Transcript English version

International Classification of Functioning, Disability and Health,
Version for Children and Youth (ICF-CY)
Prof. Dr. Judith Hollenweger
Zurich University of Teacher Education
Conference on Inclusive Education
for Children with Disabilities; Moscow, September 27, 2011
Overview
1.
2.
3.
Why is a common framework to understand disability important for inclusive
education?
Introduction to the International Classification of Functioning, Disability and
Health, Version for Children and Youth (ICF-CY, WHO 2007)
Some flashlights on how the ICF can be used to develop an information
system relevant for inclusive education.
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Why is a common framework to understand disability
important for inclusive education?
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Understanding «disability»
Disability can be understood by taking
• an economic perspective
• an educational perspective
• a human-rights perspective
• a socio-cultural perspective
• a health perspective
•…
These perspectives represent different conceptual worlds.
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Conceptual worlds
«Conceptual worlds» or «knowledge cultures» influence and shape …
• … how we explain the creation of disability
• … how we analyse the components of disability
• … how we fashion interventions for children with disabilities
• … how we share information and collaborate with others
• … our beliefs and attitudes related to disability
But our conceptual worlds are not necessarily consistent and well organised. This
leads to fragmentation, inconsistency and misunderstandings.
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Let us go down and confound their speech…
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Information for Understanding
Knowledge base
Expertise
Tacit knowledge
«conceptual worlds»
Information
Making sense of data
articulated and verbalised
knowledge with
structure added
Understanding data
Data
atomised knowledge:
fixed representation
and interpretation
Reading data
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Meaningful Information Systems
A meaningful system to organise information on disability should…
• … allow adequate representation or mapping of all important components
relevant for a specific knowledge domain
• … provide a way to not only understand entities but also at the relationship
between them
• … be as complex as necessary and as simple as possible
• … enable linkages to other information systems
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Quality of Information Systems
Information systems need to…
• … provide a reliable linkage between data (e.g. data gained through
observations or assessment instruments, self reported data) and knowledge
domains (e.g. concepts, theories, models)
• … represent knowledge which is meaningful for many people
• …provide a framework for data collection that can be used for different
purposes
• … limit coverage so that information remains manageable
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Introduction to the International Classification of
Functioning, Disability and Health
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The conceptual worlds of the WHO-FIC
World Health Organisation – Family of International Classifications
• International Classification of Diseases; ICD-10 (Alpha Draft of ICD-11 online)
• International Classification of Functioning, Disability and Health, ICF and ICF-CY
• International Classification of Health Interventions, ICHI (under development)
ICD
ICF
ICF
ICHI
Diagnosis
Assessment
Planning
Action
ICF
Evaluation
http://www.who.int/classifications/en/
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Foundations of the ICF and the ICF-CY
Human Functioning - not merely disability
Universal Model - not a minority model
Integrative Model - not merely medical or social
Interactive Model
Parity
Context - inclusive
- not linear progressive
- not etiological causality
- not person alone
Cultural applicability - not western concepts
Operational
- not theory driven alone
Life span coverage - not adult driven alone
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ICF Model
Health Condition
Body Functions
and Structures
Environmental
Factors
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Activities
Participation
Personal Factors
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Body Component
Functioning from the perspective of the body and body systems
Body Functions are physiological functions of body systems (including
psychological functions).
Body Structures are anatomical parts of the body such as organs, limbs and their
components.
Impairments are problems in body function or structure such as a significant
deviation or loss.
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A/P component and Environmental Factors
Functioning from an individual and societal perspective (life domains)
Activity is the execution of a task or action by an individual.
Participation is involvement in a life situation.
Activity Limitations are difficulties an individual may have in executing activities.
Participation Restrictions are problems an individual may experience in
involvement in life situations.
Contextual Factors have impact on all components of functioning
Environmental Factors make up the physical, social and attitudinal environment
in which people live and conduct their lives.
Personal factors are also a component of contextual factors but they are not
classified in the ICF due to large social and cultural variance
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ICF Components
Body Functions
& Structures
Activities &
Participation
Environmental
Factors
Functions
Capacity
Barriers
Structures
Performance
Facilitators
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Body Functions & Structures
Mental functions
Structures of the nervous system
Sensory functions and pain
The eye, ear and related structures
Voice and speech functions
Structures involved in voice and speech
Functions of the cardiovascular,
haematological, immunological and
respiratory systems
Structures of the cardiovascular,
haematological, immunological and
respiratory systems
Functions of the digestive, metabolic
and endocrine systems
Structures related to the digestive,
metabolic and endocrine systems
Genitouriary and reproductive functions Structures related to the genitouriary
and reproductive systems
Neuromusculoskeletal and movementStructures related to movement
related functions
Functions of the skin and related
structures
Skin and related structures
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Activities and Participation – the Life Domains
1
2
3
4
5
6
7
8
Learning & Applying Knowledge
General Tasks and Demands
Communication
Movement
Self Care
Domestic Life Areas
Interpersonal Interactions
Major Life Areas: Education, Work and Employment,
Economic Life
9 Community, Social & Civic Life
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Environmental and Personal Factors – Contextual 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
Personal factors may include gender, age, social background,
past and current experiences, ethnic background, profession.
