The School Function Assessment: Identifying Levels of Participation and Demonstrating Progress for Pupils with Acquired Brain Injuries in a Residential Rehabilitation Setting
The following shows the prices of the School Function Assessment (SFA) kits and components, which (like stated above) have not changed since 2017:
SFA Complete Kit: $243.50
SFA User’s Manual: $151.50
SFA Record Forms: $102.50
SFA Rating Scale Guides: $25.00
Article Summary:
Article Title: The School Function Assessment: Identifying Levels of Participation and Demonstrating Progress for Pupils with Acquired Brain Injuries in a Residential Rehabilitation Setting
Citation:
West S, Dunford C, Mayston MJ, Forsyth R. The School Function Assessment: identifying levels of participation and demonstrating progress for pupils with acquired brain injuries in a residential rehabilitation setting. Child: Care, Health and Development. 2013;40(5):689-697. doi:10.1111/cch.12089.
Category: Evaluative
Purpose of the Article: Rehabilitation and educational planning for children who have acquired a severe brain injury (ABI) is very complex and multifaceted. There are many medical professionals working with these children initially; however, once discharged these children are often placed in a generic community setting where teachers are often not equipped to work with them. There is a 24 hour residential rehabilitation program called The Children’s Trust (TCT) (located in the UK) that is designed for children with an ABI. This program provides a multi-disciplinary approach to therapy as well as focusing on reintegrating the child to a home and school environment. The School Function Assessment (SFA) has been shown to be valid and reliable for children with disabilities, and was selected for this study to measure functional school-based tasks. One thing to note was that the SFA was used to assess all of the pupils at the TCT (both elementary and high school age), due to it providing the greatest comprehensive assessment of participation. There were two primary purposes of this study:
- Explore the SFA’s ability to identify participation in school based functional tasks.
- Demonstrate progress in a residential rehabilitation setting for students with an ABI.
Study Population: Any student who had been admitted to the TCT between January 2007 and October 2011 participated in this study. From that timeframe, seventy students were included in the study with varying ABI’s: 31 traumatic brain injuries, 29 non-traumatic brain injuries, and 10 anoxic brain injuries. The ages ranged from 4.5-17.2 years old and the study included 42 boys and 28 girls. Additionally, the time since their injury ranged as well as their weeks in rehabilitation, 4-149 weeks and 4-95 weeks respectively. The TCT Research Scrutiny Panel reviewed the project and determined that this study did not require any external ethical approval.
Methods and Intervention: The SFA was completed by the teachers and primary therapists (physiotherapist, speech and language therapist, and occupational therapist) working with the student, and was completed at both admission and discharge. The therapists and teachers that evaluated the students underwent a training session by the head teacher and senior therapist to ensure they understood how to properly evaluate the students prior to starting the study. Following the training, the individual teams (for their specific student) met to discuss and determine a score in each area. Responsibility for each section was allotted and specified overtime. Finally, the key therapist and teacher were always responsible for completing the SFA on admission and discharge; however, if one of the key teachers or therapists left then this was not possible. The main objective of using the SFA was to see if it could identify each student’s level of participation in a residential rehabilitation setting while receiving multi-disciplinary interventions (ex: therapy from speech and language pathologists, occupational therapists, and physiotherapists).
Outcome Measures: The SFA is a judgement-based questionnaire that was administered by professionals who directly observed the students in various settings. The SFA was designed to help identify target areas (within the realm of participation, task supports, and activity performance) when writing individual education plans (IEPs). On the SFA the skills are scored out of 4 (1 = does not perform 2 = partial performance, 3 = inconsistent performance, and 4 = consistent performance), then the raw scores are converted into criterion scores (the maximum score is 100).
Results: Between-group differences in age, time post injury, and weeks in rehabilitation were determined by the Kruskal-Wallis test. Differences on admission and discharge for participation, task supports and performance scores, was determined by a linear mixed effects model. For all the tests a significance level of P < 0.05 was set. The anoxic brain injury group spent significantly longer in rehabilitation (p=0.03); however, there was no significant difference in weeks in rehabilitation between the non-traumatic and TBI group (p>0.05). There was no significant difference in the time following the injury to being admitted into therapy between all of the groups (p=0.35). And there was no significant age difference between the anoxic brain injury and the non-traumatic brain injury group (p>0.05); however, the TBI group was significantly older (p=0.001). There was a significant difference when comparing the SFA scores from admission to discharge (scores for participation, physical and cognitive assistance and adaptation, and activity performance) (p<0.05), and 54/70 students showed progress with their ability to participate in school activities. However, there were 3 students who’s ability to participate in school activities declined. There were four students who showed no progress in “participation” (of the SFA), but did show improvements in “task supports” and “activity performance”. For example, one student showed the ceiling effect scoring 100/100 in several parts of “task supports” and “activity participation” at both admission and discharge, but did not show any improvement in the “participation” component. Additionally, nine students scored a zero in “participation” and in the majority of “task supports” and “activity performance” at both admission and discharge; interestingly 6/9 of these students had anoxic brain damage. The authors also included how the SFA could be used to support the writing of an IEP and describing the student’s level of participation in school-based activities.
Major Strengths: (1) They used the SFA to identify IEP targets areas with school-based activities thus providing the therapists and educators with an avenue to implement a plan of action for these students. (2) Those administering the SFA underwent extensive training with the head teacher and senior therapist to ensure they knew how to properly evaluate the students. (3) They kept the same evaluator for the individual students on admission and discharge (to the best of their ability).
Major Limitations: (1) The study utilized the SFA which has been validated in elementary school students not for high school aged student. It is not clear how the age discrepancies affected the scores of the SFA. Additionally, a ceiling effect was noted in this study, however, it was not clear if the older students were the ones who achieved the ceiling effect or not. (2) There was almost double the amount of male students compared to females which may affect the generalizability of this study. (3) Due to this study not having a control, it is difficult to determine if the improvements noted were due to the rehabilitation program or the nature of the ABI recovery process. (4) Follow-up measures (after discharge) should have been implemented to determine if the “concern areas” that were targeted, based on the SFA outcomes, translated into long-term gains.
Conclusion: The SFA proved to be a valuable tool for this setting, particularly at recognizing areas where the student may have difficulty (i.e. in areas of participation and school-based activities). Additionally, the SFA proved helpful in identifying goals for education and therapy as well as setting IEP targets/goals. By being able to identify cognitive and physical areas of concern, the teachers and therapists were able to implement targeted goals to address each student’s deficit area(s). Individuals with ABI present in a diverse way both cognitively and physically making treatment difficult, using the SFA can be an important tool to describe the individual’s needs thus giving the therapists and educators a framework of their limitations and the support they will need.
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