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CIQ R Scoring Guidelines

The Community Integration Questionnaire-Revised (CIQ-R) is an 18 question survey that assesses community involvement in several areas such as shopping, meal preparation, housework, social activities, work, school, volunteering, and communication. It asks respondents to indicate if tasks are usually done alone, with others, or by someone else. The questions cover a range of community activities and social contact both within and outside the home.

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45 views2 pages

CIQ R Scoring Guidelines

The Community Integration Questionnaire-Revised (CIQ-R) is an 18 question survey that assesses community involvement in several areas such as shopping, meal preparation, housework, social activities, work, school, volunteering, and communication. It asks respondents to indicate if tasks are usually done alone, with others, or by someone else. The questions cover a range of community activities and social contact both within and outside the home.

Uploaded by

kiara.delucia
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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The Community Integration Questionnaire-Revised (CIQ-R)

Name: Date:

1 Who usually does the 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 yrs in the home)

5 Who usually plans social arrangements such as get-togethers 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

7 Approximately how many times a month do you usually participate in shopping outside your home?

5 or more 1-4 times Never

8 Approximately how many times a month do you usually participate in leisure activities such as movies,
sports, restaurants, etc?

5 or more 1-4 times Never

9 Approximately how many times a month do you usually visit friends or relatives?

5 or more 1-4 times Never

10 When you participate in leisure activities do you usually do this alone or with others?

Mostly alone Mostly with family members Mostly with friends who have a disability

Mostly with friends who do not have a disability With a combination of family and friends

Permission to use the CIQ-R should be requested by contacting Summer Foundation via
email at info@summerfoundation.org.au or Barry Willer at bswiller@buffalo.edu
11 Do you have a best friend in 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 check the answer 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 check the answer 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
Not applicable, retired due to age

15 In the past month, how often did you engage in volunteer activities?

5 or more 1-4 times Never

16 How often do you write to people for social contact using the Internet (e.g., email, social networking sites
such as Facebook)?

Every day / most days Almost every week Seldom / never

17 How often do you talk to people for social contact using an online video link
(e.g. Skype, FaceTime)?

Every day / most days Almost every week Seldom / never

18 How often do you make social contact with people by talking or text messaging using
your phone?

Every day / most days Almost every week Seldom / never

Comments:

Permission to use the CIQ-R should be requested by contacting Summer Foundation via
email at info@summerfoundation.org.au or Barry Willer at bswiller@buffalo.edu

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