International Classification of Functioning, Disability, and Health Children and Youth Version

Transcription

1 International Classification of Functioning, Disability, and Health Children and Youth Version Utility for Identification and Severity Don Lollar, Ed.D. Oregon Health & Science University

2 Issues Does function as a construct fit SSA needs? If so, is ICF-CY best approach for classification, definition, measurement? If not, then what? If yes, what are the relevant functional areas/chapters? Can standardized approaches/tools be identified to measure the functional areas? Will identification of children needing assistance be stronger?

3 Guidelines for development of the ICF-CY Developed over several years by an international work group across WHO regions Development of ICF-CY guided by relevant research and theory Structure ICF main volume maintained Inclusion/exclusion criteria expanded Formats to highlight applications relevant to children

4 Central concepts from theory and research guiding ICF-CY development Development and Disability as parallel processes- Changes in functions, activities and participation of child reflecting: Role of environment (transactional model) Child in context (Ecological systems theory) Development (Similar sequence/similar structure) Behavioral Regulation & organization Mediating role of Temperament/behavioral style Timing and maturation (Developmental delay)

5 ICF-CY framework for documenting functioning & disability Health Condition (disorder/disease) Body function &structure (Impairment) Activities (Limitation) Participation (Restriction) Environmental Factors Personal Factors (No codes)

6 ICF-CY: a universal framework and taxonomy of codes Body Functions Mental Sensory Voice/speech Cardiovascular, haemotological Digestive, metabolic Genitourinary Neuromuscular Skin Body Structures Nervous Eye,ear.. Voice/speech Cardiovascular Digestive Genitourinary Movement Skin.. Activities/Participation Learning Tasks demands Communication Mobility Self-care Domestic life Interpersonal Major Life Environmental factors Products/technology Natural environments Support & relationships Attitudes Services, systems, policies

7 ICF-CY FUNCTIONAL Concepts Body doesn t function properly; is impaired Personal activities are limited Participation in life situations is restricted Environment affects all dimensions of functioning Qualifiers interpret pivotal constructs

8 Using codes to classify disability: assigning the ICF-CY universal qualifier Coding with the universal qualifier defines the nature and severity of impairments, limitations/restrictions, delays or environmental barriers Coding of severity should be based on evidence that can be applied to the 0-4 scale of the ICF-CY (no=0, mild=1, moderate=2, severe=3, complete=4) Evidence for decreasing/deviating levels of functioning is common in clinical judgment as well as assessed performance on tests and measures

9 Using codes: Developmental code set for Early Intervention Eligibility d160 Focusing attention d1750 Solving simple problems d329 Communicating-Receiving Information d330 Speaking d349 Communication d4103 Sitting d4104 Standing d450 Walking d4550 Crawling d465 Moving around using equipment d435 Moving objects with lower extremities d440 Fine hand use d445 Hand and arm use d530 Toileting

10 Using codes/qualifiers: documenting treatment outcome TIME 1 TIME 2 Change of qualifier: reduction of severity level within code (e.g., d2504 Adapting activity level) d Moderate limitation d Mild limitation Change of function: moving from lower to higher level code (e.g., d155 acquiring skills) d Acquiring basic skills d Acquiring complex skills

11 C in ICF-CY--CLASSIFICATION The ICF-CY is not a psychological or physical measurement The ICF-CY is a classification system Similar to a blood test helping to decide a diagnosis (ICD), likewise Bayley, Binet or Battelle are examples of instruments used to provide information for assigning functional codes. ICF is the bridge for interpreting differing functional instruments.

12 Standardized Measures and Coding ICF tests Functional tests actually farther along than ICD at the same point in development first edition in the 1850s Tools/Instruments already established for many areas covered by the ICF components Impairments: medical tests Activities: communication, mobility, learning, selfcare Participation: school, work, community Environment: school, community, family factors

13 Using codes: linking/cross-walking to instruments Determine relevant functional areas to assess activity limitations (e.g. communication, mobility..), participation restrictions (e.g. school performance), and environmental factors, if relevant Determine instruments to assess functional areas of importance If tests are standardized that is, have means, standard deviations.., rules should be established for deciding on qualifiers based on those standards

14 Using codes: Criteria for Qualifiers for standardized tools Qualifer Descriptor Standard Percents Deviation included 0 None -.5 and 69% above 1 Mild -.5 to % 2 Moderate -1.5/-2.5 6% 3 Severe -2.5/ % 4 Complete Greater than %

15 Using codes: documenting ADHD Health Condition (ADHD) Body Structures & Functions (impairments) Intellectual functions Energy and drive impulse control Inattention Poor memory Psychomotor control Emotional regulation Organization Judgment Problem solving Activities (activity limitation) Reading Writing Calculating Carrying out single or multiple tasks Handing stress Managing one s own behavior Communication Interpersonal interactions and relationships Environmental factors Education services and systems Special education services and systems Health services and systems Particiption (particiption restrictions) Moving into education programs Attending to and adjusting Succeeding in education Leaving school Community, social, and civic life Recreation and leisure Related school activities

16 Issues Does function as a construct fit SSA needs? function is a strong contender If so, is ICF-CY best approach for classification, definition, measurement? ICF-CY with its WHO approval is a starting point for all dimensions If not, then what? If yes, what are the relevant functional areas/chapters? Activity limitations that restrict participation Can standardized approaches/tools be identified to measure the functional areas? Many already available; others to be developed Will identification of children needing assistance be stronger? Identification will be more equitable and transparent