1. Approaches to Health Care
Cole, M. & Tufano, R. (2008). Applied theories in occupational therapy. Thorofare, NJ: Slack.

2. Overview Medical Model Approach vs. Social vs. Biopsychosocial
World Health Organization Approach & ICF
Health Promotion
First compare mm to cc and then explore the WHO approach which tries to address both

3. Medical vs. Social vs. Biopsychosocial
Different names for each side, but basically one sees the client as the problem and the other see the client as having challenges, usually due to societal barriers

4. Comparison of Terminology
Medical
Client Centered (Social & Biopsychosocial)
Patient
Health is absence of disease
Disease
Diagnosis
Prescription
Treatment
Client
Health is well being
Health condition
Disability
Enablement
Intervention
What other words would you use to describe a visit to a physician?

5. Approaches to Health Medical Behavioral or Social Biopsychosocial
Client-Centered!
Medical
Behavioral or Social
Biopsychosocial
Target
Strategies
health problems- no target here
poverty,
hx of exclusion,
no access to pools
inability to swim
none
teach children to swim
personal empowerment, community organization, grant funding for inner city and rural pools run by community members
The fatal drowning rate of African American children ages 5 to 14 is 3.1 times that of white children in the same age range. Among racial groups, African Americans reported the most limited swimming ability.
Behavioral approach may blame the victim

6. Client-centered Biopsychosocial
Occupation
Person
Environment
Client choice
Respect for diversity
Collaborative partnership
Enable occupation by empowerment
Situation congruent interventions
Client is individual and unique
Situation congruent- the intervention targets what the client needs at the time according to their situation

7. WHO and the ICF

8. World Health Organization
Created by the United Nations in 1948
Provides leadership and accountability for world health
Publishes:
the ICD (International Classification of Diseases) now on version 11
Classification of Functioning, Disability and Health (ICF)
Why would we all need to use the same definitions? Why do we care?

9. ICF
Systems model
Provides an organized list of everything that impacts health
Very similar to our practice framework except OTPF provides much more detail on occupations (performance patterns etc.)
See page 54 of Willard and Spackman for graphic

10. Conceptual Model of Functioning
“Disability and functioning are viewed as outcomes of interactions between health conditions and contextual factors” p. 10
Body Functions are physiological functions of body systems (including
psychological functions).
Body Structures are anatomical parts of the body such as organs, limbs and
their components.
Impairments are problems in body function or structure such as a significant
deviation or loss.
Activity is the execution of a task or action by an individual.
Participation is involvement in a life situation.
Activity Limitations are difficulties an individual may have in executing
activities.
Participation Restrictions are problems an individual may experience in
involvement in life situations.
Environmental Factors make up the physical, socal and attitudinal
environment in which people live and conduct their lives..
WHO, 2002

11. Body Structure: Function: Structure of the Nervous System
The Eye, Ear and Related Structures
Structures Involved in Voice and Speech
Structure of the Cardiovascular, Immunological and
Respiratory Systems
Structures Related to the Digestive, Metabolic and
Endocrine Systems
Structure Related to Genitourinary and Reproductive
Systems
Structure Related to Movement
Skin and Related Structures
Function:
Mental Functions
Sensory Functions and Pain
Voice and Speech Functions
Functions of the Cardiovascular, Haematological,
Immunological and Respiratory Systems
Functions of the Digestive, Metabolic, Endocrine
Systems
Genitourinary and Reproductive Functions
Neuromusculoskeletal and Movement-Related
Functions
Functions af the Skin and Related Structures
WHO, 2002

12. Activities and Participation
Learning and Applying Knowledge
General Tasks and Demands
Communication
Mobility
Self Care
Domestic Life
Interpersonal Interactions and Relationships
Major Life Areas
Community, Social and Civic Life
WHO, 2002

13. Environmental Factors
Products and Technology
Natural Environment and Human-Made Changes to Environment
Support and Relationships
Attitudes
Services, Systems and Policies
WHO, 2002

14. Example of four levels of disability
Health Condition
Impairment
Activity Limitation
Participation Restriction
Spinal Injury
Paralysis
Incapable of public transport
Lack of accommodation leads to no participation in religious activities
Juvenile diabetes
Pancreatic dysfunction
None 2nd to medication
Doesn’t go to school because of bullying
Four levels of functioning are health, body function and structure, activity and participation
WHO, 2002

15. WHO Disability Assessment Schedule 2.0
A generic assessment instrument for health and disability
Used across all diseases, including mental, neurological and addictive disorders
Short, simple and easy to administer (5 to 20 minutes)
Applicable in both clinical and general population settings
A tool to produce standardized disability levels and profiles
Applicable across cultures, in all adult populations
Directly linked at the level of the concepts to the International Classification of Functioning, Disability and Health (ICF)
12 item and 36 item versions, excellent psychometric properties and norm referenced

16. WHODAS 2.0 Domains of Functioning
Cognition – understanding & communicating
Mobility– moving & getting around
Self-care– hygiene, dressing, eating & staying alone
Getting along– interacting with other people
Life activities– domestic responsibilities, leisure, work & school
Participation– joining in community activities

17. Health Promotion

22. Occupational Justice

23. Health People 2020
Healthypeople.gov Office of Disease Prevention and Health Promotion
Info graphics
Charts and data on leading health indicators and health disparities
Program planning tools
Evidence based resources

24. References
WHO (2002). Towards a common language for functioning, disability and Health: ICF. Geneva, Switzerland: Author.