While I agree with many of APA's views, I also find its position
rather optimistic. I have further comments at the end of the
article and would like some opinions from the list.
(See: Jennifer Daw, Reconceptualizing health care.
Monitor on Psychology January 2002 Vol. 33, No.1 pp. 70).
http://www.apa.org/monitor/reconceptual.html
Reconceptualizing health care
APA's work will guide health-care professionals in using a
new system for classifying human functioning.
BY JENNIFER DAW
Monitor staff
For decades, measures of population health worldwide have
been based on causes of death, diagnoses and prevalence
of disease--indicators that, while meaningful, don't capture
the full picture of the health status of countries. They can't,
for example, impart how a health condition is affecting a
patient's daily functioning following a heart attack or after
undergoing hip replacement surgery. Nor can these measures
adequately inform health policy-makers about the
health-care service needs of the population.
For the past six years, APA's Practice Directorate has been
collaborating with the World Health Organization (WHO) to
revise the International Classification of Functioning,
Disability and Health (ICF)--a system that will provide a more
complete picture of the world's health status. This tool
describes the impact of health conditions on people's levels
of functioning in domains such as communicating, taking
care of one's self, working and going to school. In addition to
APA, other health professionals, people with disabilities,
researchers, government officials and statisticians helped
shape the development of the ICF.
APA believes such a system is important not only to improve
individual treatment, but also to influence health policy. The
ICF will serve broad social and health policy goals by
expanding the concept of health beyond the disease model,
says Geoff Reed, PhD, assistant executive director for
professional development in APA's Practice Directorate. Use
of the ICF, with its focus on human functioning, at population
and individual levels, will better predict health service needs.
The ICF is positioned to be the universal system by which the
functional aspects of health conditions are described. WHO's
191 member states are urged to use the ICF when reporting
the health status of their countries, and ICF is already being
used in several WHO surveys.
"It's really a whole new way of looking at health," says
Marjorie Greenberg of the U.S. Department of Health and
Human Services (HHS), secretary for the National Committee
on Vital Health Statistics and head of the North American
Collaborating Center for the ICD and ICF. "Over time the ICF
will have quite an impact. It could be used in reimbursement
methodologies and outcomes assessments," she says. The
ICF can be a "common language for health professionals" to
describe functional status and report assessment findings.
To enable health professionals to easily implement the ICF,
APA has formed an interdisciplinary drafting team to develop
a Procedural Manual and Guide for a Standardized Application
of the ICF. Team members include psychologists David
Peterson, PhD, Cille Kennedy, PhD, and John Jacobson, PhD,
and speech-language pathologist Travis Threats, PhD,
occupational therapist Susan Stark, PhD, and physical
therapist Judy Hawley, PT.
The manual will help clinicians use the ICF system during
evaluation and treatment encounters with patients and
clients. "Without grassroots education that enables clinicians
to implement the system, the World Health Organization's
goal of fully capturing information on the health status of
populations will be limited," says Jayne Lux, director of board
operations in APA's Practice Directorate.
Without such an explanation of the system, "people get very
nervous," says Kennedy, also of HHS and a member of the
ICF drafting team. They need examples of how to interpret
the codes for actual clinical experiences, she says. The
manual will make the system easier to understand and will
specify a standard approach to classifying functioning using
the ICF.
So far, the team has held its first meeting to formulate a
plan for the manual and is now drafting specific chapters. The
initial draft will be written by experts in each area of human
functioning and then reviewed and further developed by
experts from other disciplines.
"By the time the chapters are written, they will have been
reviewed and revised by many disciplines," says Lux.
Threats, who is among those working with APA on the
manual, says the interdisciplinary approach to the manual
fits the cross-disciplinary utility of the ICF. "ICF aims to help
health professionals from many disciplines, such as speech,
physical therapy and psychology, describe their patients'
levels of functioning. How well can they do the things most
important to them, like going to church or reading to their
kids?" he says.
Says Jacobson, who is also on the drafting team, "The ICF is
a nomenclature that provides us with a framework to describe
how a person functions on an everyday basis in consistent
terms. It's a potential tool for all sorts of applications. And it
moves us more closely to where mainstream psychology and
clinical practice is going to be."
"Although the scope of work necessary to write the manual is
significant and time-consuming, we are confident the finished
product will facilitate the use of the ICF system, thereby
bringing a patient's functional status, in addition to their
medical diagnosis, into the health-care dialogue," says Reed.
"The inclusion of this important information will make a
critical contribution in shaping health policy reform worldwide."
-------------------------------------------
when the article says:
> expanding the concept of health beyond the disease model,
I assume they are referring to the "medical model" and there
seems to be a slight implication earlier that they might be
referring to a "social model" although this is not evident.
Because in my view, the article seems to focus on clinical
situations, evaluations and treatments I have carried out a
search in the archives of the Disability-Research Discussion
List, and found (at least partially):
- the dangers of the ICF / ICIDH-2
- the shortcomings of the ICF / ICIDH-2 when the different
common language do not always express/translate what is
spoken/thought in another language
and therefore think that they would be of interest to the
interdisciplinary drafting team established by the APA to
develop a Procedural Manual and Guide for a Standardized
Application of the ICF.
Cheers,
--
Han Tacoma
~ Artificial Intelligence is better than none! ~
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