ICF use and standardised in rehabilitation introduction
- 1. An Introduction to the An Introduction to the International Classification International Classification of Functioning, Disability, of Functioning, Disability, and Health and Health Daniel Mont Daniel Mont Disability and Development Team Disability and Development Team The World Bank The World Bank UN SPECA Regional Workshop on Disability Statistics UN SPECA Regional Workshop on Disability Statistics Bishkek, Kyrgyzstan Bishkek, Kyrgyzstan Dec 13-15 2006 Dec 13-15 2006
- 2. Presentation Overview Presentation Overview Introduction to the International Introduction to the International Classification of Functioning, Classification of Functioning, Disability and Health (ICF) Disability and Health (ICF) How can the ICF inform disability How can the ICF inform disability measurement? measurement? How does the purpose of data How does the purpose of data collection affect measurement collection affect measurement methodology? methodology?
- 3. What is the ICF? What is the ICF? A framework for describing the facets A framework for describing the facets of human functioning that may be of human functioning that may be affected by a health condition affected by a health condition A classification system – not a A classification system – not a measurement tool measurement tool
- 4. Where did the ICF come from? Where did the ICF come from? Developed by the World Health Developed by the World Health Organization (WHO) Organization (WHO) Large international and Large international and multidisciplinary participation multidisciplinary participation Extensive field testing Extensive field testing
- 5. The Aims of the ICF The Aims of the ICF To provide a To provide a scientific basis scientific basis for the for the consequences of health conditions consequences of health conditions To establish a To establish a common language common language to to improve communications improve communications To permit To permit comparisons comparisons of data across: of data across: – Countries Countries – Health care disciplines Health care disciplines – Services Services – Time Time To provide a To provide a systematic coding scheme systematic coding scheme for health information systems for health information systems
- 6. Human Functioning Human Functioning ICF does not measure ICF does not measure disability disability – It describes people’s functional abilities in It describes people’s functional abilities in various domains various domains Health conditions that affect functional Health conditions that affect functional status are not part of classification system status are not part of classification system Disability is not an “all or nothing” concept Disability is not an “all or nothing” concept – There is a wide range of functional limitations There is a wide range of functional limitations
- 7. ICF Domains ICF Domains Body Function and Structures Body Function and Structures Activities Activities Participation Participation
- 8. Body Function and Structures Body Function and Structures Physiological and psychological Physiological and psychological function of body systems function of body systems Very specific recording of detailed Very specific recording of detailed functional abilities and impairments functional abilities and impairments Not linked to cause. Not linked to cause. For example, For example, fluency and rhythm of speech fluency and rhythm of speech functions functions – could be from stuttering, – could be from stuttering, stroke, or autism stroke, or autism
- 9. Body Functions and Structures Body Functions and Structures Broken into Eight Chapters Broken into Eight Chapters Skin and related structures Skin and related structures Functions of the skin and related Functions of the skin and related structures structures Structures related to movement Structures related to movement Neuromusculoskeletal and Neuromusculoskeletal and movement-related functions movement-related functions Structures related to the genitourinary Structures related to the genitourinary and reproductive systems and reproductive systems Genitourinary and reproductive Genitourinary and reproductive functions functions Structures related to the digestive, Structures related to the digestive, metabolic and endocrine systems metabolic and endocrine systems Functions of the digestive, metabolic Functions of the digestive, metabolic and endocrine systems and endocrine systems Structures of the cardiovascular, Structures of the cardiovascular, immunological and respiratory immunological and respiratory systems systems Functions of the cardiovascular, Functions of the cardiovascular, haematological, immunological and haematological, immunological and respiratory systems respiratory systems Structures involved in voice and Structures involved in voice and speech speech Voice and speech functions Voice and speech functions The eye, ear and related structures The eye, ear and related structures Sensory functions and pain Sensory functions and pain Structures of the nervous system Structures of the nervous system Mental functions Mental functions
- 10. Activities and Participation Activities and Participation Describes Describes individual’s individual’s functioning functioning as a whole person, as opposed to as a whole person, as opposed to function and structure of his/her function and structure of his/her body parts body parts Range from Basic to Complex Range from Basic to Complex – basic would be, for example, dressing, basic would be, for example, dressing, eating, and bathing eating, and bathing – complex include work, schooling, civic complex include work, schooling, civic activities activities
