Eva Björck-Åkesson

Applying the International Classification of Functioning, Disability and Health (ICF) to measure childhood disability

The International Classification of Functioning, Disability and Health-ICF addresses the broad need for a common language and classification of functioning and disability. A parallel need is appropriate measures compatible with the content of the ICF to document the nature and impact of limitations of function, activities and participation. The interaction of developmental characteristics and disability among children represent special challenges for classification as well as measurement. Demographic trends emphasize the need for universal measures that encompass the components of the ICF and can be used in surveillance, screening and evaluation. This paper identifies issues related to application of the ICF to measure disability in childhood; reviews approaches and tools to assess childhood disability and identifies priorities for the development of measures of functioning and disability in children based on the ICF. The development of measures should be framed within a framework of childrens rights and application of the biopsychosocial model to document profiles of functioning and disability of children.

The World Health Organization's international classification of functioning, disability and health: implications for clinical and research practice in the field of augmentative and alternative communication

In 2001, the World Health Organization (WHO) ratified and published a new classification system, the International Classification of Functioning, Disability and Health (ICF). There has been a varying amount of discussion and debate across the health and disability fields about what the ICF means and what it has to offer. However, there has been little discussion of its use and value in the field of augmentative and alternative communication (AAC). This article describes the earlier International Classification of Impairments, Disabilities, and Handicaps (ICIDH), upon which the current ICF was based; and outlines the ICF and the preliminary, derived Child and Youth version of the ICF (ICF-CY). The article also proposes what the ICF has to offer the AAC field, from both a clinical and research perspective; and concludes with a discussion of the advantages and challenges of using the ICF.

AAC Interventions for Children in a Family Environment: Implementing Evidence in Practice

Interventions that focus on implementing augmentative and alternative communication (AAC) strategies and methods have been available to children in need of AAC and their families for at least 30 years. To date, most of the research that has considered AAC in family settings has been focused on gathering evidence of the effects of AAC interventions, rather than on implementing evidence-based strategies in everyday practice to improve outcomes. The purpose of this article is to discuss the research that has focused on parents as AAC interventionists, the family as a context for AAC intervention, and the effects of AAC interventions on children and other family members. The discussion is framed within the four steps associated with the process of knowledge translation: (a) deciding on desired outcomes of interventions, (b) evaluating evidence of the effectiveness of different AAC methods to obtain the desired outcomes, (c) translating the research evidence into everyday practice, and (d) implementing knowledge in practice.

Field trial of ICF version for children and youth (ICF-CY) in Sweden: logical coherence, developmental issues and clinical use.

Introduction: For ICF-CY to be used in clinical practice several issues have to be resolved concerning the logical coherence in the model, developmental and functional issues as well as clinical feasibility. Purpose: The aim is to investigate feasibility of ICF-CY as expressed by ICF-CY questionnaires in assessment prior to intervention. Methods: One hundred and thirty-nine professionals working with intervention for children with disabilities used ICF-CY questionnaires in assessment. The professionals rated and commented on the feasibility of ICF-CY and ICF-CY questionnaire. Logical coherence, developmental issues and clinical use were investigated. Results: The logical coherence on component level was good (KMO = 0.126, p < 0.005). To investigate developmental and functional issues in the model children, four age groups were compared with the help of one-way ANOVA. Significant differences were found between children younger than 3 and children 3–6 and 7–12 in four chapters in the component Activities/Participation. Professionals consider that ICF-CY is feasible in intervention but experience difficulties when using the components and qualifiers in the ICF-CY and suggest changes. Discussion: ICF-CY as expressed in ICF-CY questionnaires is a feasible tool in assessment and intervention. However, several issues can be developed and discussed to facilitate implementation of ICF-CY in clinical practice.

Differentiating activity and participation of children and youth with disability in Sweden : a third qualifier in the International Classification of Functioning, Disability, and Health for Children and Youth?

ObjectiveThis article discusses the use of a third qualifier, subjective experience of involvement, as a supplement to the qualifiers of capacity and performance, to anchor activity and participation as separate endpoints on a continuum of actions. DesignEmpirical data from correlational studies were used for secondary analyses. The analyses were focused on the conceptual roots of the participation construct as indicated by the focus of policy documents, the support for a third qualifier as indicated by correlational data, differences between self-ratings and ratings by others in measuring subjective experience of involvement, and the empirical support for a split between activity and participation in different domains of the activity and participation component. ResultsParticipation seems to have two conceptual roots, one sociologic and one psychologic. The correlational pattern between the qualifiers of capacity, performance, and subjective experience of involvement indicates a possible split between activity and participation. Self-ratings of participation provide information not obtained through ratings by others, and later domains in the activities and participation component fit better with measures of experienced involvement than earlier domains did. ConclusionsThe results from secondary analyses provide preliminary support for the use of a third qualifier measuring subjective experience of involvement to facilitate the split between activity and participation in the International Classification of Functioning, Disability and Health, Children and Youth version, activity and participation domain.

