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

References[BAR (Bundesarbeitsgemeinschaft für Rehabilitation): Rahmenempfehlungen zur ambulanten

Rehabilitation bei psychischen und psychosomatischen Erkrankungen vom 01. Januar 2004. Frankfurt/M.: BAR, 2004c

 Baron, S. & Linden, M. (2008). The role of the ‘‘International Classification of Functioning, Disability

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.

Ewert,T. & Stucki,G. (2007). "Die Internationale Klassifikation der Funktionsfähigkeit, Behinderung und Gesundheit (ICF) - Einsatzmöglichkeiten in Deutschland," Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz, vol. 50, no. 7, pp. 953-961, 2007.

 Grundmann J, Keller K, Bräuning-Edelmann M., (2005). Praxisorientierte Anwendung der

Internationalen Klassifikation der Funktionsfähigkeit, Behinderung und Gesundheit (ICF) in der medizinischen Rehabilitation von psychisch erkrankten und behinderten Menschen. Rehabilitation 44(6) S. 335-43. Stuttgart: Thieme

 

Implementierung der ICF in Deutschland : Vorwort zur 3. Auflage, "Einführung in die ICF", 2009, ecomed MEDIZIN, Verlagsgruppe Hüthig Jehle Rehm GmbH, Landsberg.

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

 Review of ICF Implementation ©2005 Open Society Mental Health Initiative, Open Society

Institute [online] http://www.osmhi.org/?page=342:(12.03.2010)

Schliehe, F (2006). Das Klassifikationssystem der ICF. Eine problemorientierte Bestandsaufnahme im Auftrag der Deutschen Gesellschaft für Rehabilitationswissenschaften. Rehabilitation 45: 258–271

  Schuntermann, M (2003). Grundsatzpapier der Rentenversicherung zur Internationalen

Klassifikation der Funktionsfähigkeit, Behinderung und Gesundheit (ICF) der Weltgesundheitsorganisation (WHO). Dtsch Rentenversicherung 1–2: 52–59

  Schuntermann, M (2005). The implementation of the International Classification of

Functioning, Disability and Health in Germany: experiences and problems. International Journal of Rehabilitation Research 2005, Vol. 28 No 2 pp.93-102

  Stefanie Schulz (2008). Application and use of the international classification of functioning,

disability and health (ICF) in rehabilitation practice and research – an updated literature review .

 Übersicht von ICF-Projekten im deutschsprachigen Raum: [online]

http://www.dimdi.de/static/de/klassi/icf/icf-projekte.html (12.03.2010)