Using the ICF in Social Services for Persons with Disability Implications and Challenges

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1 Using the ICF in Social Services for Persons with Disability Implications and Challenges Ph.d., Cand.Scient. Pol. Forsknings- og udviklingskonsulent Det Samfundsfaglige og Pædagogiske Fakultet

2 Agenda Introduction Background Evaluating the use of ICF in 10 social services/institutions: - design and methods ICF as a knowledge practice ICF as part of a management practice Discussion Further perspectives

3 ICF, rehabilitation and social work Traditionally: ICF used in the process of rehabilitation ICF common knowledge among professionals working with health and rehabilitation (i.e. occupational therapist and physiotherapist) Increasing interest from social work professionals: Social services for persons with disabilities - habilitation Professionals: social educators, social worker Dilemmas, challenges and professional implications when social workers are using the ICF in services for persons with disability

4 Background The Social Enterprise, under the Capital Region, introduced the use of ICF in social work in 2008 The Social Enterprise provides residence, activities, employment and rehabilitation for persons with disabilities her among persons with severe intellectual disabilities, multiple disabilities 10 institutions and services in The Social Enterprise has worked with implementing the ICF as a tool to measure the users functioning, impairment, and document changes in functioning (an ICF profile/ ICF document) The implementation were supported by an external consultant

5 Evaluating the use of ICF in social work Research team: Thea Wind: Occupational Therapist, cand.pæd.psyk and lecturer at Institute for Rehabilitation, Metropolitan UC Inge S. Bonfils: Ph.D. cand.scient.pol. Institute for Rehabilitation / Institute for Social Work. Metropolitan UC Steering group: The Social Enterprise, The Capital Region; the leader, experts, professionals representing the 10 institutions/social services Research Team and a leader from the school of Occupational Therapy, Metropolitan UC

6 Evaluating the use of ICF in social work Design and methods: A formative evaluation Qualitative methods: document analysis and qualitative interview Three steps: 1. Document analysis of examples of the ICF profiles/icf documents from the 10 institutions Interview with leaders and key persons 2. Interview with social workers from 4 institutions/group homes for persons with disabilities 3. Telephone interview with 5 social workers from the municipal authorities Dissemination: Three sub-reports for internal use Final report (short version) A seminar for the professionals at the Social Enterprise Article in VERA Tidsskrift for pædagoger

7 The ICF profile/ ICF document - examples The ICF profile as a framework; a narrative of the person s level of functioning and capabilities Data: name, birth etc. Short life story Development and status: mental functioning, activity and participation, environmental factors Relative s point of view User s point of view Goal-setting Ø A narrative form, short stories, examples from everyday activities. Ø Professional, relatives and the user s point of view is reflected in the document The ICF profile as a checklist, describing the person s level of functioning in details: Data; name, birth etc. Body function Activity and participation Environmental factors Common reflections; personal factors, goal setting Ø Short descriptions of the person s level of functioning, focus on problems and resources. Ø The professional s point of view

8 ICF as a knowledge practice research questions How ICF becomes part of the social worker s values, language, approach, and a tool they use in their daily work? How does this influence the social worker s understanding of their professional identity/role?

9 ICF as a knowledge practice The leaders and professionals evaluation: The positive aspects A systematic way to organize information s about the user s level of functioning It provide a common language and use of concepts between professionals It provide insights into domains of the user s life and functioning where further test or observations are needed A holistic view raise our awareness into how relatives, the network and other environmental factors influence the user s level of functioning It gives us an opportunity to focus on the individual user, and get a common understanding of their resources and impairments

10 ICF as a knowledge practice The leaders and professionals evaluations: Challenges The user s level of functioning depends on the situation, the context and the relationship to the professionals To distinguishing between activities and participation, (and therefore we repeat the same things many times ) The ICF concepts and terms as a rigid and strange way of describing the users, which do not correspond to terms used by our profession The description of the users becomes a narrative of their many deficits Difficult to describe the user s level of functioning in a neutral and respectful manner and to show the small things the users can do without assistance Many of the social workers are not used to write and to describe their knowledge in writing

11 ICF as a knowledge practice The leaders and professionals evaluation: Does the use of ICF influence the social workers understanding of their professional identity/role? Valuable professional skills and status Quote: we feel, we become more skilled and have a more valuable professional status we can express our knowledge in a more professional and neutral language Professional insecurity: Quote: we, as a profession, feel we lack the skills to make a correct description we ask: is it unethical of us to describe the user in such details? we are unfamiliar with the ICF terminology and logic, we user other terms and concepts we are unfamiliar with describing our knowledge in writing

12 ICF as part of a management practice An approach to interpret the use of ICF in a broader political and administrative context: Changes in the management of specialised services for persons with disability The local government reform 2007, the municipalities have the full authoritative and financial responsibility in disability matters A market model orderer - supplier management model comparing cost and quality The specialised services for persons with disability: under pressure to document the users functioning, impairments and needs under pressure to document the quality and effect of their services

13 ICF as part of a management practice The leaders and professionals evaluations: The ICF profile/document is seen as evidence for the user s impairment and needs The ICF profile enables a description of changes in the person s level of functioning To give reason for more resources or another kind of service The municipal authorities point of view: Quote: Information's are valuable, we can use them in our assessment and to document the services we pay for We need information's that can document the user s level of functioning

14 Discussion The user or relative s point of view: They do not participate in the process, however some institutions use a narrative form to include the relatives and user s point of view The ICF profile as a professional tool however there is a risk that it becomes a narrative of deficits The environmental impact on functioning: The professionals and the social services are part of the environment a bias The social - cultural context as environment however the professionals lack skills to analyse how the social and attitudinal environment influence the user s level of functioning The ICF as part of a management practice: Cutting back services for people with disability Is ICF used as part of a tendency to focus on the individual's capacity to manage daily activities without (so much) assistance? Risk that the support to participate in social activities are reduced

15 Further implications ICF and social work practice: Increasing interest in using the ICF framework in social work the VUM /assessment tool is based on the ICF logic A common language used in interdisciplinary work settings rehabilitation The environmental impact on functioning to develop skills to analyse and describe the environment Social research can support our knowledge in how the social and attitudinal environment influence the individual s level of functioning

16 Den Social Virksomhed og Professionshøjskolen Metropol, 2013: ICF, individuelle planer og sociale tilbud. En evaluering af brugen af ICF i de sociale tilbud i Region Hovedstanden. A278D /0/ICFevalueringsrapportendeligversion.pdf og Leif Olsen 2013: ICF- klassifikationen balancegang eller glidebane? I Bonfils, Kirkebæk, Olsen og Tetler (red.): Handicapforståelser mellem teori, erfaring og virkelighed. Akademisk Forlag.

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