School Function Assessment

Original Editor - Kapil Narale

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What it is

The School Function Assessment (SFA) is a comprehensive tool which gathers the ability of students with disabilities to participate in general, daily, school based functional activities. It was designed for primary school children, aged 4-12. It can be used research as an outcome measure or a reference standard.

The assessment helps provide an initial functional measure acting as a baseline, denotes challenging areas, facilitates therapy and education initiatives, and helps to carry out the assessment of a student's special educational accommodations.

The SFA helps identify the depth of support needed by a student when they resume schooling after a brain injury (a TBI (Traumatic Brain Injury) or ABI (Acquired Brain Injury)), with consideration for their strengths and limitations relating to participation in physical and cognitive and educational school-based functional activities. Measurements are taken on admission and on discharge, with an intervention and accommodations implemented in between.

With taking a measurement of the students admission and discharge abilities and performance, the SFA helps demonstrate the progress that was made during the intervention/rehabilitation program. The SFA helps students and their families understand how the brain injury will affect their performance in school, and also to recognise any milestones or achievements of rehabilitation or gaining an ability.

The SFA can be used as a tool to identify and document individual student's needs, to help demonstrate the understanding of the deficits that occur from ABI and TBI.

The Assessment and Scoring

The SFA is an exhaustive subjective based questionnaire. It is completed by professionals who have an understanding and have observed the student in question in the school setting. The individual conducting the test must learn about carrying out the test through the manual, or can learn from an individual experienced in administering the test.

As seen below, the SFA has 21 Activity Performance scales divided into 12 Physical Tasks scales (171 test items) and 9 Cognitive/Behavioral scales (121 test items). However, with all these various measures, it takes about 2 hours for the school professionals or personnel to carry out.

As mentioned, it was designed to identify strengths and weaknesses in participation, and academic and school related concerns and accommodations that may be suitable to include in an individual education plan (IEP). These parts are categorised into the following skills:

Part I: Participation - measures level of participation in 6 settings:

Classroom, playground, transport, toileting, mealtime, and travel around the school site.

Part II: Task Supports -

Physical	assistance
Physical	adaptations
Cognitive/behavioural	assistance
Cognitive/behavioural	adaptations

Part III: Activity Performance -

Physical

Travel
Maintaining & Changing Positions
Recreational Movement
Manipulation with Movement
Using Materials
Set Up & Clean Up
Eating & Drinking
Hygiene
Clothing Management
Up stairs/Down stairs
Written Work
Computer & Equipment Use

Cognitive

Funcitonal Communication
Memory & Understanding
Following Social Conventions
Compliance with Rules
Task/Behaviour Completion
Positive Interaction
Behavioural Regulation
Personal Care Awareness
Safety

Each Skill is scored out of 4 where:

1 = Does not perform

2 = Partial performance

3 = Inconsistent performance

4 = Consistent performance

The scoring can also be from 0 (does not perform or participate) to 100 (full participation/consistent performance).

These scores are converted into criterion categories, which are made up of 3 parts as seen in the lists above:

Part I: Participation - this indicates the degree of the student's participation in six different settings: the classroom, playground, transport, toileting, mealtime, and travel around the school site, e.g. handling tools and materials. This is similar to the participation component from the ICF framework applied to the primary school setting.

Part II: Task Supports - this indicates the degree of the needed support, assistance, or accommodations that the student requires to participate in the school setting. This has two sections: assistance (which is support received from an adult) and adaptations (which are modifications to processes, programs, or the environment). This encompasses both physical and cognitive/behavioural tasks.

Part III: Activity Performance - this is also divided into two sections: 1) physical tasks, which is categorised into 12 areas (such as written work), and 2) cognitive tasks, which is categorised into 9 areas (consisting of memory and understanding).

Reliability & Validity

The SFA is shown to be valid and reliable , have Rasch analysis, and be responsive with the measurement of functional school-based tasks, and to help guide the provision of support for students with disabilities. It is seen to differentiate students on the basis of diagnoses. However this did not work well for the diagnoses of TBI, since there was a wide variability in functional abilities, which would lead to differing scores on the SFA.

In a study by S. West et al (2013), of children with brain injury (TBI and ABI) who were assessed with the SFA, it was shown that 54 of 70 students improved their ability to participate in school activities. With this assessment, significant differences were noted between the admission and discharge SFA scores for participation, physical and cognitive assistance and adaptation, and activity performance (P < 0.05).

The SFA has been sought to be more effective and preferred than the measures of the Pediatric Outcomes Data Collection Instrument, which is designed to include and involve Parents.

The SFA is seen to be very effective, but was not sensitive enough to identify subtle changes made by certain students.

Case Examples

Using SFA to aid in the development of IEPs

A 7-year old boy with a non-traumatic ABI was admitted to the hospital 45 weeks after injury. It was noted that this individual was distracted by both internal and external factors, and needed help focusing for an extended period of time. This individual also displayed visual inattention. The Task Behaviour/Completion was the most affected with a score of 0 on admission.

An IEP goal was directed at having the individual attend to a task for 5 minutes without any assistance.

There were visual supports used, and choice of activity was given to the individual.

With achieving this target after 16 weeks, and other targets in subsequent weeks, his 'Task Behaviour/Completion score improved drastically to 54.

The SFA allowed the IEP target to be achieved, which helped influence his capability to participate in school activities and accomplish tasks on his own.

Using SFA to support advice for special educational needs

A 13 year old girl with a non-traumatic brain injury, who had difficulty with fine-motor skills, had 20 week so of rehabilitation and was assessed with the SFA. As she presented with ataxia, and received the necessary intervention, her scores on 'Manipulation with Movement', 'Using Materials', and 'Written Work' improved between Admission and Discharge. However, she needed continual assistance.

With writing assessment advice, the area of difficulty is noted from the SFA scores. This individual has ataxia in the upper limbs, with full ROM, but with a motor control impairment. An aim was to improve fine motor control ability, and improve handwriting.

This was improved with Occupational Therapy and the provision of assistive devices or resources, implementation of handwriting training, and the use of a scribe.

Using SFA to display the variability of students' profiles

Students with different levels of disability or impairment, in terms of physical and cognitive strengths and weaknesses and areas that need improvement, can have different levels of improvement:

• A student with a more severe impairment including physical difficulties with speech, with less severe cognitive impairment made impressive progress in all areas.

• A student severely impaired in all areas after a traumatic brain injury made some progress with communication and cognitive abilities had an extreme physical impairment.

• Another student had minimal physical impairment, with a minor cognitive impairment, did have a severe impairment with communication, memory, and understanding. This had a severe impact on their ability to participate in school activities.

Psychometric Properties

The SFA was standrdised on 363 students, who had varying disabilities, including TBI. Internal consistency has a range from 0.92-0.98, with the coefficient alpha procedure. Test-retest reliability coefficients ranged from 0.82-098. Inter-rater reliability are in the moderate range, for the three main categories of the Assessment, ranging from 0.68-0.73. It is noted that the same rater conducted both admission and discharge assessments.