1. Marcia Levinson, PT, PhD, MFT
A Common Language for Interprofessional Education: The World Health Organization’s International Classification of Functioning, Disability and Health (ICF)
Christine Jerpbak, MD
Nethra Ankam, MD
Marcia Levinson, PT, PhD, MFT
Lauren Collins, MD
InterProfessional Education Center

2. Objectives
Define key WHO-ICF concepts, including health conditions, impairments, participation and activity
Apply the WHO-ICF concepts to a patient
Use the WHO-ICF concepts to generate person-centered goals
Learn how ICF is integrated into IPE curriculum at TJU
Discuss WHO-ICF concepts and potential application to own IPE curricula

3. Outline of Today’s Session
Introductions
ICF as a common language
Case-based application of ICF
Generate person-centered goals
Identify team members’ roles
Describe TJU use and experience with ICF in medical student education and IPE
Audience discussion of IPE experience and potential use and application of ICF

4. Why do we need a common language?
InterProfessional Education Center

5. Words can have different meanings for different people
“Functional problem”
Without a common language, this term can refer to multiple different items – such as knee pain, osteoarthritis, inability to walk, trouble getting to the doctors office, etc
“Trauma”
For some, trauma means damage to tissues at the cellular level or from an accident; for others, it represents emotional trauma or abuse, etc.
InterProfessional Education Center

6. People use different words for a similar concept
IADLs (Instrumental Activities of Daily Living), Participation, Roles…
All refer to involvement in life situations, but use often varies by discipline
Patient, Client, Mentor, Participant…
All refer to the same person, but use often varies by discipline
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7. World Health Organization
WHO created the International Classification of Functioning, Disability, and Health (ICF) to serve as a common language for clinicians and researchers
ICF serves as a companion to the International Classification of Diseases (ICD)
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8. WHO International Classification of Functioning, Disability and Health
ICF
Health Conditions
(disease or disorder)
(Impairment of)
Participation
Activity
Body function
and structures
(Limitation)
(Restriction)
Why do we need a common language? Well take the case of someone with osteoarthritis who is having functional problems. Without a common language, someone might think the osteoarthritis itself is the functional problem, someone else might think pain from the osteoarthritis is the functional problem, someone else might think her difficulty going up stairs her functional problem, and someone else might think that the fact she cannot take public transportation to get to doctor’s visits is her functional problem. With common language, you know the osteoarthritis is her health condition (disease or disorder,) her pain is an impairment of body function and her deformity due to the arthritis is impairment of body structure, her difficulty going up stairs is an activity limitation, or trouble with a task the person does, and her difficulty getting to doctor’s appointments is a participation restriction or a difficulty in performing her societal roles and participation in the community. Each one of these things is affected by the other, and they are all affected by the environment a person lives in, and the personal strengths and weaknesses a person has. This particular person with the osteoarthritis lives in a neighborhood served by buses with stairs to enter, rather than the flat entryway buses, so she had problems getting on and off the bus, so the bus that is serving the route she is taking is an environmental factor that becomes a weakness or barrier to overcome.
Environmental
Factors
Personal
Factors
(Strengths and Weaknesses)
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9. InterProfessional Education Center
ICF
Health Conditions
(disease or disorder)
(Impairment of)
Activity
Participation
Body function
and structures
(Limitation)
(Restriction)
Environmental
Factors
Personal
Factors
(Strengths and Weaknesses)
You can even look at it like an equation---Any adjustment in any section of this diagram affects quality of life drastically. So in the last example, as the transit authority upgrades its fleet, if the type of bus that stops in front of her house changed, her quality of life would increase as she would no longer have a barrier to get to doctor’s appointments.
As an interprofessional team, once you gather this information—you could intervene at any level of this chart.
There is a power to this method of thinking, and having a common language adds power to interprofessional interactions. =
Quality of Life
InterProfessional Education Center

