In 2001, the 54th World Health Assembly-the World Health Organization's (WHO) governing body-endorsed the International Classification of Functioning, Disability and Health (ICF), a WHO-developed system that ultimately aims to become the universal standard for health-care professionals to describe patients' functioning.

The system encourages the health-care community to shift from exclusively using diagnostic labels to instead painting a more complete picture of the world's health status by describing behavioral aspects of chronic diseases, like diabetes and depression, and including people's levels of functioning in domains such as communicating, taking care of oneself and working.

The system also provides a method for health professionals-including psychologists-to classify the functional aspects of health conditions, says Geoff Reed, PhD, assistant executive director of professional development in APA's Practice Directorate.

However, while ICF's focus on functional status is applicable to a range of fields, such as nursing, occupational therapy and rehabilitation psychology, the conceptual system doesn't provide sufficient information on how professionals in these fields could apply it in their work, says Lynn Bufka, PhD, director of professional development demonstration projects for APA's Practice Directorate.

As a result, APA's Practice Directorate has developed a draft ICF manual-a tool that Reed and Bufka say should provide psychologists and other health professionals with the additional operational information to apply ICF in their clinical work. The directorate plans to release a draft of the manual early this year for clinicians' review and comment.

Potential benefits

The creation of an ICF manual-the first of its kind in the United States-represents a significant international health-care development, says David Peterson, PhD, a psychology professor at the Illinois Institute of Technology's Institute of Psychology who specializes in rehabilitation psychology.

"The manual allows us to classify nonfatal health-care outcomes and build upon functional comorbidity data in a standardized way," he says.

Peterson adds that by creating a uniform way to apply the codes and create standardized data, the APA manual will allow researchers to more quickly disseminate effective health strategies throughout the world as they are developed.

Without ICF and such a tool to apply it, "Clinicians are comparing apples and oranges," says Marjorie Greenberg, chief of the classification public health and data standards staff at the Centers for Disease Control and Prevention and head of the WHO Collaborating Center for the Family of International Classifications for North America.

In addition to the standardization of data, Susanne Bruyere, PhD, director of the Employment and Disability Institute at Cornell University, suggests that ICF, in conjunction with the manual, can help create a common cross-disciplinary language.

"[ICF and the manual] will help us to work across the cultures of our disciplines," she says.

To put those prognostications to the test, throughout the next five months Reed and Bufka are recruiting volunteers to review and comment on the manual's content and propose field trials that aim to test whether clinicians who use the manual are able to more consistently classify patients' functioning than clinicians using ICF alone.

"Now that we have the manual in place, we have to collect information to gauge its reliability, see what's missing and what works," Bufka says.

After integrating feedback from those trials, APA plans to publish the manual later this year.


Despite ICF's potential benefits, many practitioners are reluctant to embrace the system's developments since neither the U.S. Department of Health and Human Services nor insurers require them to use ICF codes, Bufka says.

"Everyone we talk to seems to love the system," Bufka says. "But they tell us that unless they are required to use it, it won't get used."

To change that, Reed and Bufka are attempting to showcase the value of incorporating systematic information about functional status in routine health care to demonstrate ICF's potential value to both clinicians and patients.

"We hope the manual will assist federal agencies, like the Centers for Medicare and Medicaid Services, to consider how ICF may be applicable for treatment planning and reimbursement," Reed says.

APA's manual is applicable to psychologists in the United States, Canada and other Western, English-speaking countries, Bufka says. However, numerous other countries, like Australia and the Netherlands, are developing their own models in order to put ICF in place.

To comment on or review the ICF manual, contact Lynn Bufka.