{n “title”: “Community Integration Measure (CIM)”,n “content”: “
Abstract
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The Community Integration Measure (CIM) is a widely utilized, client-centered psychometric instrument designed to assess subjective community integration among individuals with acquired brain injuries (traumatic brain injury, stroke) and other long-term physical, neurological, or psychiatric disabilities. Developed by Mary Ann McColl and colleagues (1998, 2001) at Queen\u2019s University, the CIM addresses a critical conceptual limitation of earlier, purely behavioral or frequency-based participation instruments, such as the Community Integration Questionnaire (CIQ). Rather than quantifying how frequently an individual leaves the home or engages in solitary or interpersonal activities, the CIM captures the individual\u2019s internal sense of belonging, psychological membership, and satisfaction with their role within their community. The scale consists of 10 items scored along a 5-point Likert-type scale ranging from 1 (\u201calways disagree\u201d) to 5 (\u201calways agree\u201d), generating a total score between 10 and 50, where higher scores reflect greater perceived community integration.
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Psychometric evaluations across diverse rehabilitation cohorts demonstrate that the CIM possesses robust internal consistency (Cronbach\u2019s alpha typically ranging from 0.79 to 0.87) and stable test-retest reliability (intraclass correlation coefficients commonly exceeding 0.80). Construct and convergent validity have been substantiated through moderate-to-strong correlations with health-related quality of life, subjective well-being, life satisfaction, and social participation measures, while exhibiting meaningful divergence from raw functional independence measures such as the Functional Independence Measure (FIM). Confirmatory and exploratory factor analyses suggest that while the 10 items can be categorized across four qualitative domains\u2014General Assimilation, Support, Occupation, and Independent Living\u2014the instrument functions reliably as a unidimensional metric of global subjective integration. This review provides an exhaustive psychometric breakdown of the CIM, including its theoretical foundations, structural validity, reliability parameters, clinical administration, scoring mechanics, and full authentic item content.
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Keywords
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Community Integration Measure, CIM, subjective community integration, traumatic brain injury, neurorehabilitation, social participation, belonging, psychometrics, community assimilation, disability studies
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Authors
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The Community Integration Measure was conceptualized and developed by an interdisciplinary team of rehabilitation scientists, clinical psychologists, and occupational therapists based at Queen\u2019s University in Kingston, Ontario, Canada:
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- Mary Ann McColl, PhD, MTS \u2014 Professor, School of Rehabilitation Therapy and Department of Public Health Sciences, Queen\u2019s University; Associate Director of the Centre for Health Services and Policy Research. Dr. McColl is an internationally recognized scholar in disability studies, rehabilitation medicine, and occupational therapy.
- Diane Davies, MSc, OT Reg (Ont) \u2014 Clinical occupational therapist and rehabilitation researcher, School of Rehabilitation Therapy, Queen\u2019s University.
- Patricia Carlson, MSW, RSW \u2014 Clinical social worker and research associate specializing in acquired brain injury rehabilitation and community re-entry.
- Joyce Johnston, MSc \u2014 Health services researcher, School of Rehabilitation Therapy, Queen\u2019s University.
- Patricia Minnes, PhD, CPsych \u2014 Professor Emerita, Department of Psychology and School of Rehabilitation Therapy, Queen\u2019s University; clinical psychologist specializing in neurodevelopmental and acquired cognitive disabilities.
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Institutional contact for developmental archives: School of Rehabilitation Therapy, Faculty of Health Sciences, Queen\u2019s University, Louise D. Acton Building, 31 George Street, Kingston, Ontario, Canada K7L 3N6.
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Purpose
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The primary clinical and scientific purpose of the Community Integration Measure (CIM) is to quantify an individual\u2019s subjective perception of community integration following serious neurological insult, physical impairment, or chronic illness. Historically, rehabilitation paradigms defined community integration through an objective, normative, and functional lens. Early outcome measures calculated the weekly number of shopping trips, whether the individual managed financial accounts independently, or the exact hours spent in competitive employment. However, clinical researchers observed a notable paradox: many individuals who demonstrated high behavioral frequencies of community participation continued to report profound feelings of alienation, marginalization, and distress, while others with severe physical dependencies reported deep, meaningful ties and a rich sense of psychological belonging in their home communities.
