The International Classification of Functioning, Disability and Health Selected slides of the Presentation for the UMINDS class September 14, 2006 Els R. Nieuwenhuijsen, PhD, MPH, OTR elsni@comcast.net

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 [Keywords] concept###[Narration] ###

Medical versus Social Model PERSONAL problem vs SOCIAL problem medical care vs social integration individual treatment vs social action professional help vs individual & collective responsibility personal vs environmental adjustment manipulation behaviour vs attitude care vs human rights health care policy vs politics individual adaptation vs social change The various models proposed to explain and classify disablements may be expressed in a dialectic of “medical model” versus “social model”. The medical model views the disablement phenomenon as a “personal” problem, directly caused by disease, trauma or health conditions, which requires medical care provided in the form of individual treatment by professionals. Management of disablement is aimed at the person’s better adjustment and behaviour change. Health care is viewed as the main issue and at the political level it is health care policy that needs to be modified. The social model of disablement, on the other hand, sees the issue mainly as a “societal” problem from the viewpoint of integration of persons with disabilities into society. Disablement is not an attribute of a person, but a complex collection of conditions many of which are created by the social environment. Hence the management of the problem requires social action and it is the collective responsibility of society to make the environmental modifications necessary for the full participation of people with disabilities into all areas of social life. The issue is, therefore, an attitudinal or ideological one which requires social change, while at political level it is a question of human rights. Hence the issue is highly political for all intents and purposes.

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

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). (Slide inserted by Els Nieuwenhuijsen)

ICF Components Body Functions & Structures Activities & Participation Environmental Factors Functions Structures Capacity Performance Barriers Facilitators Nach den Ausfuehrungen zum Kontext und Konzept des ICIDH-2 moechte ich Ihnen nun auf die Inhalte, Begriffsdefinitionen und Kodierungschema vorstellen. Deer ICIDH-2 unterscheidet zwischen drei Dimensionen…

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

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

Contextual Factors Person Environment gender Products age Close milieu other health conditions coping style social background education profession past experience character style Environment Products Close milieu Institutions Social Norms Culture Built-environment Political factors Nature

The ICF ICF is the only classification that deals with functioning, disability and health ICF is used world wide ICF is founded on the bio-psycho-social model (slide inserted by Els Nieuwenhuijsen)

References Disability and Rehabilitation, 2005, Vol 27, No 7/8; and Disability and Rehabilitation, 2003, Vol 25, No 11/12 Measuring health : a guide to rating scales and questionnaires. Ian McDowell. Oxford: Oxford University Press, 1996 American Journal of Public Health: November 2005 Surgeon General's Call to Action to Improve the Health and Wellness of Persons with Disabilities http://www.surgeongeneral.gov/library/disabilities Healthy People 2010, focus area 6 http://www.healthypeople.gov/Publications/ http://vancouver.ca/getinvolved/documents/MeasuringUpWorkbookSept26.pdf http://www3.who.int/icf/icftemplate.cfm