CIQ Syllabus

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

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?

Answer	Score
yes	2
no	0

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)