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International Classification of Functioning and Child Language Assessment

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Title: 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/Functions Children 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 Participation Children 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).
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