School Function Assessment

Last Updated

April 14, 2017

Expertise, Instruction and Mentorship

Center for Smart Use of Technologies to Assess Real World Outcomes (C-STAR)

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Upcoming Stroke Course

May 9–10
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Offered by Academy, Shirley Ryan AbilityLab

Purpose

Evaluate and monitor a student’s participation, support needs, and performance of functional (nonacademic) tasks and activities that affect academic and social aspects of school environment.

Link to Instrument

Instrument Details

Acronym SFA

Area of Assessment

Activities of Daily Living
Aerobic Capacity
Assertiveness
Attention & Working Memory
Balance – Non-vestibular
Balance – Vestibular
Behavior
Cognition
Developmental
Dexterity
Executive Functioning
Functional Mobility
Gait
Infant & Child Development
Insight
Language
Motivation
Occupational Performance
Personality
Quality of Life
Range of Motion
Reading Comprehension
Reasoning/Problem Solving
Seating
Self-efficacy
Sleep
Social Relationships
Social Support
Stress & Coping
Swallowing
Taste
Touch
Upper Extremity Function
Vestibular
Vision & Perception

Assessment Type

Performance Measure

Administration Mode

Paper & Pencil

Cost

Not Free

Actual Cost

$243.50

Cost Description

SFA User's Manual ONLY: $151.50
SFA Record Forms ONLY: $102.50
SFA Rating Scales Guides ONLY: $25.00

Pediatric Disorders

The SFA consists of three parts (Participation, Task Performance, Activity Performance) with 316 items total.
For the items addressing Participation, the minimum score given is 1 and the maximum score is 6.
For Task Performance and Activity Performance the minimum score is 1 and the maximum score is 4.
For each setting, task or activity a raw score is calculated by adding the score for all items in that section.
Using the Rating Scale Guide, the raw score is converted to a criterion score associated with a standard error.
The criterion score is then compared to a criterion cut-off-score (depending on the child’s grade) provided on the last page of the SFA Record Form.
The entire assessment can be administered or scales can be selected depending on the child’s needs.
Refer to manual for complete administration instructions.

Number of Items

Part I: 6 items

Part II: 18 items (9 Physical Tasks & 9 Cognitive Behavior Tasks)

Part III: 292 items (21 separate scales based on Part II)

User's Manual
Rating Scales Guide
Record Form

90-120 minutes

Each individual scale is administered in 5-10 minutes

Required Training

No Training

Children

6 - 12

years

Instrument Reviewers

Initially reviewed by University of Illinois at Chicago Master of Science in Occupational Therapy students Luz Chaheine, Hannah Gin, and Kaori Ogden.

ICF Domain

Activity
Participation

Measurement Domain

Activities of Daily Living
Cognition
Emotion
Motor
Sensory

Professional Association Recommendation

The Pediatrics section of the American Physical Therapy Association, the Centers for Disease Control and Prevention, and the American Occupational Therapy Association recommend the use of the School Function Assessment.

Standard Error of Measurement (SEM)

School Aged Children with Cerebral Palsy, Down Syndrome, Other Genetic Disorders, and Global Developmental Delays: (Effgen et al., 2016; n = 296; Mean Age 7.3 (2.02)).

SEM varies by criterion score and scale within the following ranges: below -5; -5 to 5; and above 5.

Cut-Off Scores

Criterion cut-off scores are provided when scoring for grades K to 3 and grades 4 to 6.

Test/Retest Reliability

First to Fifth Grade Students with Cerebral Palsy including Spastic Hemiplegia, Spastic Diplegia, Spastic Triplegia, Spastic Quadriplegia: (Li, Dong, & Fong, 2015; n = 93; mean Age 11.3 (2.7); Chinese sample)

Adequate test-retest reliability: (ICC = [.49, .97])

School-aged Children with Developmental Disabilities, Multiple Disabilities, Learning Disabilities, Orthopedic Impairment, Autism, Visual Impairments, Serious Emotional/Behavioral Disturbances, Speech/Language Impairment, Deafness, Developmental Delays, Chronic Health Problems, and Other Disabilities: (Hwang, 2005; n = 320; mean Age = 9.2 (2.0); Chinese sample)

Excellent test-retest reliability: (ICC = [.87, .98] among scales)

Students Aged 7 to 10 with Poor Handwriting Legibility: (Case-Smith, 2002; n = 29)

Excellent test-retest reliability: (ICC = [.80, .98])

Special Education Students: (Coster, Deeney, Haltiwanger, & Haley, 1998; n = 23, Mean Age 8.6)

Excellent test-retest reliability: (ICC = [.82, .98])

Interrater/Intrarater Reliability

Students in Grades K through 7 with Disabilities (Davies, Soon, Young, & Clausen-Yamaki, 2004; n = 35)

Adequate interrater reliability for Participation (ICC = 0.70)
Adequate interrater reliability for Task Supports (ICC = 0.68)
Adequate interrater reliability for Performance (ICC = 0.73)

Internal Consistency

School-aged Children with Cerebral Palsy (CP): (Li, Dong, & Fong, 2015)

Excellent internal consistency: [.91, .96]

School-age children with disabilities: (Hwang, 2005)

