Transcript Concept of the handicap and classifications

Disability-related models
and classifications
Evolution and applications
Aida Hakimi Osmanbegovic , Handicap International
The WHO Classifications
International classifications
• Evaluating the state of health in populations
• Providing a scientific basis for consequences of health
conditions
• Creating tools for describing and collecting data about the
health of populations :
–
–
establishing a common language to improve communications
permitting comparison of data across:
 countries
 health care disciplines
 services
 time
-
to provide a systematic coding scheme for health information systems
Moving from a classification of
the causes of death to
a classification of illnesses
(1893-1948)
• 1893 : Bertillon classification: international
nomenclature of the causes of death
• 1946 : ICD (10th revision on 1990):
International Statistical Classification of
Diseases & Related Health Problems
– Death statistics
– Illness statistics
Moving from a classification of illnesses
to a classification of disabilities
(1948 – 1980)
1950 : epidemiological transition in industrial countries
The medicinal improvements:
•
•
•
•
•
Reanimation
Neonatology
Surgery
Rehabilitation
Pharmacology
The effects of this:
- Decrease in infectious diseases
- Increase in chronic diseases and problems
- Ageing populations
First classification of handicaps (WHO
1980): ICIDH
Proposition of Philip Wood (1970-1980)
adopted by WHO for an experimental trial
3 levels in the development of handicaps
Disease
or
Impairments
disorder
Disabilities
Handicaps
Critiques of ICIDH
• Classification founded on the “medical
model” :
– Linear causality from impairment to
handicap
– Description of handicaps: insufficient
– Absence of an environmental dimension
• Handicaps are described in a negative
way
International conceptual evolution
in the field of disabilities
1.
Evolution of international norms
- Before 1975: UN recommendations based on rehabilitation
- Since 1980: a shift from rehabilitation to human rights
-
2.
International year of Persons with Disabilities (1982)
Decade of Persons with disabilities
World program actions for Persons with Disabilities
Standard rules for equal opportunities for Persons with disabilities
Convention on the Rights of Persons with Disabilities (13th of December, 2006)
Evolution of practices and social representation of disabilities
a- Emergence of the Independent Living Movement (USA 1960)
b- Diffusion of the model and extension of the ILM in the world
c- Development of a theory of the social model of disabilities
3.
Evolution of the political representation of people with disabilities
- 1993: Creation of the European Forum of persons with disability
- Lobbying: UN, WHO, European Council, European Parliament:
- Nothing about us without us
- Consultative status of Persons with disabilities NGOs
Models of Disability:
1- Individual Model
Disability as an individual pathology
2 variants
Biomedical approach:
- Prevention: intervention, prenatal diagnosis,
eradication of the causal disease
- Treatment: recovery by medical or technological
Means,
- Society’s responsibility: recovery of Handicapped
person
Functional approach:
Prevention: early diagnosis and reeducation
Treatment: means of functional rehabilitation
Society’s responsibility: To improve the daily lives
of persons with disabilities by means of
compensation.
2- Social Model
Disability as a social pathology
“It is society that disables us, not our
impairments.”
2 variants
Environmental approach:
- The handicap is a consequence of the absence of
environmental planning
- Treatment: make the environment accessible
- Society's responsibility: identification and
elimination of the architectural, economic, social
and psychological barriers
Approach based on human rights:
- The handicap results from social organization
problems and connection problems between the
society and the individual
- Treatment: Reformulation of the political,
economic and social “rules”
- Society's responsibility : Reducing the
inequalities in rights and permitting, ensuring
access to full citizen rights
Systemic Model of Disability
(P.Fougeyrollas RIPPH/SCCIDIH, Canada, 1998 , J.Sanchez CTNERHI 1989, 2002)
- TRT:
individual and collective
An independent life in
an accessible society
= Environmental
+ Individual approach
+ Human Rights
- Society's
responsibilities:
identifying and
eliminating individual
difficulties and social
and psychological
barriers
Interaction of Concepts
-
1998: DCP = Explanatory model of the causes and consequences of disease,
trauma and other disruptions to a person’s integrity or development based
on the anthropological model of human developpement
Patrick Fougeyrollas and Co (RIPPH, Quebec)
- 2001: ICF as the New Member in the WHO Family of international
Classifications
-
to provide a scientific basis for consequences of health conditions
-
to establish a common language to improve communications
•
to permit comparison of data across countries, health care disciplines, services
•
to provide a systematic coding scheme for health information systems
A comprehensive model
• The DCP is a global approach which considers disability not as a
fixed “state” but as a process which limits the person’s activities.
