Feature

For the past eight years, APA's Practice Directorate collaborated with the World Health Organization (WHO) on the International Classification of Functioning, Disability and Health (ICF)--a system that classifies the impact of health conditions on people's level of functioning in domains such as communication, self-care, work and school. For example, the ICF allows health-care clinicians, such as psychologists, to describe in a standard way how a health condition has affected a patient's daily functioning.

The ICF is positioned to ultimately become the universal system by which the functional aspects of health conditions are described. It is now used in several countries--including Australia, Canada and the Netherlands--and various uses are being considered in the United States.

Indeed, says Jerome Bickenbach, PhD, professor and Queen's Research Chair in the department of philosophy at Queen's University in Ontario: "There are strong indications in many parts of the world, including the United States, that functional information will soon be required of clinicians by payers...in part because of a realization that functional status information is a far better predictor of health-system usage than diagnostic information."

Widening the lens

ICF is designed to be used in conjunction with WHO's International Classification of Diseases (ICD-10), which classifies diseases and enables the reporting of international mortality rates. Geoffrey Reed, PhD, assistant executive director for professional development in APA's Practice Directorate, says that while ICF provides a long list of codes that describe the whole range of human functioning, practitioners will have a tough time applying the information to clients without additional guidance. And, adds Bickenbach, the ICF could stall if clinicians don't have a clinical applications manual that links the ICF with the assessment instruments they normally use.

Facilitating use of the ICF

Based on its long collaboration with WHO, APA is now spearheading the creation of a Procedural Manual and Guide for a Standardized Application of the ICF, a publication that will help health-care clinicians use the ICF system to gauge aspects of daily human functioning during evaluation and treatment encounters with clients.

"We're leading a multidisciplinary collaboration [to create this resource]," says Reed, who notes that the manual drafting team has already included psychologists, occupational and physical therapists, speech-language pathologists and social workers. Other disciplines will be involved as the work continues. A prototype manual for several ICF chapters has been developed and is now being field-tested.

"The first chapters took the longest to develop, in large part because we had to create the template," says Reed. "Other chapters will be easier. We wanted to be sure clinicians found this useful before proceeding further." The response so far from across disciplines has been positive: "We found we're on the right track," he notes. APA's long-term commitment to the ICF manual is fueled by the belief that the ICF will expand the concept of health beyond the disease model, and possibly change the entire health-care system, Reed says. Indeed, the ICF is more than a classification tool, say experts.

"It is also an operational model of functioning and disability itself," says Bickenbach. And, adds Reed, the ICFis better suited to the way psychologists work--the focus isn't on diagnostic criteria related to an illness, rather on how they live their lives with that illness.

The manual will meet a clear and urgent need, says Bickenbach. "The manual is vital for clinical usage [of the ICF]. It will undoubtedly become the standard in terms of which other developments will be measured."

The project is on schedule to be published in 2005.

"The degree of multidisciplinary collaboration is tremendous," says Reed. "The manual project isn't flashy but it certainly has long-term implications in health care and for psychology."