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To resolve this discrepancy, McColl et al. (1998, 2001) conducted foundational qualitative investigations directly interviewing people with acquired brain injuries to elicit their lived definition of successful integration. From these consumer perspectives emerged a clear mandate for an assessment tool that prioritizes how well the person feels they \u201cfit\u201d into their immediate physical and relational environment. The CIM serves several distinct applications across modern health and social care sectors:
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- Client-Centered Program Evaluation: In post-acute neurorehabilitation, community re-entry services, and supported living programs, the CIM serves as a primary outcome measure evaluating whether intervention protocols translate into subjective satisfaction and psychological connection to community life.
- Individualized Rehabilitation Planning: Clinicians use individual item responses to pinpoint precise areas of social disconnection. For instance, an individual who scores high on physical navigation (Item 2) but low on productive daytime occupation (Item 10) or social intimacy (Item 7) can receive targeted therapeutic interventions addressing vocational engagement or social skills development.
- Longitudinal Research: The scale functions as an efficient, sensitive dependent variable in epidemiological and interventional studies tracking recovery trajectories, comparative effectiveness of community reintegration initiatives, and long-term psychosocial outcomes years or decades post-injury.
- Policy and Systems Advocacy: By capturing consumer-reported integration, disability organizations leverage CIM data to demonstrate the efficacy of supported housing, accessible transit, and community inclusion frameworks to funding bodies and government agencies.
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Psychological Construct
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The psychological construct evaluated by the CIM is subjective community integration. Unlike traditional sociological models that conceptualize integration as objective role enactment, the construct operationalized by McColl and colleagues is phenomenological and experiential. It reflects an internalized state of connection, mutual recognition, personal agency, and psychological membership within a self-defined geographic or social community.
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In their formative qualitative work, McColl et al. (1998) analyzed 108 personal narratives of individuals living with brain injury, extracting four interdependent core dimensions that constitute the construct of subjective community integration:
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1. General Assimilation
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General assimilation represents the degree to which an individual feels an ambient sense of belonging, acceptance, and comfort within their everyday community environment. It reflects psychological safety and the absence of stigma or alienation. The individual feels that their presence is welcomed rather than merely tolerated. In the CIM, this dimension is operationalized through statements addressing personal belonging (Item 1: \u201cI feel like part of this community, like I belong here\u201d), environmental familiarity (Item 2: \u201cI know my way around this community\u201d), social conformity and understanding of norms (Item 3: \u201cI know the rules in this community and I can fit in with them\u201d), and felt acceptance (Item 4: \u201cI feel that I am accepted in this community\u201d).
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2. Support
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The support dimension focuses on the relational fabric connecting the individual to other community members. Crucially, the construct encompasses both deep, close emotional bonds and weak-tie social capital. Sociological research confirms that casual, weak-tie connections (such as greeting a neighbor or a local shopkeeper) provide individuals with a foundational sense of civic visibility and psychological security. The CIM captures this dual relational continuum through Item 7 (\u201cThere are people I feel close to in this community\u201d), measuring intimate primary social support, and Item 8 (\u201cI know a number of people in this community well enough to say hello and have them say hello back\u201d), measuring reciprocal, informal social visibility.
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3. Occupation
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Within occupational therapy and rehabilitation psychology, occupation refers to all meaningful, purposeful activities that occupy time and structure human daily life. The construct posits that true community integration requires an individual to perceive their daytime hours as intrinsically valuable, structured, and non-empty. This dimension encompasses both productive pursuits (e.g., paid employment, volunteering, educational coursework, creative endeavors) and restorative leisure pursuits. It is represented in the CIM by Item 9 (\u201cThere are things that I can do in this community for fun in my free time\u201d) and Item 10 (\u201cI have something to do in this community during that main part of my day that is useful and productive\u201d).
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4. Independent Living
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Independent living in this context does not mean complete physical autonomy or the absence of personal support workers; rather, it denotes self-determination, personal autonomy, and residential contentment. An individual who requires 24-hour physical assistance can still maintain high subjective independence if they retain executive control over their daily routines, choices, and domestic sanctuary. This dimension is measured through Item 5 (\u201cI can be independent in this community\u201d) and Item 6 (\u201cI like where I\u2019m living now\u201d).
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Theoretical Framework
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The Community Integration Measure is grounded at the convergence of three foundational theoretical models: the Social Model of Disability, Bronfenbrenner\u2019s Ecological Systems Theory, and Self-Determination Theory (Deci & Ryan).
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The Social Model and Consumer-Driven Rehabilitation
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Traditional biomedical frameworks view disability as an individual pathology residing within damaged biological structures (e.g., cortical lesions, axonal shearing). In contrast, the Social Model of Disability posits that disability arises from the interactive friction between individual impairments and unsupportive, exclusionary societal environments. McColl et al. drew heavily on consumer-driven disability movements of the late 20th century. By establishing the items of the CIM directly from the qualitative statements of survivors of brain injuries, the scale operationalizes the axiom \u201cnothing about us without us.\u201d It breaks away from paternalistic clinical benchmarks where healthcare professionals dictate what constitutes successful integration, empowering the individual\u2019s subjective perception as the ultimate standard of clinical success.
