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International Classifications
World Health Organization Classification Assessment Surveys & Terminology Group ICF as the New Member in the WHO Family of International Classifications Greetings , I am happy to greet you on behalf of the World Health Organization and it is my pleasure to provide you with this introduction on the WHO Family of International Classifications (WHO- FIC) We are now in an upgrading process and moving towards the a unified concept of integrated classification systems for health information. In this presentation, I would like to address the following points: What is the WHO Family of International Classifications ? Why is there a need for the WHO FIC ? What are the key concepts of WHO FIC And the underlying principles of family ? How can we use the WHO FIC to improve people’s health? For your information, a copy of the slides used in this presentation is available from WHO or over the INTERNET. The contact addresses are found at the end of this presentation.
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Aims to provide a scientific basis for consequences of health conditions to establish a common language to improve communications to permit comparison of data across: countries health care disciplines services time to provide a systematic coding scheme for health information systems [Keywords] context###[Narration] to provide a scientific basis for consequences of health conditions to establish a common language for describing consequences of health conditions in order to improve communications between health care workers, other sectors and people with disabilities to stimulate better care and services to improve the participation in society of people with disablements - this is central to improving quality of life and facilitating the autonomy of persons with disablements to permit comparison of data across countries, health care disciplines, services and time - the need for such an international language has long been felt to provide a systematic coding scheme for health information systems - international comparisons of epidemiological and other data has suffered from a lack of uniform systems to stimulate research on the consequences of health conditions - this will facilitate the development of more effective interventions to collect data on facilitators and inhibitors in society that affect the participation of people with disablements - this is crucial to influence policy change###
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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] ###
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Human Functioning not disability alone
Body functions vs impairments Body Structures Activities vs activity limitation 1980 disability Participation vs handicap
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Participation or Handicap?
neutral language “politically correct” correct use intervention opportunity positive aspects ICF does not only describe negative health experiences, but neutral health domains in which the state can be described as both positive and negative. For example: read slide
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Universal Model vs. Minority Model
Everyone may have disability Continuum Multi-dimensional Certain impairment groups Categorical Uni-dimensional [Keywords] concept###[Narration] ICIDH applies to 100 % disablement applies to nearly all###
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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.
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Sequence of Concepts ICIDH 1980
Disease or disorder Impairments Disabilities Handicaps
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Interaction of Concepts
ICF 2001 Health Condition (disorder/disease) Body function&structure (Impairment) Activities (Limitation) Participation (Restriction) Environmental Factors Personal Factors
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Equity / Parity Loss of limb Missed days at usual activities Stigma
landmines = diabetes = thalidomide Missed days at usual activities flu = depression = back pain = angina Stigma leprosy = schizophrenia = epilepsy = HIV [Keywords] concept###[Narration] ###
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Contextual Factors Person Environment gender Gross National Products
age other health conditions social background education profession past experience character style Environment Gross National Products Close milieu Institutions Social Norms Culture Built-environment Political factors Nature [Keywords] structure###[Narration] ###
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Cultural Applicability
[Keywords] concept###[Narration] ### Conceptual and functional equivalence of Classification Translatability Usability International Comparisons
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Functioning and Disability
Structure ICF Classification Part 1: Functioning and Disability Part 2: Contextual Factors Parts Body Functions and Structures Activities and Participation Environmental Factors Personal Factors Components Change in Body Functions Change in Body Structures Capacity Performance Facilitator/ Barrier Constructs/ qualifiers ICIDH categories are organized in a "nested" approach Broader Category detailed subcategory The classification has two parts, each with two components. [An example may help to illustrate the point: The universe of health and disability is being classified (this is the forest). Within that forest we classify the dimensions of Impairments, Activities and Participation (the trees). In the Activities dimension we have several chapters or domains ranging from simple to complex activities - from sensing and recognizing to interpersonal behaviors (the trunks). Within, for example, the chapter on Interpersonal Behaviors are included activities such as general interactive skills (the branch) and included in that broad category are behaviors such as initiating social contact, responding to cues and so on (the leaves).] Item levels: 1st 2nd 3rd 4th Item levels: 1st 2nd 3rd 4th Item levels: 1st 2nd 3rd 4th Item levels: 1st 2nd 3rd 4th Item levels: 1st 2nd 3rd 4th Domains and categories at different levels
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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. Der ICIDH-2 unterscheidet zwischen drei Dimensionen…
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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
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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
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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
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ICF in health & disability statistics
Common Domains Mobility - Cognition - Mood Self Care - Usual Activities ... link data from both health and disability Multiple Components overcomes the “impairment” focus Environmental Factors Comparability Another principle that underlies ICIDH is that of parity. There is no distinction, at the level of impairment, activity limitation or participation restriction, between different health conditions (e.g. mental and physical). In other words, disablement is not differentiated by etiology. ICIDH is etiologically neutral.
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ICF in clinical practice & management
Needs assessment Outcome assessment Utilization patterns Comparison of different interventions Consumer satisfaction Service performance outcomes cost-effectiveness Electronic records Clinical terminology (Vorhersage des Inanspruchnahmeverhaltens & Länge der Hospitalisierung)
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ICF Domains used in International WHO Surveys
Health Domains Vision Hearing Speech Digestion Bodily excretion Fertility Sexual activity Skin & disfigurement Breathing Pain Affect Sleep Energy / vitality Cognition Communication Mobility and Dexterity Health Related Domains Self-care: Including eating Usual activities: household activities; work or school activities Social functioning: interpersonal relations Participation: societal participation including discrimination/stigma
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사회학과 작업치료 조지 짐멜 작업치료와 관련되는 사회학 이론 내부적인 완성은 본질적으로 완성된 과제와의 상호작용에서 창출된다.
This statement would seem to fit very well with the notion within occupational therapy of the importance of a balance of activities in daily life. 작업치료와 관련되는 사회학 이론 Action theory Functionalism Marxism Feminism Postmodernism
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작업치료와 행동이론 베버; 근대의 삶은 합리적 행동에 의해 제한되고 인도되는 것 관료주의와 시장화의 과정
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작업치료와 기능주의 역할 인간작업수행모델(MOHO) 사회적 역할은 기능적 관점에서 중요 사람들은 다양한 역할로 사회화
해석학자들과 획일화된 성의 역할 부정하는 입장의비판 인간작업수행모델(MOHO)
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Q: 당신은 학생이나 고객이 단지 기계의 톱니바퀴인지?
또는 베버의 효율성과 합리적인 행동의 이해를 바탕으로 하고 있는가?
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작업치료와 마르크시즘 구조적 갈등이론가는 환경에 적응하는 인간을 부정 인간의 능력에 낙관적인 관점 사회문제
사람들의 행동을 하는 능력을 강조 스스로 역사적 과정을 창출 인간의 노동 & 실질적 활동이 중요 사회문제 자연적인 것이 아닌 사회조직의 특정한 형태에서 야기됨 상황에 구속
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작업치료와 페미니즘 페미니즘과 작업치료는 관련성이 높다(?).
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작업치료와 포스트모더니즘 작업치료 영국대학에서의 회담에서 소개 과학적 전문가의 진실에 도전 활동의 관점 치료의 성과
효율성의 측정에 도전질적연구방법을 강조 활동의 관점 고객관점을 토대로 둠
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