The project is being implemented with the support of UNICEF Ukraine and with financial support from the Government of Norway.
Implemented by: Partner:
gessica.dellabella@opbg.net
• Welcome to thiscomprehensive overview of the International Classification of
Functioning, Disability and Health for Children and Youth (ICF-CY)
• Asrehabilitation specialists, we are committed to providing holistic care that addressesall aspectsof a child'shealth and development.
PHYSICAL AND REHABILITATION MEDICINE
According to the Union Européenne des Médecins Spécialistes (UEMS)
PRM is an independent medical specialty aimed at promoting physical and cognitive functioning (including behavior), participation (including quality of life), and modifying personal and environmental factors that may influence them.
-It is responsible for the prevention, diagnosis, treatment, and rehabilitation management of people with disabling medical conditions and comorbidities of all ages.
The field of rehabilitation does not address the disease itself, but the consequences of diseases in their three dimensions:
- Impairment, disability, and handicap (ICIDH-1, 1980)
- Impairment, activity, and participation (ICF, 2001)
Main objective:
How?
Goal?
improve the child’s quality of life
Enable the child to reach the desired levels and models of autonomy
Treat the underlying condition
- Reduce damage and/or disability
- Prevent and treat complications
- Improve function and activity level
- Enable participation
From ICD to ICF
The WHO (World Health Organization) has an institutional mandate to develop a common language in the field of health, understood as physical, mental and social well-being.
1970: International Classification of Diseases (ICD)
•1980: International Classification of Impairments, Disabilities and Handicaps (ICIDH) – [Second version 1997]
•2001: International Classification of Functioning, Disability and Health (ICF)
•2007: International Classification of Functioning, Disability and Health
– Children and Youth (ICF- CY)
International
Classification of Diseases (ICD)
• Health conditions are mainly classified through the ICD, which provides an etiological reference model:
• coding of the main diagnosis and secondary diagnoses in the Hospital Discharge Cards (SDO)
• development of the prospective payment system for hospital services based on the DRG (Diagnosis-Related Groups) system
International Classification of Diseases (ICD)
LIMITS:
It does not categorize the variety of experiences and needs expressed by people living with health issues. Diagnosis alone provides LIMITED INFORMATION and is not completely suggestive of CAPACITIES, NEEDS of the person and the PROGNOSIS of illness. This model does not take into account the repercussions of the disease on the individual.
International Classification of Diseases (ICD)
LIMITS:
Two people with the same disease may have different levels of functioning (and therefore also different rehabilitation needs)
Two people with the same level of functioning do not necessarily have the same health condition
International Classification of Impairments, Disabilities and Handicaps (ICIDH)
Classification of the consequences of diseases:
Illness/damage -> impairment -> disability -> social disadvantage
Impairment: any loss or abnormality of physiological or anatomical structure or function
Disability: any limitation or loss of ability to perform an activity in a way that is considered normal for a human being
Social disadvantage: disadvantage resulting from an impairment or disability, which limits or prevents the performance of a normal role in relation to age, sex and socio-cultural factors
[Caruso I. «Lezioni di medicina riabilitativa»; CIC – Edizioni Internazionali – Roma 2006]
International Classification of Impairments, Disabilities and Handicaps (ICIDH)
Impairment = Disabling damage Organ or apparatus
Disability = reduction of the subject's abilities Person
Handicap = Social disadvantage Environment
International Classification of Impairments, Disabilities and Handicaps (ICIDH)
-> It has provided the world of rehabilitation with a precise and shared definition of some fundamental terms for its cultural development and for the training of rehabilitation professionals.
Let's change the point of view
What do you notice?
What they don't have OR……
International
Classification of Functioning, Disability and Health (ICF)
From HANDICAP (ICIDH, 1980)
To ADULT/CHILD with disabilities (ICF, 2001)
C. Foti, L. Basile, R. Labriola
International Classification of Functioning, Disability and Health (ICF)
The ICF is no longer a classification of the 'consequences of disease', but is instead a Classification of 'components of health’.
