ICF Model and Goal Writing in Paediatrics

Original Editor - Robin Tacchetti based on the course by

Krista Eskay

Top Contributors - Robin Tacchetti and Jess Bell

Introduction[edit | edit source]

The International Classification of Functioning, Disability and Health (ICF) is a World Health Organization classification of health and health-related domains. This framework measures health and disability at both the individual and population levels while also looking at environmental factors.[1] This framework emphasises function, impact and health rather than disability and cause.[2] Understanding the functional deficits associated with a health condition promotes better patient management. The ICF offers a more holistic model of health, which utilises goal setting, and requires the evaluation of outcomes and communication among colleagues.[3]

ICF Model[edit | edit source]

Figure 1. ICF Model.

The ICF framework is a biopsychosocial model, which intertwines medical and social models of disability. The ICF framework recognises that one's health is shaped by environmental and personal factors. The ICF can be separated into three components of health:

  1. Body functions and structures
  2. Activities
  3. Participation

Then, there are contextual factors that influence an individual's life:

  1. Environmental factors
  2. Personal factors

Body functions refers to the physiological functions of body systems. Body structures refers to the anatomical parts of the body (e.g. organs, limbs etc). Activities and participation refer to involvement in life events and the implementation of various tasks. Environmental factors are the attitudinal, social and physical environments where people conduct and live their lives. Personal factors might relate to the individual and their family.[4][5]

Functional Limitations[edit | edit source]

It is important during the physiotherapy evaluation to determine what functional limitations the individual has. Specifically, physiotherapists are interested in learning how the individual's functional limitations are inhibiting or restricting their activity and participation. Activity refers to the ability of the individual to execute a task or action, whereas participation is the ability to fulfill a socially defined role. Participation can relate to activities with family, at work and/or with peer groups. The ICF framework considers immediate or distant factors that might facilitate or hinder overall functioning, including:

  • Environmental factors
    • Setting at home
    • Setting at school
    • Motivation of the individual
    • Amount of family support
    • Accessibility to assistive devices[3]
  • Personal factors
    • Age
    • Gender
    • Lifestyle
    • Fitness
    • Coping styles
    • Cultural beliefs
    • Pain experience[3]

Interventions[edit | edit source]

The plan of care is created once the impairments, functional limitations and activity limitations have been identified. Interventions are targeted at minimising disability and using function as an outcome.[3] Within the paediatric population, the ICF emphasises the importance of a child's environment on their functional outcomes. The environment encompasses not just the physical world, but the values and attitudes of the family and community. Accessibility to services and support will affect overall daily function for a child with functional impairments.[6]

Goal-Setting[edit | edit source]

The ICF framework can be helpful for goal-setting. Goals are created to increase activity and participation, which are impacted by functional impairments.[7] [8] Goal creation favours the strengths of the child and focuses on how to build on these strengths to accomplish new tasks.[8] Within the paediatric population, a family-centred approach is adopted when setting goals.[7] This sort of collaboration enables the patient and family to highlight their interests and provide assistance in intervention planning.[4] Research has shown that a family-/patient-centred approach can increase patient motivation and improve therapy outcomes.[4]

SMART Goals[edit | edit source]

When creating meaningful functional goals, the SMART method is recommended. The acronym SMART stands for:

  • S: specific
  • M: measurable
  • A: attainable
  • R: realistic
  • T: time-limited[4]

Using the SMART acronym, physiotherapists can ensure they have set realistic goals for the child that are attainable. Goals are typically geared for the short term or long term depending on the particular task.[8]

Resources[edit | edit source]

References[edit | edit source]

  1. Barlett CP, Madison CS, Heath JB, DeWitt CC. Please browse responsibly: A correlational examination of technology access and time spent online in the Barlett Gentile Cyberbullying Model. Computers in Human Behavior. 2019 Mar 1;92:250-5.
  2. World Health Organization. Towards a common language for functioning, disability, and health: ICF. The international classification of functioning, disability and health. 2002.
  3. 3.0 3.1 3.2 3.3 Jiandani MP, Mhatre BS. Physical therapy diagnosis: How is it different?. Journal of postgraduate medicine. 2018 Apr;64(2):69.
  4. 4.0 4.1 4.2 4.3 Angeli JM, Schwab SM, Huijs L, Sheehan A, Harpster K. ICF-inspired goal-setting in developmental rehabilitation: an innovative framework for pediatric therapists. Physiotherapy theory and practice. 2021 Nov 2;37(11):1167-76.
  5. Eskay K. ICF Model and Goal Writing Course. Plus. 2022.
  6. Houtrow A, Murphy N, Kuo DZ, Apkon S, Brei TJ, Davidson LF, Davis BE, Ellerbeck KA, Hyman SL, Leppert MO, Noritz GH. Prescribing physical, occupational, and speech therapy services for children with disabilities. Pediatrics. 2019 Apr 1;143(4).
  7. 7.0 7.1 Rast FM, Labruyère R. ICF mobility and self‐care goals of children in inpatient rehabilitation. Developmental Medicine & Child Neurology. 2020 Apr;62(4):483-8
  8. 8.0 8.1 8.2 Eskay, K. ICF Model and Goal-Writing Course. Physioplus. 2022