10. Introduction to the ICF Framework: InterProfessional Education Center
Lilly-a case study
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11. InterProfessional Education Center
Lilly
75 years old
Mother of 2, grandmother of 5
Lives with her husband in a 2 story house with 5 steps to enter; they have lived there for 35 years
Attends church every week
Hosts Sunday dinner every week
Expects all her children and grandchildren will be there
InterProfessional Education Center

12. ICF Environmental Factors
The people and structures that surround a person
Can be strengths or weaknesses when trying to achieve a goal
ICF
Health Conditions
Body function
and structures
Participation
Activity
Bathroom on 2nd floor
Husband
Lots of family nearby
Health insurance
Environmental
Factors
Personal
Factors
InterProfessional Education Center

13. ICF Personal Factors The general sketch of the person
Can be strengths or weaknesses when trying to achieve a goal
ICF
Health Conditions
Body function
and structures
Participation
Activity
Determination
Faith
Independent
Likes control
Bathroom on 2nd floor
Husband
Lots of family nearby
Health Insurance
Environmental
Factors
Personal
Factors
InterProfessional Education Center

14. ICF Participation Involvement in life roles and community
The meaningful parts of a person’s life
ICF
Health Conditions
Matriarch
Wife
Homemaker
Church member
Body function
and structures
Participation
Activity
Bathroom on 2nd floor
Husband
Lots of family nearby
Health Insurance
Determination
Faith
Independent
Likes Control
Environmental
Factors
Personal
Factors
InterProfessional Education Center

15. InterProfessional Education Center
Lilly
New health condition
Several weeks ago, Lilly had a left sided stroke with resultant right sided weakness
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16. InterProfessional Education Center
Health Conditions
Disease or disorder
ICF
Health Conditions
Left brain
stroke
Matriarch
Wife
Homemaker
Church member
Body function
and structures
Participation
Activity
Bathroom on 2nd floor
Husband
Lots of family nearby
Health Insurance
Determination
Faith
Independent
Likes Control
Environmental
Factors
Personal
Factors
InterProfessional Education Center

17. Body Function and Structure InterProfessional Education Center
can be impaired
ICF
Right hemiparesis
Dysphagia
Aphasia
Visual field cut
Impaired cognition
Health Conditions
Left brain stroke
Matriarch
Wife
Homemaker
Church member
Body function
and structures
Participation
Activity
Could go from body systems… to the cellular level, hemorrhagic or ischemic, ischemic neuron becomes depolarized
Intracerebral hemorrhage originates from deep penetrating vessels and causes injury to brain tissue by disrupting connecting pathways and causing localized pressure injury. In either case, destructive biochemical substances released from a variety of sources play an important role in tissue destruction.
Bathroom on 2nd floor
Husband
Lots of family nearby
Health Insurance
Determination
Faith
Independent
Likes Control
Environmental
Factors
Personal
Factors
InterProfessional Education Center

18. InterProfessional Education Center
Activities: individual tasks the person can do
Activity Limitations: Individual tasks a person cannot do
to get through a day
Right hemiparesis
Dysphagia
Aphasia
Visual field cut
Impaired cognition
ICF
Health Conditions
Left brain stroke
Can’t eat
Can’t cook
Can’t walk
Can’t communicate wants and needs
Matriarch
Wife
Homemaker
Church member
Body function
and structures
Participation
Activity
Bathroom on 2nd floor
Husband
Lots of family nearby
Health Insurance
Determination
Faith
Independent
Likes Control
Environmental
Factors
Personal
Factors
InterProfessional Education Center

19. ICF Participation restriction
decreased involvement in life roles and community
ICF
Right hemiparesis
Dysphagia
Aphasia
Visual field cut
Impaired cognition
Left brain stroke
Health Conditions
Can’t eat
Can’t cook
Can’t walk
Can’t communicate wants and needs
Matriarch
Wife
Homemaker
Church member
Body function
and structures
Participation
Activity
Can’t attend church
Can’t shop or drive
Bathroom on 2nd floor
Husband
Lots of family nearby
Health Insurance
Determination
Faith
Independent
Likes Control
Environmental
Factors
Personal
Factors
InterProfessional Education Center

20. Health condition impact on activities and participation
Lilly can’t eat, talk, walk, cook, shop, drive
Lilly feels out of control of her life, and she and her family have to cope with a new reality
So, how can various members of the health care team help Lilly and her family?