The 'health components' identify the building blocks of health, while the 'consequences' focus on the impact of diseases or other health conditions that may result from them.
The ICF therefore takes a neutral position with respect to etiology.
International Classification of Functioning, Disability and Health (ICF)
Body functions and structures
Activity (what the person can do)
Participation
1) Rejection of negative aspects
2) Rejection of terms that are now irretrievably negative
3) Rejection of special categories for persons with disabilities
Basic scientific Common language Encoding scheme
International
Classification of Functioning, Disability and Health (ICF)
Structure
• The ICF can be divided into two parts, each consisting of two components:
Part 1: Functioning and Disability:
- Body Functions and Structures
- Activities and Participation
Part 2: Contextual Factors: - Environmental Factors
- Personal factors
• Each component consists of several domains and, within each domain, other categories, which are the classification units.
The full version of the ICF provides a four-level classification, while the short version reports only the first two levels of the classification.
International Classification of Functioning, Disability and Health (ICF)
Structure
The ICF uses an alphanumeric system:
B (body) – body functions
S (structure) – body structures
D (domain) – activities and participation
E (environment) – environmental factors
Each prefix letter is followed by a numeric code: chapter number -> first digit second level -> two successive digits
third level -> one digit fourth level -> one digit
International Classification of Functioning, Disability and Health (ICF)
Structure: an example
Movement deficit due to osteoarthritis of the hip s75001
s = (structure)
Body structures
7 = (chapter) Movement-related structures
50 = (2nd level) Structure of the lower limb
01 = (3rd - 4th level) hip joint
International Classification of Functioning, Disability and Health (ICF)
Structure
ICF codes are only complete in the presence of a qualifier, which indicates the extent of a health level (e.g. severity of the problem).
Qualifiers are encoded as one, two or more numbers after the period (or "separator").
Without qualifiers, codes have no intrinsic meaning.
International Classification of Functioning, Disability and Health (ICF)
Structure: qualifiers
BODY FUNCTIONS (1 qualifier):
Extent of impairment (none, mild, medium, severe...)
BODY STRUCTURES(3 qualifiers):
- Extent of impairment
- Nature of change (absence, excess, deviant position…)
- Location (right, left, proximal, distal…)
ACTIVITIES AND PARTICIPATION (2 qualifiers):
- Performance = performing tasks in the current environment
- Capacity = performing tasks in a standard environment
International Classification of Functioning, Disability and Health (ICF)
Core Set
Core Sets are lists of ICF categories, relevant to specific health conditions and care contexts, selected by the whole ICF, following a scientific approach based on psychometric studies and the involvement of experts.
- Brief ICF Core Set (short version), to classify all patients in a clinical trial with a condition
- Comprehensive ICF Core Set (full version), to guide multidisciplinary assessments of patients with the same condition
International
Classification of Functioning, Disability and Health (ICF)
Quality of Life Assessment
The ICF focuses on the quality of life of children with disabilities, in particular those relating to the state of health
But how can we evaluate it?
BODY FUNCTIONS
ENVIOMENTAL FACTORS
International Classification of Functioning, Disability and Health (ICF)
Structure
International Classification of Functioning, Disability and Health (ICF)
The ICF provides information on how CHILDREN are living with the disease and relies on a
BIO-PSYCHO-SOCIAL
MODEL
integrating functioning disability and health
The joint use of ICDs and ICFs increases data quality They are therefore complementary.
«Health is a dynamic state of complete physical, mental, social, and spiritual wellbeing, not merely the absence of disease.” WHO, 1998»
Health condition (disease/disorder
Body functions and structures Activity (limitazione) Partecipation (restrizione)
Environmental factors
Personal factors
Facilitator
Factors that, through their absence or presence, improve functioning and reduce disability.
A person's environmental factors that, through their absence or presence, limit functioning and create disability.
