Applicability of ICF for Vocational Rehabilitation
Yuichiro Haruna1, Nobuo Matsui1, Ryosuke Matsui2, and Fred McFarlane3
（1National Institute of Vocational Rehabilitation, 2Hokusei Gakuen University,
and 3San Diego State University）
I. Introduction
The World Health Assembly in May 2001 approved the International Classification of Functioning, Disability and Health (ICF) as one of the WHO family of International Classifications*. The ICF is a substantially revised version of ICIDH (International Classification of Impairments, Disabilities, and Handicaps) published in 1980 for trial purposes. The major changes include:
- Universal scope of human functioning wider than disability,
- Interactive model of individual and environment,
- Distinction between Capacity (can) and Performance (do),
- Integrated unique list of Activities (individual level) and Participation (societal level),
- Development of a comprehensive classification of Environmental factors,
- Comprehensive scheme neutral of theories and policies, and
- Operational definitions for each domain with inclusions and exclusions.
The ICF is developed to be a de facto standard of international and interdisciplinary common language in every health-related area, which certainly includes implications for vocational rehabilitation. Therefore, we examined the ICF and discussed its applicability for theory and practice of vocational rehabilitation in professional preparation, policy development and service delivery.
II. Relevance of the revision to the current concerns of vocational rehabilitation
The revision is relevant to current important concerns of vocational rehabilitation, as it contains an essentially revised consensus of the concept of disability and provides a unique international and interdisciplinary common language.
1 The revised concept of disability
The revised concept of disability applies in the development of individualized and functional vocational assessment. Further, the standardization of job accommodation for persons with disability dramatically increases support technologies throughout the world.
(1) Vocational assessment including environmental factors
There is an increased emphasis on the environment. The emphasis will identify potential barriers for the persons to be productive and self-sufficient, or in the reverse, identify facilitators for “natural supports” , . The focus is on the interface between the person and the environment and minimizes the emphasis on the person’s disability and impairments.
What a person can do in a standard facilitating environment (“Capacity”) and what a person actually does in the current environment (“Performance”) are to be determined separately in ICF’s domains of Activity and Participation (Table 1). This basic conceptualization of Capacity and Performance is clearly indicative of what environmental interventions are appropriate between the current environment and the standard one, or what personal interventions are advised by observing the maximal Capacity in the most facilitating environment (Fig. 1).
The standard facilitating environment for employment of persons with disabilities has not yet been defined. In theory, it should include an ergonomic work area and surrounding environment, effective usage of rehabilitation technology, supportive colleagues and community, and coordinated services and systems. The proposed standard is a unique universal one, which supports the principles of universal design and universal access. Nevertheless, the definition of the standard facilitating environment needs further research about the effects of variable environmental factors on Performance. Thus, the practical usage of ICF in vocational rehabilitation starts with the data collection and international comparison on the work environments and actual work performance of persons with comparable impairments or abilities.
(2) Functional definition of disability
In the classification of Activity and Participation of ICF, elements of work-related activities (e.g. learning, performing tasks, communication, movements, interpersonal relationships, etc.) are comprehensively listed with operational definitions. Thus, the list can be used to analyze the required functions to work, as an alternative to traditional job-analysis . The description of disability in terms of work-related activities is more understandable than traditional medical-oriented description, so it enables consumers, rehabilitation experts, and employers to make interventions that are more specific to increase employment opportunities for persons with disabilities.
Moreover, the quota system for the employment of persons with disabilities sometimes has discrepancies between the medical assignment of disability and actual problems in terms of work; e.g. there are persons with occupational problems who are not classified as disabled, and the degree of disability is controversial. The functional definition of ICF is expected to develop a reasonable understanding of disability in terms of employment and workability, apart from a traditional concept of disability in terms of health care or welfare.
(3) Individualized vocational assessment
A specific case can be described as multidimensional arrays of codes using ICF (cf. Table 2).
In a work situation, the description could be specifically individualized reflecting not only personal conditions, but also requirements and conditions of the specific job, workplace, company, and community.
The individualized description of ICF enables the consumer, rehabilitation experts and employers to address the uniqueness of the individual as compared to the prior criteria, which addressed more of a class of persons by the disability. ICF strengthens the individuality of each person’s disability and the person’s interface with their environment, thus necessitates an individualized approach to the person’s rehabilitation.
2 ICF as a common language
The nature of ICF as international and interdisciplinary common language surely has applicability in international comparison of disability statistics and interdisciplinary networking for person-centered approach.
(1) International comparison of employment statistics of persons with disability
As a common language, ICF is expected to enable the international comparison on the employment statistics of persons with disabilities, which has been interfered by international inconsistencies of the definition of disability and a variety of environmental backgrounds, such as social infrastructure, work requirements, and industrial structure. The interaction model in ICF aims at integration between “medical” and “social” models (Fig. 2). It is applicable to all countries regardless of their social policies, such as the quota system (i.e., Japan, Germany, France, etc.) and anti-discrimination laws (i.e., North America, Scandinavian countries, UK, etc.).
Statistical data collected using ICF will provide information on the types of employment, specific workability, and environmental influences as barriers or facilitators for each operationally defined population with disabilities. The international comparison would give greater impacts on the vocational rehabilitation and employment policies for people with disabilities.
(2) Interdisciplinary networking
The ICF's perspective of disability is multidimensional involving all relevant information such as medical and psychological diagnostic information, capacity and actual performance of work-specific activities, environmental factors and personal factors.
Vocational assessment and service provisions should be specialized and organized by interdisciplinary networking between the consumer and professionals in health care, employment, education, welfare etc., rather than sectionalized and incompatible assessments and provisions. Since the consumer would select a job and a company, the vocational assessment needs to involve the consumer throughout the assessment. The perspective employer should also be involved in the process of assessment, preparation, placement and continued employment support. Moreover, information about rehabilitation technology is becoming international common property with database provided through Internet.
The ICF, as a de facto standard of common language in the field of disability and rehabilitation and as a practical tool with operational definitions, is expected to facilitate the networking in a large scale, utilizing information technologies, which has been difficult due to the lack of common coding and standard.
III. Conclusions
ICF reflects the recent progress in the theory and practice of disability and rehabilitation. The applicability for vocational rehabilitation is substantial. It provides a unique and practical common language for international and interdisciplinary applications in the field of disability and rehabilitation. Vocational assessment, rehabilitation technology, rehabilitation management, and interdisciplinary and international networking are just some of its applicable areas.