Title: International Classification of Functioning and Child Language Assessment
1International 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
2Questions 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/
3Aims 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
4Foundations 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
5Cultural Applicability- Not Only Western Concepts
- Conceptual and functional equivalence of
Classification - Translatability
- Usability
- International comparisons
6Medical 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
7ICF Components
Body Functions Structures
Activities Participation
Environmental Factors
Functions Structures
Barriers Facilitators
Capacity Performance
8Interaction of Concepts
Condition (disorder/disease)
9Impairments 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
10Impairments 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
11Body Functions and Structures
12Qualifiers Extent of Impairment
13Example 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
14Influence 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
15Interaction of Concepts
Condition (disorder/disease)
16Activity 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
17Activities Participation
Capacity an individuals ability to execute a
task or an action Performance what an individual
does in his or her current environment
18Activity 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
19Qualifiers 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
20Qualifiers 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
21Contextual 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
22Qualifiers 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
23Types 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.
24Capital 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.
25Structure 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
26Clinical 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
27Core 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
28Body 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
29Body Functions Bilingual (ASL/Spoken English) 4
Year Old
30Body Structures 6-Year-Old Profoundly Deaf Child
31Body Structures 6-Year-Old Profoundly Deaf Child
32Body Functions 6-Year-Old Profoundly Deaf Child
33Body Functions 6-Year-Old Profoundly Deaf Child
34Core 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)
35Activity/Participation 4 year-old ASL/oral
English Bilingual
36Activity/Participation 4 year-old ASL/oral
English Bilingual
37Activity/Participation 4 year-old ASL/oral
English Bilingual
38Activity Participation Profoundly Deaf Child
39Activity Participation Profoundly Deaf Child
40Activity Participation Profoundly Deaf Child
41Core 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
42Environmental Factors Bilingual 4 year-old
43Environmental Factors Bilingual 4 year-old
44Personal Factors 4 year-old Bilingual
45Environmental Factors 6-Year-Old Profoundly Deaf
46Environmental Factors 6-Year-Old Profoundly Deaf
47Personal 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). -