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ICF-CHILDREN & YOUTH. Donald J. Lollar, Ed.D. Centers for Disease Control & Prevention National Center on Birth Defects & Developmental Disabilities Atlanta, Georgia USA. Presentation overview. Place ICF-CY in the context of W.H.O. classifications—ICD and ICF

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icf children youth
ICF-CHILDREN & YOUTH

Donald J. Lollar, Ed.D.

Centers for Disease Control & Prevention

National Center on Birth Defects & Developmental Disabilities

Atlanta, Georgia USA

presentation overview
Presentation overview
  • Place ICF-CY in the context of W.H.O. classifications—ICD and ICF
  • Identify contribution of ICF/ICF-CY to documentation in public health and services to children and youth
  • Describe applications in documentation with children
  • Identify continuing issues in application of ICF/ICF-CY in assessment and intervention
icd history
ICD HISTORY
  • 1853 FIRST INTERNATIONAL STATISTICAL CONGRESS
    • FIRST UNIFORM CLASSIFICATION OF CAUSES OF DEATH-INTERNATIONAL CAUSES OF DEATH (ICD)
    • TWO COMPETING APPROACHES
  • 1855 CONGRESS ENTERTAINED BOTH SETS
    • WILLIAM FARR USED ANATOMICAL SITES AS BASIS
    • MARC d’ESPINE USED NATURE OF DISEASE (GOUTY, HERPETIC, HEMATIC)
    • INITIAL COMPROMISE--186 RUBRICS
    • 20 YEARS TO RECONCILE THE DIFFERENCES—FARR WON
    • NOW ICD REVISED ABOUT EVERY DECADE—HENCE ICD-10
icd icf history
ICD/ICF HISTORY
  • 1979 NINTH REVISION OF ICD/ICD-9
    • RECOMMENDED “PROVISIONAL PROCEDURES CLASSIFICATIONS” BE PUBLISHED TO NINTH REVISION--CPT CODES BEGIN

1980 RECOMMENDED IMPAIRMENTS AND HANDICAPS CLASSIFICATIONS AS SUPPLEMENT Provisional acceptance--INTERNATIONAL CLASSIFICATION OF IMPAIRMENTS, DISABILITIES, AND HANDICAPS (ICIDH)

1993 REVISION OF ICIDH BEGUN

2001 International Classification of Functioning, Disability, and Health (ICF) APPROVED BY THE WORLD HEALTH ASSEMBLY

who family of classifications
WHO Family of Classifications
  • ICD classifies diseases
  • ICF classifies health.
  • “Together, the two provide us with exceptionally broad and yet accurate tools to understand the health of a population and how the individual and his or her environment interact to hinder or promote a life lived to its full potential”. (Brundtland, WHO Director General, 5/2002)
icf aim and principles
ICF AIM AND PRINCIPLES
  • AIM—PROVIDE A UNIFIED AND STANDARD LANGUAGE AND FRAMEWORK FOR THE DESCRIPTION OF HEALTH STATES
          • PRINCIPLES
  • UNIVERSAL NATURE OF DISABILITY EXPERIENCE
  • CROSSES THE LIFE SPAN— BIRTH TO DEATH
  • ETIOLOGY NEUTRAL— PHYSICAL, EMOTIONAL,etc.
  • NEUTRAL LANGUAGE— FUNCTION, ACTIVITY, PARTICIPATION, ENVIRONMENT
slide7

Body function&structure(Impairment)

Activities

(Limitation)

Participation

(Restriction)

Environmental Factors

Personal Factors

ICF Conceptual Framework

Health Condition (disorder/disease)

body functions structures impairments
BODY FUNCTIONS

Mental

Sensory

Voice, speech

Cardiovascular, haematological,immunological & respiratory

Digestive, metabolic, endocrine

Genitourinary & reproductive

Neuromusculoskeletal, & movement related functions

Skin & related structures

Body Functions & Structures/Impairments

BODY STRUCTURES

Nervous system

Eye, ear & related structures

Voice & speech structures

Cardiovascular, immunological & respiratory structures

Digestive, metabolism & endocrine

Genitourinary structures

Movement related structures

Skin & related structures

activities and participation limitations restrictions
Activities and Participation:Limitations/Restrictions

1 Learning & Applying Knowledge

2 General Tasks and Demands

3 Communication

4 Movement

5 Self Care ______________mind the gap__

6 Domestic Life Areas

7 Interpersonal Interactions

8 Major Life Areas

9 Community, Social & Civic Life

environmental factors barriers facilitators
Environmental Factors:Barriers/Facilitators

