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The professional community has long discussed the application of the ICF to speech-language pathology services. ASHA incorporated the ICF framework into the Scope of Practice for the Profession of Speech-Language Pathology (ASHA, 2007) and the Preferred Practice Patterns for Speech-Language Pathology (ASHA, 2004). ASHA has a web page featuring the ICF and at least two professional journal issues have been devoted to the ICF framework [see Seminars in Speech and Language (Vol. 28, No. 4, 2007) and the International Journal of Speech-Language Pathology (Vol. 10, Nos. 1–2, 2008)].

Putting the ICF Framework into Practice

Although the ICF is not a model of care, it does provide a framework for structuring care to focus on function (activity and participation) within a range of communicative contexts. According to Palmetto GBA Medicare (the Part A/B Medicare administrative contractor for eight states), using the ICF to structure clinical care allows for:

Enhanced decision support

Identification of care pathways

Coordination of care

Education

Continuous quality improvement

A transcript, presentation, and case scenarios for the module Going Beyond Diagnosis: The Value of ICF are available online (search “Going Beyond Diagnosis Series”). Nickola Wolf Nelson contributed to our knowledge of focusing on functional outcomes in her article “Seven Habits of Highly Effective Change Agents (with apologies to Stephen Covey): Focusing on the Needs of School-Age Students” (Nelson, 1996). She confided that her personal paradigm shift occurred when she “stopped looking at the purpose of speech-language services as fixing deficits and began to see it as assisting individuals to meet their needs” (p. 12). Nelson outlined seven habits associated with the change process that serve to illustrate use of the ICF framework:

Expect change to occur.

Expect to work for change as part of a system.

Ask others what changes are needed.

Think about how a successful outcome will look.

Consider the steps between where you are and where you want to be.

Take the first (or next) step with the goal in focus.

Measure change and celebrate it when it happens.

Nelson also posed four key questions that clarify how the ICF framework can be used to structure care for speech-language pathologists:

What does the individual’s communicative context require?

What does the individual currently do in that context?

What might the individual do differently to increase communicative success in the future?

How might the context (environment) be modified to increase success?

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