Are Life-Participation Goals Reimbursable? If you use the International Classification of Functioning, Disability and Health framework to develop goals, you can help patients get their lives back with reimbursable treatment. On the Pulse
Free
On the Pulse  |   October 01, 2015
Are Life-Participation Goals Reimbursable?
Author Notes
  • Janet Brown, MA, CCC-SLP, is director of ASHA health care services. jbrown@asha.org
    Janet Brown, MA, CCC-SLP, is director of ASHA health care services. jbrown@asha.org×
  • Candace Vickers, PhD, CCC-SLP, associate professor at California Baptist University, chaired the 2015 Ad Hoc Committee on the ICF. She is an affiliate of ASHA Special Interest Group 2, Neurophysiology and Neurogenic Speech and Language Disorders. cvickers@calbaptist.edu
    Candace Vickers, PhD, CCC-SLP, associate professor at California Baptist University, chaired the 2015 Ad Hoc Committee on the ICF. She is an affiliate of ASHA Special Interest Group 2, Neurophysiology and Neurogenic Speech and Language Disorders. cvickers@calbaptist.edu×
Article Information
Speech, Voice & Prosodic Disorders / Voice Disorders / Hearing Disorders / Special Populations / Older Adults & Aging / Practice Management / Professional Issues & Training / Normal Language Processing / Speech, Voice & Prosody / On the Pulse
On the Pulse   |   October 01, 2015
Are Life-Participation Goals Reimbursable?
The ASHA Leader, October 2015, Vol. 20, 36-38. doi:10.1044/leader.OTP.20102015.36
The ASHA Leader, October 2015, Vol. 20, 36-38. doi:10.1044/leader.OTP.20102015.36
Payers already press clinicians to do more with less. Can clinicians focus on improving life participation during treatment? And is there time for it?
The answer to both questions is a resounding yes. The World Health Organization’s International Classification of Functioning, Disability and Health (ICF) provides a framework for targeting function and meaningful life changes for patients—outcomes that payers demand in today’s health care market.
The ICF components include:
  • Body functions and body structures, which reflect impairments to physiologic functions or anatomical parts of the body that result in impairments.

  • Activities and participation, which refer to how people function in specific communication activities or life roles in their everyday lives.

  • Personal factors, which make each patient unique.

  • Environmental factors that may encourage or hinder participation in family, work or community.

Traditional treatment in medical settings focuses on addressing impairments and setting goals that could be quantified, but they do not necessarily have a direct connection to life outside the treatment room. The ICF framework validates the focus of rehabilitation to include all aspects of life so people can participate in life as fully as possible. “Patient-centered care” or “person-centered care” are other frequently used phrases that signal the change in treatment focus from isolated impairments to overall change in life participation.
By using this framework to conceptualize goals, clinicians can individualize treatment to each patient’s unique needs and circumstances. Two examples demonstrate how the ICF can work.

The ICF framework validates the focus of rehabilitation to include all aspects of life so people can participate in life as fully as possible.

Case 1
Ms. Y, a teacher, has vocal fold nodules and cannot lecture for longer than 10 minutes without experiencing hoarseness and vocal fatigue, and can no longer participate in her community theater group. She also has to compete with traffic noise outside her classroom.
  • Body function: Impact of voice disorder on voice functions (production and quality).

  • Body structure: Impact of voice disorder on structure of larynx (vocal hygiene to promote vocal fold health).

  • Activity and participation: Impact of voice disorder on work and employment (remunerative employment) and on community, social and civic life (recreation and leisure): How can treatment improve participation in these arenas?

  • Environmental factors: Products and technology for employment (How does the environment affect the voice and are there technologies that enhance her participation?).

Ms. Y’s goals address impairments to both structure and function, but incorporate functional goals with attention to environmental factors meant to promote increased life participation. Here’s a sample of what her goals might look like:
  • Long-term goal: Ms. Y will demonstrate healthy vocal quality in the context of her daily work and social activities during continuous voice use of monologues of at least 15 minutes (combined focus on reduction of impairment and improved overall life participation).

  • Short-term goals: (1) Ms. Y will identify baseline behaviors that affect vocal hygiene by charting frequency of instances of unhealthy vocal behaviors (loud talking, throat clearing) as they occur throughout the day in natural settings once each week (focus on body function); (2) she will use a portable voice amplifier for at least three hours of teaching per day (focus on activity and participation).

Case 2
Mr. L is a retired businessman with mild anomic aphasia caused by a unilateral left hemisphere stroke. Because he is embarrassed about his slow sentence formulation and word-finding delays, he is no longer comfortable talking with friends at their weekly coffee times.
  • Body function: Impact of aphasia on the mental functions of language (expression).

  • Body structure: Structure of the brain (stroke-induced changes affecting areas of the brain).

  • Activity and participation: Impact of aphasia on interpersonal interactions and relationships (informal social relationships) and community, social and civic life (recreation and leisure): How can treatment be tailored so that Mr. L resumes participation in social and community life?

  • Environmental factors: What is the impact of the communication behaviors and the attitudes and actions of others in Mr. L’s life on his communication participation? Can family members or friends be trained to provide communication support techniques if needed (support and relationships).?

In Mr. L’s situation, a person-centered approach to treatment would address remediation of impairments that are tied to Mr. L’s specific life participation goals, so he can continue to enjoy social interaction in the community:
  • Long-term goal: Mr. L will independently use personalized scripts and vocabulary lists as needed to express complex ideas to familiar and unfamiliar partners in at least two community settings of choice.

  • Short-term goal: Mr. L will increase accuracy of word retrieval for complex nouns through self-cueing strategies.

More examples of how to infuse the ICF framework into treatment and documentation—with additional case studies on dementia, dysarthria, childhood hearing loss, hearing loss and falls, swallowing, tinnitus, and traumatic brain injury—are available on ASHA’s website. Each one-page handout (in PDF format) demonstrates how the ICF could apply to each condition and addresses assessment data collection, clinical reasoning and goal-setting.
Online Chat: Setting Functional Goals

Candace Vickers, along with Tammy Hopper of the University of Alberta, recently led an online chat, “Meaningful, Functional Goals for Adults With Aphasia and Dementia.” Read a transcript of the chat, which focused on using the ICF framework to set functional treatment goals for people with these diagnoses.

0 Comments
Submit a Comment
Submit A Comment
Name
Comment Title
Comment


This feature is available to Subscribers Only
Sign In or Create an Account ×
FROM THIS ISSUE
October 2015
Volume 20, Issue 10