The document discusses the impact of the International Classification of Functioning (ICF) on collaboration and communication. It provides an overview of the ICF framework which considers body functions, structures, activities, participation and environmental/personal factors in understanding health and disability. The ICF is seen as having positive impacts by providing a dynamic, interconnected model that focuses on what people can do and is applicable to health for everyone. The ICF also influences policy, decision making, and the role of patients in healthcare. Considerations for applying the ICF include taking a child rights-based and personalized approach while ensuring functioning assessments are collaborative and change over time and context.

1. Impact of ICF on collaboration
and communication
Olaf Kraus de Camargo
IDPA Conference, December 1st, 2023 – Johannesburg, South Africa

2. 21st Century Thinking:
Health Condition
(e.g., CP,ASD)
Body Structures
and Functions
Activities Participation
Environmental
Factors
Personal
Factors
The ICF

3. ICF Framework
Body Structure &
Function
Activities
Participation
Environment
Personal Factors
Body Functions: The physiological functions of body systems (including psychological functions)
Body Structures: Anatomical parts of the body such as organs, limbs, and their components
Activities: The execution of a task or action by an individual.
Participation: Involvement in a life situation
Environmental factors: The physical, social and attitudinal environment in which people live and conduct
their lives; these are either barriers to or facilitators of the person’s functioning
Personal Factors: Internal personal factors which can include gender, age, education, profession, past and
current experience, character and other factors that influence how disability is experienced by the individual
Kraus de Camargo, O., Simon, L., Ronen, G. M., & Rosenbaum, P. L. (2019). ICF - A Hands-on Approach
for Clinicians and Families. MacKeith Press.

4. What do we like about the ICF?
Health Issue
BS&F Activity Partn
Environt Personal
• This is a ‘dynamic system’ of inter-connected parts,
and where we start our interventions may be less
important than we used to think
• ICF reminds us to look at/focus on what people
CAN do
• This is a focus on strengths!

5. • It is a framework for health for everyone
• The words are ‘neutral’
• Everything is connected to everything else
Health Issue
BS&F Activity Partn
Environt Personal
What do we like about the ICF?

7. Impact on Policy
*MCCSS Ministry of Children, Community and Social Services (2022). Retrieved from
https://files.ontario.ca/mccss-smart-start-hubs-policy-and-practice-guidelines-en-2022-05-02.pdf

8. Impact on decision-making
• Broad availability of information
• Social networks
• Precision medicine
Topol, E. (2016). The Patient Will See You Now. Basic Books.

9. The patient will see you now!
Acute Care
Developmental Care
Strategy Patients Physician/Clinician

10. The patient will see you now!
Acute Care
Developmental Care
Strategy
curative,
cause oriented
optimizing,
bio-psycho-social
Patients Physician/Clinician

11. The patient will see you now!
Acute Care
Developmental Care
Strategy
curative,
cause oriented
optimizing,
bio-psycho-social
Patients
passive, enduring,“patient”
active, empowered
Physician/Clinician

12. The patient will see you now!
Acute Care
Developmental Care
Strategy
curative,
cause oriented
optimizing,
bio-psycho-social
Patients
passive, enduring,“patient”
active, responsible
Physician/Clinician
Giving orders, prescribing,“in charge”
facilitating,
member of a team

13. The voices of children
§ United Nations' Convention on the Rights of Persons with Disabilities
(2006): “Children with disabilities have the right to express their views
freely on all matters affecting them.” (Art. 7)
§ Strategy for Patient Oriented Research:“Patients need to be involved in all
aspects of research to ensure questions and results are relevant”
§ World Health Organization:“ICF respects the rights of every person and
actively avoids labelling, stigmatisation and discrimination.”
§ United Nations Convention on the Rights of the Child: “…the right to
have their views given due weight in all matters affecting them.” (Art 12)

14. The Lundy Model of meaningful
participation Model courtesy of Prof. Laura Lundy (2007): ‘Voice is not enough’ – shared by Louise Thivant
Inclusive space & time
• Is the space suitable for young children (can
they move around safely, are there
distractions, do they feel comfortable)?
• Are methods adapted to the needs of young
children?
• Is there sufficient time and resources to listen
to what children share?
Voice
• Do adults routinely give children
opportunities to express themselves, either
verbally or otherwise?
• Is there sufficient time and resources to listen
to what children share/observe them?
Audience
• When adults listen, are children being heard?
• Do adults acknowledge that children's agency
/ that they can make meaningful
contributions?
• Does the adult audience have the power to
act on children's proposals/preferences?
Influence
• Are children's opinions reflected in
subsequent decision-making?
• Is feedback given to children or their
caregivers on how their contributions have
been used or not, and why?
Lundy, L. (2013). ‘Voice’ is not enough: conceptualising Article 12 of the United Nations Convention on the Rights of the Child.
British Educational Research Journal, 33(6), 927-942. https://doi.org/10.1080/01411920701657033

15. Barriers
Facilitator:Wheelchair
Barrier: lack of pavement
Activity & Participation: getting to school
DALL-E2

16. Facilitators
Facilitator: Wheelchair, puddle
Barrier: none
Activity & Participation: being active
outdoors and have fun
DALL-E2

17. Functioning is Personal
§ Any assessment of Functioning needs to consider the whole ICF
framework
Health Issue
BS&F Activity Partn
Environt Personal
Person
Context
Functioning/Disability

18. Ethical considerations
§ Functioning assessment
§ Collaborative Child rights-based framework (UNCRPD)
§ Time and Context specific changeable
§ Documentation & Statistics
§ Patients/caregivers need access to update their health record
§ Electronic health records need to be interoperable across providers and
services (currently in Ontario exist over 300 EMR providers according to
www.getapp.ca)
§ Health Statistics need to include data about Functioning

19. Contact Us
canchild.ca
@canchild_ca
905.525.9140 x27850
facebook.com/canchild.ca
canchild@mcmaster.ca
Institute for Applied Health
Sciences, McMaster University
1400 Main Street W., Room 408
Hamilton, ON, Canada