Lynn F. Bufka

Operationalizing the International Classification of Functioning, Disability and Health in Clinical Settings

Functional status may be a better indicator of health care needs and outcomes than diagnosis. Appropriate use of the International Classification of Functioning, Disability and Health (ICF) in health service settings can provide a standardized way for clinicians to communicate complex clinical assessments to other professionals, administrators, and payers. The American Psychological Association is working with the World Health Organization to develop a Procedural Manual and Guide for a Standardized Application of the ICF for use by multidisciplinary health professionals. The Procedural Manual includes operational definitions of concepts, examples of each code, and assessment information relevant to each qualifier. The purpose of the Procedural Manual is to provide health professionals with the guidance necessary for reliable, valid, and clinically useful classification. This article discusses a range of issues and problems in the application of individual ICF codes in the context of health care and offers some potential solutions.

Development of Clinical Practice Guidelines

Clinical practice guidelines (CPGs) are intended to improve mental, behavioral, and physical health by promoting clinical practices that are based on the best available evidence. The American Psychological Association (APA) is committed to generating patient-focused CPGs that are scientifically sound, clinically useful, and informative for psychologists, other health professionals, training programs, policy makers, and the public. The Institute of Medicine (IOM) 2011 standards for generating CPGs represent current best practices in the field. These standards involve multidisciplinary guideline development panels charged with generating recommendations based on comprehensive systematic reviews of the evidence. The IOM standards will guide the APA as it generates CPGs that can be used to inform the general public and the practice community regarding the benefits and harms of various treatment options. CPG recommendations are advisory rather than compulsory. When used appropriately, high-quality guidelines can facilitate shared decision making and identify gaps in knowledge.

Three model curricula for teaching clinicians to use the ICF

Purpose. Three systematic programmes to train health professionals to use the World Health Organizations International Classification of Functioning, Disability, and Health (ICF) are described, along with efforts to evaluate their effectiveness. Methods. The first programme was a randomized study comparing the effects of a 2-hour instructor-led programme and a self-directed learning module on ICF-related knowledge, attitudes, and coding skills among occupational therapy graduate students. The second programme was a series of intensive 3.5-day workshops for public sector rehabilitation professionals in South Africa. The third programme involved a series of internet-based teaching modules regarding the ICF for graduate students in rehabilitation counselling. Results. The first project found that both instructor-led and self-guided training formats were effective in improving basic ICF-related knowledge, but only instructor-led training led to a significant improvement in coding skill. It also had more positive effects on ICF-related attitudes. This approach to learning assessment was generalizable to multidisciplinary health professionals in South Africa, who achieved a relatively high degree of coding accuracy after the 3.5-day workshop. Participant evaluations supported the structure, content, and length of the training. Students in the third programme also reported a very positive learning experience and positive views of the ICF. Conclusions. An empirical basis is important for identifying the best and most efficient training methods for particular audiences and specific purposes. The length and format of training can be differentially related to specific training goals (i.e., knowledge, attitudes, and coding skills). Interactive distance learning methods may help to overcome the weaknesses of self-directed training in comparison to face-to-face training.

Assessment practices of professional psychologists: Results of a national survey.

Psychological assessment has been a defining area of practice, training, and research for professional psychologists since the field’s inception. We conducted the present survey of professional psychologists as a follow-up to surveys conducted by the American Psychological Association in the 1990s to describe (a) current psychological assessment practices and trends; (b) demographic factors and beliefs associated with assessment use; (c) barriers discouraging assessment use; and (d) factors that may encourage psychologists to make assessments a larger part of their practices. Our survey supports the common perception that, in general, assessment represents a smaller part of the practices of professional psychologists than before managed care; however, for psychologists in some specialty areas and settings (e.g., forensic psychology, inpatient settings), assessment represents a significant portion of their work. Moreover, the large majority of psychologists believe psychological assessment is a valuable aid in making diagnostic decisions and treatment recommendations. Many psychologists identify that greater coverage by third-party payers, as well as having access to less costly assessment instruments, would enable greater use of assessment.

P226 A Multidisciplinary Approach To Creating Behavioral Health Guidelines: Challenges Of Adhering To IOM Standards

Background In 2010 our organisation began creating evidence-based clinical practice guidelines for behavioural health, focusing initially on depression, PTSD, and obesity, following emerging IOM standards. Context Selected challenges in five areas: 1. Terminology. For many years, our organisation used guideline terminology that was inconsistent with the field. 2. Representation. Given the diverse types of professionals in behavioural health and the breadth/depth of each topic, attaining sufficiently diverse panel membership has been challenging. 3. Stakeholders. Obtaining the patient perspective has been challenging, particularly given the stigma and privacy concerns often associated with mental health. 4. Systematic Reviews. The high cost of developing de novo systematic reviews, especially for large scope topic areas, is limiting. 5. Education. Professionals have varying knowledge and lexicons for the process, requiring education, particularly surrounding non-financial conflicts of interest. Description of Best Practice •Terminology- Implemented organisation-wide systemic change in lexicon via change in organisation policy and routine dissemination. •Representation- Used multi-step consensus nomination process to assemble multidisciplinary panels. •Stakeholders- Using multi-tiered approach to involve stakeholders via Consultation, Participation, and Communication models and outreach to mental health peer support programmes. •Systematic Reviews- Applied Delphi poll method in topic scoping/refinement to work within organisational resources. Other mechanisms to enhance resources include topic nominations to AHRQ, possible organisational partnerships, and developing products from guidelines. •Education- Creating a series of self-study educational modules on guideline development. Lessons for Guideline Developers and Others Our challenges and resolutions could be helpful to others in guideline development.