Simon Hannaford – @TherapistOT has agreed to host this Tuesday’s #OTalk exploring the ICF Model. He shares his reflection below – do come and share your reflections too. I’ve added a couple of questions that Simon’s reflection prompted me to ask underneath and here is a link to online information on the ICF (including training materials and an online version of the ICF) for those who may not be as familiar with it.
My immediate response to the World Health Organisation’s 2001 amendment to the original ICF was a mixture of suspicion and anxiety! Although I could immediately feel the relief of the move away from the medical model, I was faced with a series of issues that immediately put me off the taxonomy. The absence of ‘occupation’ as a term of value within the ICF was troubling … but, a part of me felt that this notion was such a long leap for the established order in health that the successful winning of this notion as a universally accepted component of everyday life was unlikely. Originally the ICF was set out in a little red book which, in my view, could only lead to a direct reference to Mao Zedong’s Little Red Book (and thereby the horror of the Cultural Revolution). It made an electrical pulse of anxiety run all through my body and sparked messages to my brain saying ‘RESIST!’ This sense of mistrust was extended by what appeared to be the conceit of the taxonomy that claimed human life could be precisely encompassed and measured! I struggled for ages trying to understand what this classification was really saying. It seemed to be a mixture of astonishing complexity which unravelled into rather obvious statements and each of these categories had complicated number codes (which annoyed me more). I had to teach about it, so, I had to find some point of purchase to show how on earth we could use this mechanism. I kept returning to the central diagrammatic representation of the dynamic relationship between Diagnosis, Body Function, Activity, Participation, Personal Factors and Environment. I remained blank for some time. Looking and thinking and not really getting it until I started to view the dynamic transaction as a template. A template that could support me, as a therapist, avoid some of my discriminatory assumptions and limited experiences I had of the world. It was possible to use these component elements of the mechanism to try and capture the unique map of each person I worked with (and myself). It was this idea of mapping the individual’s unique configuration of Diagnosis, Body Function, Activity, Participation, Personal Factors and Environment that would allow the formulation I would make of a person to become deeper and to manage my own limited knowledge over things like cultural experience and illness experience. These could be diminished by striving to understand these categories before offering a formulation of the person. Over time I have decided that this mapping is a useful tool to reveal the context a person inhabits and to allow us to reconsider the occupational choices available to each person. Time spent with this mechanism (especially if you utilise a social constructionist perspective) deepens the therapist’s insight and his/her ability to creatively offer relevant input to clients and to inhibit reductionist tendencies in the services within which we work. I now like the ICF a lot! But I have said before in relation to other theories and models only to realise at a later point great holes exist in the value of these tools. I am sure that ICF does have issues that will be revealed, and I don’t advocate giving uncritical support to it, but I do find it helpful. That can only be a good thing don’t you think?
Simon Hannaford @TherapistOT
World Health Organisation (2001) International Classification of Functioning, Disability and Health (ICF). WHO Geneva
A couple of questions that struck me when reading Simon’s post
Is the ICF like Marmite – you either love it or hate it?
What strategies have people used to integrate ICF into their services?
Where people do use ICF what benefits does it have? And challenges?
And not really for the talk but more general questions it raised for me were:
How can we make using the term occupation a short leap for people outside the profession?
As professionals what steps should we take to move beyond our initial gut-reaction/emotions about changes or new developments? (I think Simon demonstrates this really well in his reflection).
See you there – Kirsty