This form structure is an organized set of data definitions for a copyrighted form

 General Details

Title:
Child and Adolescent Scale for Environment (CASE)
Short Name:
CASE
Description:
The Child and Adolescent Scale for Environment (CASE) consists of 18 items that measure environmental problems that might hinder a childÂ’s participation at home, school, and in the community. These problems may be physical, social, or attitudinal problems in the community, including lack of resources, crime, and negative perceptions of others. The scale is an adaptation of the Craig Hospital Inventory of Environment Factors (CHIEF). The CASE is completed by the parent and can be administered in about 5 minutes. Copyright 2011 Bedell G. The Child and Adolescent Scale of Environment (CASE): Administration and scoring guidelines. Available online at: http://sites.tufts.edu/garybedell/measurement-tools/ (Last accessed 6 May 2013) Bedell, G. (2004). Developing a follow-up survey focused on participation of children and youth with acquired brain injuries after inpatient rehabilitation. NeuroRehabilitation, 19, 191-205.
Disease:
General (For all diseases) , Traumatic Brain Injury
Organization:
NIH/CIT/BRICS
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-10-11
Owner:
Number of Data Elements:
42
eForms:
N

 Documentation


 Groups & Attached Data Elements

Logically grouped data elements with defined frequency at which they repeat.

# Title Short Description Variable Name Required? Type
1 GUID   Global Unique ID which uniquely identifies a subject GUID Required CDE
2 Subject identifier number   An identification number assigned to the participant/subject within a given protocol or a study. SubjectIDNum Optional CDE
3 Age in years   Value for participant's subject age recorded in years. AgeYrs Recommended CDE
4 Vital status   Status of participant/subject as alive or dead VitStatus Optional CDE
5 Visit date   Actual interview or visit date VisitDate Recommended CDE
6 Site name   The name of the site for the study SiteName Recommended CDE
7 Days since baseline   The number of days since baseline DaysSinceBaseline Optional CDE
8 Case control indicator   Indicator of whether subject is in the case or control arm of the study CaseContrlInd Optional CDE
9 General notes text   General notes GeneralNotesTxt Optional CDE

Additional Element Groups

Listed below are your additional element groups.

Form Administration (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Language form administration ISO code  Code (ISO 639-2) for the language that was used for CRF/instrument/scale/etc. administration LangCRFAdministratISOCode Recommended CDE
2 Language form administration ISO code other text  The free-text field related to 'Language used for CRF/instrument/scale/etc. administration ISO code' specifying other text. LangCRFAdministratISOCodeOTH Recommended CDE
3 Context type  The context to which the questions were answered ContextType Recommended CDE
4 Context type other text  The free-text related to ContextType specifying other text ContextTypeOTH Recommended CDE
5 Data source  Source of the data provided on the case report form DataSource Recommended CDE
6 Data source other text  The free-text field related to Data source specifying other text. Source of the data provided on the case report form DataSourceOTH Recommended CDE