21. Use the ICF Realize every person/story/family is different
Anticipate problems
Help the family to reorganize their structure to this change in their dynamics
Inform collaborative and person-centered goals
Will they be supportive and help her with daily activities ??????
Every family is different

22. Person-Centered goals What does the patient want to accomplish?
Presupposes that the individual has within himself resources for self-understanding and that s/he is part of the health care team. Therefore the patient can decide/explain what is meaningful and desirable in his/her life.
Should include behavior that is
Important to the patient
Doable/possible
Measurable

23. Lilly’s person-centered goals
Host Sunday Dinner
Contributions by members of IP team:
Optimize pain, spasticity control to allow her to sit at the table (physician)
Help patient improve her swallow (speech & language pathologist)
Teach patient how to feed herself and do simple meal prep (occupational therapist)

24. Lilly’s person- centered goals
Attend Church
Contributions by members of IP team:
Help her with her mobility--whether it be wheelchair or walking--and problem solve the specifics of getting to church (physical therapist)
Work on speech so she can participate in the service (speech & language pathologist)
Develop a continence plan to allow for social continence during church (nurse, physician)

25. InterProfessional Education Center
ICF
Health Conditions
(disease or disorder)
(Impairment of)
Activity
Participation
Body function
and structures
(Limitation)
(Restriction)
Environmental
Factors
Personal
Factors
(Strengths and Weaknesses)
You can even look at it like an equation---Any adjustment in any section of this diagram affects quality of life drastically. So in the last example, as the transit authority upgrades its fleet, if the type of bus that stops in front of her house changed, her quality of life would increase as she would no longer have a barrier to get to doctor’s appointments.
As an interprofessional team, once you gather this information—you could intervene at any level of this chart.
There is a power to this method of thinking, and having a common language adds power to interprofessional interactions. =
Quality of Life
InterProfessional Education Center

26. Thomas Jefferson University Health Mentors Program
Began in Fall 2007 as a required experience for all beginning medical, nursing, PT, and OT students; pharmacy and couple and family therapy students joined in Fall 2008
Student teams: 4-5 students from 3-4 professions
Partnered with a Health Mentor: an adult volunteer who has one or more chronic conditions or disabilities
Teams complete 4 curriculum-based assignments with their mentors over 2 years

27. Thomas Jefferson University Health Mentors Program Goals
Students will understand and value the roles and contributions of various members of the interprofessional healthcare team
Students will understand the perspective of the patient and value patient-centered care
Students will appreciate how a person’s health conditions and impairments interact with personal and environmental factors

28. Thomas Jefferson University Health Mentors Program Curriculum
4 Modules:
Obtaining a comprehensive life and health history
Preparing a wellness plan
Assessing patient safety (based on a home visit)
Assessing self-management support and healthy behavior
Professionalism, teamwork, person-centered care interwoven throughout
1.Obtaining a Comprehensive Life and Health History, which includes a discussion of the health mentor’s personal narrative, health beliefs and interactions with the healthcare system
2.Preparing a Wellness Plan, which uses a person-centered, evidence-based approach to outline the Health Mentor’s wellness goals
3.Assessing Patient Safety, which includes a team-based evaluation of home and medication safety, based on a team home visit
4.Self-Management Support and Healthy Behavior, which uses the Transtheoretical Model of Behavior Change and SMART goals to assess the Health Mentor’s health behaviors and self-management support needs

29. Discussion Do you see using the ICF? Where?
How would you put this in your curriculum?
With faculty
With students
How does this translate to clinical situations?