School Functional Assessment (SFA) 2017
These are the prices of the SFC kits and components as of 2018. These prices have not updated since 2017:
SFA Complete Kit: $243
SFA User’s Manual: $151.50
SFA Record Forms: $102.50
SFA Rating Scale Guidelines: $25
Reference: Effgen, S. K., Mccoy, S. W., Chiarello, L. A., Jeffries, L. M., Starnes, C., & Bush, H. M. (2016). Outcomes for Students Receiving School-Based Physical Therapy as Measured by the School Function Assessment. Pediatric Physical Therapy,28(4), 371-378. doi:10.1097/pep.0000000000000279
Title: Outcomes for Students Receiving School-Based Physical Therapy as Measured by the School Function Assessment
Category: Evaluative
Purpose: This article describes the SFA as a standardized assessment established to examine the participation and functional performance in school aged children from kindergarten to 6th grade, who have disabilities. It is a judgement-based assessment, measuring change over a period of time and identifying the individuals’ functional limitations. Therefore, this assessment is considered both evaluative and discriminative. This article also reveals that there are three areas the FAS focuses on: level of activity, amount of support needed, and performance in the school during the student’s daily routines. There were 2 purposes associated with the design of this study. Purpose 1: to report the descriptive results of FSA outcome measures, following 6 months of school-based physical therapy with the participants. The associated outcome measures were as follows: “Participation, Task Supports; Clothing Management, Eating and Drinking, Hygiene; Maintaining and Changing Positions; Manipulation with Movement, Travel; and Recreational Movement.” Purpose 2: examination of the effects of functional mobility level and age on the outcomes related to the SFA.
Population: There was a total of 296 students between 5-12-years-old, who were determined to have disabilities. These participants were recruited from 28 school systems throughout a total of 28 states in the USA. In addition, there was a total of 109 physical therapists (PT’s) recruited and trained to assist in the study.
Methods and Intervention: The study involved administering the SFA to each of these students at the beginning of the school year, and then again 6 months later. Within the 6 months, students were treated with school-based physical therapy interventions, which were not described in the article. Adequately achieving these goals required the study to be conducted over a 2-year period. The first year involved recruiting and training of the physical therapists on research ethics, data collection, and administration of the outcome measures to increase the reliability of the results of the study. Following training, the therapists were required to take and pass a test on each of these three components. Next, the physical therapists recruited students and began the data collection during the second year of the study, which ran from fall of 2012 into the 2013 school year.
Outcome measures: Outcome measures included the Gross Motor Function Classification System (GMFCS) and the School Function Assessment (SFA). The GMFCS was used to develop insight into the functional ability of each of the students recruited for the study. The SFA consists of a 3-part system, and each assess a variety of functional components of the child during a typical school day. Part 1 examines the student’s participation in 6 different settings and rates the results on the Likert scale from 1-6. Part 2 and 3 is rated on a Likert scale from 1-4. Each of the raw total scores were calculated and then converted into criterion scores.
Data Analysis and Results: Criterion score of the SFA scale was divided into the following three categories, which were based on the outcomes’ standard error measurement (SEM): those below -5, which were considered to have regressed; those from -5 to 5; and those above 5, who were considered to have improved. There was suggested improvement in 37-51% of students, with most improvement in the following areas: Task Support Adaptations, Manipulation with Movement, Participation, and Maintaining and Changing Position. Comparison between age and GMFCS interaction and single effects was also analyzed, using ANCOVA’s. Although all of the ANCOVA analyses were statistically significant, there were no suggested interactions between the GMFCS and age. Single effect differences between age groups had significant effects in the following areas: Maintaining and Changing Positions, Hygiene, Participation, Clothing Management, and Recreational Movement. Higher change in scores was most closely correlated with ages 5-7. Single effect differences in GMFCS occurred in all scales but travel. Only 2-8% of students showed regression in Task Support: Assistance. Based on these results, it is suggested that most students improved in Participation and Maintaining and Changing Positions.