They are understood as the particular background of an
individual’s living situation in relation to functioning.
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Functioning is understood as a continuum
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Different domains can be selected as fit-for-purpose
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Structure of the ICF
ICF
Part 1:
Functioning and
Disability
Body Functions
and Structures
Part 2:
Contextual
Factors
Activities and
Participation
Change in
Body
Functions
Change in
Body
Structures
Capacity
Item
levels:
1st
2nd
3rd
4th
Item
levels:
1st
2nd
3rd
4th
Item
levels:
1st
2nd
3rd
4th
Classification
Environmental
Factors
Parts
Components
Personal
Factors
Constructs/
qualifiers
Performance Facilitator/
Barrier
Item
levels:
1st
2nd
3rd
4th
Item
levels:
1st
2nd
3rd
4th
Domains and
categories
at different levels
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Aims of the ICF and ICF-CY
ICF and ICF-CY are multi-purpose classifications, which aim at:
• providing a scientific base for understanding functioning and disability
• establishing a common language to improve communication between users
• permitting comparisons of data across countries, disciplines, services, time
• providing systematic coding scheme for information systems
OECD 2007
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Applications of the ICF and ICF-CY
The ICF can be applied for various purposes, for example:
• as a statistical tool – for the collection and recording of data
• as a research tool – to measure outcomes, quality of life or environmental
factors
• as a clinical tool – to assess needs, vocational assessment
• as a social policy tool – to use for compensation systems, eligibility, policy
design
• as an educational tool – to raise awareness, teach about disability
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Some flashlights on how the ICF can be used to develop
an information system relevant for inclusive education
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Selecting information that is «fit-for-purpose»
“Deficit orientation”
Understand problems
Functioning in ICF
used for mapping
“Competency orientation”
Plan for intervention
differential diagnostic
criteria to establish
a syndrome
(e.g. learning
disabilities)
components of abilities
as criteria to establish
competencies (e.g. ability
to learn)
functional properties
linked to problem
functional properties
linked to participation
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Ensure consistency across professional action cycle
Goal Orientation
Checking/
Assessing/
Evaluating
Analysing
Planning/
Deciding
Situation
Analysis
Planning
Acting/
Implementing
Action
Hollenweger & Luder, Sonderpädagogische Förderung heute 2010
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Facilitate cross-sectoral cooperation at different levels
Health
Education
Social Services
Rules, regulations and standards to organise, control and monitor services
Macro-Level / Policies
Administrative and organisational mechanisms related to service provision
Meso-Level / Systems
Programmes and operations designed to meet the needs of individuals
Micro-Level / Services
Individuals in the context of institutions
Hollenweger, Disability and Rehabilitation 2010
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Develop a System of Indicators for Participation
Chronological Perspective
Situation/
Input
Assessment/
Analysing
Assignment/
Planning
Intervention/
Acting
Evaluation/
Outcome
Systems
Perspective
Policies
Systems
Services
Functioning and
Disability of Child
European Agency for Development in Special Needs Eudcation, 2011
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Expanded ICF-model
Educational and
developmental goals
Methods, provision
and services
Vision of responsible, happy and healthy
citizen with capabilities, competence
and the ability to adjust to the
challenges of society
Hollenweger, BMC Public Health 2011
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Thank you for your attention!
References:
Minow, M. (1985). Learning to Live with the Dilemma of Difference: Bilingual and Special Education,
Law and Contemporary Problems, 48(2), 157-211.
Rogers, R. (2002). Through the eyes of the institution: A critical discourse analysis of decision making
in two special education meetings. Anthropology & Education Quarterly, 33(2), 213–237.
OECD (2007). Students with Disabilities, Learning Difficulties and Disadvantages. Policies, Statistics
and Indicators. Paris: OECD.
WHO (2001). International Classification of Functioning, Disability and Health. Geneva: WHO (also
available in Russian).
WHO (2007). International Classification of Functioning, Disability and Health, Version for Children
and Youth. Geneva: WHO.
Available online: http://apps.who.int/classifications/icfbrowser/Default.aspx
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