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

uses of icf not a tool a standard language for documentation
USES OF ICF-not a TOOL; a standard language for documentation
  • DOCUMENTATION OF CHILDREN’S RIGHTS
  • CLINICAL — assess needs, evaluate progress and interventions
  • RESEARCH—measure outcomes, impact of environmental factors on activity limitations and societal participation
  • SOCIAL POLICY—social security planning, environmental design and implementation
  • EDUCATIONAL—assess and monitor function
  • STATISTICAL— collecting data for population surveys or administrative data
icf cy reference standard for documenting children s rights
ICF-CY: reference standard for documenting children’s rights
  • UN Convention on the Rights of the Child-emphasis on Article 23 (1989)
  • UN Standard Rules for the Equalization of Opportunities (1994)
  • Salamanca Statement on the Right to Education
  • Education for All-World Education Forum @ Dakar (2000)
need for version of icf for children youth
Need for version of ICF for children & youth
  • Nature and form of functioning in children different from that of adults—children are not small adults
  • Child is a “moving target” in classification of function—changes every 6-12 months throughout developing years, esp. activities
  • Primary environments and participation areas differ for children
  • ICF version for children and youth facilitates continuity of documentation e.g. transitions from child to adult services and communication among professionals and with parents
presentation overview14
Presentation overview
  • Summarize development of ICF-CY as 1st derived version of the International Classification of Functioning, Disability & Health
  • Describe relevance of ICF-CY for current issues in childhood disability
  • Identify emerging priorities for

ICF-CY

slide15

Need for ICF-CY

  • Developing child as “moving target”
slide16

Need for ICF-CY

  • Activities differ from those of adults
slide17

Need for ICF-CY

  • Precursors of participation and life roles
slide18

Need for ICF-CY

  • Emerging habitual, frequent and occasional environments
current issues in child assessment and intervention
Current issues in child assessment and intervention
  • Masking of functional characteristics within a diagnosis- same diagnosis , varied function
  • Masking of functional commonalities across different diagnoses- different diagnoses, common functional problems
  • Disconnect between diagnostic identification and the nature of intervention
  • Selecting appropriate variables to document outcome with development and intervention—usually Activities or Participation
development of the icf cy
Development of the ICF-CY
  • Structure ICF main volume maintained
  • Inclusion/exclusion criteria for codes were expanded
  • New content added to unused codes at 4, 5 and 6 character level to address needs outlined before
  • 2nd draft prepared for review on WHO website fall of 2005
  • Publication expected 2006
icf cy example of new code for body functions
ICF-CY: Example of new code for Body Functions
  • b120 General cognitive functions
  • General mental functions required to represent, and constructively integrate knowledge of objects, events and experiences and apply that knowledge in tasks requiring mental rather than physical activity.
  • Exclusion: higher level cognitive functions (b164)
icf cy representative new a p codes
ICF-CY: representative new A/P codes
  • d1200-03 mouthing, touching, smelling, tasting
  • d133 Acquiring language
    • d1330 acquiring single words or meaningful symbols
    • d1331 combining words into phrases
    • d1332 acquiring syntax
  • d2300 Following routines
  • d2304 Adapting to changes in daily routine
  • d2305 Adapting to changes in time demands
  • d2306 Managing one’s time
  • d5205 Caring for the nose
  • d53000-10/ Indicating need for urination, defecation
  • d880 Engagement in play—solitary, onlooker, parallel, shared
framework for use of icf cy in documentation
Framework for use of ICF-CY in documentation

Health Conditions-

Syndrome, diagnosis, category

Activities

(Intervention/outcomes)

Participation

(Outcomes)

Body Structures

& Functions:

(Assessment)

Environmental Personal

Factors: (Assessment Factors

& Intervention)

joint use of family of icd and icf to document function and health
FOCUS DIMENSION

What is child’s health status? Health conditions-ICD

How does child’s Structure/Function-ICF body/mind function?

How does the child Activities-ICF

perform daily life activities?

How is child involved in Participation-ICF roles/situations?

What are the things, Environment-ICF conditions, & circumstances surrounding the child?

Joint use of family of ICD and ICF to document function and health
icf cy uses in documentation
ICF-CY Uses in Documentation
  • I. Document child’s intra-individual profile of health & functioning
  • II. Clarify inter-individual variability across diagnoses with use of ICD/ICF
  • III. Generate intervention or treatment plan
  • IV. Track developmental status
  • V. Frame measurement and select indicators of outcome
i documenting intra individual differences autism spectrum disorders
I. Documenting intra-individual differences: autism spectrum disorders
  • “…the manifestations of autism are diverse, creating difficulty in using traditional categorical classification schemes”. (Beglinger & Smith, 2001)
  • Differentiation of autism and autistic-like disorders in individuals with normal intelligence (c.f. Volkmar, Klin, & Pauls, 1998)
  • Regression issues in autism
  • Autism and early onset schizophrenia (Konstanteras & Hewitt, 2001)
  • Overlap with language disorders (c.f. Bishop & Norbury, 2002)
documenting criteria for diagnosis of autism diagnostic and statistical manual iv
Documenting criteria for diagnosis of autism—Diagnostic and Statistical Manual IV
  • Preschooler with Autistic disorder
  • impairment in social function
    • d710.3 basic interpersonal interactions
    • d710.2 basic interpersonal interactions
    • D750.2 informal social relationships
    • D760.3family relationships
  • impairment in communication
    • d310.2 communicating with – receiving spoken messages
    • d315.4 communicating with – receiving nonverbal messages
    • d330.4 speaking
    • d335.3 producing nonverbal messages
  • restricted, repetitive stereotypic behavior pattern
    • b7653 Stereotypies and mannerisms
ii use of icf cy and icd to clarify inter individual differences across diagnoses
Child A

