human rights health care policy vs politicshealth care policy vs politics individual adaptation vs social changeindividual adaptation vs social change

Medical Model Medical Model Etiology EtiologyDiseaseDisorderInjuryPathology Manifestation Manifestation

Sequence of Concepts ICIDH 1980 Impairments ImpairmentsDisease or or disorde r Disabilities Disabilities Handicaps

Health Condition ( disorder/disease ) Interaction of Concepts ICF 2001 Environmental Factors Personal Factors Body function&structure (Impairment ) Activities(Limitation)Participation(Restriction)

Equity / Parity Loss of limb Loss of limb landmines = diabetes = thalidomide Missed days at usual activities Missed days at usual activities flu = depression = back pain = angina Stigma Stigma leprosy = schizophrenia = epilepsy = HIV

Examples Two workers, one is a construction worker, another is teacher, have the same health condition, chronic back pain (impairment). They both experience functional activity limitations such as bending, stooping, lifting and carrying heavy objects, standing for long periods of time. For the construction worker this can result in major participation restrictions at work. The teacher who can adjust the activities in the classroom may most likely continue teaching using a chair, stool, and walking around. (Slide inserted by Els N.)Cure

Example A child diagnosed with asthma (impairment of the respiratory system) may not have the capacity to run, climb, or play soccer (activity limitations), and may experience lack of support (environmental barriers) from friends. (Slide inserted by Els N.)

Contextual Factors Person Ýgender Ýage Ýother health conditions Ýcoping style Ýsocial background Ýeducation Ýprofession Ýpast experience Ýcharacter style Environment ÝProducts ÝClose milieu ÝInstitutions ÝSocial Norms ÝCulture ÝBuilt-environment ÝPolitical factors ÝNature

Cultural Applicability Conceptual and functional equivalence of Classification Conceptual and functional equivalence of Classification Translatability Translatability Usability Usability International Comparisons International Comparisons

Comparability: equivalence across cultures Conceptual equivalence: Conceptual equivalence: similar understanding /meaning of concepts similar understanding /meaning of concepts Functional equivalence: Functional equivalence: similar domains similar domains Metric equivalence:Metric equivalence: similar measurement characteristics similar measurement characteristics

ICF Field Testing 7 years years countries61 countries ICF drafts translated into / tested in 27 languagesICF drafts translated into / tested in 27 languages 38 National Consensus Conferences38 National Consensus Conferences 7 International Consensus Conf.7 International Consensus Conf Live Case evaluations2000 Live Case evaluations 3500 Case Summary evaluations3500 Case Summary evaluations

Structure Classification Parts Components Constructs/qualifiers Domains and categories at different levels at different levels ICF Part 1: Functioning and Disability Part 2: Contextual Factors Body Functions and Structures Activities and Participation EnvironmentalFactorsPersonalFactors Change in Body Structures StructuresCapacityPerformanceFacilitator/Barrier Item levels: 1 st 2 nd 3 rd 4 th Item levels: 1 st 2 nd 3 rd 4 th Item levels: 1 st 2 nd 3 rd 4 th Change in Body Functions Functions Item levels: 1 st 2 nd 3 rd 4 th Item levels: 1 st 2 nd 3 rd 4 th

ICF Components Body Functions &StructuresActivities&Participation Environmental Factors BarriersFacilitatorsFunctionsStructuresCapacityPerformance

Body Functions and Structures Skin and related structures Functions of the skin and related structures Structures related to movement Neuromusculoskeletal and movement-related functions Structures related to the genitourinary and reproductive systems Genitourinary and reproductive functions Structures related to the digestive, metabolic and endocrine systems Functions of the digestive, metabolic and endocrine systems Structures of the cardiovascular, immunological and respiratory systems Functions of the cardiovascular, haematological, immunological and respiratory systems Structures involved in voice and speech Voice and speech functions The eye, ear and related structures Sensory functions and pain Structures of the nervous system Mental functions

Activities and Participation 1Learning &Applying Knowledge 2General Tasks and Demands 3Communication 4Movement 5Self Care 6Domestic Life Areas 7Interpersonal Interactions 8Major Life Areas 9Community, Social & Civic Life

Environmental Factors 1. Products and technology 2. Natural environment and human- made changes to the environment 3. Support and relationships 4. Attitudes 5. Services, systems and policies

ICF Checklist l One component- One page “at-a-glance” “at-a-glance” l Salient Categories (169 out of 1494) ! Impairments with: ! Body Functions ! Body Structures ! Activity and Participation ! Environmental Factors l Other Contextual information l Available for: ! Clinicians & providers ! Consumers

ICF Applications Health sectorHealth sector Social securitySocial security Education sectorEducation sector Labour sectorLabour sector Economics & development sectorEconomics & development sector Legislation & lawLegislation & law Other ….Other ….

ICF in health & disability statistics Common DomainsCommon Domains –Mobility- Cognition- Mood –Self Care- Usual Activities... link data from both health and disabilitylink data from both health and disability Multiple ComponentsMultiple Components overcomes the “impairment” focusovercomes the “impairment” focus Environmental FactorsEnvironmental Factors ComparabilityComparability

Needs assessmentNeeds assessment Outcome assessmentOutcome assessment Utilization patternsUtilization patterns Comparison of different interventionsComparison of different interventions Consumer satisfactionConsumer satisfaction Service performanceService performance –outcomes –cost-effectiveness Electronic recordsElectronic records Clinical terminologyClinical terminology ICF in clinical practice & management

ICF in policy making assessment of population healthassessment of population health impact of disabilityimpact of disability –economic –social evidence-base for policy makers on different policy interventionsevidence-base for policy makers on different policy interventions –responsiveness of services –efficiency –performance assessment

ICF research applications joint assessment of disease and functioningjoint assessment of disease and functioning –description of association –intervention response & synchrony of change –explanatory power on: utilizationutilization needsneeds costscosts outcomesoutcomes –Cost-effectiveness of interventions –Unified approaches

ICF Domains used in International WHO Surveys Health Domains VisionVision HearingHearing SpeechSpeech DigestionDigestion Bodily excretionBodily excretion FertilityFertility Sexual activitySexual activity Skin & disfigurementSkin & disfigurement BreathingBreathing PainPain AffectAffect SleepSleep Energy / vitalityEnergy / vitality CognitionCognition CommunicationCommunication Mobility and DexterityMobility and Dexterity Health Related Domains Self-care: Including eating Self-care: Including eating Usual activities: household activities; work or school activities Usual activities: household activities; work or school activities Social functioning: interpersonal relations Social functioning: interpersonal relations Participation: societal participation including discrimination/stigma Participation: societal participation including discrimination/stigma

Summary ICF is a classification of Functioning Applicable for all peopleApplicable for all people Environment plays a major roleEnvironment plays a major role Classification can help distinguishing differences and similaritiesClassification can help distinguishing differences and similarities Collection of uniform data is essential to compare and contrast findings and to move the body of knowledge forwardCollection of uniform data is essential to compare and contrast findings and to move the body of knowledge forward (Slide inserted by Els N.)