Implementation of the International Classification of Functioning, Disability and Health (ICF) in Portuguese Special Education Policy and Practice

Author(s):

Manuela Sanches-Ferreira(submitting)Sílvia Alves(presenting)Rune J. Simeonsson Mónica Silveira-Maia

Conference:

ECER 2013

Network:

04. Inclusive Education

Format:

Paper

Session Information

04 SES 05 B, Labelling

Paper Session

Time:

2013-09-11

11:00-12:30

Room:

D-501

Chair:

Susanne Schwab

Contribution

In January 2008 with the introduction of the Decree-L aw n.º3/2008, Portugal became the first country implementing the International Classification of Functioning, Disability and Health, ICF (WHO, 2001) as a framework to be obligatorily used in special education system. This policy was responsible for the introduction of substantial changes among which the ICF implementation to support the assessment and eligibility processes represented the major challenge for educational professionals.

The ICF framework emerges in the legislation as an organizing information system supporting descriptions that are not only restricted to the documentation of the negative aspects of disability, but also the mapping of the positive attributes of functioning related to key environmental factors (Silveira-Maia & Lopes-dos-Santos, 2010). Based on this assumption, professionals are asked to guide the assessment process using the ICF conceptual framework and taxonomy, by selecting ICF categories related to students’ functioning that should be assessed. From this process, professionals must report the assessment information producing a student’ functioning profile that should reflect ICF multidimensional properties, describing the interaction of different components of human functioning – body functions and structures, activities and participation and environmental factors. The produced functioning profile would basis the eligibility decision-making, which current criteria is also framed into the ICF taxonomy. The target group for special education services is defined as: “students with significant limitations in terms of activity and participation in one or more areas in life due to permanent functional and structural issues, which result in continued difficulty in terms of communication, learning, mobility, autonomy, interpersonal relationships and social involvement” (European Agency for Development in Special Needs Education, 2009).

These changes revealed a great effort to adopt a common language to base the eligibility decision-making and to replace traditional dichotomy approaches – disabled and not disabled – by using a continuum of functioning descriptions. This is seen as a step forward to ensure more equitable criteria in deciding the resources’ allocation within special education services(Simeonsson, 2009).

Due to the changes introduced, the Portuguese Ministry of Education commissioned a two-year research project (2009-2010) with the overall aim to evaluate the national implementation of the Decree-Law n.º3/2008, namely, the ICF use (Sanches-Ferreira et al., 2010; 2012). For that, a multimethod research was conducted using: (1) case studies – a documental analysis of students’ assessment and eligibility processes; (2) focus groups – to assess the perceptions and experiences of parents, teachers and other educational professionals regarding the decree law n.º3/2008 implementation; (3) and a questionnaire to examine how and from what depends the successfully implementation of innovations comprised in the Decree-Law.

This paper is part of that national research project and aims to explore how the ICF is being implemented in order to inform the policy system about needed improvements in its use. This can be broken into the following research questions:

- How has the ICF been supporting the eligibility process?

- How the biopsychosocial model operationalized by the ICF has been contributing for understanding students’ needs?

- What constrains have been identified in the ICF use?

Method

A nationally representative sample was used in each method procedure. To carry out the documental analysis of the assessment and eligibility processes, 237 processes – composed by a total of 477 documents – were examined. The detailed description of documental analysis can be found in Sanches-Ferreira et al. (2012). Parents, special education and regular teachers and other educational staff opinion about the decree-law implementation, in particular, about the ICF use, was explored in 33 focus group meetings, attended by 220 participants. The questionnaire - designed in the basis of the two previous methods - was completed by 577 participants (educational staff). In order to achieve our goals we analysed students’ functioning profiles collected in case studies. This implied the registration of all codes and qualifiers embodying the descriptions of the students’ functioning profiles. We also analysed, through a content analysis, answers provided in focus groups to the following open-question: “What your opinion about the use of the ICF framework on the assessment and eligibility processes?”. In questionnaire, data gathered with questions concerning the perceived ease on the ICF-CY use and factors contributing for that, were explored.

Expected Outcomes

Results from documental analysis showed that the ICF use in the eligibility process allowed the differentiation of eligible and non-eligible students for the provision of special education services based on their functioning profiles (Sanches-Ferreira et al., 2012). Eligible students registered within their functioning profiles higher severity in categories addressing activities and participation and body functions components than non-eligible students. The multidimensional approach comprised in ICF contributed, in the opinion of most of participants in focus groups, for a better comprehension of students’ needs. Consistently, the results from documental analysis confirmed that the ICF multidimensional properties have been applied in students’ functioning profiles which contain descriptions about the three ICF components. The component activities and participation receives high attention from teachers, being the ICF component most represented in functioning profiles. The criticisms regarding ICF were related to technical difficulties: qualifiers attribution; selection of codes in terms of body functions; selection of the most suitable codes matching characteristics to describe. As shown in focus groups and in questionnaires these difficulties exist due to the lack of professionals’ collaboration to assess and describe information regarding body functions and also to the lack of appropriate assessment measures and training in the ICF use.

References

European Agency for Development in Special Needs Education. Identification of special educational needs – Portugal. 2009. Retrieved from: http://www.european-agency.org/country-information/portugal/national-overview/identification-of-special-educational-needs Decreto-Lei n.º 3/2008 (Decree-Law 3/2008). Ministério da Educação. Diário da República – Série n.º 4 – 7 de Janeiro de 2008, pp. 154–164. Sanches-Ferreira, M., Simeonsson, R., Silveira-Maia, M., Alves, S., Tavares, A., & Pinheiro, S. (2012). Portugal’s special education law: implementing the ICF in policy and practice. Disability & Rehabilitation. Advance online publication (August, 13). doi:10.3109/09638288.2012.708816 Sanches-Ferreira, M., Simeonsson, R., Maia, M., Pinheiro, S., Tavares, A., & Alves, S. (2010). Projecto da Avaliação Externa da Implementação do Decreto-Lei n.º 3/2008: Relatório Final. Lisboa: Direcção-Geral de Inovação e de Desenvolvimento Curricular. Available in: http://www.dgidc.min-edu.pt/educacaoespecial/data/ensinoespecial/estudo_simeonsson.pdf Silveira-Maia, M. & Lopes-dos-Santos, P. (2010). Práticas em Educação Especial à Luz do Modelo Biopsicossocial: O Uso da CIF-CJ como Referencial na Elaboração dos Programas Educativos Individuais. Actas do VII Simpósio Nacional de Investigação em Psicologia, Minho. Simeonsson, R. J. (2009). ICF-CY: a universal tool for documentation of disability. Journal of Policy and Practice in Intellectual Disabilities, 6(2), 70-72. World Health Organization. (2001). International Classification of Functioning, Disability and Health. Geneva: World Health Organization.

Author Information

Manuela Sanches-Ferreira (submitting)

School of Education, Polytechnic Institute of Porto

Special Education

Porto

Sílvia Alves (presenting)

School of Education of Polytechnic Institute of Porto

Special Education

Porto

Rune J. Simeonsson

University of North Carolina, Chapel Hill

Mónica Silveira-Maia

School of Education, Polytechnic Institute of Porto, Portugal

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