Life Design Measures: Applying ICF

Framework Concepts

Elias Mpofu, PhD, DEd, CRC

28/06/2011 Think Before Your Measure Symposium

1

•  Propose life design to define the need for rehabilitation and health assessment assessments

•  Position activity and participation concepts of the ICF within a life design approach to rehabilitation intervention

•  Suggest to map measures in regard to how they provide the essential data to enable consequential life design decisions

Premise •  The experience of chronic illness and

disability may result in the disruption or realignment of personal scripts for designing a lifestyle of choice.

•  (Mpofu & Bishop, 2006).

Premise cont. •  Personal scripts are the individual’s

repertoire of characteristic predispositions acquired through experience and serve as guides for behavior.

Premise cont. •  Living with a chronic illness or disability

often involves scripting of re-scripting of personal scripts necessary for the effective community participation

Premise cont. •  Rehabilitation interventions to

reconfigure disrupted personal scripts with a chronic illness or disability are essentially are about life design with a disability.

•  Mpofu et al. in press

Premise cont •  Assessments for rehabilitation care

provide information important for effective life design living with chronic illness or disability.

Life Design •  Making choices to script and a

meaningful life. –  Think about the nature, source and

ownership of the data for life design decisions with a chronic illness and disability.

8

Life Design cont •  Life design preferences comprise personal

stories that carry meanings important for their ongoing life adaptation. –  Think of the person with CID as the source and

owner of information to construct own life plan. –  Think with the person with CID about what other data

(information) would add to the storyline. •  Prioritize enabling story themes for effective life

design. •  Go for solution-laden stories

Life Design cont •  Competencies in self-development

critical to effective life design. –  Think about what and how personal and

environmental resources would enable genuine life design (i.e., a preferred lifestyle with a chronic illness and disability).

10

Life Design cont. •  Value added assessment are those that

directly address life design needs. – Go beyond thinking about assessment

aimed to restore, maintain or augmenting functioning to self-development living with a chronic illness and disability.

Life Design cont. •  Adaptive learning for life design results

when personal values are taken into account (Mpofu &Ortiz, 2009; Sherman, Nelson & Steele, 2000). – Think about whose values the assessment

data speak to and make choices to prioritize values that support health and wellbeing in clients with CID

ICF Framework Concepts •  The ICF framework considers

participation as “involvement in life situations” (WHO, 2001, p. 10). – Think about how assessment data will

facilitate meaningful involvement in life situations.

ICF concepts cont. •  Participation, a central ICF concept is

yet to be fully operationalized. •  Magasi et al. 2009

–  Think about how your approach to assessment adds to participation for life design.

14

ICF Concepts •  Participation in life situations involve

engaging in activities that are part of participation and enable participation –  Seek to understand how individuals with

CID construct participation? •  Ask “What would you like for yourself? How

would you like to get that? Etc”

Life Design •  Thinking about assessment within the

ICF framework and from a life design perspective will enable the prioritization and use of data that matters!! –  To people living with CID and their allies

16

Example Study •  Determine community living participation

values by Pennsylvanians with chronic illness and disability.

Method •  Use participatory action research to

identify priority participation domains and their structure.

•  Apply concept mapping to the data to construct participation value maps that would guide assessment life design

What is the Concept System?

•  A method that... Focuses and helps objectify the group

planning process Helps individuals think as a group...

...without losing their individuality Helps groups to manage complexity...

...without trivializing or losing detail

04/09/2010 20

brainstorm •  innovations in way network is delivered •  (investigate) corporate/structural alignment •  assist in the development of non-traditional partnerships (Rehab with the Medicine

Community) •  expand investigation and knowledge of PSN'S/PSO's •  continue STHCS sponsored forums on public health issues (medicine managed care forum) •  inventory assets of all participating agencies (providers, Venn Diagrams) •  access additional funds for telemedicine expansion •  better utilization of current technological bridge •  continued support by STHCS to member facilities •  expand and encourage utilization of interface programs to strengthen the viability and to

improve the health care delivery system (ie teleconference) •  discussion with CCHN

Work quickly and effectively

under pressure

49

Organize the work when

directions are not specific.

