Community Integration Questionnaire (CIQ)
(click here for .pdf version)

The Community Integration Questionnaire (CIQ) is intended as a brief, reliable measure of an individual’s level of integration into the home and community following traumatic brain injury.   No formal training and credentialing process for the administration of the CIQ exists; it is recommended that prospective users contact Dr. Willer or another experienced user for guidance in administration, mock interviews, etc.

1.       Who usually does shopping for groceries or other necessities in your household?
          ___       yourself alone
          ___       yourself and someone else
          ___       someone else
 
2.       Who usually prepares meals in your household?
          ___       yourself alone
          ___       yourself and someone else
          ___       someone else
 
3.       In your home, who usually does normal everyday housework?
          ___       yourself alone
          ___       yourself and someone else
          ___       someone else
 
4.       Who usually cares for the children in your home?
          ___       yourself alone
          ___       yourself and someone else
          ___       someone else
          ___       not applicable/ no children under 17 in the home.
 
5. Who usually plans social arrangements such as get-together's with family and friends?
 
          ___       yourself alone
          ___       yourself and someone else
          ___       someone else
 
6.       Who usually looks after your personal finances, such as banking or paying bills?
          ___       yourself alone
          ___       yourself and someone else
          ___       someone else

Can you tell me approximately how many times a month you now usually participate in the following activities outside your home?
 
7.       Shopping
          ___        Never
          ___        1-4 times
          ___        5 or more
 
8.       Leisure activities such as movies, sports, restaurants, etc.
          ___        Never                  
          ___        1-4 times            
          ___        5 or more
 
9.       Visiting friends or relatives
          ___        Never
          ___        1-4 times
          ___        5 or more
 
10.    When you participate in leisure activities, do you usually do this alone or with
         others?
          ___       mostly alone
          ___       mostly with friends who have head injuries
          ___       mostly with family members
          ___       mostly with friends who do not have head injuries
          ___       with a combination of family and friends

11.     Do you have a best friend with whom you confide?
          ___        yes          
          ___        no

12.     How often do you travel outside the home?
          ___       almost every day
          ___       almost every week
          ___       seldom/never (less than once per week)
 
13.     Please choose the answer below that best corresponds to your current (during the past month) work situation:
          ___       full-time (more than 20 hours per week)
          ___       part-time (less than or equal to 20 hours per week)
          ___       not working, but actively looking for work
          ___       not working, not looking for work
          ___       not applicable, retired due to age

 14.     Please choose the answer below that best corresponds to your current (during the past month) school or training program situation:
          ___       full-time
          ___       part-time
          ___       not attending school or training program

 15.     In the past month, how often did you engage in volunteer activities?
          ___       Never
          ___       1-4 times
          ___       5 or more

Scoring Guidelines

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 higher score indicates greater integration, and a lower score reflects less integration.  The CIQ can be further divided into three subscores, corresponding to integration in the home, social integration, and productivity.  Procedures for deriving the subscores are outlined on the scoring sheet.
 
The following guidelines provide scoring information for specific items or groups of items.
 
Items 1 to 6: 
Score:
2         =        The activity is performed alone
1         =        The activity is performed with someone else
0         =        The activity is performed by someone else
 
Note:   For item 4, if there are no children under 17 in the home, the average (mean) score for items 1 through 3 and item 5 should be substituted.
 
Items 7 to 9:
 
Score:
2        =        The activity was performed 5 or more times in the past month
1        =        The activity was performed 1 - 4 times in the past month
0        =        The activity was not performed in the past month
 
Item 10
 
Score:
2        =        Mostly with friends without head injury or combination of family and friends
1        =        Mostly with friends who have head injuries or with family
0        =        Mostly alone

Item 11
 
Score:
2        =        Yes response
0        =        No response
 
Item 12
 
Score:
2        =        Almost every day
1        =        Almost every week
0        =        Seldom/never (less than once per week)
 
Items 13 to 15 
Although these items are collected individually, they will be combined to form one variable, Productivity.  The scoring of this variable is dependent on the combination of answers to questions 13, 14 and 15.  On page 4, is a listing of answer sets to these questions and their associated score.

Scoring of the Productivity Variable

Subscales 

Subscales 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; 2) activities associated with socialization; and 3) educational or vocational activities.  These groupings have been made both logically and on the basis of principal components analysis of items which cluster together. Separate home integration, social integration and productivity subscale scores are derived as follows:
 
Home Integration:              Summation of items 1 through 5
 
Social Integration:              Summation of items 6 through 11
 
Productivity:                      Summation of item 12 and the Productivity variable
 
The overall CIQ score is the additive sum of items 1 through 12 and the Productivity variable.

CIQ Scoring Sheet

Home Integration Scores

1                              Shopping                                              _______               

2                              Prepare Meals                                     _______

3                              Housework                                           _______

4                              Caring for Children                             _______

5                              Social Arrangements                          _______

                          HOME INTEGRATION SUBSCALE                      ______

Social Integration Scores

6                              Personal Finances                             ________

7                              Shopping (times/month)                    ________

8                              Leisure Activities (times/month)       ________

9                              Visiting friends or relatives                 ________

10                           Having a best friend                            ________

                                SOCIAL INTEGRATION SUBSCALE                      ________

 
Productivity Scores

12                           Travel outside of home                      ________

13, 14, 15              Productivity                                            ________

                                PRODUCTIVITY SUBSCALE                                   ________

CIQ TOTAL SCORE                                                                     _________

 Copyright Notice

Barry Willer Ph.D., who was the principal investigator in developing the CIQ, holds the copyright. Permission for use of the CIQ is freely given but should be requested, by contacting him at the Centre for Research on Community Integration at the Ontario Brain Injury Association, 3550 Schmon Parkway, Thorold, Ont L2V 4Y6, Canada, email: willer@vaxxine.com