Richard Oborn?

1. Richard Oborn? • Registered Psychologist with Clinical endorsement under the new national registration requirements. • Full time Private Practitioner since 2001. • Part time lecturer at the University of Adelaide. • Specialize in dealing with the psychological consequences of persisting injury. • 15 years private sector involvement in manufacturing and commerce. • 10 years government service as a psychologist. • 4 years not-for-profit sector as a psychologist.

2. My bias (given that I am a Psychologist). Not so much: • Psychologist: psyche-logy - study of the human mind, soul, or spirit. More: • Ahli Kaji Jiwa: student of the study of life.

3. Injury Management & the World Health Organization’s ICF and WHO-DAS. Being comprehensive, systematic, and directed. Richard Oborn.

4. World Health Organization Acronyms • ICF: International Classification of Functioning, Disability and Health. • DAS: Disability Assessment Scales.

5. WHO-DAS-II – the ‘What’. The WHO-DAS II is an instrument designed by the WHO to assess health conditions for both initial contact and follow-up purposes. While it is firmly rooted in the ICF, it can be used independently for health assessment purposes.

6. Six Domains are assessed & measured. • Understanding and communicating (six primary questions). • Getting around (five primary questions). • Self care (four primary questions). • Getting along with people (five primary questions). • Life activities (eleven primary questions – comprising five questions on household duties and six on work and schooling capacity). • Participation in society (six primary questions). All domain questions are supplemented by questions on interference with life, and all answers are graded for severity.

7. Versions of the WHO-DAS II • Self Administered, 12 questions. • Self administered, 36 questions. • Interviewer administered, 12 questions. • Interviewer administered, 36 questions. • Interviewer administered, 12 + 24 questions. • Proxy version, 36 questions. There is mention of 6 question versions. Clear preference is for the interviewer administered 36 question version unless there are pressing reasons to use the other versions.

8. WHO-DAS II – the ‘So what”. It is a measure!!! So what do you want to measure? For what ends do you want to measure something? What is the cost/benefit payoff? Is relevant normative data available?

9. Utilization of the WHO-DAS. • Put measurement in the context of the ICF. • Develop a structure within which you want to view and use the information that it can provide. • Have an idea as to how the information can be usefully elaborated for assessment, intervention planning & implementation, and input gains or lacks evaluated. This is where the ICF becomes very useful.

10. Conceptual Basis • Bio / Psycho / Social - as the accepted analysis paradigm. • Injured Self / Evolved or Usual Self / Context (What are you now)/(What were you)/(What’s in your life). - as the related rehabilitation paradigm.

11. Question of Perception. • Can we decide what we should be seeing? • How can we be sufficiently comprehensive? • How can we assess systematically and consistently? • Do we have a justifiable and specifiable basis for assessing? With these answered we are best positioned for assessing, planning, intervening, & reviewing comprehensively.

12. Problem of applied specification. • Important though it is, this needs to be beyond a clinical diagnosis of disorder. • To call Leonardo da Vinci ‘creative’ is insufficient, ultimately simplistic, and quite unhelpful in describing the workings of the man. • Yet far too often the specification a person in reports is limited to a clinical diagnosis (commonly not even graded) of the most prominent mental disorder. • Even if the specification is more comprehensive than this, it often stops at just that. So the ‘What’ is described, but the crucial ‘So what’/’What now’ is either absent or covered in only the vaguest of terms.

13. Comprehensive diagnosis. • Clinical diagnosis. • Personality summary. • Client’s available resources. All of these considered in conjunction with a relevant history. Has a fit with with ICF body function/ activity/participation concept.

14. Sources for standards. • Clinical diagnosis – DSM-IV-TR, although ICD-10 is a good alternative. • Personality – utilization of a conceptualization having a strong research basis, e.g. the five factor theory, using the NEO-PI-R as a measure. • Resources – International Classification of Functioning, Disability and Health (ICF) using WHO-DAS as a measure.

15. The ICF – International Classification of Functioning, Disability and Health. • A very under-utilized document. • A stunning conceptualization. It is an attempt to comprehensively specify all the impacting factors of the lived human experience in applied and functional terms. • Foundation reference document for a range of measures and methods in a wide number of health and rehabilitation settings. • It springs from the tradition of humanism, but strives to systematically make extant the specifics of existence, and to quantify sufficiency.

16. Functioning versus Disability. Functioning is the human experience in relation to body functions, structures and activity. It is also measured by the level of interaction with health conditions and personal and environmental factors. Disability is the human experience of impaired body functions and structures, activity limitations and participation restrictions between health conditions, personal and environmental factors.

17. Structure of ICF… the person in his or her world. The ICF is structured around the following broad components: • Body functions and structure. • Activities (related to tasks and actions by an individual) and Participation (involvement in a life situation). • Additional information on Severity and Environmental factors. Functioning and disability are viewed as a complex interaction between the health condition of the individual and the contextual factors of the environment as well as personal factors.

