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ICIDH-2: International Classification of Functioning and Disability |
The International Classification of Functioning and Disability (ICIDH-2) builds on developments arising from the World Health Organization’s International Classification of Impairments, Disabilities and Handicaps (ICIDH, 1980). ICIDH-2 is currently in exposure draft form and is due to be published in 2001.
ICIDH-2 endeavours to classify, in a very specific and systematic way, anything and everything a person, or a body, can do. It is an attempt to ‘codify human functioning’ (p.7). It does not classify people, or disabilities, but aims to identify and describe the full range of human functions and any ‘disturbance’ of those functions.
In order to achieve the new approach to classification the World Health Organization’s Assessment, Classification and Epidemiological Group has developed a ‘code’ or a series of numbers and letters with specific meanings. When these codes are put together they provide a profile of an individual’s functioning capacity. In short, they describe what a person can and cannot do.
The aim of the new classification is to provide a common language for describing functional states associated with health in order to improve communication between health care providers, other public sectors, and people with disabilities, and to facilitate the proper comparison of data across countries, disciplines and services. It can be used as a tool for structuring research, collating data, developing social policy, or for clinical assessment and education.
The classification identifies three ‘dimensions’ in which these functions of the body operate: [1] body function (physiological or psychological functions) and structure (anatomical parts) (b — body); [2] activities at the individual level (a - activity); and [3] participation in society (p - participation).
These dimensions replace the original ICIDH’s words, and associated concepts, of ‘impairment,’ ‘disability,’ and ‘handicap’.
b, a and p, are conceived as having two poles; one end indicates problems, e.g. impairment, activity limitation or participation restriction, and the other end indicates non-problematic aspects and, as such, is neutral or positive.
Functions — i.e. what a person can do and how much they can participate in society — are categorised and coded in detail. In fact, the ICIDH attempts to identify everything that a body is capable of, both autonomic and deliberate.
Each function is defined and given a three digit numerical code, for example specific mental functions of recognising and using signs and symbols and other components of language is coded b175.
Coordinated action of advancing on foot, step by step, in a manner in which at least one foot is always on the ground is coded a410.
Involvement in appropriate residence for living alone, or with others, either with a family or with some other group, as a function of the availability and accessibility of housing resources and services is coded p510.
The dimensions a, b and p may be affected by ‘Environmental factors’ (e), which may be physical, social, or attitudinal, and ‘Personal factors’, which relate to the personality and attributes of an individual.
Environmental factors are similarly coded, for example, legislation, regulations and standards, together with associated administrative control and monitoring mechanisms that govern the delivery of education programs is coded as e675, (e for environmental factors).
Any of these codes then may be used to describe a particular aspect of a person’s life — what they can and cannot do — in any given environment at any time. The codes are personalised, or ‘qualified’ by the addition of a number, which provides further information about the particular characteristic. The numbers denote the degree of problem:
b, a and p, and the environmental factors (e), are treated in the same way, so that having a problem may mean an impairment, limitation, restriction or barrier.
In addition, if an activity can be performed, or participation facilitated by means of a carer or assistant, a ‘+’ sign is used instead of the decimal point eg. xxx+2.
The classification system provides a valuable, if complex, new way of looking at and discussing traditional notions of impairment, disability and handicap, and provides a means of making comparisons over diverse situations, and over time.
Geneva, World Health Organization, 1999, Beta-2 draft, Short Version (114 pages)
Wen, X and Fortune, N 1999. The definition and prevalence of physical disability in Australia. Australian Institute of Health and Welfare cat no. DIS 13. Canberra: AIHW