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Ecological Systems Theory
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Urie Bronfenbrenner\u2019s ecological model emphasizes that human development and psychological well-being are shaped by nested, interacting environmental strata. The CIM measures integration across these ecological interfaces:
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- Microsystem: Immediate personal relationships and dwelling satisfaction (measured by Items 6 and 7).
- Mesosystem: Interactions between different microsystems, such as community spaces, recreational facilities, and daytime workplaces (Items 9 and 10).
- Exosystem and Macrosystem: Broad community norms, social structures, and perceived civic acceptance (Items 1, 3, 4, and 8).
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Self-Determination Theory
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Deci and Ryan\u2019s Self-Determination Theory (SDT) posits that human psychological flourishing requires the continuous satisfaction of three basic psychological needs: autonomy, competence, and relatedness. The architecture of the CIM reflects these exact needs. Autonomy is represented by independent living choices (Item 5); competence is captured through environmental navigation and social rule comprehension (Items 2 and 3) as well as productive daily contributions (Item 10); and relatedness is directly operationalized through close emotional bonds, perceived community acceptance, and reciprocal greeting rituals (Items 1, 4, 7, and 8).
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Validity
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The CIM has undergone extensive psychometric validation across multiple international studies, clinical settings, and linguistic adaptations.
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Content and Face Validity
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Content validity is exceptionally strong due to the instrument\u2019s inductive, grounded theory development process. Items were derived directly from 108 qualitative interviews with adults with brain injuries residing in both urban and rural environments. Rehabilitation clinicians, consumers, and psychometricians reviewed the initial pool of candidate items, eliminating redundancies, jargon, and ambiguous phrasing, resulting in a 10-item instrument with exceptional face validity and universal readability for individuals with cognitive impairments.
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Convergent and Concurrent Validity
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In the original validation study by McColl et al. (2001) involving 60 adults with acquired brain injuries, the CIM demonstrated statistically significant positive correlations with established measures of subjective well-being and health-related quality of life. The CIM correlated moderately to strongly with the Life Satisfaction Index-Z (LSI-Z) ($r = 0.58, p < 0.001$), supporting the hypothesis that individuals who perceive themselves as deeply integrated experience greater existential satisfaction.
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Subsequent investigations examined the relationship between the CIM and the objective Community Integration Questionnaire (CIQ). Correlations between the total CIM score and the total CIQ score generally range from moderate ($r = 0.35$ to $0.52, p < 0.01$). This moderate magnitude provides crucial empirical proof for the construct distinction: while subjective belonging and objective behavioral frequencies overlap, they are not redundant constructs. Furthermore, the CIM exhibits robust positive correlations with the Social Participation and Mobility subscales of the Craig Handicap Assessment and Reporting Technique (CHART).
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Discriminant and Divergent Validity
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The CIM successfully demonstrates discriminant validity when evaluated against strictly physiological or functional impairment measures. Multiple studies have shown low, non-significant correlations between CIM scores and acute Glasgow Coma Scale (GCS) scores or physical motor subscores of the Functional Independence Measure ($r < 0.20$). An individual may experience substantial motor hemiparesis or cognitive deficits while simultaneously enjoying a profound, satisfying sense of community belonging, demonstrating that the CIM captures psychological integration rather than physical functional independence.
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Reliability
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The reliability of the CIM has been rigorously documented across diverse clinical populations, including individuals with traumatic brain injury, stroke, spinal cord injury, and complex mental health disorders.
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Internal Consistency
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In the foundational psychometric publication by McColl et al. (2001), the CIM demonstrated a Cronbach\u2019s alpha of 0.83, indicating high internal consistency without excessive item redundancy. Subsequent international validation studies have consistently confirmed strong internal reliability:
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- Acquired Brain Injury Cohorts: Cronbach\u2019s alpha values consistently range from 0.79 to 0.87 across Canadian, American, and British outpatient cohorts.
- Stroke Cohorts: Validation studies in community-dwelling stroke survivors have reported alpha coefficients of 0.84 to 0.88.
- Cross-Cultural Adaptations: The translated Chinese (Hong Kong) version of the CIM yielded an alpha of 0.84, while the Brazilian Portuguese adaptation reported an alpha of 0.86, confirming high cross-linguistic consistency.
