ICF-CY International Classification of Functioning, Disability and Health Children and Youth Version

This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (18.06.2023)

Original Editor - Lauren Heydenrych

Top Contributors - Ewa Jaraczewska, Jess Bell, Lauren Heydenrych, Tarina van der Stockt, Kim Jackson, Chelsea Mclene and Robin Tacchetti  

Introduction

Children and youth version of the the International Classification of Functioning, Disability and Health (ICF) was developed and published as the ICF-CY. The purpose of developing this version was to provide a holistic perspectives on barriers and facilitators that affect child’s functioning. It was design to “record the characteristics of the developing child and the influence of its surrounding environment.” This article will provide an overview of the ICF-CY and its application in clinical practice when treating a child diagnosed with cerebral palsy.

ICF-CY Components and Domains

The International Classification of Functioning, Children and Youth (ICF-CY) version is derived from the original ICF framework (2001), used to classify health and health-related domains. Just as in the ICF model, the ICF-CY uses language and terminology in recording problems involving structures of the body, activity limitations and participation restrictions. It further incorporates the environmental factors important for children and youth. It makes use of standardised language to allow for communication between different disciplines, sciences and indeed across the globe. ICF-CY adaptations to the ICF include further details and addition of content when documenting characteristics of children and youth below the age of 18. This extends through body functions, activities, participation and environments.

The need for an adjunct to the main ICF becomes apparent when considering aspects such as:

• The health manifestations of children and youth differ in nature, intensity and impact when compared to adults.
• Development in these populations is strongly influenced by environmental factors, physical and social characteristics unique to children and youth.
  • Environmental and social factors include 'the child in the context of the family' and needs to consider the unique involvement of children in life situations - moving from total dependence to dependance.
  • Physical factors include aspects such as developmental delay. With developmental delay, limitations in structure or function may not be permanent or seen to change through the aging and developing process. Severity in the nature of limitations need to take into account the lag or delay in the emergence of structure and functions etc.
• The need to support the human rights of children and youth in the sphere of heathcare.
  • The ICF-CY model incorporates human rights of children and youth as defined by the UN Convention on the Rights of Persons with Disabilities.
  • The design of the ICF-CY is specifically made so that children's and adolescents' growth and health is promoted across a spectrum of situations and environments.

ICF-CY Components

The ICF-CY uses the following alphanumeric coding system:

• “s” for Body Structures
• “b” for Body Function
• “d” for Activities/Participation
• “e” for Environmental Factors

Component example: Body Function (b)

ICF-CY Domains

The numeric code is entered after the letter. It starts with one digit chapter number, two digits second level heading, and one digit each of the third and fourth level headings:

Domain example:

• b710: Chapter 7: Neuromusculoskeletal and movement-related functions
• b710: Functions of the joints and bones
• b7101: Mobility of several joints

ICF-CY Qualifiers

The first digit after the decimal point indicate the generic qualifier, while the second digit after decimal point denotes the nature of impairment (.8 not specified).

Qualifier example:

Body function qualifier defines problems in body function as a significant deviation or loss and the extent of impairments.

In summary: A neuromusculoskeletal and movement-related functions including multiple joints and bones and presenting with mild, not specified impairment will be coded as follow: b7101.18

Application of the ICF-CY

The ICF-CY is used from birth to 18 years of age. Belonging to the World Health Organisation's Family of International Classification (WHO-FIC), the ICY-CY provides a framework for coding information relating to a wide range of health issues. The ICF-CY framework classifies disability and functioning as manifestations of the interaction of body functions and structures, activities and participation, and environmental factors . This classification system can be used by clinicians, educators, policymakers, family members and researchers, as well as consumers. In fact, this model was created for use by anyone involved in the health, education and well-being of children and youth.

1. Document characteristics of health and functioning in children and youth.
2. Provide a conceptual framework, common language and terminology for recording problems manifested across the spectrum, including infancy, childhood and adolescence.
3. Record a single problem or creating a profile to define a child's health and functioning difficulties.

The ICF-CY can be used in clinical, administrative, surveillance, policy and research.

Clinical Application

Clinically, the ICF-CY can be used to provide the following:

• A summary of assessment findings
• Clarification for diagnostic information
• Assistance in planning relevant intervention plans.

Example:

• Using ICF-CY codes for interprofessional cleft palate-craniofacial teams to help identifying appropriate starting points for assessment, counseling, and therapy, and to include the children's environment and their familial/societal context when planning intervention.
• Documenting limitations of functioning in child with disabilities when there is a lack of classifications of static diagnoses in ICD, such as mental functions, attention and memory.

Administrative Application

In administrative areas, information can be recorded using the ICF-CY codes to assist with the following:

• determining eligibility for service provision
• obtaining reimbursement for services
• receiving an appropriate follow-up

Surveillance Application

With surveillance programs, codes can be selected "to standardize data collection procedures across instruments and over time in order to document prevalence of conditions, project service needs and service utilization patterns."

Policy Application

In policy, the conceptual framework of the ICF-CY allows focus on particular topics.

Examples:

• Portugal: Implementing the ICF-CY in Education
  • Using functioning-oriented criteria for special needs assessment and eligibility processes as oppose to traditional classification of disability, defined by the nature or the severity of biological deficits.

Research Application

In research, the careful selection of particular ICF-CY codes assists in the standardization of participants, selection of assessment measures and definitions of outcomes.

Examples:

• Researchers and clinics using ICF-CY universal language to increase description specificity for certain disorders
• Consolidating the research knowledge regarding the instruments used for assessing functionality in children with cerebral palsy
• Syntetysing the outcome measurements used in clinical trials
• analyzing how these concepts relate to ICF-CY and describing which functioning components are mostly assessed; associating the subcategories of the ICF to the items of the Assessment of Motor Coordination and Dexterity (abbreviated in Portuguese as Acoordem) and determining whether the items of the Acoordem fit into the structure of the ICF; seeing how the content of the deficiency measures differed in f

Considerations in the use of the ICF-CY

The unit of classification in the ICF-CY model is not a diagnosis, but a profile of functioning.

The purpose of the ICF-CY is to describe the nature and severity of the limitation and to identify influencing factors in the environment.

While the ICF-CY can be used in many different contexts and scenarios, application should be constant. Assignment of codes should be based on direct measurements, observations and interviews as well as professional judgments.

In order to use ICF-CY coding it is important to consider all aspects of development. It is further highlighted that accurate coding can only be done when there is a good understanding of functioning in relation to growth and development - being able to differentiate between growth and development which falls into normal ranges, versus those which are atypical. Finally, it is highly encouraged that revision of the guidelines be undertaken, as well as training.