Frieda Brauneis
Vice-president - Professional profile
E-mail : elfriede.brauneis@univie.ac.at

Marianne Leterme
Vice-president - Education
E-mail : marianneleterme@swing.be

Between 1988 to 1998, the commission "Education and professional practice" worked on the definition and the description of the foundation of our professional activity. I shall only mention these works briefly, but you can find them in CPLOL's publication "10 years of activities".

1. The definition of the professional profile of the European speech and language therapists or logopedists.
2. The description of the initial education for speech therapists or logopedists as it exists in the various countries of the European Union.
3. The proposition of minimum standards for the initial or under-graduate education.

When this work was completed, the commission had decided to work on a pressing subject which will be discussed tomorrow in the Forum: that is the measurement of treatment efficacy in the field of speech and language therapy. Our commission found that it was important to work on this topic because, firstly, it is directly linked to our professional practice since it is the question of the utility of our work and secondly, because we think that the initial education for speech and language therapists or logopedists needs to be adjusted to the new realities of the profession and that the question of treatment efficacy is one of these .

In the course of the commission's preliminary discussions on determining the methodology we would use, we decided that at first an important step would be to create a European framework for the classification of speech and language disorders. Why ?

• Initially we thought it would be impossible to discuss outcomes measurement and the treatment efficacy of our interventions if we did not start with a clear definition of the domain of our interventions. It is very important to have a European nomenclature to allow good communication between all European professionals.
• Another reason was that CPLOL needs to update its terminology.
• Moreover, in doing so, we are able to help the countries that have to work on their own classification systems.

We do not intend to develop a European version of the work that was done by the WHO (World Health Organization). We would like to create a framework for the classification of communication disorders that would be common for all European speech therapists or logopedists.

We commenced this new project by:

1. comparing the classification systems used in the European countries and
2. analysing the new version of ICIDH that is ICIDH-2 Beta-2 Draft.

1. The classification systems for communication disorders within the European Union

During our last meeting in Paris, in November 1999, the delegates presented summaries of their national classification system. They also answered several questions so that we were able to get a clearer picture of the situation in each of the countries. The following is a synthesis of this information.

- In some countries the professional association found that it was important to elaborate its classification system. In other countries this work was carried out by one or several health insurance organizations so that they were able to specify which interventions would be reimbursed. Not all the countries have a national classification system.

• Three aims were identified for the elaboration of these classification systems:

1. to enable interventions to be reimbursed by the health insurance organizations; the classification precise the various disorders that may be reimbursed;
2. to facilitate the communication between the various health care professionals; between the speech and language therapists or logopedists themselves, between the latter and other professionals and between speech and language therapists and their clients/patients; the classification constitutes a common reference;
3. to permit statistical surveys on financing in the field of speech and language disorders.

• The classification systems are based mainly on medical diagnoses, that is, on the aetiology. However, they are rarely based only on the aetiology. The descriptive aspects of both pathology and aetiology are more frequently stated. For example, "hearing disorders" and "aphasia" can be found at the same level.

• The diagnoses are usually made by medical doctors. In Denmark, Finland and Great Britain, however, the diagnoses are made by the speech and language therapists or logopedists.

• Advantages of these classification systems are:

1. that they facilitate the reimbursement for the interventions in speech and language therapy ;
2. they demonstrate that our profession is recognised by the medical field;
3. they are points of common reference and thus facilitate the communication between speech and language therapists or logopedists.
4. they constitute a reference for discussions between the therapist and the doctor who prescribed the treatment.

• Disadvantages of these classifications are:

1. that some of the specific treatments are not included in the classifications and are therefore not reimbursed;
2. the categories are often unclear. They do not give a clear description of the patient's needs and therefore cannot be used for scientific research;
3. the terminology, being medical, makes it difficult for the client/patient to understand the problem;
4. in several classification systems, some of the disorders are missing or the criteria that are used are not suitable;
5. sometimes the classification needs to be adjusted to integrate the progress of knowledge in our field.

The majority of the EU countries are working on improving their classification systems so as to make them more efficient in daily practice and to reduce the disadvantages mentioned.

I would like to describe the situation of our colleagues in the Netherlands, both to illustrate the present state and because it is linked to outcomes measurement previously mentioned. The Dutch speech and language therapists working in private practice are now required to register their clients/patients by computer in a special logopedic information program. The information that has to be documented includes the disorder or diagnosis, the degree of severity, the therapy method and each therapy session. This database compiles surveys for epidemiological studies with this information and also offers the speech and language therapists a sort of feedback on their work so that they can modify or adjust their therapy accordingly.

This demonstrates the relevance of this new project.

2. ICIDH-2 Beta-2 Draft

During our last meeting in Paris, we met Jayne Lux, an American speech and language pathologist who worked at the WHO on the revision of ICIDH (International Classification of Impairments, Diseases and Handicaps).

She explained the philosophy of this work, the main aspects and the parts of interest to our profession.

Jayne Lux explained, first of all, that the two WHO documents were complementary. ICD-10 (International Classification of Diseases, Tenth Revision) is an aetiological framework, while ICIDH-2, Beta-2 Draft is a classification of the functioning and disability associated with health conditions. It was developed by the WHO to take in account the current knowledge of health care, ( e.g. the increase in the average life expectancy) and also to provide a unified and standardized common language to improve the communication between the various health care professionals disciplines. This new classification can also be used, e.g., in scientific studies of data across countries.

The ICIDH-2 classification organises information in three dimensions.

Body function and structure; Activities performed by the individual and Participation, all areas of life in which an individual is involved, e.g. social aspects.

Field trial studies have been and are being carried out in many WHO member states and across many disciplines, sectors and groups.

This new version is of interest to speech and language therapists or logopedists because it appears to facilitate the decision as to when an intervention is necessary.