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UNICEF/WG Module on Child Functioning

A module to identify children at risk of limited participation in various activities. Developed through cognitive and field testing to provide cross-nationally comparable data. Questions cover multiple domains and are designed to assess difficulties in activities. Used in various countries to ensure accurate identification of children with disabilities.

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UNICEF/WG Module on Child Functioning

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  1. UNICEF/WG Module on Child Functioning

  2. Development of the module • Purpose • To to identify the sub-population of children and youth (aged 2-17 years) with functional difficulties. These difficulties may place children at risk of experiencing limited participation in a non-accommodating environment • Aim • To provide cross-nationally comparable data • To be used as part of national population surveys or in addition to specific surveys (e.g., health, education, etc.)

  3. Development of module • WG Workgroup on Child Functioning and Disability was established fall 2009 under the leadership of ISTAT (Italy) • UNICEF joined the Workgroup in early 2011 • November 2011; 11th WG meeting in Bermuda - presentation of the literature review and first draft of questions • June 2012: Technical Consultation on the Measurement of Child Disability meeting hosted by UNICEF with disability/child development experts & survey experts • October 2012: 12th WG meeting - presentation of the revised modulein preparation for field work • September 2012-2016: validation process through cognitive and field testing

  4. Construction of module • Used the ICF biopsychosocial model • Avoided a medical approach • Used, when appropriate, questions already tested and adopted by the WG • Included the reference “Compared with children of the same age…” • Considered age specificity (2-4, 5-17) • Response options reflected disability continuum

  5. Selected domains • Seeing • Hearing • Mobility • Self-care • Communication • Learning • Emotions • Behaviour • Attention • Coping with change • Relationships • Playing

  6. Development of the module • Questions ask about difficulties the child may have in doing certain activities • Unless noted otherwise, all response categories are: • No difficulty • Some difficulty • A lot of difficulty • Cannot do at all • Questions on vision/hearing and mobility include questions on the use of glasses/hearing aids/ assistance with walking

  7. Cognitive Testing • Cognitive testing(2012-2016) • September 2012, India • January 2013, Belize • April 2013, Oman • July 2013, Montenegro • 2012/2013/2014/2015/2016 (including testing on teens), USA • March 2016, India • April 2016, Jamaica

  8. Field Testing • Field testing (2013-2016) • Independent field testing on earlier version of the module or subset of questions completed in Haiti (Brown University, 2013), Cameroon & India (London School of Hygiene and Tropical Hygiene, 2013), and Italy (NSO, 2013) • Field testing of complete version of the module in Samoa (NSO, 2014) and El Salvador (NSO, 2015) with technical assistance from UNICEF/WG • Module also used in surveys in Zambia (National Disability Survey, NSO, 2014) and Mexico (MICS, 2016) • Dedicated methodological work in Serbia (NSO, 2016)

  9. India: field test with medical follow-up • 227 parent interviews between November 2012-February 2013 • 2 stage process: • Stage 1: Administration of Child Functioning module to a sample of parents of children from 2-17 years old • Stage 2: Clinical assessment (medical, vision, hearing, speech, motor, and psychological) of all children identified as having functional difficulties in stage 1. • Sensitivity = 100% of children who were identified as having “a lot of difficulty or cannot do at all” in stage 1 were found to have an impairment in stage 2 • Specificity = 99% of children who were identified as NOT having difficulty were found to be non-disabled children in stage 2 • Overall, this indicates that the module is correctly identifying children with disabilities, and is accurately differentiating between those with disabilities and those without.