Excellent internal consistency: [.94, .98] for each scale

Special Education Students: (Coster, Deeney, Haltiwanger, & Haley, 1998)

Excellent internal consistency: [.92, .98]

Students with Poor Handwriting Legibility: (Case-Smith, 2002)

Excellent internal consistency: [.92, .98]

School-aged Children with Cerebral Palsy (CP) and Motor Patterns Consistent with Spastic Diplegia: (Rabinovich, Patel, Gates, & Otsuka, 2015; n = 103; 11.75 (3.25))

Excellent internal consistency: [.92, 98]

Criterion Validity (Predictive/Concurrent)

School-aged Children with Cerebral Palsy (CP): (Rabinovich et al., 2015)

Spearman’s rank correlation comparing SFA to GMFCS showed a significant correlation between the composite SFA criterion score and GMFCS class (r = -0.847, p < 0.02).
Analysis between the mean score of each SFA subscale and respective GMFCS levels exhibited statistically significant correlations for many of the subscales.

Construct Validity

Students with Disabilities: (Coster et al., 1998)

ANOVA mean ratings across setting was significant (F(6,209) = 36.86, p<.0001)

School-aged Children with Cerebral Palsy (CP) Including Diplegia, Hemiplegia, Triplegia, Quadriplegia, and Unspecified Types: (Gates, Otsuka, Sanders, & McGee-Brown, 2008; n = 102: Mean Age 11.8 (3.3))

PODCI predicted performance in all 31 subscales of the SFA when comorbidity subscales were included (r = .35-.64).

Content Validity

If the participation scale is a valid global measure of function, then individual performance should vary across the different settings. Repeated measures ANOVA on Mean ratings across settings was significant (F(6,209) = 36.86, p < .0001)

Floor/Ceiling Effects

Students with Acquired Brain Injury (ABI) Including Non-traumatic Brain Injury, Anoxic Brain Injury, and Traumatic Brain Injury: (West, Dunford, Mayston, & Forsyth, 2014; n = 70; mean age = 12.8; median [range] weeks post-ABI = 22.0 [4, 149])

Adequate floor & ceiling effects
Ceiling effect was evident in one student, scoring 100/100 on admission and discharge in several areas of Part I and II.
Ceiling effect occurred in 4% of the scores, with 3% within Part III: Activity Performance & Physical tasks.

Bibliography

Case-Smith, J. (2002). Effectiveness of school-based occupational therapy intervention on handwriting. The American Journal of Occupational Therapy: Official Publication of the American Occupational Therapy Association, 56(1), 17-25. https://doi.org/ 10.5014/ajot.56.1.17

Coster, W., Deeney, T., Haltiwanger, J., & Haley, S. (1998). School Function Assessment User’s Manual. San Antonio, TX: The Psychological Corporation/Therapy Skills Builders.

Davies, P.L., Soon, P.L., Young, M., & Clausen-Yamaki, A. (2004). Validity and reliability of the School Function Assessment in elementary school students with disabilities. Physical & Occupational Therapy in Pediatrics, 24(3), 23-43. https://doi.org/ 10.1300/J006v24n03_03

Effgen, S.K., Westcott-McCoy, S., 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 [including commentary by Laurie Ray]. Pediatric Physical Therapy, 28(4), 371-379. https://doi.org/ 10.1097/PEP.0000000000000279

Gates, P.E., Otsuka, N.Y., Sanders, J.O., McGee-Brown, J. (2008). Relationship Between Parental PODCI questionnaire and School Function Assessment in measuring performance in children with CP. Developmental Medicine & Child Neurology, 50, 690-695. https://doi.org/ 10.1111/j.1469-8749.2008.03011.x

Hwang, J. (2005). The reliability and validity of the School Function Assessment: Chinese version. OTJR: Occupation, Participation & Health, 25(2), 44-54. https://doi.org/ 10.1177/153944920502500202

Jeng-Liang, H., & Davies, P.L. (2009). Rasch analysis of the School Function Assessment provides additional evidence for the internal validity of the activity performance scales. American Journal Of Occupational Therapy, 63(3), 369-373. https://doi.org/10.5014/ajot.63.3.369

Li, X., Dong, V.A., & Fong, K.N. (2015). Reliability and validity of School Function Assessment for children with cerebral palsy in Guangzhou, China. Hong Kong Journal Of Occupational Therapy, 2643-50. https://doi.org/10.1016/j.hkjot.2015.12.001

Rabinovich, R.V., Patel, N.V., Gates, P.E., & Otsuka, N.Y. (2015). The relationship between the School Function Assessment (SFA) and the Gross Motor Function Classification System (GMFCS) in ambulatory patients with cerebral palsy. Bulletin of the Hospital for Joint Disease (2013), 73(3), 204-209.

Sakzewski, L., Boyd, R., & Ziviani, J. (2007). Clinimetric properties of participation measures for 5- to 13-year-old children with cerebral palsy: A systematic review. Developmental Medicine and Child Neurology, 49(3), 232-240. https://doi.org/10.1111/j.1469-8749.2007.00232.x

West, S., Dunford, C., Mayston, M.J., & Forsyth, R. (2014). 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, 40(5), 689-697. https://doi.org/10.1111/cch.12089