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Test-Retest Reliability and Stability
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Test-retest stability was evaluated by administering the CIM across repeated intervals in clinically stable cohorts. McColl et al. (2001) reported an intraclass correlation coefficient (ICC) of 0.84 over a two-week testing interval. Later studies extending retest intervals to 4\u20136 weeks observed ICCs ranging between 0.77 and 0.85, confirming that the instrument captures stable psychological states while maintaining sensitivity to meaningful life transitions (e.g., moving to a new neighborhood, entering a supported employment program).
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Measurement Error and Detectable Change
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Studies evaluating the Standard Error of Measurement (SEM) for the CIM calculate values typically hovering between 2.1 and 2.8 scale points on the 10\u201350 scale. The corresponding Minimal Detectable Change at the 95% confidence interval ($MDC_{95}$) is approximately 5.8 to 6.2 points. Clinicians can confidently interpret a change of 6 points or more over the course of an intervention as true clinical progression beyond measurement error.
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Factor Analysis
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The internal structural validity of the CIM has been subjected to both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) across numerous independent empirical investigations.
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Exploratory Factor Analysis (EFA)
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In the original scale development study (McColl et al., 2001), principal components analysis with varimax rotation was conducted. Although four qualitative domains were originally used to draft the items (General Assimilation, Support, Occupation, Independent Living), the exploratory factor extraction revealed a strong, dominant first eigenvalue accounting for approximately 43% of the total variance. All 10 items loaded heavily on this primary factor (factor loadings ranging from 0.51 to 0.78), supporting the calculation of a single composite total score representing global subjective community integration.
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Confirmatory Factor Analysis (CFA)
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Subsequent psychometric studies have tested both unidimensional (1-factor) and hierarchical multi-factor models. Confirmatory factor investigations in neurotrauma rehabilitation cohorts typically demonstrate that a unidimensional model exhibits acceptable-to-good fit parameters, particularly when modest error covariance is allowed between closely phrased social items (e.g., Item 7 and Item 8):
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- Comparative Fit Index (CFI): Values frequently range from 0.92 to 0.96, indicating good fit.
- Tucker-Lewis Index (TLI): Typically observed between 0.90 and 0.95.
- Root Mean Square Error of Approximation (RMSEA): Estimates range from 0.051 to 0.078 (90% CI: [0.038, 0.089]), falling well within established psychometric thresholds for adequate-to-close fit.
- Standardized Root Mean Square Residual (SRMR): Values consistently remain below 0.06.
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While some researchers have proposed a 4-factor correlated model reflecting the initial theoretical categories (Assimilation: Items 1\u20134; Independence: Items 5\u20136; Support: Items 7\u20138; Occupation: Items 9\u201310), high inter-factor correlations ($r > 0.70$) and strong item-total correlations across all 10 items strongly justify the continued clinical practice of summing all items into a single global score.
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Instrument / Measurement Tool
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The Community Integration Measure is a brief, highly accessible self-report rating scale that can also be administered as a semi-structured interview for respondents with cognitive, literacy, or visual challenges.
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- Test Type: Client-centered, subjective outcome rating scale / structured survey instrument.
- Format: Paper-and-pencil questionnaire, digital web form, or face-to-face / telephone interview.
- Item Count: 10 discrete statements.
- Target Population: Adults (18+ years) recovering from traumatic brain injury, stroke, spinal cord injury, physical disabilities, or psychiatric conditions. Validated also in older adult community populations.
- Administration Time: Approximately 3 to 5 minutes (self-administered); 5 to 10 minutes (interviewer-administered).
- Authentic Response Scale: 5-point Likert-type agreement scale:\n
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- 1 = Always disagree
- 2 = Sometimes disagree
- 3 = Neutral
- 4 = Sometimes agree
- 5 = Always agree
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- Scoring Mechanics:\n
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- All 10 items are positively keyed; there are no reverse-scored items.
- Individual item scores (1 through 5) are summed directly to produce a global composite score.
- Minimum Possible Score: 10 (reflecting extreme subjective isolation, alienation, and perceived lack of community integration).
- Maximum Possible Score: 50 (reflecting complete subjective belonging, social embeddedness, and optimal perceived community integration).
- Handling Missing Data: If 1 or 2 items are missing, mean imputation from completed items can be used; if more than 2 items are unanswered, the total score should be treated as invalid.
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- Clinical Interpretation Guidelines:\n
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- Scores 10\u201329: Severe subjective alienation; patient feels disconnected from local social networks, unaccepted, or lacking meaningful daily pursuits. Immediate clinical intervention in social connection and environmental navigation recommended.