18. Definitions. Body functionsare defined as the physiological functions of body systems, including psychological functions. Body structures are the anatomical parts of the body, such as organs, limbs and their components. (What have you got.) Activity is the execution of a task or action by an individual and represents the individual perspective of functioning. (What can you do with it.) Participation refers to the involvement of an individual in an everyday situation and represents the societal perspective of functioning. (What do you actually do with what you’ve got with what you can do with it.)

19. Definitions (continued) Abnormalities of function, as well as abnormalities of structure, are referred to as impairments, which are defined as a significant deviation or loss (e.g. deformity) of structures (e.g. joints) and/or functions (e.g. reduced range of motion (ROM), muscle weakness, pain and fatigue). Contextual factors represent the entire background of an individual’s life and living situation. Within the contextual factors, the environmental factors make up the physical, social and attitudinal environment in which people live their lives.

20. Interactions between components of the ICF Health condition (disorder or disease) Body functions and structures Activity Participation (impairments) (limitations) (restrictions) Environmental factors Personal factors (facilitators/ barriers)

21. What does the ICF cover? Body Functions. • Mental function. • Sensory function & pain. • Voice & speech function. • Cardiovascular, haematological, immunological & respiratory functions. • Digestive, metabolic & endocrine function. • Genitourinary & reproductive function. • Neuromusculoskeletal and movement-related function. • Skin & related function.

22. What does the ICF cover? … continued. Body structures. • Nervous system. • Eye, ear & related areas. • Voice & speech. • Cardiovascular, immunological, & respiratory systems. • Digestive, metabolic, & endocrine systems. • Genitourinary & reproductive systems. • Movement systems. • Skin & related structures.

23. What does the ICF cover? … continued. Activities & participation. • Learning & applying knowledge. • General tasks & demands. • Communication. • Mobility. • Self-care. • Domestic life. • Interpersonal interactions & relationships. • Major life areas. • Community, social, & civic life.

24. What does the ICF cover? … continued. Environmental factors. • Products & technology. • Natural environment & human-made changes to environment. • Support & relationships. • Attitudes. • Services, systems, & policies. Down to the first branching (two-level) of classification this am0unts to 361 categories. More than double that at the detailed level.

25. Advantages of ICF. • The integration of the medical and social aspects of a person’s health condition. Development, participation, and environment are incorporated into the ICF instead of just a diagnosis. • Awareness of the daily activities required of a client enables use of the problem solving sequences set up by the ICF. • Facilitates working with other medical disciplines; hospitals and other health care administrations; health authorities and policy makers. • Operational definitions with clear descriptions that can be applied to real life evaluations with clarity and ease

26. Variants of the ICF. • Core sets: these are lists of ICF items that are particularly relevant to particular health conditions or more specific settings. • Child and Youth Version (ICF-CY): a version of ICF developed for children and youth with a greater emphasis on developmental issues and disabilities that result. Codes were added to document characteristics as adaptability, responsivity, predictability, persistence, and approachability.

27. Samples of Psychological factors. • Pain (p68-70) b2800-2804 • Undertaking multiple tasks (p130) d220-2209 • Handling stress & other psych demands (p131-132) d2400-2409 • Driving (p147) d4750-4759 • Looking after one’s health (p152) d5700-5709 • Informal social relationships (p161-162) d7500-7509 • Remunerative employment (p165-166) d8500-8509 • Recreation & leisure (p168-169) d9200-9209 • Friends – relationships & support (p187) e320 • Individual attitudes of people in positions of • authority (p190) e430

28. Application of ICF to rehabilitation. The Rehab Cycle ICF Tools Assessment ICF Core Sets ICF Assessment Sheet ICF Categorical Profile Assignment ICF Intervention Table Intervention ICF Intervention Table Evaluation ICF Evaluation Display

29. Sample ICF Assessment Sheet. Courtesy: Swiss paraplegic Research – an institute of the Swiss paraplegic Foundation.

31. Sample ICF Intervention Sheet. Courtesy: Swiss paraplegic Research – an institute of the Swiss paraplegic Foundation.

33. Sample ICF Assessment Sheet. Courtesy: Swiss paraplegic Research – an institute of the Swiss paraplegic Foundation.

35. Limitations on ICF. Ultimately it is what it says it is – a functional analysis. Hence its’ stance is that of the practical external observer. Therefore it: • Takes no account of personal history factors. • Generally only rates the strengths of factors. It does not make a qualitative statement. • Has nothing to say on the individual’s perceptions or existential experience. • Allocates responsibility, at best, only by implication. It is, in the end, a tool that does whatever it is used for. Hence the need for the diagnostic format outlined earlier, and the exercise of professional judgement.

36. From here …. ? • Given my wish for high standards and utilization of more than just personal judgement, I really like this sort of stuff. • If you like it as well, you need to get used to using it and requesting it. • Then to find someone to pay for it so that it can be done!!! Good things aren’t cheap, cheap things aren’t good. • Poorly run systems cost – at both the human & financial levels.

37. My contact details. • Mobile: 0417 835 344. • Email: gazebo@bigpond.net.au • Address: P.O. Box 3380, Norwood. S.A. 5067.