CHIEF Syllabus

Conceptual Framework

Several 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.

In 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:

1. Accessibility

2. Accommodation

3. Resource availability

4. Social support

5. Equality

Accessibility 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.

Accommodation 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.

Resource 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.

Social 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.

Finally, 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.

These 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.

In 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).

Administration Guidelines

1. The instrument can be self-administered, or administered by interview, either in person or by telephone.

2. 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.

3. It is NOT recommended to use proxy respondents in the absence of the primary respondent.

4. 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 of age.

5. It can be used with individuals with or without any type of disability.

6. 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.

Scoring Overview

1. 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, or 0=never).

• 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).

2. 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 from 0-8.

3. 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.

4. 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".

5. 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.

6. The higher the item, sub-scale or total CHIEF score indicates a greater frequency and/or magnitude of environmental barriers.

The 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:

Policies Subscale: *Policies businesses, *policies government, policies employment/education & services community.

Physical/Structural Subscale: *Surroundings, *natural environment, design home, design community, design work/school, & technology.

Work/School Subscale: *Attitudes work/school, *help work/school & support work/school.

Attitudes/Support Subscale: *Attitudes home, *discrimination, support community, attitudes community & support home.

Services/Assistance Subscale: *Transportation, *medical care, *help home, *information, education/training, help community & personal equipment.