The document discusses the International Classification of Functioning, Disability and Health (ICF) framework and its use in early intervention services. It provides an overview of the ICF components and history of its use in early intervention. Examples are given of how the ICF can be implemented, including developing a checklist, integrating different professional knowledge, focusing on resources, and systematically capturing information. Challenges and lessons learned from 11 years of using the ICF in early intervention are also summarized.

1. Research Making
a Difference
www.canchild.ca
Putting the ICF
into Practice
First ICF Education Symposium, Helsinki,
Finland
June 5th 2015
Liane Simon
Olaf Kraus de Camargo @Devpeds

2. Outline
• Overview of the ICF and its use as a framework in
disability (Olaf)
• Brief history and experience with the use of ICF codes in
Early Intervention Services (Liane)
• Video example
• Summary

3. 3

4. Components of the ICF

5. We can give you a
diagnosis!

6. Change of the Definition of Disability
➡ "He-Who-Must-Not-Be-Named"
➡ In the ICF-language “The” disability is an experience
➡ All people can find themselves in disabling life situations
(“Disability” as a relative term)
➡ Disability can be prevented (in relative terms)
➡ The relations between Disability and Functioning are complex

7. Disability: Why does it matter?
• People with disabilities and chronic health conditions are the largest
minority on earth (1 billion people) (WHO and The World Bank (2011).
World Report on Disability)
• Chronic health conditions affect around 25% of the paediatric patients
(http://childhealthdata.org/)
• Care for children with disabilities is complex and demanding (Burke, R.
T. and B. Alverson (2010). Pediatrics 126(4): 789-790).
• Psychosocial factors are of major importance for the wellbeing of
children and families (Lach, L. et al. (2009). Disability and rehabilitation
31(9): 741-752.
• “too much care that is important is often not delivered, and too much care
that is delivered is often not important” (Institute of Medicine, 2011)

8. A person is functioning well, if – with regard to the context in which she is
living (Concept of Environmental Factors) –
• Her Body Functions (including the mental functions) and her Body
Structures correspond to general accepted norms
(Concept of Body Functions and Body Structures),
• She is able to perform the type of activities in the same way as a person
without a health problem
(Concept of Activities),
• She is able to develop her existence in all domains that are important to
her in the same way and the same extent as it would be expected to be by
a person without impairments of body functions or structures or restrictions
in activities.
(Concept of participation)
Functioning
Bio
Psycho
Social

9. Contextual factors (Environmental factors, personal factors)
influence functioning:
Positively (Facilitators)
Therefore, it is always necessary to take into consideration
the contextual factors when evaluating functioning!
Negatively (Barriers)
Functioning and Contextual Factors

10. Common Language
• Professionals can communicate across disciplines
• Patients can identify common needs across
diagnoses - speak with one voice!
• Service providers can identify populations for
programs and services across diagnoses
• Public Health services can identify priorities based
on needs

11. Laulima
Many hands
working together in
cooperation and
harmony

12. Acute Care
The ICF and
Cultures of Care
Developmental Care/Early Intervention

13. The ICF and
Cultures of Care
Acute Care
Strategy
curative,
cause oriented
optimizing,
bio-psycho-social
Developmental Care/Early Intervention

14. The ICF and
Cultures of Care
Acute Care
Strategy
curative,
cause oriented
optimizing,
bio-psycho-social
Developmental Care/Early Intervention
Patients/Parents
passive,
enduring, „patient“
active, responsible

15. The ICF and
Cultures of Care
Acute Care
Strategy
curative,
cause oriented
optimizing,
bio-psycho-social
Developmental Care/Early Intervention
Patients/Parents
passive,
enduring, „patient“
active, responsible
Physician
giving orders,
„in charge“
counselling
accompanying
member of a team

16. Putting the ICF into Practice

17. First contact
?
?
?

18. Who are you?
Who are
you?
What do/would you like to do?

19. Where and how do you live?

20. Now, let’s focus on what you want!

21. What do people want?
Function
Family
Fitness
Fun
Friends
Future

23. 11 years with ICF

24. Vortragstitel - Headline
e
Referent: Name
Frühförderung Norderstedt

25. • 2004 Developing an ICF-Checklist
 Marijke Kaffka-Backmann
 Olaf Kraus de Camargo
 Jürgen Kühl
 Liane Simon
• 2005 Impelmentation of ICF in daily praxis of
early childhood intervention
ICF in early intervention 2004-2015

26. Searching for a „common language“
Integration of different professional knowledge
Focused on ressources
Capturing them systematically
Why?

27. „Development is a dynamic process by which the child moves
progressively from dependency on others for all activities in
infancy towards physical, social and psychological maturity and
independence in adolescence. In this dynamic process, the
child´s functioning is dependent on continuous interactions with
the family or other caregivers in a close, social environment.
Therefore the functioning of a child cannot be seen in isolation
but rather in terms of the child in the context of the family system“
(WHO,2007, XV).
Thinking in interdependencies

28. Connecting the dots.
interprofessional goal setting.
Talk and listen to each other
Requirements to the team

29. „The continuos reflection with caregivers
and within the team is crucial for the
success of early intervention“
(VIFF 1999).

30. Implementation by decision of the leadership
Slowly because it takes time to learn a language
Including the informations of external
professionals to the reports.
Joint reports.
The implementation

31. Every child
Every 6-12 month
Multiprofessional diagnostic at the beginning
Video-consultation in teams
The person, who works with the child and it´s family
presents the facts
Questions
Video
Hypothesis and “talking prosa”
Using the ICF-CY Code set for goal setting for the next 6
month (max. 6)
How do we use it?

32. Confusion about the most apropriate component.
Aiming too high (b2, d3…), i.e. wanting to solve
everything
We used the common language but sometimes
didn´t want to talk or listen to each other
The coding is not enough to be understandable
We also needed a short comment.
Learning from our mistakes

33. :
1.asking
Caregivers describe the childs and familiys needs
PEM-CY
Participation and Environment Measure für Children and Youth (PEM-CY) von Coster and
Khetani
Khetani, M.A., Graham, J., & Alvord, C. (in press). Community participation patterns among
preschool-aged children who have received Part C early intervention services. Child: Care,
Health and Development (Special Issue). Volume 39, Issue 4, July 2013, Pages: 490–499,
ICF-PEI
IC-CYF based schedule for Individualized Education Plan
Alberto Raggi, Paolo Meucci, Matilde Leonardi, Tiziana Barbera, Annamaria Villano, Maria R
Caputo, and Alessandra Grassi (2014) The development of a structuredschedule for collecting
ICF-CY based information on disability for school and preschool children: an action research
from Italy. Int J Rehab Res, 37, 86-96.
ICF-CY- based approach

34. 2. Interprofessional discussion
 Not only professions but professionals discuss and cooperate
 They need the disposition to do this
 Interprofessional discussion is subject to the terms of
communication theories
ICF-CY- based approach

35. 3. coding
Is not enough, you need a additional comment.
ICF-CY- based approach

36. VIDEO

37. When putting the ICF into practice – importance of
taking different perspectives and views
Use of a Code-set makes it easier for paper-based
approach
Using the ICF to classifiy goals allows to match
resources and needs
Using the ICF facilitates the communication within the
team and professionals and services outside of the
team.
Summary