The ICF-based functioning profiles of school children in care with the neuropsychiatric community services in the Piedmont region: evidences for better caring and programming.

Purpose: In the Piedmont region, as in the rest of Italy, school integration of 'handicapped students' in regular classes, independently of the pathologies they are suffering from, involves almost the totality of students between the age of 3 and 14 and the majority of students between the age of 14 and 18. The responsibility to 'recognise the student as a handicapped person' is attributed to the regional public health system (Child Neuro-Psychiatry Services - CNPS). The information about the students is registered in the regional NPI.net, a Web-based application. The question was if ICF could help to develop a monitoring system about school inclusion processes better than the existing one. In fact, because all information is based on medical diagnosis embedded in narrative descriptions, it is often difficult to obtain reliable and comparable data on the disability profiles and the quality of children and adolescents school experience.
Methods: Six CNPS, covering 50% of the Piedmont region, started a pilot study on disabled children at school. Diagnostic data of the children and a brief description of their functioning profiles using ICF were considered. Approximately 1000 school children and adolescents with disability were selected for this study.
Results: We studied the extension and the severity of impairment of body functions (BF) and/or of activity (A&P) restriction, and the extension and the intensity of facilitators and barriers (EF) together with other factors such as provenience (Local Health Authorities - LHA), main health condition and age of the subjects. The analysis of variance, taking into account LHA, main health condition and age, confirmed the statistical significance of these three factors in differentiating the personal profiles in terms of BF, A&P and EF.
Conclusions: The study shows the feasibility and reliability of the use of ICF-based functioning descriptions to monitor school inclusion processes and to better investigate the differences between LHAs in diagnostic procedures, disease prevalence and characteristics of facilitators and barriers. As a direct consequence of the study, the Regional Councils for Instruction, Health and Social Politics have started a 3-year training programme for approximately 2500 school operators, 350 health operators in NPI services and 350 social operators.