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

Original Editor - Lauren Heydenrych& Ewa Jaraczewska

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 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 perspective on barriers and facilitators that affect a child’s functioning. It was designed 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 uses standardised language to allow communication between disciplines, sciences and, indeed, across the globe. ICF-CY adaptations to the ICF include further details and the addition of content when documenting characteristics of children and youth below 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 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 the need to consider the unique involvement of children in life situations - moving from total dependence to independence.
  • Physical factors include aspects such as developmental delay. With the developmental delay, limitations in structure or function may not be permanent or seen to change through the ageing and development process. Severity-like limitations must consider the lag or delay in the emergence of structure and functions etc.
• The need to support the human rights of children and youth in healthcare.
  • 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 are 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 indicates the generic qualifier, while the second digit after the 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 a 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 about various 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, researchers, and consumers. In fact, this model was created for 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 across the spectrum, including infancy, childhood and adolescence.
3. Record a single problem or create 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 identify appropriate starting points for assessment, counselling, and therapy and include the children's environment and familial/societal context when planning intervention.
• Documenting functioning limitations in children with disabilities when there is a lack of classifications of static diagnoses in ICD, such as mental functions, attention and memory.
• Using the ICF-CY among children and adolescents within the Augmentative and Alternative Communication (AAC) field

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

Examples:

• To support the funding of augmentative and alternative communication (AAC) devices for children and adolescents based on assessing the benefits of using them among children and adolescents and their communication partners in daily communication life.

Surveillance Application

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

Example:

• Assessing and comparing the knowledge of doctors and allied health professionals working with cerebral palsy children regarding ICF-CY use.

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 opposed to the 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
• Assessing the correlation between the outcome measures and the concepts related to ICF-CY
• Identifying which ICF-CY categories are the most relevant for evaluating patients.

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 ICF-CY aims to describe the nature and severity of the limitation and identify influencing factors in the environment.
• The application should be constant as the ICF-CY can be used in many different contexts and scenarios. Assignment of codes should be based on direct measurements, observations and interviews, as well as professional judgments.Primary caregivers can serve as proxy respondents for young children and children with limited verbal skills.
• 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 - differentiating between growth and development, which falls into normal ranges, versus those atypical. Finally, it is highly encouraged that revision of the guidelines be undertaken, as well as training.

ICF Core Sets

ICF Core Sets (ICF­CS) is a " selection of essential categories from the full ICF classification that are considered most relevant to describe the functioning of a person with a specific health condition or in a specific healthcare context" Their purpose is to facilitate assessment in clinical practice and research.You can find more information in the ICF Core Sets here.

Resources

1. ICF Core Sets for Cerebral Palsy in CY
2. Noten S, Selb M, Troenosemito LAA, Thorpe DE, Rodby-Bousquet E, van der Slot WMA, Roebroeck ME; ICF Core Set for Adults with CP Consensus Group. ICF Core Sets for the assessment of functioning of adults with cerebral palsy. Dev Med Child Neurol. 2022 May;64(5):569-577.
3. Schiariti V, Longo E, Shoshmin A, Kozhushko L, Besstrashnova Y, Król M, Neri Correia Campos T, Náryma Confessor Ferreira H, Verissimo C, Shaba D, Mwale M, Amado S. Implementation of the International Classification of Functioning, Disability, and Health (ICF) Core Sets for Children and Youth with Cerebral Palsy: Global Initiatives Promoting Optimal Functioning. Int J Environ Res Public Health. 2018 Sep 1;15(9):1899.