Invited talk at the Russian Annual Congress of Pediatrics

1. ICF in Social Pediatrics
Olaf Kraus de Camargo, krausdc@mcmaster.ca
Twitter: @DevPeds

2. Outline
1. What is Social Pediatrics?
2. What is the ICF?
3. The “F-Words”
4. The FACT Tool

3. Social Pediatrics
“Every pediatrician that fully
understands his/her task, in the first
place, has to be a social doctor”
(Stefan Engel, 1878–1968)

4. 21st Century Thinking:
Health Condition
(e.g., CP,ASD)
Body Structures
and Functions Activities Participation
Environmental
Factors
Personal
Factors
The ICF

5. ICF Framework
Body Structure &
Function
Activities
Participation
Environment
Personal Factors
Body Functions: The physiological functions of body systems (including psychological functions)
Body Structures: Anatomical parts of the body such as organs, limbs, and their components
Activities: The execution of a task or action by an individual.
Participation: Involvement in a life situation
Environmental factors: The physical, social and attitudinal environment in which people live and conduct
their lives; these are either barriers to or facilitators of the person’s functioning
Personal Factors: Internal personal factors which can include gender, age, education, profession, past and
current experience, character and other factors that influence how disability is experienced by the individual

6. ICF Framework
Environment
Environmental factors: The physical, social and attitudinal environment in which people live and conduct
their lives; these are either barriers to or facilitators of the person’s functioning

7. Social Determinants of Health
Healthy People 2030, U.S. Department of Health and Human Services, Office of
Disease Prevention and Health Promotion. Retrieved Feb 22, 2021, from
https://health.gov/healthypeople/objectives-and-data/social-determinants-health
1. Economic Stability
2. Education Access and Quality
3. Health Care Access and Quality
4. Neighborhood and Built Environment
5. Social and Community Context

8. The ICF - Health
§ Health is ‘the ability to adapt and self-manage in the face of social,
physical and emotional challenges’ (Huber et al. 2011).
§ In other words, functioning (however it is done, regardless of
ability/disability) can be understood as the evidence of health.
Huber M, Knottnerus JA, Green L, et al. How should we define health? BMJ
2011; 343: d4163.

9. The ICF - Diagnoses
§ The ‘non-categorical’ way of thinking and talking reminds us that
many issues are common across ‘developmental disabilities’ and
’chronic health conditions’
§ It is also essential to take a life-course approach to these life-long
‘child-onset’ conditions.
§ And, to accept/celebrate diversity & variation.

10. What do we like about the ICF?
• This is a ‘dynamic system’ of inter-connected parts,
and where we start our interventions may be less
important than we used to think
• ICF reminds us to look at/focus on what people
CAN do
• This is a focus on strengths!
Health Issue
BS&F Activity Partn
Environt Personal

11. • It is a framework for health for everyone
• The words are ‘neutral’
• Everything is connected to everything else
Health Issue
BS&F Activity Partn
Environt Personal
What do we like about the ICF?

12. Perspectives
Health Condition
(e.g., CP,ASD)
Body Structures
and Functions Activities Participation
Environmental
Factors
Personal
Factors
The ICF

13. Perspectives
Health Condition
(e.g., CP,ASD)
Body Structures
and Functions
Activities
Participation
Environmental
Factors
Personal
Factors
The ICF

14. Teamwork
Acute Care
Social Pediatrics
Strategy Patients Physician/Clinician

15. Teamwork
Acute Care
Strategy
curative,
cause oriented
optimizing,
bio-psycho-social
Patients Physician/Clinician
Social Pediatrics

16. Teamwork
Acute Care
Strategy
curative,
cause oriented
optimizing,
bio-psycho-social
Patients
passive, enduring,“patient”
active, responsible
Physician/Clinician
Social Pediatrics

17. Teamwork
Acute Care
Strategy
curative,
cause oriented
optimizing,
bio-psycho-social
Patients
passive, enduring,“patient”
active, responsible
Physician/Clinician
Giving orders, prescribing,“in charge”
counseling, accompanying,
member of a team
Social Pediatrics

18. Therapists
(SLT, PT,
OT)
Pediatrician
Social
Worker
Psychologist
Child &
Family
Teamwork

19. F-Words
Downloaded >24,000 times
(September 2011 – Feb 2021)
Presented > 150 times locally
& internationally
Shared around the world and
being translated into > 30
languages
Rosenbaum P, Gorter JW.The “F-words” in childhood disability: I swear
this is how we should think! Child Care Heal Dev 2012; 38: 457–63.

20. F-Words
Health Condition
(e.g., CP,ASD)
Function Fitness Friends
Family Fun
The ICF
Future

21. https://canchild.ca/en/res
earch-in-practice/f-
words-in-childhood-
disability/f-words-
translations
Русский?

22. F-Words in Goal Setting
§ Reframing what is
important and why
§ Support shared decision
making
§ Create a common
understanding of the
journey ahead

23. FACT – The Tool
https://doi.org/10.3389/feduc.2018.00002

24. FACT - Participation

25. FACT - Functioning

26. FACT – Contextual Factors

27. Bio-Psycho-Social Medicine
Science:
Biomedical
Research &
Evidence-based
Medicine
The Patient’sVoice:
Narrative Medicine &
Patient-reported outcomes
Physician’s
Tools:
ICF Framework &
Ethics principles
ICF & Ethics:
What can we do to
improve participation?
Evidence:
What will work to achieve the
patient's goals?
The Patient’sVoice:
What matters to them?
Ronen GM, Kraus de Camargo O, Rosenbaum PL. How CanWe Create Osler’s “Great Physician”? Fundamentals
for Physicians’ Competency in theTwenty-first Century. Med Sci Educ 2020. DOI:10.1007/s40670-020-01003-1

28. Links & Literature
§ МКФ в реабилитациию 2-е (Russian)
§ https://rus.logobook.ru/prod_show.php?object_uid=2308460
§ ICF – A hands-on approach for Clinicians and Families (English)
§ http://www.mackeith.co.uk/shop/icf-a-hands-on-approach-for-clinicians-and-
families-ebook/
§ Die ICF-CY in der Praxis (German)
§ https://www.hogrefe.com/de/shop/die-icf-cy-in-der-praxis-87565.html
§ MultilingualWebsite with educational materials about the ICF
§ http://icfeducation.org

29. Q & A Session
Q A
&
Спасибо!