Question: Why use the International Classification of Functioning, Disability & Health in pediatric PT?
Answer: The framework of the ICF will help you access and organize your knowledge to provide a sound foundation for clinical decision making.
The International Classification of Functioning, Disability and Health (ICF) is a framework for describing and organizing information on functioning, health and disability. In 2001, the World Health Organization adopted the ICF as the basis of standardized scientific data on health and disability for use throughout the world. It is applicable in health fields from mental health to orthopedics, neurology to cardiology. The Neuro-Developmental Treatment Association (NDT) immediately recognized its importance as a conceptual framework for applying the NDT concept to pediatric physical therapy and began to use the framework in eight-week pediatric courses. Moving on in time, in 2008, The American Physical Therapy Association publicly endorsed the use of the ICF. This set the expectation that ICF language begin to be used in publications, documents and communication. Already, participation and environmental factors were becoming common points of discussion in pediatric physical therapy. In current time, therapists are learning that we must begin to use ICF terminology and the ICF framework in our daily practice and communication, but what is it and how does it work? That is the tricky part.
I was first introduced to the ICF during a section at the 2001 NDTA Conference. I immediately began to restructure the way I approached and thought about my more complicated clients. I was a fairly new PT at that time and goodness knows I needed some help prioritizing. Initially, I filled in the ICF domains in what could best be described as a redundant mess. I pondered the domains after work hours and during my morning commute. I found it difficult and confusing and it remained separate from my reports. There was a struggle deciding where to start, what to put in each domain and how things were related. I also struggled to edit what was irrelevant or redundant. Taking the eight-week NDT pediatric course, I was required to use the ICF as a framework for daily treatment sessions. This was where I really started to put it to use. Eventually, after the fog and lost feeling began to wane, I realized that I was changing…the ICF was allowing me to see how everything worked together! I started to be more observant and more curious. I started to understand how activities allowed participation in the really enjoyable things in life and, conversely, how activity limitations prevented participation in meaningful areas of life. The ICF framework directed me to ask parents and children important questions about their daily experience and to closely listen and understand the answers. It led me to notice how body structures, activities, participation, personal and environmental factors are intricately related. After a long while, I began to feel the benefit of more efficient clinical decision-making. I also started to see myself as part of a larger system. I reached out to contact parts of the team outside of my immediate clinical environment. I was able to stand back and see the larger picture; how all the pieces of functioning make the child’s individual world and how every child is truly unique. The ICF showed me strengths to build on and gaps to address. I don’t truly think I knew why participation was so important prior to using the ICF as a conceptual framework.
To be honest, I’m still on this learning curve this some sixteen years later. It’s a long process, but it’s what makes the job of pediatric physical therapy so much fun and also so meaningful.
This is the first of several posts on how I use the ICF in my daily practice. I hope they can launch you on a journey with this amazing tool.