A survey on feasibility of ICF-CY use to describe persisting difficulties in executing tasks and activities of children and adolescent with disability in Italy.

BACKGROUND: The criterion for the provision of disability benefits to people under 18 in Italy is the presence of persistent difficulties in carrying out the duties and functions of their own age; however, no national guidelines are available to support the Disability Commissions in assessing such difficulties. OBJECTIVE: This study identified the different kinds of persisting difficulties in performing tasks and activities of children and adolescents with disability in Italy. METHODS: We used a protocol based on a selection of 55 categories taken from the Activity and Participation components of the International Classification of Functioning, Disability and Health - Children and Youth version. Problems were represented dividing children by age groups, and categories were selected as relevant if reported by 20% of the cases as very severe/complete problems. A count-based methodology was chosen and categories were counted at the level of domain, showing differences related to age groups. Count-based complexity and severity indexes were calculated, reflecting the global amount of problems and the portion of very severe/complete ones. RESULTS: Out of 415 children with disability enrolled in the study, 290 had persisting difficulties, with those referring to domestic life, major life areas and learning being the most common, and with specific age-related trends. The highest number of problems was reported for children in the 4-6 year age group. CONCLUSIONS: Our approach is meant to foster a way toward understanding disability and functioning as a continuum, based on the amount and severity of difficulties that children may have, as opposed to a categorical, diagnosis-based approach.

The ICF and labour policies project: the first Italian nation-wide experience of ICF implementation in the Labour Sector.

PURPOSE: To describe the first Italian experience of ICF implementation in the Labour Sector by a Ministerial body, and the development of the International Classification of Functioning, Disability and Health (ICF)-based worker checklist. METHODS: Nation-wide training was provided. ICF-based worker checklist was developed by linking Italian legislative procedures and schedules to the ICF, and by adding standard ICF checklist's categories. When a third-level ICF category was linked, the corresponding second-level one was included in the worker checklist too. RESULTS: Eighty-four ICF categories were linked and five were added due to rolling-up procedure: 15 from body functions, 65 from activities and participation and 4 from environmental factors. In total, the dedicated ICF-based worker checklist is composed of 183 ICF categories, 34 of whom are at the third level and 89 from the domain of activities and participation. CONCLUSIONS: The inclusion of the standard ICF checklist's items aimed to complement the information contained in the ministerial schedule, in which ICF categories from environmental factors domain are underrepresented. Future directions include the development of an ICF-based company checklist and an application tool for matching the information derived from the worker and the company ICF-based checklists.

Italian ICF training programs: describing and promoting human functioning and research.

Purpose of the article is to report on 5 years of ICF training experiences in Italy aimed at promoting a consistent approach to ICF's field application. More than 7000 persons participated in around 150 training events: almost half were organised by political bodies, at national, regional or local level, directly linked to implementation experiences. Few training events were organised by the school sector, while training commissioned by NGOs represent a relevant area and, in our opinion, constitute the first step towards a full inclusion of persons with disabilities. Central pillars of our training modules are: the inclusion of all ICF components in the description of functional profiles, the need of providing brief theoretical background information before moving to practical aspects and the importance of providing personalised face to face training modules, in contrast to self-administered learning modules, or web-based protocols. On the basis of our experience, we can conclude that training's objectives are generally reached: trainees improved their knowledge of the ICF and its related tools, and are able to begin practical applications in their contexts.

The ICF-based functioning profiles of school children in care with the neuropsychiatric community services in the Piedmont region: evidences for better caring and programming.

PURPOSE: In the Piedmont region, as in the rest of Italy, school integration of 'handicapped students' in regular classes, independently of the pathologies they are suffering from, involves almost the totality of students between the age of 3 and 14 and the majority of students between the age of 14 and 18. The responsibility to 'recognise the student as a handicapped person' is attributed to the regional public health system (Child Neuro-Psychiatry Services - CNPS). The information about the students is registered in the regional NPI.net, a Web-based application. The question was if ICF could help to develop a monitoring system about school inclusion processes better than the existing one. In fact, because all information is based on medical diagnosis embedded in narrative descriptions, it is often difficult to obtain reliable and comparable data on the disability profiles and the quality of children and adolescents school experience. METHODS: Six CNPS, covering 50% of the Piedmont region, started a pilot study on disabled children at school. Diagnostic data of the children and a brief description of their functioning profiles using ICF were considered. Approximately 1000 school children and adolescents with disability were selected for this study. RESULTS: We studied the extension and the severity of impairment of body functions (BF) and/or of activity (A&P) restriction, and the extension and the intensity of facilitators and barriers (EF) together with other factors such as provenience (Local Health Authorities - LHA), main health condition and age of the subjects. The analysis of variance, taking into account LHA, main health condition and age, confirmed the statistical significance of these three factors in differentiating the personal profiles in terms of BF, A&P and EF. CONCLUSIONS: The study shows the feasibility and reliability of the use of ICF-based functioning descriptions to monitor school inclusion processes and to better investigate the differences between LHAs in diagnostic procedures, disease prevalence and characteristics of facilitators and barriers. As a direct consequence of the study, the Regional Councils for Instruction, Health and Social Politics have started a 3-year training programme for approximately 2500 school operators, 350 health operators in NPI services and 350 social operators.

Training on the International Classification of Functioning, Disability and Health (ICF): the ICF-DIN Basic and the ICF-DIN Advanced Course developed by the Disability Italian Network.

The objective is to present training on the International Classification of Functioning, Disability and Health (ICF) prepared by the Disability Italian Network (DIN) and to present strategies of ICF dissemination in Italy. A description of DIN's training methodology, prepared in collaboration with World Health Organization (WHO) experts, is provided within its practical applications in health, labour, rehabilitation and statistical sectors. The ICF-DIN Basic Course is eight hours long and focuses on ICF basic principles, structure and application in different settings. The ICF-DIN Advanced Course, three days long followed by three months of distance learning, assumes Basic Course completion, and focuses also on ICF-checklist's coding and WHO-DAS II administration. The first training courses' outcomes, held in Italy and addressed to health, social and labour professionals, are provided. The feedback received by participants at the end of the courses showed that the main mistake they made was to consider ICF as an assessment instrument. The ICF-DIN training course was crucial in explaining the correct use of the ICF as a classification and to show its impact and usefulness on daily practice, particularly in multidisciplinary teams. The ICF-DIN courses already carried out in Italy show that this teaching methodology teaches how to avoid incomplete applications, simplification and misunderstanding of ICF's complexity.