• In this model, the “disability” is differentiated from the “handicap” by
the social variable that separates the two.
• The “handicap” is considered as a disturbance in a person’s life
habits as a result of interaction between personal factors
(impairment or disability) and environmental factors (obstacles). It’s
a relative “situation” which varies according to the context and
the environment, but which can also be modified by reducing
impairment (medical care) and develops capabilities (rehabilitation)
as well as adapting the environment (policies, elimination of physical
obstacles).
DCP: based on the Model of human
development
Every human being develops himself in an interactive model
Personal factors (PF)
(intrinsic)
Environment
Factors (EF) (extrinsic)
Interaction
Social participation
Illustration of the
dynamic of the
interactive process
between PF and EF
that determines the
performance of
habits life
realization
depending on the
age, gender, sociocultural identity of
the individual
Disability Creation Process
The disability is not considered as
a fixed state but an unsatisfying
process that places the person in
a situation of handicap
Risk factors
Cause
Envrionmental Factors
Personal Factors
Organic systems
Integrity
Impairment
Capabilities
Facilitator
capacity
Obstacle
incapacity
Interaction
« A life habit is a
daily activity or a
social role
promoted by the
person or his
socio-cultural
context according
to his/her
characteristics
(age, sex, cultural
identity).
Life Habits
Participation
handicap Situation
The HS is the partial
or non-achievement of
life habits resulting
from the interaction
between personal
factors and
environmental factors.
Interaction of Concepts
ICF 2001
Health Condition
(disorder/disease)
Body
function&structure
(Impairment)
Activities
(Limitation)
Environmental
Factors
Participation
(Restriction)
Personal
Factors
Synthesis
DCP
ICF
Health Condition
(disorder/disease)
Risk Factors
Cause
Personal factors
Organic system
Environmental Factors
Capabilities
Facilitator
Interaction
Life habits
Participation
Handicap Situation
Obstacle
Body function &
structure
(Impairment)
Activities
Limitation
Environmental
Factors
Participation
(Restriction)
Personal
Factors
DCP Application:
Individual plan of intervention
To extract the information
Risk
factors
Impairment
Capabilities/
Disabilities
to select the USEFUL information
Request,
expectation,
desires
Life
habits
Environment
Surveys Syntheses and formulation of the handicap situation
INDIVIDUAL
PLAN OF
INTERVENTION
Synthesis
document)
Coordination of
goals to reach
The plan of the team
Intervention
ICF APPLICATIONS IN POLICY
MAKING
• Assessment of population health
• Impact of disability
– economic
– social
• Evidence-base for policy makers on different policy
interventions
– responsiveness of services
– efficiency
– performance assessment
ICF-based tools
In France: the new disability policy defined by the law n°2005-102 is partially
based on the ICF concepts. The law attempts to reduce the activities
limitations or the restriction of participation by:
- A better accessibility
- Collective and individual compensations
A multidisciplinary team assesses the compensation needs for a person
with disability on the basis of:
- His or her life objectives (life project)
- Defining references by the law
Using the GEVA (guide for multidimensional assessment of
compensation needs of person with disability) for:
- Assessment the different dimensions of the disability of the person
- Analysis compensation needs
- Elaborating a compensation plan
the team proposes a personalized plan of compensation of the
disability