Introduction to the Craig Hospital Inventory of Environmental Factors

CHIEF
The World Health Organization (WHO) has been both praised and criticized for the model of disablement conceptualized in the landmark publication, An International Classification of Impairments, Disabilities, and Handicaps (ICIDH) (WHO, 1980, 1993). The WHO model of disablement has been praised for its important conceptual distinctions among three types of outcomes: impairments (defined as limitations in the presence or performance of organs or organ systems), disabilities (defined as limitations in the performance of activities of daily living at the person level), and handicaps (defined as limitations in the performance of social roles as members of society). On the other hand, the WHO model of disablement has been criticized for its excessive reliance on the medical model, its failure to adequately recognize the importance of the environment in determining disablement outcomes, and its use of the term "handicap" (often used pejoratively in America) to describe limitations in the performance of social roles. The WHO recognized these shortcomings in its forward to the 1993 reprint of the ICIDH (WHO, 1980, 1993) by inaugurating a worldwide revision process that is under way. Current drafts of the revised model of disablement (WHO, 1999, 2000) address the areas that have been criticized while retaining the former areas of strength by adding a fourth domain of Environmental Factors and renaming the third domain of social role fulfillment (formerly handicap) as "Participation".

In the area of societal participation, considerable conceptual and empirical research has been conducted to develop measurement instruments. Within the domain of Environmental Factors, however, little research has been conducted towards instrument development. What work had been done focused primarily on architectural barriers in the physical environment (Steinfeld, 1997). What was needed was a broad-based measure of the environment that quantified the degree to which elements of the physical, social, and political environments acted as barriers or facilitators to full participation for people with disabilities. The goal underpinning the development of the Craig Hospital Inventory of Environmental Factors (CHIEF) was to provide a new type of instrument that allows the quantification of Environmental Factors and leads to a better understanding of the degree to which elements of the environment impede or facilitate the lives of people with disabilities.

Development of the CHIEF began at Craig Hospital in 1997, with funding from the Centers for Disease Control, Disability and Health Branch. The CHIEF is designed to assess the frequency and magnitude of perceived physical, attitudinal, and policy barriers that keep people with disabilities from doing what they want or need to do. It is designed to be a short inventory of environmental barriers that can be utilized in large-scale surveys and surveillance systems, and be valid for both individuals with and without disabilities. The CHIEF has demonstrated that compared with non-disabled people, people with disabilities encounter more frequent and more problematic environmental barriers. Moreover, the CHIEF has demonstrated that the impact of barriers is associated with the type and severity of the disability.

The focus of the CHIEF is on the quantification of barriers experienced within five domains of environmental factors (Policies; Physical and Structural; Work and School; Attitudes and Support; Services and Assistance). Respondents rate the frequency with which they encounter barriers (daily, weekly, monthly, less than monthly, or never) on the 25 items of the CHIEF reflecting elements of the environment. 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 a big or a little problem. Scoring of each CHIEF item is the product of the frequency score (from never=0 to daily=4) and the magnitude of impact score (little problem=1 and big problem=2) to produce an item score that ranges from 0-8. Therefore, higher scores indicate greater frequency and/or magnitude of environmental barriers.

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 CHIEF; add five minutes to each if administered by interview. Participant-proxy agreement across disability groups on the CHIEF indicates that it is NOT recommended to use proxy data for persons with various types of disabilities. 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. 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 that may occur over time.

CHIEF-SF
The CHIEF-SF was developed from the 25-item CHIEF using a set of criteria designed to select items that were indicative of greatest or most significant environmental barriers, showed the ability to discriminate between groups with and without disability, and demonstrated conceptual validity. Results of this analysis identified 12 items within the original five subscales to be retained.

Information regarding the CHIEF was provided by Craig Hospital. Please contact Cindy Harrison-Felix, PhD, at for more information.

If you find the information in the COMBI useful, please mention it when citing sources of information. The information on the Craig Hospital Inventory of Environmental Factors may be cited as:

Harrison-Felix, C. (2001). The Craig Hospital Inventory of Environmental Factors. The Center for Outcome Measurement in Brain Injury. http://www.tbims.org/combi/chief ( accessed ).*

*Note: This citation is for the COMBI web material. Dr. Harrison-Felix is not the scale author for the CHIEF.