Figure 2.

The elements of the International Classification of Functioning, Disability and Health are reorganized into a participation-focused framework. In this figure, communicative participation is the central focus. As such, clinicians are urged to consider participation first and foremost. They do this by working together with their clients to first develop goals for participation for specific situations identified by the client and other key stakeholders as most important to address. This is followed by developing goals for communication skills, communication environment, and personal perspectives, which support the primary participation goal. The circular nature of the figure is intended to represent that there is not an inherent hierarchy among communication skills, communication environment, and personal perspectives but that all warrant commensurate consideration and may influence each other. The porous border between communicative participation and the surrounding elements is intended to represent the frequent interactions among these elements and the flow of influences back and forth.