ICD/ICF and Models

Discussion of Mental and Social Models

  • Context of Scenario:

    • Individual desires to engage in a discussion while visiting historic buildings.

    • Objective: Explore the mental and social models through practical scenarios.

  • Activity Instruction:

    • Participants instructed to find a partner outside of a designated four to five block radius.

  • First Scenario - Job Application:

    • Context: A local individual in Greenville applies for a job and has intellectual disabilities.

    • Possible Job Role: Task-based roles such as stocking shelves that require minimal problem-solving.

    • Discussion Points:

    • Explore perceived abilities and limitations from two perspectives:

      • Medical Model: Assesses individual as having intellectual disabilities, may suggest the inability to work in certain jobs.

      • Social Model: Acknowledges the individual's potential strengths and focuses on finding a suitable job based on those strengths.

    • Contrasting Models:

      • Medical Model: Limits prospects based on perceived disability; potential employer views it as a hindrance.

      • Social Model: Encourages hiring based on strengths, advocates for fairness and potential advantages of hiring individuals with intellectual disabilities.

    • Examples of Positive Attributes:

    • Many people with intellectual disabilities may be characterized as happy and bring positive energy to the workplace.

    • Potentially suitable for repetitive job roles.

  • Discussion Outcome:

    • Shifting focus from limitations to abilities and strengths helps in considering employment opportunities.

Second Scenario - Quality of Life vs. Life-Saving Care

  • Context:

    • A 20-year-old woman with cerebral palsy (CP), high support needs, admitted to the hospital with pneumonia.

    • Critical Question: Should we provide life-saving care or consider quality of life?

  • Medical Model Perspective:

    • Focused primarily on treating the individual based on medical assessments.

    • Assumes lack of quality of life due to severe illness and disabilities which may lead to recommendations to forgo life-saving treatment in favor of palliative care.

  • Social Model Perspective:

    • Views the individual's life as valuable and meaningful, irrespective of her disabilities.

    • Emphasizes the importance of quality of life, suggesting the need for continued supportive care as an ethical consideration, as well as leveraging family support (e.g., communication through the mother).

    • Raises questions about the responsibilities of healthcare professionals in supporting both the patient and family in decision-making.

  • Outcome of Discussion:

    • Potential for different interpretations of quality of life can lead to different care decisions and approaches between medical and social models.

Discussion of Disablement Models

  • Definition:

    • Disablement models serve as frameworks for clinical practice and research to integrate various aspects of patient care including evidence-based medicine, personal values, clinical expertise, and research evidence.

    • Health professions utilize a variety of disablement models to guide decisions.

  • Key Models:

    • Biomedical Model: Focuses on biological aspects of disease.

    • Medical Model: Centers on diagnosis and treatment primarily through medical interventions.

    • Social Model: Looks at the societal implications of disability and highlights support to increase individual capabilities.

    • ICD (International Classification of Diseases):

    • Framework for reporting diseases and health conditions.

    • Useful for coding and billing within healthcare systems, impacting healthcare databases and population health trends.

    • Example ICD Codes: For diabetes, the corresponding codes are categorized as follows:

      • E10E10 - Type 1 diabetes,

      • E11E11 - Type 2 diabetes,

      • E10.2E10.2 - Type 1 diabetes with kidney complications.

    • ICF (International Classification of Function):

    • Addresses health and disability, considering body functions, activities, and participation on individual and population levels.

    • Helps healthcare professionals understand the complete impact of medical conditions on patients' lives.

ICF Model Breakdown

  • Components of the ICF Model:

    • Health Condition: Identifies the medical diagnosis (e.g., fractured kidney).

    • Body Functions and Structures: Analyzes anatomy and physiological aspects affected by health conditions, such as wrist mobility.

    • Activity Limitations: Describes specific tasks the individual struggles to perform.

    • Participation: Refers to engagement in society, activities, or roles affected by limitations and impairments.

    • Personal Factors: Details individual’s background, including age, gender, socio-economic status, and personal history.

    • Environmental Factors: Discusses external influences on the individual’s performance, such as family support, accessibility, and living conditions.

Example Case Study Breakdown

  • Example Presentation - Patient with Fractured Distal Radius:

    • Diagnosis: Fracture of the distal radius.

    • Personal Factors: 14-year-old male, living in a single-parent household; potential challenges with healthcare access and follow-up treatment.

    • Body Functions and Limitations:

    • Limited wrist movement affects tasks such as holding a pencil or playing basketball.

    • What activities he can and cannot do based on functional capacity.

    • Environmental Factors:

    • Living arrangements and socio-economic background play critical roles in healthcare access and support needs.

  • Reflection on the Case Study:

    • The need to adapt healthcare approaches based on individual patient contexts and the influence of broader socio-economic factors on health outcomes.