THE MODEL OF ICF
Two major conceptual models of disability have been proposed. The medical
model views disability as a feature of the person, directly caused by disease,
trauma or other health condition, which requires medical care provided in the
form of individual treatment by professionals. Disability, on this model, calls for
medical or other treatment or intervention, to 'correct' the problem with the
individual.
The social model of disability, on the other hand, sees disability as a sociallycreated
problem and not at all an attribute of an individual. On the social model,
disability demands a political response, since the problem is created by an
unaccommodating physical environment brought about by attitudes and other
features of the social environment.
On their own, neither model is adequate, although both are partially valid.
Disability is a complex phenomena that is both a problem at the level of a
person's body, and a complex and primarily social phenomena. Disability is
always an interaction between features of the person and features of the overall
context in which the person lives, but some aspects of disability are almost
entirely internal to the person, while another aspect is almost entirely external. In
other words, both medical and social responses are appropriate to the problems
associated with disability; we cannot wholly reject either kind of intervention.
A better model of disability, in short, is one that synthesizes what is true in the
medical and social models, without making the mistake each makes in reducing
the whole, complex notion of disability to one of its aspects.
This more useful model of disability might be called the biopsychosocial model.
ICF is based on this model, an integration of medical and social. ICF provides,
by this synthesis, a coherent view of different perspectives of health: biological,
individual and social.
Two major conceptual models of disability have been proposed. The medical
model views disability as a feature of the person, directly caused by disease,
trauma or other health condition, which requires medical care provided in the
form of individual treatment by professionals. Disability, on this model, calls for
medical or other treatment or intervention, to 'correct' the problem with the
individual.
The social model of disability, on the other hand, sees disability as a sociallycreated
problem and not at all an attribute of an individual. On the social model,
disability demands a political response, since the problem is created by an
unaccommodating physical environment brought about by attitudes and other
features of the social environment.
On their own, neither model is adequate, although both are partially valid.
Disability is a complex phenomena that is both a problem at the level of a
person's body, and a complex and primarily social phenomena. Disability is
always an interaction between features of the person and features of the overall
context in which the person lives, but some aspects of disability are almost
entirely internal to the person, while another aspect is almost entirely external. In
other words, both medical and social responses are appropriate to the problems
associated with disability; we cannot wholly reject either kind of intervention.
A better model of disability, in short, is one that synthesizes what is true in the
medical and social models, without making the mistake each makes in reducing
the whole, complex notion of disability to one of its aspects.
This more useful model of disability might be called the biopsychosocial model.
ICF is based on this model, an integration of medical and social. ICF provides,
by this synthesis, a coherent view of different perspectives of health: biological,
individual and social.
How can ICF be used?
Because of its flexible framework, the detail and completeness of its
classifications and the fact that each domain is operationally defined, with
inclusions and exclusions, it is expected that ICF, like its predecessor, will be
used for a myriad of uses to answer a wide range of questions involving clinical,
research and policy development issues. (For specific examples of the uses of
ICF in the area of service provision, and the kinds of practical issues that can be
addressed, see the box below.)
ICF Applications
Service Provision
At the individual level
• For the assessment of individuals: What is the person's level of functioning?
• For individual treatment planning: What treatments or interventions can maximize
functioning?
• For the evaluation of treatment and other interventions: What are the outcomes of the
treatment? How useful were the interventions?
• For communication among physicans, nurses, physiotherapists, occupational therapists and
other health works, social service works and commmunity agencies
• For self-evaluation by consumers: How would I rate my capacity in mobility or
communication?
At the institutional level…
• For educational and training purposes
• For resource planning and development: What health care and other services will be needed?
• For quality improvement: How well do we serve our clients? What basic indicators for
quality assurance are valid and reliable?
• For management and outcome evaluation: How useful are the services we are providing?
• For managed care models of health care delivery: How cost-effective are the services we
provide? How can the service be improved for better outcomes at a lower cost?
At the social level…
• For eligibility criteria for state entitlements such as social security benefits, disability
pensions, workers’ compensation and insurance: Are the criteria for eligibility for disability
benefits evidence based, appropriate to social goals and justifiable?
• For social policy development, including legislative reviews, model legislation, regulations
and guidelines, and definitions for anti-discrimination legislation: Will guaranteeing rights
improve functioning at the societal level? Can we measure this improvement and adjust our
policy and law accordingly?
• For needs assessments: What are the needs of persons with various levels of disability -
impairments, activity limitations and participation restrictions?
• For environmental assessment for universal design, implementation of mandated accessibility,
identification of environmental facilitators and barriers, and changes to social policy: How
can we make the social and built environment more accessible for all person, those with and
those without disabilities? Can we assess and measure improvement?
classifications and the fact that each domain is operationally defined, with
inclusions and exclusions, it is expected that ICF, like its predecessor, will be
used for a myriad of uses to answer a wide range of questions involving clinical,
research and policy development issues. (For specific examples of the uses of
ICF in the area of service provision, and the kinds of practical issues that can be
addressed, see the box below.)
ICF Applications
Service Provision
At the individual level
• For the assessment of individuals: What is the person's level of functioning?
• For individual treatment planning: What treatments or interventions can maximize
functioning?
• For the evaluation of treatment and other interventions: What are the outcomes of the
treatment? How useful were the interventions?
• For communication among physicans, nurses, physiotherapists, occupational therapists and
other health works, social service works and commmunity agencies
• For self-evaluation by consumers: How would I rate my capacity in mobility or
communication?
At the institutional level…
• For educational and training purposes
• For resource planning and development: What health care and other services will be needed?
• For quality improvement: How well do we serve our clients? What basic indicators for
quality assurance are valid and reliable?
• For management and outcome evaluation: How useful are the services we are providing?
• For managed care models of health care delivery: How cost-effective are the services we
provide? How can the service be improved for better outcomes at a lower cost?
At the social level…
• For eligibility criteria for state entitlements such as social security benefits, disability
pensions, workers’ compensation and insurance: Are the criteria for eligibility for disability
benefits evidence based, appropriate to social goals and justifiable?
• For social policy development, including legislative reviews, model legislation, regulations
and guidelines, and definitions for anti-discrimination legislation: Will guaranteeing rights
improve functioning at the societal level? Can we measure this improvement and adjust our
policy and law accordingly?
• For needs assessments: What are the needs of persons with various levels of disability -
impairments, activity limitations and participation restrictions?
• For environmental assessment for universal design, implementation of mandated accessibility,
identification of environmental facilitators and barriers, and changes to social policy: How
can we make the social and built environment more accessible for all person, those with and
those without disabilities? Can we assess and measure improvement?
Source:
http://www.who.int/classifications/icf/training/icfbeginnersguide.pdf
17/06/2010
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