The F‐words for child development: functioning, family, fitness, fun, friends, and future

In 2012, two CanChild health services researchers published a paper entitled ‘The ‘F-words in Childhood Disability: I swear this is how we should think’.1 Grafted onto the World Health Organization’s International Classification of Functioning, Disability and Health (ICF)2 these six words – functioning, family, fitness, fun, friends, and future – have captured the imagination of people around the world. Their purpose was to bring to life the ICF’s way of considering any health condition. This was originally done in the context of childhood disability, but as people have embraced these ideas, they have been recognized to be more broadly applicable and are now being referred to as the ‘F-words for Child Development’. We have all been trained and acculturated to a biomedical model of disability – with the prime focus on diagnosis and treatment.2 In traditional thinking, disability has been considered a within-the-person issue for which treatment was expected to make a difference.1, 3, 4 We have, however, experienced the limitations of this approach despite decades of often unsuccessful efforts to try to show that biomedical interventions worked.5 We were taking for granted, and usually ignoring, the role of the myriad environmental factors that impact people’s lives. When we became aware of the ICF’s broad biopsychosocial framework for functioning and health, the scope of our thinking widened considerably, and with this awareness, the strands of our clinical, teaching, and research experience coalesced in the F-words work. The F-words (Fig. S1, online supporting information) bring together 21st century themes important to children and young people’s functioning and well-being at home, school, and in the community.1 We are now listening to and celebrating parents’ voices and values, and the centrality of their roles as decision-makers and equal partners in their families’ services. Moving beyond fixing and normality, we now accept that functioning should be an important goal in all our efforts at intervention to enhance child and family well-being. We recognize the importance of a strengths-based approach that focuses on, highlights, and celebrates the ‘can do’ aspects of children’s lives and not solely on the ‘cannots’! This involves a holistic approach to child development and well-being, emphasizing the importance of a rule-in approach that considers strengths and issues in all areas of the ICF/F-words framework. We know that children with disabilities grow up and become adults with these conditions, and we are increasingly promoting a life-course approach to our counselling and intervention planning. The merging of biomedical and social concepts of health into the integrated ICF framework provides an internationally recognized way to bring these 21st century ideas together. In contrast to the important but limited biomedical approach to diagnosis and treatment of neurodisabilities using tests and assessments to rule out competing diagnostic possibilities, the ICF framework rules in important elements of a person’s situation to create a three-dimensional portrait of their individual reality. Doing so enables people to identify what is working and positive in their lives, as well as their issues and concerns; in this way, it provides professionals with information that is not automatically gleaned from a standard diagnostic work-up. Thus, without diminishing any of the best of what we have to offer with conventional clinical/educational assessment and intervention activities, the ICF/F-words framework expands the scope and discourse of our work. In so doing, it both widens the spotlight and focuses it more sharply on issues we have often either ignored or simply assumed would happen but have not addressed explicitly. The F-words allow parents and service providers to create a strengths-based picture of a child and their family. The issues and challenges are identified, but are woven into the rich fabric of the life of this person and family; this interconnected set of elements thus enables people to see the individual beyond their biomedical condition. By encouraging parents and young people to report, in their own words, what each of the F-words concepts means to them, we (in reality, they) can apply the framework to create a portrait that can be used across time, space, and environments. That means that parents can present their child as a person – be it to extended family, health professionals, teachers, community people – and in so doing essentially provide a person-first account of their child rather than a picture grounded primarily in medical terminology and problems. With this account, parents together with service providers can identify meaningful goals, enhancing personal enjoyment and child/family participation in life. Evidence of impact abounds: more than 45 000 downloads of the original paper, more than 360 citations in the literature, more than 30 translations, and an ever-expanding array of tools and representations of the F-words concepts. For us, the F-words bring together the key ideas that inform our clinical, research, and educational activities. Having had the opportunity to present these ideas hundreds of times at invited lectures and workshops, we have learned about some of the uncertainties that people still experience. The F-words ideas may, on the one hand, appear to some listeners to be a challenge to the status quo, and on the other hand, simply a statement of the obvious. Whatever perspectives people share with us, these comments are invaluable, as they give us the opportunity to clarify our thinking and be more precise about how we tell the F-words story. To share and address these important and still-emerging ideas we have created a document called ‘Lessons Learned’, posted on the CanChild F-words Knowledge Hub (https://www.canchild.ca/en/research-in-practice/f-words-in-childhood-disability), to be annotated and updated regularly as these issues continue to develop. In response to increasing requests to offer invited workshops with colleagues in many countries, we have now created both an online F-words Foundations I be explicit about the reality of the incredible diversity of families in terms of ethnicity, language, and culture; and reflect on the challenges and opportunities associated with family-centred services. The full CanChild F-words Research Team is Peter L Rosenbaum, Andrea Cross, Alice Kelen Soper, Vanessa Tomas, Danijela Grahovac, Rachel Teplicky, and Marilyn Wright. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.