DISABILITY WITHIN THE APA
International Classification of Functioning, Disability and Health: APA Update
By Lynn Bufka, PhD
The International Classification of Functioning, Disability and Health (ICF) is a comprehensive classification system designed to capture aspects of human functioning in the context of a health condition. The ICF was endorsed for international use by the World Health Assembly in May 2001. The system consists of a hierarchy of classifications for each of its domains: Body Functions and Structures, Activities and Participation, and Environmental Factors (See figure below). Codes can be recorded for each classified item within a domain to indicate the extent of ‘problem’ with any of these aspects of functioning. Environmental Factors can be recorded as being either barriers to or facilitators of a person’s functioning.
The classification system permits clinicians to fully discuss the complex issues encountered in clinical situations. It is intended that the ICF would be used in conjunction with the ICD (International Classification of
Diseases) so that not only could health conditions be systematically classified but their functional consequences could also be universally described. However, it is possible for the ICF system to be used in settings outside of health care as well. The ICF recognizes human functioning as multi-faceted and involving more than a purely biological perspective on health. Impairment is related to functional status, but it is not strictly predictive of functional independence and performance on an everyday basis in one’s natural environment. By capturing information about more than level of impairment alone, the ICF allows for a more comprehensive description of functioning.
Parts and Components of the Classification System:
Implementing the International Classification of Functioning and Disability (ICF)
In 2001, the World Health Assembly approved the International Classification of Functioning, Disability, and Health (ICF) as a universal system to classify the functional aspects of health and health conditions. APA was the largest American site for field trials of the ICF involving many psychologists in the pre-publication final review and has been committed to incorporating functional classification in health care through its ongoing educational and health policy efforts.
APA is now involved in the next step toward implementing the ICF. Although the ICF provides a framework and individual codes for classifying human functioning, the codes themselves are not yet operationalized in a reliable way to ensure consistent use of the ICF across health care systems (such as hospitals, clinics, and national health ministries) and health care professionals.
With the collaboration of the World Health Organization, APA has spearheaded an effort to further the operationalization of the codes and to create a manual for health care professionals. The work is being done by a network of official representatives from several professional organizations as well as identified content experts. Psychologists and health care professionals from across the world have provided some preliminary comment and review on the prototype version of the manual. One section of the manual is available for public comment at and all are invited to review relevant sections. Additional sections will be released for review and comment on this website as they are finalized.
Additionally, APA staff routinely attend North American and international meetings to update colleagues on this work and to collaborate on other related educational and implementation endeavors related to the ICF. Their involvement reinforces the role of organized psychology in matters related to health and health care and helps to provide a behavioral and psychological perspective on human health in WHO’s discussions and activities.
Further information on APA’s involvement with the ICF or contact:
Dr. Lynn Bufka, PhD
Assistant Executive Director
Professional Development and Training