b1142 orientation to person

b122 global psychosocial functions

d310 communicating

d510 self care

d710 interpersonal interactions

F84.4 Stereotyped movements

F84.1 Atypical autism

Child B

b1142 orientation to person

b144 memory functions

d1600 attending to touch, face and voice

d130 copying

d310 communicating

d330 speaking

F84.2 Rett syndrome

F76 Moderate Mental Retardation

II. Use of ICF-CY and ICD to clarify inter-individual differences across diagnoses
iii use of icf cy to identify focus of interventions or treatments
Problems/ limitations

*social interaction

*communication

*rigid repetitive, stereotyped behavior patterns

*developmental level

*attention

Intervention focus

d710-729 personal interactions

d310-329 communication

d235 managing one’s own behavior

d 880 engaging in play

d220 undertaking multiple tasks

III. Use of ICF-CY to identify focus of interventions or treatments
icf cy framing functional outcomes of child interventions measuring progress
ICF-CY- framing functional outcomes of child interventions: measuring progress
  • Gradient of change: reduction of severity level within code (regulating behaviors within interaction)
  • d7202.4 --> d7202.2
  • Hierarchy of change: moving from lower level code to higher level code (undertaking simple task)
  • d2100.2  (undertaking complex task) d2101.2
v use of icf cy to frame functional outcomes of intervention
V. Use of ICF-CY to frame functional outcomes of intervention

Body Functions

&

Structures

Activities

&

Participation

Environmental

Factors

Access to

needed

interventions

Progressive

transitions in

clinical and

educational

settings

Positive effects of medication on mental functions -attention

Improvement in school functioning;

in personal functioning;

in social relationships

public health uses usa
Public Health Uses/USA
  • Survey of Children with Special Health Care Needs
  • Early Intervention Data Handbook—US Dept of Educ.
    • Includes A/P codes for eligibility/personal functioning, examples
      • Focusing attention
      • Solving simple problems
      • communicating/
      • Sitting/standing
      • Crawling/walking
      • toileting
  • Georgia Early Intervention Project
    • Pilot testing in EI (0-3 years) programs
    • Using inventory from ICF-CY workgroup as baseline, intermediate , and exit evaluations
slaits cshcn survey 2005
SLAITS/CSHCN Survey--2005
  • Body Functions—
    • seeing, hearing,
    • breathing, swallowing/digesting food, circulation,
    • pain,
    • feeling anxious or depressed
  • Activities/participation—
    • Eating, dressing, bathing, moving around, using hands,
    • Learning, understanding, or paying attention?
    • Speaking, communicating, being understood
    • Behavior problems, such as acting out, fighting, bullying,
    • Making and keeping friends
icf as common language for special education practice example
ICF as common language for special education practice: example

*Manual for use of ICF for children and youth with disabilities

*Edited and written

by National Institute of

Special Education Japan,

Approved by WHO

slide37

Educational Outcomes of ADHD

ADHD

Activities: Limitations

Learning to read, write, calculate; carrying out tasks; managing own behavior, stress, frustration

Participation: Restriction

Problems moving across education levels, succeeding in program; school life

Body functions: ImpairmentsAttention, memory, emotion regulation, higher cognitive functions

Environmental Factors

General and special education

Personal Factors

From Loe and Feldman, 2005

slide38
Revisiting a priority: classification of children (1975) -> classification of functioning & disability in children (2005)
  • “..classification is serious business. Classification can profoundly affect what happens to a child. It can open doors to services and experiences the child needs to grow in competence, to become a person sure of his worth, and appreciate the worth of others, to live with zest and to know joy”.
  • (Classification of Children, Hobbs, 1975; The futures of children, Hobbs, 1975)
slide39
Don Lollar, Ed.D.
    • CDC/NCBDDD, Atlanta, GA, USA
      • dlollar@cdc.gov
  • Rune J. Simeonsson, Ph.D.,MSPH
    • University of North Carolina, Chapel Hill, USA
      • rjsimeon@email.unc.edu