World Health Organization Classification Assessment Surveys & Terminology Group

1. World Health OrganizationClassification Assessment Surveys & Terminology Group ICF as the New Member in the WHO Family of International Classifications www.who.int/classification/icf

2. Basic Messages • ICF has been systematically revised in the last decade • large international and multidisciplinary participation • extensive field testing • guided by scientific principles • taxonomic guidelines: logic and terminology • practical utility: feasibility, ease of use, ethical guidelines • reliability, validity and comparability • When the rubber hits the road... • ICF can serve as a useful tool for Health Information Systems • evaluation: needs, outcomes, costs, quality, satisfaction • service provision, social policy • Application guidelines, training, tools are needed

3. World Health Assembly • Endorse and publish ICF • use the ICF in Member States in: • research • surveillance • reporting • Joint use with ICD • Operational subsets: • surveys • clinical encounters • Periodic revision

4. WHO Family of International Classifications ICD-10 International Statistical Classification of Diseases& Related Health Problems Interventions procedures Primary care adaptations Reasons forencounter ICF International Classificationof Functioning, Disability and Health Speciality adaptations IND Nomenclature of Diseases Main Classifications Adaptations Associated Products

5. ICD: An International Public Good 150 years of history International Standard WHO Mortality Database: 85 countries, >3000 Country Years Conversion tables ICD 8, 9, 10 Internet Connection On-line instructions

6. ICF Publications • 1. Main volume with glossary • - Full version 9999 cat. • - Short version 99 cat. • 2. Clinical Descriptions • & Assessment Guidelines • 3. Assessment Criteria • for Research • 4. Other versions • - Specialty adaptations • Children and Youth • 5. Dedicated • Assessment Tools

7. Multilingual CD-ROM Browser • & Internet Edition • classification in its tree structure • Two languages at the same time • Advanced search function • Cross references via hyperlinks • Selects and work on subsets • Internet based upgrading facilities

8. ICF Checklist • One component- One page “at-a-glance” • Salient Categories (169 out of 1494) • Impairments with: • Body Functions • Body Structures • Activity and Participation • Environmental Factors • Other Contextual information • Available for: • Clinicians & providers • Consumers

9. Aims • to provide a scientific basis for consequences of health conditions • to establish acommon language to improve communications • to permit comparison of dataacross: • countries • health care disciplines • services • time • to provide asystematic coding scheme for health information systems

10. 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 - notperson alone Cultural applicability - not western concepts Operational - not theory driven alone Life span coverage - not adult driven

11. Human Functioning not disability alone • Body functionsvsimpairments • Body Structures • Activitiesvsactivity limitation 1980 disability • Participationvshandicap

12. Participation or Handicap? • neutral language • “politically correct” • correct use • intervention • opportunity • positive aspects

13. Universal Model vs. Minority Model Everyone may have disability Continuum Multi-dimensional Certain impairment groups Categorical Uni-dimensional

14. Medical versus Social Model • PERSONAL problem vs SOCIAL problem • medical care vs social integration • individual treatment vs social action • professional help vsindividual & collective responsibility • personal vs environmental adjustment manipulation • behaviour vsattitude • care vs human rights • health care policy vs politics • individual adaptation vs social change

15. Impairments Disabilities Handicaps Sequence of Concepts ICIDH 1980 Disease or disorder

16. Body function&structure(Impairment) Activities (Limitation) Participation (Restriction) Environmental Factors Personal Factors Interaction of Concepts ICF 2001 Health Condition (disorder/disease)

17. Equity / Parity • Loss of limb landmines = diabetes = thalidomide • Missed days at usual activities flu =depression = back pain = angina • Stigma leprosy = schizophrenia = epilepsy =HIV

18. Contextual Factors • Environment • Products • Close milieu • Institutions • Social Norms • Culture • Built-environment • Political factors • Nature Person • gender • age • other health conditions • coping style • social background • education • profession • past experience • character style

19. Cultural Applicability • Conceptual and funtional equivalence of Classification • Translatability • Usability • International Comparisons

20. Comparability: equivalence across cultures • Conceptual equivalence: • similar understanding /meaning of concepts • Functional equivalence: • similar domains • Metric equivalence: • similar measurement characteristics

21. ICF Field Testing • 7 years 1994-2001 • 61 countries • ICF drafts translated into / tested in 27 languages • 38 National Consensus Conferences • 7 International Consensus Conf. • 2000 Live Case evaluations • 3500 Case Summary evaluations

22. Structure ICF Classification Part 1: Functioning and Disability Part 2: Contextual Factors Parts Activities and Participation Body Functions and Structures Environmental Factors Personal Factors Components Constructs/ qualifiers Change in Body Functions Change in Body Structures Capacity Performance Facilitator/ Barrier Domains and categories at different levels 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

23. ICF Components Body Functions & Structures Activities & Participation Environmental Factors Functions Structures Capacity Performance Barriers Facilitators

24. Body Functions and Structures Mental functions Structures of the nervous system The eye, ear and related structures Sensory functions and pain 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

25. 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

26. 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

27. ICF Applications • Health sector • Social security • Education sector • Labour sector • Economics & development sector • Legislation & law • Other ….

28. 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

29. 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

30. ICF in policy making • assessment of population health • impact of disability • economic • social • evidence-base for policy makers on different policy interventions • responsiveness of services • efficiency • performance assessment

31. ICF research applications • joint assessment of disease and functioning • description of association • intervention response & synchrony of change • explanatory power on: • utilization • needs • costs • outcomes • Cost-effectiveness of interventions • Unified approaches

32. ICF Domains used in International WHO Surveys • 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 Health Domains • Vision • Hearing • Speech • Digestion • Bodily excretion • Fertility • Sexual activity • Skin & disfigurement • Breathing • Pain • Affect • Sleep • Energy / vitality • Cognition • Communication • Mobility and Dexterity