Download - The Implementation of the ICF in Germany -a brief review Anna Kelley, Center of Psychotraumatology
The Implementation of the ICF in Germany -a brief review
Anna Kelley, Center of Psychotraumatology
Table of Contents
1. Introduction: The role of the ICF in the German Health System
2. The implementation of the ICF for mental disorders 2.1. Development of Core-Sets 2.2. Mini ICF Rating for Mental Disorders 2.3. Exemplary implementation of the ICF “Haueser am Latterbach”
3. Critical Considerations
4. References
Introduction: The role of the ICF in the German Health System
ICF has been taken up in legislation and regulations of the German health system
New German Social Code (SGB IX) is based on the ICF
Guideline and general recommendations within the context of rehabilitation have been adjusted to the ICF (Rehabilitations-Richtlinien nach § 92, Abs 1. Nr 8. SGB V)
Insurance companies have begun to include the ICF on their rehabilitation application forms
The implementation of the ICF for mental disorders
Development of Core-Sets= “generally-agreed-upon” list of ICF categories
for a certain disability
ICF-Core-Set Project in Munich
1. ICF Core Sets for Depression (A. Cieza et al., 2004)
2. ICF Core Set for Bipolar Disorders - currently being developed (ICF Research Branch in Munich, the Autonoma University in Madrid, Barcelona University)
ICF Core Sets for Depression
= Comprehensive Core Set: for a multiprofessional description of patients with a health disorder (= 121 categories)
= Brief Core Set: for clinical studies and research (= 31 categories)
The implementation of the ICF for mental disorders
9
48
12
Brief ICF Core Set for Depression
A. Cieza et al., 2004
Mini ICF Rating for Mental Disorders(Mini-ICF-P) Linden & Baron, 2005
= short observer rating instrument for the assessment of disabilities
Background: Lack of instruments with which to measure disabilities in activity and participation (d) in mental disorders
The implementation of the ICF for mental disorders
MINI-ICF-PMINI-ICF-P ICF - Activities and participation
(d)
1. Ability to adapt to rules and routines
CHAPTER 8 : MAJOR LIFE AREAS
2. Ability to plan and structure duties and responsibilities
CHAPTER 2 : GENERAL TASKS AND DEMANDS
3. Flexibility and ability to adjust CHAPTER 2 :GENERAL TASKS AND DEMANDS
4. Professional competence5. Perseverance
CHAPTER 2 :GENERAL TASKS AND DEMANDSCHAPTER 8 : MAJOR LIFE AREAS
6. Self-assertiveness7. Interpersonal skills 8. Ability to work in a team9. Ability to have family and intiMmate relationships
CHAPTER 3: COMMUNICATIONCHAPTER 7 :INTERPERSONAL INTERACTIONS AND RELATIONSHIPSCHAPTER 9 :COMMUNITY, SOCIAL AND CIVIC LIFE
10. Ability to engage in activities not pertaining to the career
CHAPTER 6: DOMESTIC LIFECHAPTER 9 :COMMUNITY, SOCIAL AND CIVIC LIFE
11. Self-sufficiency CHAPTER 5: SELF-CARE
12. Ability to cover distances (move from place to place)
CHAPTER 4 :MOBILITYLinden & Baron, 2005, translated from German
Mini-ICF-P 125 patients from the Rehab Center “Seehof” were
tested with the Mini-ICF-P (52% suffered from an F4 disorder, 29% from an F3 disorder and 21% from an F6 disorder)
The items are rated on a scale of 0 (=no impairment) to 4 (= full impairment)
Significant inter-rater congruence Significant correlations with psychopathology,
motivation to work and duration of the inability to work Reliable, practicable, valid and economical instrument
with which to measure the level of activity and participation
The implementation of the ICF for mental disorders
The implementation of the ICF for mental disorders
1. Development of Core Sets for psychiatric rehabilitation
Delphi-method146 Items
2. Assessment methods- Direct dialogue with the patient- Behavior observation- Psychological tests (SCL-90-R)
3. Integration of the ICF into the Rehabilitation Program
- Rehab-Cycle-Model
Exemplary implementation of the ICF in a rehabilitative setting: “Haueser am Latterbach”
Grundmann et al., 2005
Exemplary implementation of the ICF in a rehabilitative setting: “Haueser am Latterbach”
ResultsSatisfactory depiction of the functional health
of the patients through the ICF Core SetHigh acceptance rate throughout all
occupational groupsTransparent and easily comprehendible
rehabilitation managementRelatively simple and non-judgmental
language simplifies the communication with the patients
The implementation of the ICF for mental disorders
Considerations Ethical debate Increase in bureaucracy Time consuming and difficult to implement
The implementation of the ICF for mental disorders
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Rehabilitation bei psychischen und psychosomatischen Erkrankungen vom 01. Januar 2004. Frankfurt/M.: BAR, 2004c
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and Health, ICF’’ in the description and classification of mental disorders. Eur Arch Psychiatry Clin Neurosci (2008) 258 [Suppl 5]:81–85.
Bundesarbeitsgemeinschaft Rehabilitation (2008). "ICF - Praxisleitfaden 2 – Trägerübergreifende
Informationen und Anregungen für die praktische Nutzung der Internationalen Klassifikation der Funktionsfähigkeit, Behinderung und Gesundheit (ICF) in medizinischen Rehabilitationseinrichtungen"
Büscher et al.(2004). The development of guidelines for the treatment of patients with mental
disorders under particular consideration of rehabilitative aspects. Psycho-Social-Medicine (Vol. 1) (2004).
Cieza, A., Chatterji, S., Andersen, C., Cantista, P., Herceg, ., Melvin, J., Stucki, G & de Bie, R. (2004).
ICF Core Sets for Depression. Journal of Medical Rehabilitation, 44: 128-34.
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Linden, M. (2007) „Der Beitrag von Sozialmedizin und ICF zu einer integrativen psychiatrischen Diagnostik“ . Die Psychiatrie, 2007, 4: 209–215
Linden M, Baron S., (2005). Das “Mini-ICF-Rating für psychische Störungen (Mini-ICF-P)”. Ein Kurzinstrument zur Beurteilung von Fähigkeitsstörungen bei psychischen Erkrankungen. Rehabilitation 44(3) S. 144-51. Stuttgart: Thieme
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