1. Wout de Boer, Regina Kunz and very, very many others
Development of an ICF based instrument for functional assessment of work capacity in psychiatry
Wout de Boer, Regina Kunz and very, very many others

2. I have no conflicts of interest to report

3. Organisation
University of Basel, Hospital, Swiss academy of insurance medicine
Fachhochschule Nordwestschweiz
Assessment centres: asim Basel, MEDAS Interlaken, MEDAS Zentralschweiz, ZMB Basel
Suva
University of Basel, Psychiatrische Kliniken
Financing: SNF, BSV, Suva, asim

4. Background
Evaluation for work disability is performed by medical specialists who are not trained for this
Evaluation for work disability is subject to criticism:
Reliability
Transparency
A functional approach is recommended «ICF» but not instrumented

5. ICF ICF is three things ICF is not We provided for that (2010-2016)
A concept of disability (thinking)
A big pile of relevant items (documenting)
A hierarchical classification of these (organising)
ICF is not
An instruction of how to elicit
An instruction of how to document
We provided for that ( )

6. Aim Develop an instrument that is
reliable
transparent
for functional assessment in psychiatric evaluation of work disability

7. IFAP 18 Psych. 100 Reports Expertgroup 12 Mental Functions 13 Activ.
own
work
Hotel
50 Psych.
55 Claimants

8. Current practice
From 100 reports, a survey (120 psychiatrists), a survey (55 psychiatrists) we know that:
Reporting is very heterogeneous
Psychiatrists are ill informed about a claimant’s work
Psychiatrists have very different ideas about how suitable work should be conceptualised
Psychiatrists are not trained in eliciting a claimant’s functional capacity

9. Results: Instrument We drafted an instrument to report
mental functions (12)
activity limitations own work (13)
activity limitations suitable work in hotel (same 13)
Based on our earlier results and Mini ICF (Linden)
Iterative with psychiatrists in training (N=25)
Psychiatrists tested in practice (N=25)

10. Mental functions compared to healthy person (ICF)
Functions of temperament and personality
Agreeableness
Psychic stability
Being open towards new experiences
Self confidence
Mental energy
Attention
Memory
Emotional function
Thinking
Higher cognitive functions
Experience of self and of time
Other impairment of mental function:

11. Activity limitations compared to work (Mini ICF; examples added)
(1) adherence to regulations and routines (2) planning and structuring of tasks (3) flexibility and capacity to adapt (4) using professional competences (5) competence to judge and to decide (6) endurance (7) assertiveness (8) contact with others (9) contact within groups (10) intimate relationships (11) non-work activities (12) self care (13) mobility

12. Scale Function/ Activity (examples added)
0 = no impairment/ no limitation
1 = mild impairment/ slight limitation
2 = moderate impairment/ compensable limitation
3 = severe impairment/ requires adaptation of work
4 = loss of function/ impossible

13. Eliciting and documenting functional capacity
We trained psychiatrists in documenting in IFAP and in functional interviewing
Functional interviewing is: Work-capacity- health conditions that set limits
Training initially 9 hours
Improved training 18 hours

14. Testing
RELY 1: feasibility; reliability trained psychiatrists: diagnose, impairments, limitations, %;
RELY 1: adherence to function oriented interview
RELY 2: judgment reliability trained psychiatrists: diagnose, impairments, limitations, %; (ongoing)
RELY 3: user (claimants, psychiatrists, insurers) satisfaction with IFAP and transparency (ongoing)