American Speech-Language-Hearing Association

International Classification of Functioning, Disability, and Health (ICF)

The ICF is a classification of health and health-related conditions for children and adults that was developed by World Health Organization (WHO) and published in 2001. The WHO would like the ICF classification system to be considered a partner to the ICD (International Classification of Diseases and Related Health Problems) system used in the U.S. and abroad. Whereas the ICD classifies disease, the ICF looks at functioning. Therefore, the use of the two together would provide a more comprehensive picture of the health of persons and populations.

Key Points

  • The ICF is not based on etiology or "consequence of disease," but as a component of health. Thus, while functional status may be related to a health condition, knowing the health condition does not predict functional status.
  • The World Health Organization defines "health" as "the complete physical, mental, and social functioning of a person and not merely the absence of disease." In this definition, functioning as classified in the ICF is an essential component of health.
  • The ICF describes health and health related domains using standard language.
  • The purposes of the ICF include:
    • Collection of statistical data
    • Clinical research
    • Clinical use
    • Social policy use
  • The ICF is stated as the framework for the field in both the Scope of Practice for Speech-Language Pathology (2001) and the Scope of Practice for Audiology (2004).

Components of ICF

The ICF framework consists of two parts: Functioning and Disability and Contextual Factors. These parts are further broken down in the following manner:

Functioning and Disability includes:

  • Body Functions and Structures—describes actual anatomy and physiology/psychology of the human body.
  • Activity and Participation—describes the person's functional status, including communication, mobility, interpersonal interactions, self-care, learning, applying knowledge, etc.

Contextual Factors include:

  • Environmental Factors—factors that are not within the person's control, such as family, work, government agencies, laws, and cultural beliefs.
  • Personal Factors—include race, gender, age, educational level, coping styles, etc. Personal factors are not specifically coded in the ICF because of the wide variability among cultures. They are included in the framework, however, because although they are independent of the health condition they may have an influence on how a person functions.

ICF Coding

ICF codes utilize an alphanumeric system to describe health and health-related domains, with the following letter codes:

b=body functions

s=body structures

d=activities and participation

e=environmental factors

The letters are followed by a numeric code that starts with a one digit chapter number, a second level denoted by two-digits, and third and fourth levels represented by one digit each.

Codes are only complete when a qualifier has been added. Qualifiers denote the severity of the problem and are represented by one or more numbers following a point or separator. The first number after the separator is a universal qualifier that ranges from 0 (no problem) to 4 (complete problem). If a code is not applicable, the code will be followed by a .9. Further qualifiers have different meanings, depending on the component being coded. For example, the second qualifier for body structures indicates the nature of the anatomical change, while the second qualifier for activity/participation denotes the person's ability to perform in a standard environment such as a clinic room without assistance. It is important to note that in the Activity/Participation construct, there is a distinction made between a person's ability to perform a skill in the clinic and their ability to perform the same skill in their natural environment. This is vital information about a person's true functional abilities. 

Examples of ICF Codes

Activity/Participation

  • Speaking=d330
  • Communicating with–receiving spoken messages=d310
  • Conversation=d350
    • Ending a conversation=d3502
  • Using communication devices and techniques=d360
  • Using communication techniques (includes speech reading)=d3602
  • Producing messages in formal sign language=d340

Body Functions

  • Quality of voice=b3101
  • Articulation functions=b320
  • Manipulation of food in mouth=b5103
  • Speech discrimination=b2301
  • Vestibular function of balance=b2351

Environment

  • Sound intensity=e2500
  • Individual attitudes of people in positions of authority=e430
  • Assistive products and technology for communication (includes hearing aids and cochlear implants)=e1251
  • Communication services (includes TTD and TTY)=e5350

Again, a qualifier is needed to complete the codes. For example, a severe spoken language comprehension problem in the person's natural environment would be coded as d310.3.

Additional Resources

Functional Goal Writing Using ICF

Communication Disorders and the ICF [PDF]
Article by Travis Threats

ICF Research Branch Core Sets Project

ICF Resources

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