Mats Granlund

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.

'Participation': a systematic review of language, definitions, and constructs used in intervention research with children with disabilities.

Improving participation of children with disabilities is a priority; however, the participation construct lacks clarity. This systematic review investigated how researchers defined ‘participation’ and the language used in participation intervention research.

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.

Participation – challenges in conceptualization, measurement and intervention

An important purpose for research is to aid clinicians who are working with children in need of special support to enable their participation in everyday life activities. To do this, researchers must understand the complex relationship between personal and environmental characteristics and positive childhood functioning in these children. Discussion on this topic, between Granlund, Imms and Raghavendra in 2012 in conjunction with a collaborative funding application, constitutes the foundation for this invited commentary.

‘I can play!’ Young children's perceptions of health

Health is today viewed as a multi-dimensional concept partly conceptualized independent from not being ill. The aim of this study was to gain knowledge of how young children perceive health. Interviews were conducted with 68 children (4–5 years), within their pre-school setting, with the help of a semi-structured interview guide. A multi-dimensional perspective represented by the health dimensions of the International Classification of Functioning, Disability and Health (ICF) was used in a manifest deductive content analysis. The childrens statements were categorized and placed under one of the four health dimensions, body, activity, participation and environment. A latent content analysis was applied to identify underlying themes in the manifest categories. The results revealed that young children perceive health as a multi-dimensional construct, largely related to being engaged, i.e. to be able to perform wanted activities and participate in a supportive every-day context. This implies that improvements of child engagement should be emphasized in health promotion and to a greater extent be the central focus of health interventions for young children.

Perceived participation. A comparison of students with disabilities and students without disabilities

According to a recent study (Almqvist & Granlund, accepted), participation is not strongly related to type and degree of disability but probably to the context of the individual as well as generic personal factors. Such diverse factors can over time become orchestrated and pull the development of individuals with disability in a certain direction. This study compares how 959 students with and without disabilities in two age‐groups 7–12 and 13–17 perceive their participation in school activities. The main method of analysis is one‐way‐ANOVA. The result indicates that students without disabilities rated their perceived participation higher, especially in unstructured “free”; activities. Further, students without disabilities experience a higher degree of autonomy and rate the availability of school activities as higher. Students with disabilities rate their interaction with teachers as better and more frequent, but their interaction with peers as less frequent. These differences increase with age and may reinforce a stigmatization process.

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.