methods of conceptualizing Environmental Factors and their relationship
to disability have been suggested. Fougeyrollas (1995) was the first
within the field of disability studies to offer a taxonomy of Environmental
Factors. He and the Canadian Society for the International Classification
of Impairments, Disabilities and Handicaps cataloged over a hundred
elements of the environment which they viewed as important determinants
of handicap or participation. This strategy has been incorporated
into the current classification scheme of the environment included
in the beta draft of the ICIDH-2 (WHO, 1999, 2000). While this strategy
does provide an exhaustive list of environmental elements that may
influence the disablement process, it does not provide a very useful
conceptual framework for quantifying environment in survey tools.
contrast to the approach of categorizing elements of the environment,
Whiteneck et al (1997) have attempted to identify a few salient
characteristics of the environment which correspond to major dimensions
of the environment that act to either impede or facilitate participation
by people with disability. This conceptualization proposes five
characteristics of the environment:
answers the question, "Can you get where you want to go?" It is
defined in terms of physical access and includes architectural barriers
such as steps and inaccessible bathrooms as well as the accessibility
of transportation. These aspects of the environment either restrict
or facilitate an individual's ability to move about freely in his
or her community.
addresses the question, "Can you do what you want to do?" It is
defined in terms of the equipment, services, or modifications to
tasks that facilitate full participation and independent living.
Areas of accommodation include home, workplace, school, other business
and organizations, and other community settings. This aspect of
the environment either restricts or facilitates an individual's
ability to participate in an activity once he or she is at the location
of that activity.
availability addresses the question of, "Are your special needs
met?" It is defined in terms of the availability and provision of
services and resources made necessary by the particular disability.
These may include medical care, personal assistant services, and
income security. This category assesses the degree to which the
extra resources needed by a person with a disability are available.
support addresses the question, "Are you accepted and supported
by those around you?" It is defined in terms of the attitudes and
prejudices of others that either discourage community integration
or provide a supportive environment that allows community integration
to flourish. Social support may be provided by family and friends,
employers and teachers, neighbors and peers, and other community
members. This category focuses on the social barriers, which can
only be remedied by attitude change in others. Extra funding is
not likely to solve these particular problems.
equality addresses the question, "Are you treated equally
with others?" It is defined in terms of the degree to which the
policies and regulation of governments and institutions insure equality
of opportunity for people with disabilities. Included in this category
are discrimination, financial disincentives, health care management
and rationing, and legislative mandates to name a few.
five environmental characteristics form useful criteria for evaluating
environments. However, they must be applied to each individual's
own situation, since the same environment that may restrict one
person may assist or not affect another. In each case, these five
environmental characteristics can be assessed on a continuum ranging
from restrictive barriers to inclusive facilitators.
addition to these two methods of conceptualizing the environment
(by listing its elements and by defining influential characteristics)
a more recent method of characterizing disability has also been
suggested which plays a substantial role in the design of the CHIEF.
For several years, the study of disability has progressed through
research isolated on the study of diagnostic categories. For example,
considerable research relating to disability issues has focused
on spinal cord injury, traumatic brain injury, stroke, visual impairments,
hearing impairments, etc. Most research did not cross diagnostic
groups and was categorically funded due to interest in a particular
diagnosis. In 1997, the Disability and Health Branch of the Centers
for Disease Control announced two programs related to disability
(730 and 731, which funded the development of the CHIEF) that defined
four primary disability domains without reference to impairment
diagnoses. These included mobility limitations, personal care/home
management limitations, communication limitations, and learning
limitations. This newer approach focuses disability research
on common themes of limitation that cross multiple diagnoses. Furthermore,
this approach is grounded in a growing body of literature that demonstrates
considerable commonality of secondary conditions result from a wide
variety of primary diagnoses (White, et al, 1996).
The instrument can be self-administered, or administered by interview,
either in person or by telephone.
If self-administered, it takes approximately 10 minutes to complete
the 25-item CHIEF and five minutes to complete the CHIEF-SF; add
five minutes to each if administered by interview.
It is NOT recommended to use proxy respondents in the absence
of the primary respondent.
The CHIEF was developed and tested with individuals aged 16 to 95,
thus it is recommended for use within this age range. It has not
been tested or used for children or adolescents less than 16 years
It can be used with individuals with or without any type of disability.
There is no set time period for administering the CHIEF; however,
it is recommended that multiple measurements be taken over the course
of a person's lifetime to assess changes with adaptation to the
disability and to gain insight into changes in environmental barriers
which may occur over time.
Each of the 25 items on the CHIEF or 12 items on the CHIEF-SF are
composed of two questions:
Respondents are first asked to rate the frequency with which they
encounter barriers (4=daily, 3=weekly, 2=monthly, 1=less than monthly,
When respondents indicate that they encounter
environmental barriers at any frequency other than never, a follow-up
question is asked about whether they consider the barrier to be
2=a big problem or 1=a little problem (a score of 0=no problem
is automatically entered for this item if the first question regarding
the frequency of encountering barriers is 0=never).
Scoring of each CHIEF item is the product of the frequency score
(from never=0 to daily=4) and the magnitude of impact score (from
no problem=0 to big problem=2) to produce an item score that ranges
A valid rating must be entered for all items, with the exception
of the Work and School items which can be scored as not applicable=8,
if the respondent does not work or attend school.
The Work/School items can then be re-coded to missing so as not
to be included in the calculating of domain/sub-scale scores or
a total CHIEF score. However, depending on the type of analysis,
if missing data is an issue (e.g., multivariate analysis), these
items can be re-coded to zero (0) for both frequency and magnitude,
indicating "no environmental barrier".
A score for each of the five domains or subscales (1-Attitudes and
Support, 2-Services and Assistance, 3-Physical and Structural, 4-Policies
and 5-Work and School) is calculated as the average frequency-magnitude
product score across all of the non-missing sub-scale items. A total
CHIEF score across all 25 CHIEF items or 12 CHIEF-SF items is calculated
the same way, as the average frequency-magnitude product score across
all of the non-missing scale items.
The higher the item, sub-scale or total CHIEF score indicates a
greater frequency and/or magnitude of environmental barriers.
following indicates which items are contained in each subscale of
the CHIEF Long Form, those items indicated with an asterisk are
those retained in the CHIEF Short Form:
Subscale: *Policies businesses, *policies government, policies
employment/education & services community.
Subscale: *Surroundings, *natural environment, design home,
design community, design work/school, & technology.
Subscale: *Attitudes work/school, *help work/school &
Subscale: *Attitudes home, *discrimination, support community,
attitudes community & support home.
Subscale: *Transportation, *medical care, *help home, *information,
education/training, help community & personal equipment.