Child and Adolescent Scale for Environment (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Child and Adolescent Scale of Environment (CASE) - School work question type  The type of setting relating to the school or work question being asked, as part of the as part of the Child Adolescent Scale of Environment (CASE) CASESchoolWorkQuesTyp Recommended CDE
2 Child and Adolescent Scale of Environment (CASE) - Home design layout problem scale  The scale relating to the child having a problem with the design or layout of his/her home, as part of the Child Adolescent Scale of Environment (CASE) CASEHomeDesLayProbScl Recommended CDE
3 Child and Adolescent Scale of Environment (CASE) -Community building place design layout problem scale  The scale relating to the child having a problem with the design or layout of buildings or places that he or she uses in his/her community of neighborhood, as part of the Child Adolescent Scale of Environment (CASE) CASEBuildPlaceDesLayProbScl Recommended CDE
4 Child and Adolescent Scale of Environment (CASE) - School work design layout problem scale  The scale relating to the child having a problem with the design or layout of his/her school or workplace, depending on which is selected, as part of the Child Adolescent Scale of Environment (CASE) CASESchoolWorkDesLayProbScl Recommended CDE
5 Child and Adolescent Scale of Environment (CASE) - Child community support encouragement lack scale  The scale relating to the child lacking support or encouragement in his/her community or neighborhood, as part of the Child Adolescent Scale of Environment (CASE) CASEChldComtySuprtEncLackScl Recommended CDE
6 Child and Adolescent Scale of Environment (CASE) - Child school work support encouragement lack scale  The scale relating to the child lacking support or encouragement at school or work, depending on which is selected, as part of the Child Adolescent Scale of Environment (CASE) CASEChldSchWorkSuprtEncLackScl Recommended CDE
7 Child and Adolescent Scale of Environment (CASE) - School work attitude towards child problem scale  The scale relating to there being a problem with other people's attitudes towards the child at school or work, depending on which is selceted, as part of the Child Adolescent Scale of Environment (CASE) CASESchWorkAttTowChldProbScl Recommended CDE
8 Child and Adolescent Scale of Environment (CASE) - Community attitude towards child problem scale  The scale relating to there being a problem with other people's attitudes towards the child in his/her community or neighborhood, as part of the Child Adolescent Scale of Environment (CASE) CASEComtyAttTowChldProbScl Recommended CDE
9 Child and Adolescent Scale of Environment (CASE) - Inadequate lack of assistive device equipment scale  The scale relating to there being an inadequate amount or lack of assistive devices or equipment for the child, as part of the Child Adolescent Scale of Environment (CASE) CASEInadLackAssistDevEquipScl Recommended CDE
10 Child and Adolescent Scale of Environment (CASE) - Inadequate lack of assistance people home community scale  The scale relating to there being an inadequate amount or lack of assistance from people at home or in the child's community or neighborhood, as part of the Child Adolescent Scale of Environment (CASE) CASEInadLackAsstHomeComScl Recommended CDE
11 Child and Adolescent Scale of Environment (CASE) - Inadequate lack of assistance people school work scale  The scale relating to there being an inadequate amount or lack or assistance from people at school or work, depending on which is chosen, as part of the Child Adolescent Scale of Environment (CASE) CASEInadLackAssPplSchoWorkScl Recommended CDE
12 Child and Adolescent Scale of Environment (CASE) - Inadequate lack of transportation scale  The scale relating to there being an inadequate amount or lack of transportation for the child, as part of the Child Adolescent Scale of Environment (CASE) CASEInadLackTrsptScl Recommended CDE
13 Child and Adolescent Scale of Environment (CASE) - Inadequate lack of program service school scale  The scale relating to there being an inadequate amount or lack of programs or services for the child at school, as part of the Child Adolescent Scale of Environment (CASE) CASEInadLackProgServSchoolScl Recommended CDE
14 Child and Adolescent Scale of Environment (CASE) - Inadequate lack of program service community scale  The scale relating to there being an inadequate amount or lack of programs or services for the child in his/her community or neighborhood, as part of the Child Adolescent Scale of Environment (CASE) CASEInadLackProgSrvcComtyScl Recommended CDE
15 Child and Adolescent Scale of Environment (CASE) - Inadequate lack of family finance scale  The scale relating to the child's family having inadequate or a lack of family finances, as part of the Child Adolescent Scale of Environment (CASE) CASEInadLackFmlyFinScl Recommended CDE
16 Child and Adolescent Scale of Environment (CASE) - Family stress scale  The scale relating to the child having stress from his/her family, as part of the Child Adolescent Scale of Environment (CASE) CASEFmlyStressScl Recommended CDE
17 Child and Adolescent Scale of Environment (CASE) - Crime violence community neighborhood scale  The scale relating to crime or violence in the community or neighborhood, as part of the Child Adolescent Scale of Environment (CASE) CASECrmVlCmmNghScl Recommended CDE
18 Child and Adolescent Scale of Environment (CASE) - Government agency policy problem scale  The scale relating to child having problems with government agencies and policies, as part of the Child Adolescent Scale of Environment (CASE) CASEGovtAgenPolicyProbScl Recommended CDE
19 Child and Adolescent Scale of Environment (CASE) - Inadequate lack of information child diagnosis condition intervention approach scale  The scale relating to there being an inadequate amount or lack of information about the child's diagnosis or condition or interventions or approaches, as part of the Child Adolescent Scale of Environment (CASE) CASEInaLacInfChiDiaConIntApScl Recommended CDE
20 Child and Adolescent Scale of Environment (CASE) - Problem comment other text  The free-text field describing any other problems or comments about the child, as part of the Child Adolescent Scale of Environment (CASE) CASEProbCommOTH Recommended CDE
21 Child and Adolescent Scale of Environment (CASE) - Physical social environment support description text  The free-text field identifying the physical or social aspects of the environment or qualities about the services that child receives that are supportive or helpful to child, as part of the Child Adolescent Scale of Environment (CASE) CASEPhysSocEnvirDescTxt Recommended CDE

Child and Adolescent Scale for Environment Scoring (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Child and Adolescent Scale of Environment (CASE) - Total item level score  The total of the current score based item-level scores, as part of the Child Adolescent Scale of Environment (CASE). CASETotalItemLevelScore Recommended CDE
2 Child and Adolescent Scale of Environment (CASE) - Total summary score  The total summary score is summing the items responses that are applicable and dividing by maximum possible score and then multiplying this number by 100 to conform to a 100-point scale. CASETotalSummaryScore Recommended CDE
3 Child and Adolescent Scale of Environment (CASE) - Composite 5-item school score  The total score of 5- item questions for children who are in school only, as part of the Child Adolescent Scale of Environment (CASE). CASEComposite5ItemSchoolScore Recommended CDE
4 Child and Adolescent Scale of Environment (CASE) - Composite children youth score  The total composite score for applicable for all children and youth, as part of the Child Adolescent Scale of Environment (CASE). CASECompositeChildYouthScore Recommended CDE
5 Child and Adolescent Scale of Environment (CASE) - Composite 4-item youth transition score  The total score for 4-item questions applicable only to youth in transition to work, as part of the Child Adolescent Scale of Environment (CASE). CASEComposit4ItemYouthTrnScore Recommended CDE
6 Child and Adolescent Scale of Environment (CASE) - Composite youth transition score  The total of the current score based item-level scores for a subsection, as part of the Child Adolescent Scale of Environment (CASE). CASECompositeYouthTransScore Recommended CDE

 Change History

 Administrative Change History