Barriers
F-Words
Based on the World Health Organization’s ICF framework,these six words bring a positive, strength-based approach to health and development
Rosenbaum and Gorter published an article titled, "The 'F Words' in Childhood Disability: I Swear This Is How We Should Think!" The article features six F-words that the authors believe should be at the heart of childhood disability: functioning, family, fitness, fun, friends, and future.
Integrating ICF-CY into Clinical Practice
Assessment
Conduct comprehensive evaluations across all ICF -CY domains using validated tools and structured interviews with children, families and teachers
• Standardised measures
• Observational assessments
• Participation inventories
Goal Setting
Develop meaningful, functional goals that address participation restrictions and activity limitations, not just impairments
• Child and family priorities
• Measurable outcomes
• Contextual relevance
Intervention Planning
Design holistic intervention programmes that target multiple ICF -CY domains through collaborative, interdisciplinary approaches
• Environmental modifications
• Skill development
• Capacity building Implementing the ICF-CY framework transforms paediatric rehabilitation from impairment-focused interventions to comprehensive programmes addressing the whole child within their unique context. This approach requires interprofessional collaboration and family-centred care principles.
International Classification of Functioning, Disability and Health (ICF)
Terminology
HEALTH STATUS AND DISABILITY
The state of health does not only include a disease, disorder, injury or trauma but also other factors (e.g. ageing, stress, congenital abnormalities, genetic predisposition) or pathogenetic or etiological information
Between health status and all components of functioning (body functions and structures, activity and participation) can occur interactions
"Functioning" is an umbrella term encompassing all bodily functions, activities and participation.
In the same way, "disability" serves as an umbrella term for impairments, activity restrictions or participation restrictions.
International Classification of Functioning, Disability and Health (ICF)
Terminology
BODY FUNCTIONS AND STRUCTURES
Body Functions
Body Structures
physiological functions, including psychological anatomical parts of the body
Functional abnormalities
(e.g. decreased range of motion, muscle weakness, pain and fatigue)
Structural anomalies (significant alteration or loss, e.g. deformity)
International Classification of Functioning, Disability and Health (ICF)
Terminology
ACTIVITIES AND PARTICIPATION
• Activity is the performance of a task or action by an individual and it considers functioning from an individual perspective.
-> Difficulties are called ACTIVITY LIMITATIONS
(e.g. mobility limitations such as walking, climbing stairs, grasping an object)
• Participation is the involvement in existential events and evaluates the functioning from a social perspective
-> RESTRICTIONS ON PARTICIPATION are the problems that the individual encounters in this field
(e.g. restrictions on community life, leisure activities)
International Classification of Functioning, Disability and Health (ICF)
Terminology
CONTEXTUAL FACTORS: ENVIRONMENTAL AND PERSONAL
Contextual factors represent the entire background of the life and existential condition of the individual:
I. Environmental factors indicate the physical, social and attitudinal environment in which the subject leads his existence; These factors are external to the person and can represent a "facilitator" or a "barrier"
II. Personal factors are the specific background of a person's life and existential condition and include aspects that do NOT fit into the state of health (e.g. gender, age, race, lifestyle and social context). They are NOT classified in the ICF because of the great social and cultural variability associated with them.
International Classification of Functioning, Disability and Health (ICF) Terminology
CONTEXTUAL FACTORS:
ENVIRONMENTAL AND PERSONAL
International Classification of Functioning, Disability and Health (ICF) Terminology
CONTEXTUAL FACTORS: ENVIRONMENTAL AND PERSONAL
EVERYONE can have a health condition that, in an unfavorable environmental context, causes disability
International Classification of Functioning, Disability and Health (ICF)
Quality of Life Assessment
• To measure the effects of health services and health status it is no longer enough to refer to NEGATIVE measures such as mortality (survival), morbidity (disease free time) or pathophysiological measures, it is necessary to investigate the individual perception of Quality of Life
• Among the plethora of different questionnaires, some, such as SF-36 and SF-12, proved to be valid and reliable.