  10. Field test in Serbia • 2,915 parent interviews in February 2016 in one Serbian province - Vojvodina • Primary goal of the field test was to assess the performance of the Child Functioning module in the field • Secondary goal was to compare: • the 2-4 year old questionnaire of the Child Functioning module with the 2-4 year old questionnaire of the Ten Questions (TQ) module • the 5-17 year old questionnaire of the Child Functioning module with the 5-17 year old questionnaire of the Washington Group short set of questions. • The TQ module and the Washington Group short set were combined to form a control group questionnaire (CG questionnaire)

  11. Field test in Serbia • Two-stage stratified cluster sampling approach: • Random sample of enumeration areas from 2011 population census data, with probability proportional to size • 3,852 households selected, 3,396 located, 2,905 interviewed with the response rate of 86% • 2,937 children aged 2-17 were identified. Questionnaires were filled out for 2,915 children, with the response rate of 99% • Six teams • Each team consisted of four interviewers, one controller and one supervisor • The field work : 19 January 2016 - 8 February 2016 • Training: 5 days in January 2016

  12. Feedback from interviewers Questions to be filled out by interviewers at the time of the survey, right after the corresponding questions were asked • whether the interviewer had to repeat the question • whether the respondent asked for clarifications of words or concepts • whether the respondent had difficulties with response categories For children 2 to 4 CF10= difficulty walking CF13= difficulty being understood by you CF14= difficulty learning things CF15= difficulty playing For children 5 to 17 CF35= Anxiety CF36 = Depression CF38 = Difficulty concentrating on an activity CF39 = Difficulty accepting change

  13. Feedback from interviewers • Note from the field: at the end of each day about what they observed in administering the questionnaires • 10 questions to be filled out by interviewers at the end of the field work • Focus group discussions with interviewers and controllers (two full days, 4 group for interviewers - each group with 6 interviewers + 3 groups for controllers each group with 3 participants each).

  14. Feedback from interviewers CF10= difficulty walking CF13= difficulty being understood by you CF14= difficulty learning things CF15= difficulty playing CF35= Anxiety CF36 = Depression CF38 = Difficulty concentrating on an activity CF39 = Difficulty accepting change

  15. Feedback from interviewers CF10= difficulty walking CF13= difficulty being understood by you CF14= difficulty learning things CF15= difficulty playing CF35= Anxiety CF36 = Depression CF38 = Difficulty concentrating on an activity CF39 = Difficulty accepting change

  16. Feedback from interviewers CF10= difficulty walking CF13= difficulty being understood by you CF14= difficulty learning things CF15= difficulty playing CF35= Anxiety CF36 = Depression CF38 = Difficulty concentrating on an activity CF39 = Difficulty accepting change

  17. Feedback from interviewers • “The findings of the qualitative survey show that the CQ questionnaire has generally been administered without any major problems; the interviewers generally managed the questionnaire well and the reactions of the respondents were mostly neutral to positive” • Repetitive to read out loud response categories : no need to repeat for each questions as respondents get to know them

  18. Modification post-field work • Inclusion of the word “very” for the questions on anxiety and depression • Instruction for interviewers to stop repeating response categories after first three questions unless needed • Modifications tested in India and Jamaica

  19. Data analysis • Data analysis to determine cut-offs – similar results in levels obtained in Serbia and Samoa • Module able to capture moderate to severe forms of difficulties, not mild (some difficulty leads to false positive) • Inclusion of “a lot of difficulties or cannot do at all” is the recommended cut-off for international comparison, expect for emotions (5-17) and controlling behavious (for 2-4) for which only most severe forms are included – more variations on what is considered ‘normal” for children

  20. Results from the UNICEF/WG module

  21. Results from the TQ (children 2 to 4)

  22. Results from the WG short set (children 5 to 17)

  23. Translation of the module • Professional translation of the Child Functioning module into six languages • Spanish • French • Arabic • Russian • Vietnamese • Chinese • Portuguese • Translation methodology: • Forward/backward translation by separate translators • Internal focus group comprising of different translators to discuss and review translations • Focus group discussions with UNICEF and the Washington Group to discuss and review translations • Review of translated questionnaires by UNICEF staff (disability focal points) who are native speakers of each language • Feedback to translators with any required changes

  24. THANK YOU!

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