The International Classification of Functioning, Disability and Health and the version for children and youth as a tool in child habilitation/early childhood intervention – feasibility and usefulness as a common language and frame of reference for practice

Early childhood intervention and habilitation services for children with disabilities operate on an interdisciplinary basis. It requires a common language between professionals, and a shared framework for intervention goals and intervention implementation. The International Classification of Functioning, Disability and Health (ICF) and the version for children and youth (ICF-CY) may serve as this common framework and language. This overview of studies implemented by our research group is based on three research questions: Do the ICF-CY conceptual model have a valid content and is it logically coherent when investigated empirically? Is the ICF-CY classification useful for documenting child characteristics in services? What difficulties and benefits are related to using ICF-CY model as a basis for intervention when it is implemented in services? A series of studies, undertaken by the CHILD researchers are analysed. The analysis is based on data sets from published studies or master theses. Results and conclusion show that the ICF-CY has a useful content and is logically coherent on model level. Professionals find it useful for documenting childrens body functions and activities. Guidelines for separating activity and participation are needed. ICF-CY is a complex classification, implementing it in services is a long-term project.

Family Involvement in Assessment and Intervention: Perceptions of Professionals and Parents in Sweden

This article describes perceptions of professionals and parents of the current and ideal state of family involvement in early intervention in Sweden. Both professionals and parents expressed significant discrepancies between current and ideal practices in four dimensions: parent involvement in decisions about child assessment, parent participation in assessment, parent participation in the team meeting and decision making, and the provision of family goals and services. Professionals showed preferences for a higher degree of family involvement. In identifying barriers, both professionals and parents most frequently mentioned system barriers. Causes for the discrepancies include the need for training and earlier inclusion of parents in the case management process.

ICF and ICF-CY lessons learned: Pandora’s box of personal factors

Abstract Purpose: The aim of this article is to examine the component of “personal factors” described as a contextual factor in the ICF and ICF-CY. Methods: A critical examination of the construct of “personal factors” and description of the component was made with reference to conceptual and taxonomic criteria. Results: The “personal factors” component in the ICF/ICF-CY is not defined, there is no taxonomy of codes, there is no explicit purpose stated for its use and no guidelines are provided for its application. In spite of these constraints, the component of “personal factors” is being applied as part of the classifications. Such uncontrolled applications constitute significant risks for the status of ICF/ICF-CY as the WHO reference classification in that: (a) the component is accepted for use by default simply by being applied; (b) component content is expanded with idiosyncratic exemplars by users; and (c) there is potential misuse of “personal factors” in documenting personal attributes, including “blaming the victim”. Conclusion: In the absence of formal codes, any application of the component of “personal factors” lacks the legitimacy that documentation with a scientific taxonomy should provide. Given the growing use of the ICF/ICF-CY globally, a priority for the revision process should be to determine if there is in fact need for “personal” or any other factors in the ICF/ICF-CY. Implications for Rehabilitation A central contribution of the ICF/ICF-CY is the universal language of codes for the components of body structure, body function, activities and participation and Environmental Factors. As such the codes provide taxonomical legitimacy and power for documenting dimensions of functioning and disability in clinical and rehabilitation contexts. As there are no codes of “personal factors”, there is no basis for documentation of the component. Demographic information, if needed for identification, should be recorded in customary formats, independent of any component or codes of the ICF/ICF-CY.

EVALUATION OF IN-SERVICE TRAINING IN USING THE ICF AND ICF VERSION FOR CHILDREN AND YOUTH

OBJECTIVE To study the effects of in-service training on staffs self-reported knowledge, understanding use of the International Classification of Functioning, Disability and Health (ICF) and ICF Children and Youth version (ICF-CY). DESIGN Quasi-experimental with a questionnaire prior to training and another one year after training. METHODS Intervention was in-service training in using the ICF and ICF-CY. Subjects were 113 professionals working in habilitation services. Two subgroups were compared: (i) subjects who reported one year after the training that they had used the ICF and ICF-CY in daily practice; and (ii) subjects who had not used these frameworks. RESULTS The gender, age, and years of work experience of the members in the subgroups were similar. The professionals who used what they learnt from the training, and who already had knowledge about and a positive attitude to the ICF/ICF-CY prior to the training, were found to benefit most from the training. They also increased their ability to apply it to statements about everyday work. These professionals should focus on increasing their understanding and use of the ICF/ICF-CY in their everyday work and in assessment, while those who have limited prior knowledge of the ICF/ICF-CY should focus on gaining knowledge and understanding the purpose, terms and components of the framework. CONCLUSION It is recommended that in-service training in using the ICF and ICF-CY is tailored to different groups of professionals depending on their degree of knowledge of the ICF/ICF-CY.

