The
CIQ is usually completed by phone interview with the individual
being assessed. It also can be completed by the individual, in which
case the interviewer should be present to assist with interpretation
of specific items. In certain instances, the individual being assessed
may not be able to complete the questionnaire (e.g, due to expressive
or receptive language deficits, memory impairment, physical disabilities,
etc.). In these instances, a person who is familiar with the individual
being assessed may complete the form.
The
CIQ consists of a total of 15 questions. The overall score, which
represents a summation of the scores from individual questions,
can range from 0 to 29. A high score indicates greater integration,
and a low score reflects less integration. The CIQ can be further
divided into three subscores. Subscores have been developed to allow
an analysis of integration within specific domains of everyday life.
Items have been grouped with respect to their association with 1)
activities primarily related to the home (designated with H); 2)
activities associated with socialization (S); and 3) education,
vocational or other productive activities outside the home (P).
Most
of the questions are directed at how the individual performs a specific
activity within the household or the community. Responses usually
indicate that the individual performs the activity alone, with another
person, or that the activity is typically performed by someone else.
For some responses, the individual being assessed may find it difficult
to decide which response fits best with how a particular activity
is performed. In these instances, the individual should be encouraged
by the examiner to choose the response reflecting the usual or typical
performance of that activity.
Scoring
Home
Integration Section
1. Who usually does shopping for groceries or other
necessities in your household?
Answer
|
Score |
yourself
alone |
2 |
yourself
and someone else |
1 |
someone
else |
0 |
2.
Who usually prepares meals in your household?
Answer
|
Score |
yourself
alone |
2 |
yourself
and someone else |
1 |
someone
else |
0 |
3.
In your home who usually does normal everyday housework?
Answer
|
Score |
yourself
alone |
2 |
yourself
and someone else |
1 |
someone
else |
0 |
4.
Who usually cares for the children in your home?
Answer
|
Score |
yourself
alone |
2 |
yourself
and someone else |
1 |
someone
else |
0 |
not
applicable/ no children under 17 in the home |
* |
* score is average of items 1, 2, 3, and 5
5.
Who usually plans social arrangements such as get-togethers with
family and friends?
Answer
|
Score |
yourself
alone |
2 |
yourself
and someone else |
1 |
someone
else |
0 |
HOME
INTEGRATION SCORE = (sum of items 1 through 5)
Social
Integration Section
6.
Who usually looks after your personal finances, such as banking
or paying bills?
Answer
|
Score |
yourself
alone |
2 |
yourself
and someone else |
1 |
someone
else |
0 |
Questions
7-9: Can you tell me approximately how many times a month you now
usually participate in the following activities outside your home?
7.
Shopping
Answer
|
Score |
5
or more |
2 |
1-4
times |
1 |
Never
|
0 |
8.
Leisure activities such as movies, sports, restaurants, etc.
Answer
|
Score |
5
or more |
2 |
1-4
times |
1 |
Never
|
0 |
9.
Visiting friends or relatives
Answer
|
Score |
5
or more |
2 |
1-4
times |
1 |
Never
|
0 |
10.
When you participate in leisure activities do you usually do this
alone or with others?
Answer
|
Score |
mostly
alone |
0 |
mostly
with friends who have head injuries |
1 |
mostly
with family members |
1 |
mostly
with friends who do not have head injuries |
2 |
with
a combination of family and friends |
2 |
11.
Do you have a best friend with whom you confide?
SOCIAL
INTEGRATION SCORE = (sum of items 6 through 11)
Productivity
Section
12.
How often do you travel outside the home?
Answer
|
Score |
almost
every day |
2 |
almost
every week |
1 |
seldom/never
(less than once per week) |
0 |
JOBSCHOOL
VARIABLE: (items 13 to 15):
These
items, although collected individually, will be combined to form
one variable, Jobschool.
13.
Please check the answer below that best corresponds to your current
(during the past month) work situation:
Answer
|
full-time
(more than 20 hours per week) |
part-time
(less than or equal to 20 hours per wk) |
not
working,
but actively looking for work |
not
working, not looking for work |
not
applicable, retired due to age |
14.
Please check the answer below that best corresponds to your current
(during the past month) school or training program situation:
Answer
|
full-time
|
part-time
|
not
attending school or training program |
not
applicable, retired due to age |
15.
In the past month, how often did you engage in volunteer activities?
Answer
|
5
or more |
1-4
times |
never
|
JOBSCHOOL
VARIABLE SCORING (items 13 to 15):
These
items, although collected individually, will be combined to form
one variable, Jobschool.
For the Jobschool variable, the following scoring system will apply:
JOBSCHOOL
|
Score |
Not
working, not looking for work, not going to school, no volunteer
activities |
0 |
Volunteers
1 to 4 times a month AND not working, not looking for work,
not in school |
1 |
Actively
looking for work AND/OR volunteers 5 or more times per month
|
2 |
Attends
school part-time OR working part-time
(less than 20 hours per wook) |
3 |
Attends
school full-time OR works full-time |
4 |
Works
full-time AND attends school part-time
OR
Attends school full-time AND works part-time (less than 20
hours per week) |
5 |
If Retired due to Age, the JOBSCHOOL variable is based on item 15
(Volunteer Activities) only
IF RETIRED, SCORE AS:
In the past month, how often did you engage in volunteer activities?
Answer
|
Score |
5
or more |
4 |
1-4
times |
2 |
Never
|
0 |
PRODUCTIVITY
SCORE = (sum of item 12 and the Jobschool variable)
TOTAL
CIQ SCORE
= HOME INTEGRATION SCORE+SOCIAL INTEGRATION SCORE+PRODUCTIVITY
SCORE
range
= 0 to 29 (maximum community integration)
|