1. Who usually does shopping for groceries or other necessities in your household?
a. Yourself alone
b. Yourself and someone else
c. Someone else
2. Who usually prepares meals in your household?
a. Yourself alone
b. Yourself and someone else
c. Someone else
3. In your home‚ who usually does everyday housework?
a. Yourself alone
b. Yourself and someone else
c. Someone else
4. Who usually cares for the children in your home?
a. Yourself alone
b. Yourself and someone else
c. Someone else
d. Not applicable/no children under 17 in the home
5. Who usually plans social arrangements such as get-togethers with family and friends?
a. Yourself alone
b. Yourself and someone else
c. Someone else
6. Who usually looks after your personal finances‚ such as banking or paying bills?
a. Yourself alone
b. Yourself and someone else
c. Someone else
7. Approximately how many times a month do you usually participate in shopping outside your home? [Approximately how many times in the past month have you gone shopping?]
a. Never
b. 1-4 times
c. 5 times or more
8. Approximately how many times a month do you usually participate in leisure activities such as movies‚ sports‚ restaurants‚ etc. [Approximately how many times in the past month have you done leisure activities such as sports‚ restaurants‚ etc.?]
a. Never
b. 1-4 times
c. 5 times or more
9. Approximately how many times a month do you usually visit your friends or relatives? [Approximately how many times in the past month have you visited family or friends?]
a. Never
b. 1-4 times
c. 5 times or more
10. When you participate in leisure activities‚ do you usually do this alone or with others?
a. Mostly alone
b. Mostly with friends who have head injuries
c. Mostly with family members
d. Mostly with friends who do not have head injuries
e. With a combination of family and friends
11. Do you have a best friend with whom you can confide?
a. Yes
b. No
12. How often do you travel outside the home?
a. Almost every day
b. Almost every week
c. Seldom/never (less than once/month)
13. Please choose the answer below that best corresponds to your current work situation during the past month:
a. Full-time (more than 20 hours/week)
b. Part-time (less than or equal to 20 hours/week)
c. Not working‚ but actively looking for work
d. Not working‚ not looking for work
e. 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:
a. Full-time
b. Part-time
c. Not attending school or training program
15. In the past month‚ how often do you engage in volunteer activities?
a. Never
b. 1-4 times
c. 5 times or more
91 for individuals and .97 for family members’ assessment ofindividuals. Additionally‚ reliability coefficients were .93 (individual) and .96 (familymember) for home integration‚ .86 (individual) and .90 (family member) for socialintegration‚ and .83 (individual) and .97 (family member) for integration into productiveactivities (Willer et al.‚ 1993)
Home integration is measured in items 1 through 5‚ social integration is measured in items 6 through 11‚ and individual productivity is measured in items 12-15
Willer‚ B.‚ Rosenthal‚ M.‚ Kreutzer‚ S.‚ Gordon‚ A.‚ & Rempel‚ R. (1993). Assessment of community integration following rehabilitation for traumatic brain injury. Journal of Head Trauma Rehabilitation‚ 8(2)‚ 75-87.
Willer‚ B.‚ Ottenbacher‚ K.‚ & Coad‚ M.L. (1994). The community integration questionnaire: A comparative examination. American Journal of Physical Medicine and Rehabilitation‚ 73‚ 103-111.
Sander‚ A.‚ Seel‚ R.‚ Kreutzer‚ J.‚ Hall‚ K.‚ High‚ W.‚ & Rosenthal‚ M. (1997). Agreement between persons with traumatic brain injury and their relatives regarding psychosocial outcome using the community integration questionnaire. Archives of Physical Medicine and Rehabilitation‚ 78‚ 353-357.
McColl‚ M.‚ Carlson‚ P.‚ Johnston‚ J.‚ Minnes‚ P.‚ Shue‚ K.‚ Davies‚ D.‚ & Karlovits‚ T. (1998). The definition of community integration: Perspectives of people with brain injuries. Brain Injury‚ 12‚ 15-30.
Mccoll‚ M. A.‚ Davies‚ D.‚ Carlson‚ P.‚ Johnston‚ J.‚ Minnes‚ Patricia.‚ (2001). The community integration measure: Development and preliminary validation.
Minnes‚ Patricia.‚ Carlson‚ P.‚ Mccoll‚ M. A.‚ Nolte‚ M. L.‚ Johnston‚ J.‚ & Buell‚ Katherine. (2003). Community integration: a useful construct‚ but what does it really mean? Brain Injury‚ 12(2)‚ 149-159.
Agonis‚ Julianne. (2012). Family Resiliency‚ Family Needs And Community Re-Integration In Persons With Brain Injury. Florida Atlantic University‚ Doctoral dissertation
