International Classification of Functioning and Child Language Assessment

1
International Classification of Functioning and
Child Language Assessment

• Carol Westby, PhD
• Albuquerque, NM
• mocha_at_unm.edu
• Mary Hartley, MS
• New Mexico Preschool for the Deaf
• Albuquerque, NM
• ASHA 2006
• Miami, Florida

2
Questions to be Answered

• What is the International Classification of
  Functioning (ICF)?
• Developed by the United Nations World Health
  Organization
• Framework for the ASHA Scope of Practice
• Part of the U.S. Department of Educations Early
  Intervention Data Handbook (Version 1.0).
• How can the ICF be used to guide assessment and
  intervention for children with developmental
  delays and disorders?

ICF website http//www3.who.int/icf/
3
Aims of the International Classification of
Functioning

• to provide a scientific basis for consequences of
  health conditions
• to establish a common language to improve
  communications
• to permit comparison of data across
• countries
• health care disciplines
• services
• time
• to provide a systematic coding scheme for health
  information systems

4
Foundations of ICF

• Human Functioning - not merely
  disability
• Universal Model - not a minority
  model
• Integrative Model - not merely medical
  or social
• Interactive Model - not linear
  progressive
• Parity - not
  etiological causality
• Context - inclusive - not person alone
• Operational - not theory
  driven alone
• Life span coverage - not adult driven

5
Cultural Applicability- Not Only Western Concepts

• Conceptual and functional equivalence of
  Classification
• Translatability
• Usability
• International comparisons

6
Medical versus Social Model

• PERSONAL problem vs SOCIAL problem
• medical care vs social integration
• individual treatment vs social action
• professional help vs individual collective
  responsibility
• personal vs environmental
  adjustment/adaptation manipulation/social
  change
• behaviour vs attitude
• health care policy vs politics

7
ICF Components
Body Functions Structures
Activities Participation
Environmental Factors
Functions Structures
Barriers Facilitators
Capacity Performance
8
Interaction of Concepts
Condition (disorder/disease)
9
Impairments in Body Functions

• Body functions are the physiological functioning
  of body systems (including psychological
  functioning)
• Impairments in body functioning are problems in
  body functioning such as a significant deviation
  or loss
• hearing/visual impairment
• language learning disability
• hypersensitivities
• memory problems
• reduced cognitive functioning
• speech fluency/stuttering
• swallowing difficulties

10
Impairments in Body Structures

• Body structures are anatomical parts of the body
  such as organs, limbs, or their components
• Impairments of body structures are problems in
  structure such as a significant deviation or loss
• missing/deformed limb
• absence of hair cells in cochlea
• agenesis of the corpus callosum
• cleft lip/palate

11
Body Functions and Structures
12
Qualifiers Extent of Impairment
13
Example of Qualifiers for Body Structure/Function
Structure of the nervous system Cranial nerves
Extent of impairment (1st qualifier) Nature of
impairment (2nd qualifier) Location of
impairment (3rd qualifier)
s1106.4 ? 3 cranial nerves
(6,7,8), complete impairment, both
sides structure b2300.4
hearingsound detection, complete
impairment function
Degree of difficulty 0 no difficulty 0-4 1
mild difficulty 5-24 2 moderate difficulty
25-49 3 severe difficulty 50-95 4
complete/total 96-100
14
Influence of Ethnicity on Incidence of Body
Structure/Function Impairments

• Oral facial anomalies greater incidence in Asian
  American Indian children less in African
  Americans
• Otitis media greater in Aboriginal Native
  American children less in African Americans
• Sickle cell anemia more common in persons of
  African and Mediterranean descent
• High blood pressure more common in African
  Americans

15
Interaction of Concepts
Condition (disorder/disease)
16
Activity Limitations Participation Restriction

• Activity execution of a task by an individual
  (in a standard environment)
• Activity limitations difficulties an individual
  may have in executing activities
• Participation involvement in a life situation
• Participation restrictions problems an
  individual may have in involvement in life
  situations

17
Activities Participation
Capacity an individuals ability to execute a
task or an action Performance what an individual
does in his or her current environment
18
Activity Limitations Participation Restriction

• Capacity qualifier indicates extent of activity
  limitation
• describes persons ability to execute a task or
  action
• focuses on limitations that are inherent or
  intrinsic features of the persons themselves
• direct manifestations of respondents health,
  without assistance
• should be judged relative to that normally
  expected of a person
• Performance qualifier indicates extent of
  participation restriction
• describes persons actual performance of a task
  or action in current environment
• measures difficulty persons experience in doing
  things, assuming they want to do them
• influenced by contextual factors

19
Qualifiers for Activities/Participation

• Performance in the current environment
  (considering assistance that is available)
• nonpersonal assistance
• personal assistance
• both nonpersonal and personal assistance
• Capacity without assistance
• Capacity with assistance
• nonpersonal assistance
• personal assistance
• both nonpersonal and personal assistance
• Performance without assistance

20
Qualifiers for Activities/Participation
Communication Conversation Starting a
conversation
Performance (1st qualifier)
Capacity without assistance (2nd qualifier)
Capacity with assistance (3rd qualifier)
Performance without assistance (4th qualifier)
Degree of difficulty 0 no difficulty 0-4 1
mild difficulty 5-24 2 moderate difficulty
25-49 3 severe difficulty 50-95 4
complete/total 96-100
d3500. 2 3 2 4
21
Contextual Factors