Strengths: (1) The study took a great deal of care into ensuring reliability of the results through extensive training and assessment of the physical therapists. (2) There was a large sample size. (3) There was adequate time (6 months) for therapeutic improvements given between the administration of the SFA. (4) Age groups and sex of student participants were relatively balanced, increasing generalizability to these populations.
Limitations: (1) The study was unclear as to who was administering the physical therapy and what type of physical therapy was being administered to these students throughout the school year. I was curious as to whether the same physical therapists administering the SFA, were the ones providing the therapy. (2) There was no assessment of how accurate the physical therapist’s completion of the students SFA scores were. (3) GMFCS was used as an assessment tool on all of the individuals in the study, however, it has only been supported as a measurement tool for children with cerebral palsy. (4) The standard error measurement (SEM) tool was found to have affected interpretation of the results, because most of the participants did not exceed the SEM. (5) Lastly, race/ethnicity for the student population primarily consisted of white/non-Hispanic students, decreasing generalizability to various races/ethnicities.
Discussion and Conclusion: Based on the results of the study, we can see that school aged students do not improve as much in the ADL’s as some of the other areas, such as Participation, Travel, and Maintaining and Changing Positions. It is thought that this may be due to the lack of intervention with ADL’s by the school physical therapists. With that said, there were only a few students who demonstrated signs of regression, which was correlated to new medical problems. We also learned of suggested age ranges to expect greater improvements, indicating that utilizing SFA may be more beneficial for a more concise set of age ranges. Overall, the results of this study suggest positive gains in the majority of the students, and emphasize the importance of considering how and with whom we utilize the SFA tool as physical therapists.
5 responses to “School Functional Assessment (SFA) 2017”
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Great summary Laura! It’s concise and your formatting make it easy to read.
I am a bit confused about the their first stated purpose “to report the descriptive results of FSA outcome measures, following 6 months of school-based physical therapy with the participants.” Is the intention here to assess the PT intervention or to analyze the descriptive qualities of the SFA? Without a comparative group little can be said of the intervention, and without example of SFA descriptive terminology, it’s hard for me grasp the applicability of the study.
Thank you Steven! There was actually no information of who or how intervention was conducted, though it does indicate that there was some type of intervention provided within this 6 month period. This was one of the greatest limitations to the study in my opinion. I do understand what you are saying about the comparative group, and from what I gathered when reading the article, the first purpose was to analyze and report the outcomes of the School Functional Assessment (SFA) and reporting those results for each of these students from their baseline to 6 months after. Then, the second purpose, was to assess variables such as how many regressed/improved, correlation between functional mobility (GMFCS scores) and SFA, and what age ranges were showing the most improvement according to the SFA.
That helps a lot, thanks again!
I had a similar/related concern about the physical therapy intervention. I understand that the article purpose (#2) is to examine the effects of functional mobility, level, and age on the outcomes related to the SFA. I would think that the interventions specifically have a role to play in the effects of functional mobility and ultimately affect the SFA. I think the diagnoses are also an important factor– What if the diagnosis is one that has a progressive nature? I think there a few missing links for me in this article but I can see what the authors were intending to convey!
Excellent point Rebecca! Those were my exact thoughts when reflecting on the article. When looking further into the article, it does state, “Greater details on the methods of the larger study can be found in Effgen et al.10” The reference is provided below if you are interested in greater details of the study! I read through the intervention portion of this, and it is much more detailed on how they accounted for discrepancies in the intervention. Here is a direct full-text link, if either of you are interested in diving deeper into the study: https://journals.lww.com/pedpt/fulltext/2016/28010/Physical_Therapy_Related_Child_Outcomes_in_School_.13.aspx
Reference: Effgen SK, Westcott McCoy S, Chiarello LA, Jeffries LM, Bush H. Physical therapy-related child outcomes in school: an example of practice based evidence methodology. Pediatr Phys Ther. 2016;28(1):47-56. doi:/PEP.0000000000000197.