The construct of social competence : how preschool teachers define social competence in young children

SummaryPreschool teachers share their environment with young children on a daily basis and interventions promoting social competence are generally carried out in the preschool setting. The aim was to find out if and how preschool teachers’ definitions of social competence are related to factors in the preschool environment like: a) the number of children having problems related to social competence; b) the support provided to the children; and c) the preschool environment and current research definitions.Method: 481 preschools from 22 municipalities in Sweden participated. Data was analyzed using a mixed methods design in which a qualitative content analysis was followed by group comparisons using quantitative methods.Results: Preschool teachers defined social competence mainly as intrapersonal skills, or as interpersonal relations. The definitions of social competence were not related to the numbers of children having problems related to social skills or social competence in units, the amount of the support provided to the children or the preschool environment.Conclusion: Preschool teachers’ definitions of social competence are partly multidimensional, which implies that the interventions aimed at promoting children’s social skills and social competence also should be multidimensional. Preschool teachers’ definitions of social competence have little relevance to environmental factors, which indicate that social competence, as a construct is more dependent upon perceptions of the individual than on contextual factors.RésuméLes enseignants préscolaires partagent tous les jours leur environnement avec de jeunes enfants et leurs interventions pour promouvoir la compétence sociale se réalisent généralement dans le contexte préscolaire. Le but de la recherche était de savoir si et comment leurs définitions de la compétence sociale sont liées à certain facteurs du milieu préscolaire comme a) le nombre d’enfants ayant des problèmes relatifs à la compétence sociale, b) l’aide apportée aux enfants et c) le milieu préscolaire et les définitions actuelles de la recherche. Méthode: les données provenant de 481 établissements préscolaires de 22 municipalités suédoises ont été analysées à l’aide d’un devis mixte utilisant une analyse qualitative de contenu suivie d’une comparaison de groupes au moyen de méthodes quantitatives. Résultats: les enseignants préscolaires définissent avant tout la compétence sociale comme des habiletés intrapersonnelles ou comme des relations interpersonnelles. Leurs définitions de la compétence sociale ne sont reliées ni au nombre d’enfants ayant des problèmes de compétence sociale, ni à la quantité d’aide apportée aux enfants, ni à l’environnement préscolaire. Conclusion: Les définitions de la compétence sociale proposées par les enseignants préscolaires sont en partie mutidimensionelles, ce qui implique que les interventions ayant pour but de pronouvoir les habiletés et la compétence sociales, des enfants devraient elles aussi être mutidimensionelles. Les définitions de la compétence sociale proposées par les enseignants préscolaires ont peu de relations aux facteurs environnementaux ce qui indique que la compétence sociale, en tant que construit, dépend davantage des perceptions individuelles que des facteurs contextuels.ResumenLos educadores preescolares comparten su ambiente con los niños diariamente y las intervenciones educativas que promueven la competencia social son, generalmente, llevadas a cabo en ese marco preescolar. El objetivo del estudio ha sido ver si se evidenciaba y en qué forma., la definición de competencia social del educador preescolar está relacionada con factores del medio preescolar como: a) el número de niños con problemas relacionados con la competencia social, b) el apoyo dado a los niños y c) el ambiente preescolar y las definiciones de la investigación actual. Método: Se analizaron datos de 481 escuelas preescolares usando un diseño mixto, en el que un análisis de contenido cualitativo fue seguido por comparaciones grupales usando métodos cuantitativos. Resultados: Los educadores preescolares definieron la competencia social principalmente como habilidades intrapersonales o como relaciones interpersonales. Sus definiciones de competencia social no estuvieron relacionadas con el número de niños con problemas de este tipo, ni con el apoyo provisto a los niños o el ambiente preescolar. Conclusión: Las definiciones de competencia social de los educadores preescolares son, en parte, multidimensionales, lo que implica que las intervenciones educativas, para fomentar las habilidades sociales y la competencia social del niño, también deben ser multidimensionales. Las definiciones de competencia social de los educadores preescolares tienen pocas relaciones con los factores medioambientales, lo que indica que la competencia social, como construcción, es más dependiente de percepciones individuales que de factores contextuales.