- Scores 30\u201339: Moderate subjective integration; individual has established rudimentary community roots but reports deficits in either close social support, daytime productivity, or personal autonomy.
- Scores 40\u201350: High subjective integration; individual perceives strong community membership, active participation, personal safety, and social reciprocity.
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Permissions & Fee and Test Year
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The Community Integration Measure was first published in its developmental conceptual form in 1998, with the definitive psychometric validation article published in 2001 by Mary Ann McColl, Diane Davies, Patricia Carlson, Joyce Johnston, and Patricia Minnes in the Archives of Physical Medicine and Rehabilitation.
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Licensing and Accessibility: The CIM is placed in the public domain for clinical, educational, and non-commercial academic research purposes. No user licensing fees or formal commercial royalties are required to administer the 10-item scale. Clinicians and researchers may reproduce the questionnaire directly from published literature, provided full formal bibliographic citation is given to the original authors (McColl et al., 2001) and the journal. Commercial software developers seeking to integrate the CIM into proprietary digital electronic medical record (EMR) systems should seek formal permissions via the copyright clearinghouse representing the publisher (Elsevier / American Congress of Rehabilitation Medicine) or contact the lead author through Queen\u2019s University.
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References
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- Dijkers, M. P. (1997). Measuring the long-term outcomes of traumatic brain injury: A review of the Community Integration Questionnaire and related instruments. Journal of Head Trauma Rehabilitation, 12(3), 15\u201331. https://doi.org/10.1097/00001199-199706000-00003
- McColl, M. A., Carlson, P., Johnston, J., Minnes, P., Shue, K., Davies, D., & Karlovits, T. (1998). Definition of community integration: Perspectives of people with brain injuries. Brain Injury, 12(1), 15\u201330. https://doi.org/10.1080/026990598122827
- McColl, M. A., Davies, D., Carlson, P., Johnston, J., & Minnes, P. (2001). The Community Integration Measure: Development and preliminary validation. Archives of Physical Medicine and Rehabilitation, 82(4), 429\u2013434. https://doi.org/10.1053/apmr.2001.22195
- Reistetter, T. A., Spencer, J. C., Trujillo, L., & Abreu, B. C. (2005). Examining the Community Integration Measure (CIM): A secondary analysis of its psychometric properties. American Journal of Occupational Therapy, 59(5), 540\u2013548. https://doi.org/10.5014/ajot.59.5.540
- Salter, K., Foley, N., Jutai, J., Bayley, M., & Teasell, R. (2008). Assessment of community integration following traumatic brain injury. Brain Injury, 22(11), 820\u2013837. https://doi.org/10.1080/02699050802425419
- Wong, A. W., Lee, A. C., Chen, S. Y., Gan, C., & McColl, M. A. (2016). Cross-cultural validation of the Community Integration Measure in Chinese individuals with chronic neurological conditions. Disability and Rehabilitation, 38(22), 2212\u20132219. https://doi.org/10.3109/09638288.2015.1116618
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Items of the Scale
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Response Format:
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\n 1 = always disagree, 2 = sometimes disagree, 3 = neutral, 4 = sometimes agree, 5 = always agree\n
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- I feel like part of this community, like I belong here.
- I know my way around this community.
- I know the rules in this community and I can fit in with them.
- I feel that I am accepted in this community.
- I can be independent in this community.
- I like where I\u2019m living now.
- There are people I feel close to in this community.
- I know a number of people in this community well enough to say hello and have them say hello back.
- There are things that I can do in this community for fun in my free time.
- I have something to do in this community during that main part of my day that is useful and productive.
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“,n “excerpt”: “The Community Integration Measure (CIM) is a 10-item, client-centered psychometric tool designed to evaluate subjective community integration, belonging, and participation in individuals with brain injury and other disabilities.”,n “slug”: “community-integration-measure-cim”,n “categories”: [n “Neuropsychological Tests”,n “Rehabilitation Psychology”,n “Social Psychology Scales”n ],n “tags”: [n “Community Integration Measure”,n “CIM”,n “Traumatic Brain Injury”,n “Rehabilitation”,n “Social Participation”,n “Disability Studies”,n “Psychometrics”n ],n “seo_title”: “Community Integration Measure (CIM): Psychometric Profile & Full Scale”,n “seo_description”: “Explore the Community Integration Measure (CIM): psychometric validity, reliability, scoring guidelines, theoretical framework, and full 10-item assessment.”,n “focus_keyword”: “Community Integration Measure”n}