- 11. Activities and Participation (cont.) Activities and Participation (cont.) UN Washington Group approach UN Washington Group approach – Activities – tasks an individual can do that Activities – tasks an individual can do that require multiple body functions require multiple body functions – Participation – higher order activities that Participation – higher order activities that involve integration in the community involve integration in the community WHO approach WHO approach – Activities – what people can do inherently Activities – what people can do inherently without assistance or barriers without assistance or barriers – Participation – functioning taking into account Participation – functioning taking into account the impact of barriers and facilitators in the the impact of barriers and facilitators in the environment environment
- 12. Activities and Participation (cont.) Activities and Participation (cont.) What is most important is that there What is most important is that there are a range of activities going from are a range of activities going from basic to complex that describe a basic to complex that describe a person’s ability to live independently person’s ability to live independently and be integrated into their and be integrated into their communities communities
- 13. Classification of Activities and Classification of Activities and Participation Participation 1 1 Learning &Applying Knowledge Learning &Applying Knowledge 2 2 General Tasks and Demands General Tasks and Demands 3 3 Communication Communication 4 4 Movement Movement 5 5 Self Care Self Care 6 6 Domestic Life Areas Domestic Life Areas 7 7 Interpersonal Interactions Interpersonal Interactions 8 8 Major Life Areas Major Life Areas 9 9 Community, Social & Civic Life Community, Social & Civic Life
- 14. Universal Model vs. Minority Model Universal Model vs. Minority Model Universal Model Universal Model -- everyone has a -- everyone has a range of functional abilities range of functional abilities – A continuum of functioning A continuum of functioning – Multidimensional Multidimensional – Even those without what is commonly Even those without what is commonly perceived as “a disability” have functional perceived as “a disability” have functional needs needs A A Minority Model Minority Model is categorical and uni- is categorical and uni- dimensional. People are classified based dimensional. People are classified based on certain impairment groups without on certain impairment groups without reference to their functioning at the reference to their functioning at the activity and participation levels activity and participation levels
- 15. Medical versus Social Model Medical versus Social Model PERSONAL PERSONAL vs. SOCIAL vs. SOCIAL Medical care Medical care vs. social integration vs. social integration Individual treatment Individual treatment vs. social action vs. social action Professional help Professional help vs. individual and collective vs. individual and collective responsibility responsibility Personal adjustment Personal adjustment vs. environmental vs. environmental adjustment adjustment Behavior Behavior vs. attitude vs. attitude Care Care vs. human rights vs. human rights Individual adaptation Individual adaptation vs. social change vs. social change
- 16. Health Condition Health Condition ( (disorder/disease disorder/disease) ) Interaction of Concepts Interaction of Concepts Environmental Environmental Factors Factors Personal Personal Factors Factors Body Body function&structure function&structure (Impairment (Impairment) ) Activities Activities (Limitation) (Limitation) Participation Participation (Restriction) (Restriction)
- 17. Example: Polio Example: Polio May have caused paralysis of legs May have caused paralysis of legs (Body Function) (Body Function) Affects ability to walk or climb stairs Affects ability to walk or climb stairs (Activity) (Activity) Impedes ability to attend school or Impedes ability to attend school or find employment within the current find employment within the current environment (Participation) environment (Participation) BUT…. BUT….
- 18. Example, continued Example, continued Mobility related activities, such as getting Mobility related activities, such as getting around the house or community can be around the house or community can be improved with accessible environment and improved with accessible environment and assistive devices assistive devices Participation can be increased with Participation can be increased with reduced stigma, accessible environments reduced stigma, accessible environments and flexible job design and flexible job design Disability Disability is NOT independent of the is NOT independent of the environment, and therefore is not static environment, and therefore is not static
- 19. Later Presentations Later Presentations How to use the ICF to guide in question How to use the ICF to guide in question and indicator development and indicator development – What are different purposes for measuring What are different purposes for measuring disability? disability? – How do these purposes align with the ICF How do these purposes align with the ICF model? model? – Under what circumstances does it make sense Under what circumstances does it make sense to focus on Body Function, Activities, or to focus on Body Function, Activities, or Participation? Participation? – How do you go about deciding who is How do you go about deciding who is “disabled”? “disabled”?
Editor's Notes
- #1: 1) Building large knowledge kit on Disability and Development -- Background info on many sectors, good practices 2) Today we are addressing Disability Data Collection --growing demand for information on disability 3) Disability Data Collection is important to: a) Generate prevalence measures b) Understand the connection between Disability, poverty, other MDGs, and development in general c) Construct indicators and methods for monitoring and evaluating projects for their effectiveness in reaching disabled people 4) More and more work is being done – findings Ecuador, India, Vietnam -- still need to work on comparability and interpretation 5) End product – layered tool on the design and implementation of quantitative data collection 6) Today’s purpose Present information Get feedback on toolkit design – both content and presentation
- #5: Framework with which to think about functioning and how when goes about defining disability