39

Decide how to manage multiple

tasks. 20 Manage resources effectively.

4

sort

...organize the issues...

rate

04/09/2010 21

brainstorm •  innovations in way network is delivered

•  (investigate) corporate/structural alignment •  assist in the development of non-traditional partnerships (Rehab with the Medicine

Community) •  expand investigation and knowledge of PSN'S/PSO's •  continue STHCS sponsored forums on public health issues (medicine managed

care forum) •  inventory assets of all participating agencies (providers, Venn Diagrams) •  access additional funds for telemedicine expansion •  better utilization of current technological bridge •  continued support by STHCS to member facilities •  expand and encourage utilization of interface programs to strengthen the viability

and to improve the health care delivery system (ie teleconference) •  discussion with CCHN

organize

Work quickly and effectively under

pressure 49

Organize the work when directions are not specific.

39

Decide how to manage multiple tasks.

20 Manage resources effectively.

4

sort

rate

Management Financing

Regionalization

STHCS as model

Community & Consumer Views

Information Services Technology

Management Financing

Regionalization

Mission & Ideology

Community & Consumer Views

Information Services Technology

r = .72

Counties 1 & 2 County 3

4.23

3.55

4.4

3.56

Community & Consumer Views

Management

Information Services

Regionalization

Technology

Financing

Mission & Ideology

Technology

Community & Consumer Views

Information Services

Management

Regionalization

Financing

Mission & Ideology

Concept Mapping

identify group shared vision represent group ideas pictorially encourage teamwork facilitate group decision making

Analytical Procedures •  Multi-dimensional scaling •  Hierarchical cluster analysis

–  Ward’s criterion –  Sten test

Outputs •  Descriptive statistics

–  Exportable for analysis with other software

•  Point map •  Cluster map •  Cluster rating map •  Cluster point rating map •  Pattern match analysis •  Go-zones

Point map

04/09/2010 NIDRR Grant # H133F070025 25

Cluster rating map of Participation Domains

04/09/2010 NIDRR Grant # H133F070025 26

Personal Values •  55.Effective goal setting •  51. Personal privacy •  34. Patience •  37. Meaningful living •  42. Family values •  21.Trusting others •  22. Openness to new ideas and choices •  16. Respect for self and others •  12. Involvement with family 04/09/2010 NIDRR Grant # H133F070025 27

Conclusions 1.  Think with people living with CID of

participation domains important to their life design

2.  Collect data important for decision making with people living with CID on their terms.

References •  Kane, M., & Trochim, W. M. (2007). Concept system for planning and evaluation. Thousand Oaks:

Sage. •  Magasi, S., Hammel, J., Heinemann, A., Whiteneck, G., & Bogner, J. (2009). Participation: A

comparative analysis of multiple rehabilitation stakeholders’ perspectives. Journal of Rehabilitation Medicine, 41, 936–944.

•  Mpofu, E. (2011) Value changes that occur with disability. Paper presented at the National Conference on Rehabilitation Education, Los Angeles, CA: April 8.

•  Mpofu, E., & Bishop, M. (2006). Value change and adjustment to disability: Implications for rehabilitation education, practice, and research. Rehabilitation Education, 20(3), 147-161.

•  Mpofu, E., Madden, R., Gitchel, W.D. et al. (in press). Person-centered assessment in rehabilitation and health care. In M. Bishop et al. (Eds). New trends in rehabilitation counseling. NY, NY: Springer.

•  Mpofu, E. & Ortiz, J. (2009). Equitable assessment practices in diverse contexts. In E. Grigorenko (Ed.). Multicultural psychoeducational assessment (pp. 41-76). NY: Springer.

•  Sherman, D.A., Nelson, L.D., & Steele, C.M. (2000). Do messages about health risks threaten the self? Increasing the acceptance of threatening health messages via self-affirmation. Personality and Social Psychology Bulletin, 26(9), 1046-1058

•  World Health Organization (2001). The International Classification of Functioning, Disability and Health (ICF). Geneva: WHO. http://www.who.int/classifications/icf/en/