The Implementation of the ICF in Germany -a brief review

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1 The Implementation of the ICF in Germany -a brief review
Anna Kelley, Center of Psychotraumatology

2 Table of Contents Introduction: The role of the ICF in the German Health System The implementation of the ICF for mental disorders Development of Core-Sets Mini ICF Rating for Mental Disorders Exemplary implementation of the ICF “Haueser am Latterbach” Critical Considerations References

3 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 special knowledge in the application of the ICF is required of all medical personnel who prescribe medical rehabilitation benefits (3.) Leistungen zur Teilhabe koennen nur erbracht werden wenn participation in aspects of daily life is considerably limited

4 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)

5 ICF Core Sets for Depression
48 12 9 = 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

6 Brief ICF Core Set for Depression
A. Cieza et al., 2004

7 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

8 MINI-ICF-P MINI-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 competence 5. Perseverance 6. Self-assertiveness 7. Interpersonal skills 8. Ability to work in a team 9. Ability to have family and intiMmate relationships CHAPTER 3: COMMUNICATION CHAPTER 7 :INTERPERSONAL INTERACTIONS AND RELATIONSHIPS CHAPTER 9 :COMMUNITY, SOCIAL AND CIVIC LIFE 10. Ability to engage in activities not pertaining to the career CHAPTER 6: DOMESTIC LIFE 11. Self-sufficiency CHAPTER 5: SELF-CARE 12. Ability to cover distances (move from place to place) CHAPTER 4 :MOBILITY Linden & Baron, 2005, translated from German

9 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

10 The implementation of the ICF for mental disorders
Exemplary implementation of the ICF in a rehabilitative setting: “Haueser am Latterbach” 1. Development of Core Sets for psychiatric rehabilitation Delphi-method 146 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 Rehab-Cycle-Model: problem analysis, intervention planning, evaluation for the results -24 patients were assessed using this method, 80% schizophrenia Grundmann et al., 2005 The implementation of the ICF for mental disorders

11 High acceptance rate throughout all occupational groups
Exemplary implementation of the ICF in a rehabilitative setting: “Haueser am Latterbach” Results Satisfactory depiction of the functional health of the patients through the ICF Core Set High acceptance rate throughout all occupational groups Transparent and easily comprehendible rehabilitation management Relatively simple and non-judgmental language simplifies the communication with the patients The implementation of the ICF for mental disorders

12 Considerations Ethical debate Increase in bureaucracy
Time consuming and difficult to implement The implementation of the ICF for mental disorders

13 References [BAR (Bundesarbeitsgemeinschaft für Rehabilitation): Rahmenempfehlungen zur ambulanten Rehabilitation bei psychischen und psychosomatischen Erkrankungen vom 01. Januar 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: 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 , 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 Stuttgart: Thieme

14 Implementierung der ICF in Deutschland : Vorwort zur 3
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 Stuttgart: Thieme Review of ICF Implementation ©2005 Open Society Mental Health Initiative, Open Society Institute [online] 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 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] projekte.html ( )