• Person
• Gender
• Age
• Other health conditions
• Coping style
• Social/cultural background
• Education
• Profession
• Past experience
• Character style

• Environment
• Products/ technology
• Natural environment and human changes to
  environment
• Support Relationships
• Attitudes
• Services, systems, policies

22
Qualifiers for Environmental Factors

• 0 no barriers
• 1 mild barriers
• 2 moderate barriers
• 3 severe barriers
• 4 complete barriers

• 0 no facilitator
• 1 mild facilitator
• 2 moderate facilitator
• 3 substantial facilitator
• 4 complete facilitator

23
Types of Capital

• Economic capital command over economic resources
  (cash, assets)
• Social capital resources developed through
  participation in social networks and the
  activation of those resources for social benefit.
  
• Functions of social capital
• as a source of social control
• as a source of family support
• as a source of benefits through networks outside
  the family.
• Cultural capital knowledge, skills, education,
  and any other advantages persons have that give
  them a higher status in society, including high
  expectations.
• includes familiarity with the dominant culture in
  society and the ability to use an educated
  language

Bourdieu, P. (1986). The forms of capital. In
J.G. Robinson (Ed.), Handbook of theory and
research for the sociology of education. New
York Greenwood Press.
24
Capital in Critical Race Theory

• Aspirational capital ability to maintain hopes
  dreams for the future in face of real and
  perceived barriers
• Linguistic capital intellectual social skills
  attained through communication experiences in one
  or more languages
• Familial capital cultural knowledge nurtured
  among family that carry a sense of community
  history
• Social capital networks of people community
  resources that can provide support to navigate
  through societys institution
• Navigational capital skills of maneuvering
  through social institutions
• Resistant capital knowledge and skill fostered
  through oppositional behavior that challenges
  inequality

Yosso, T.J. (2005). Whose culture has capital? A
critical race theory discussion of community
cultural wealth. Race Ethnicity and Education,
8(1), 69-91.
25
Structure of the ICF
ICF
Classification
Part 1 Functioning and Disability
Part 2 Contextual Factors
Parts
Activities and Participation
Body Functions and Structures
Environmental Factors
Personal Factors
Components
Constructs/ qualifiers
Change in Body Structures
Capacity
Performance
Facilitator/ Barrier
Change in Body Functions
Domains and categories at different levels
Item levels 1st 2nd 3rd 4th
Item levels 1st 2nd 3rd 4th
Item levels 1st 2nd 3rd 4th
Item levels 1st 2nd 3rd 4th
Item levels 1st 2nd 3rd 4th
26
Clinical Use of ICF

• When possible
• clinician should explain to individual/advocate
  purpose for the use of ICF invite questions
  about classifications
• person whose level of functioning is being
  classified (or advocate) should have opportunity
  to participate and challenge/affirm categories
  used and assigned

27
Core Body Structures/FunctionsChildren with
Hearing Impairment/Deafness

• Functions
• Sensory Functions Hearing
• Voice and Speech Functions Voice, Articulation,
  Fluency and Rhythm of Speech

• Structures
• The Eye, Ear and Related Structures External,
  Middle, Inner Ear

28
Body Structures Bilingual (ASL/Spoken English) 4
Year Old

• s2600.323 cochlear
• Qualifier 1 Extent of impairment
• Severe unaided
• Mild-moderate aided
• Qualifier 2 Nature
• Partial absence
• Qualifier 3 Location
• Bilateral

29
Body Functions Bilingual (ASL/Spoken English) 4
Year Old
30
Body Structures 6-Year-Old Profoundly Deaf Child
31
Body Structures 6-Year-Old Profoundly Deaf Child
32
Body Functions 6-Year-Old Profoundly Deaf Child
33
Body Functions 6-Year-Old Profoundly Deaf Child
34
Core Activities and ParticipationChildren with
Hearing Impairment/Deafness

• Learning and Applying Knowledge Purposeful
  Sensory Experiences, Basic Learning, Applying
  Knowledge
• Communication Receiving, Producing, Conversation
  and Use of Communication Devices and Techniques
• Interpersonal Interactions and Relationships
  General and Particular Basic and Complex
• Community, Social and Civic Life Recreation and
  Leisure (Play Socializing)

35
Activity/Participation 4 year-old ASL/oral
English Bilingual
36
Activity/Participation 4 year-old ASL/oral
English Bilingual
37
Activity/Participation 4 year-old ASL/oral
English Bilingual
38
Activity Participation Profoundly Deaf Child
39
Activity Participation Profoundly Deaf Child
40
Activity Participation Profoundly Deaf Child
41
Core Environmental Factors

• Products and Technology Assistive Products and
  Technology for Communication (hearing aids, CI)
• Natural Environment and Human Made Changes to
  Environment Light, Sound (classroom
  environments)
• Support and Relationships
• Attitudes
• Services, Systems and Policies

42
Environmental Factors Bilingual 4 year-old
43
Environmental Factors Bilingual 4 year-old
44
Personal Factors 4 year-old Bilingual
45
Environmental Factors 6-Year-Old Profoundly Deaf
46
Environmental Factors 6-Year-Old Profoundly Deaf
47
Personal Factors 6-Year-Old Profoundly Deaf
48

• Treat people as if they were who they ought to
  be and you help them become what they are capable
  of being (Goethe).