The effectiveness of any therapeutic approach must be periodically assessed using standardized and validated measures. The Family Hope Center assesses the effectiveness of its approach using the WeeFIM®, the pediatric version of the Functional Independence MeasureTM (FIM®).

Both the FIM® and WeeFIM® were developed by Uniform Data System for Medical Rehabilitation (UDSMR) from the World Health Organization’s bio-psycho-social model of disability. They are functional assessment tools for evaluating essential abilities in individuals with neurodevelopmental disabilities along three dimensions: self-care, motor function, and cognition.

UDSMR notes: “Since its inception in 1987, the FIM® instrument has been widely regarded and adopted by clinicians and researchers around the world for its brevity and reliability. A sizeable library of supporting research and study sustains the FIM® instrument’s reliability and validity. To date, more than 1,300 published articles support the FIM® instrument, and ongoing research and study continues.” (Read more clinical research about the WeeFIM here).

Our WeeFIM® results show that children’s neurological and functional capabilities significantly improve through the Family Hope Center’s parent-implemented home-based therapy.

The WeeFIM II® System

“The WeeFIM II® System is the most respected pediatric outcomes management tool in the market. Used by pediatric inpatient, outpatient, and community-based rehab programs, the WeeFIM II® System provides a simple, uniform construct that measures function in children. Based on the principal underpinnings of the FIM® instrument, the system allows clinicians to quickly assess functional status and track progression. It also provides patient-level data, profile reports, and program summary reports that demonstrate individual patient progress and overall program effectiveness.”²

The WeeFIM Instrument

Both the WeeFIM and the FIM were developed from the World Health Organization’s bio-psycho-social model of disability – the International Classification of Functioning, Disability, and Health – which identifies individuals as having a disability according to functional ability along various domains, their limitations in basic activities, and participation (or restrictions) in work, school, family life, and other social activities.

Both instruments have also been researched extensively and have high reliability and validity as diagnostic tools. This makes them especially helpful in measuring the outcome of rehabilitative treatment.

“The Functional Independence Measure (WeeFIM) for children is a simple-to-administer scale for assessing independence across 3 domains in American children” (Wong, 2002, p. 1).

The instrument’s three domains are Selfcare, Mobility, and Cognition. In total, there are 18-items. Each item is assessed on a 7-level ordinal scale by the clinician, either through parent interview, or by observing a child’s performance of essential daily functional skills to criterion standards.

Scoring is categorized into 2 main functional streams: “Dependent” (i.e., requires helper: scores 1–5) and “Independent” (i.e., requires no helper: scores 6–7) (Wong, 2002).

This means the WeeFIM measures how well children independently perform basic activities of daily living and over time, demonstrates their “decrease in disability” in response to therapy.

The Target Population

“WeeFIM was based on a conceptual framework by the World Health Organization (1980) of pathology, impairment, disability and handicap, and the “burden of care.” The instrument is useful in assessing functional independence in children aged 6 months to 7 years. It can be used for children with developmental disabilities aged 6 months to 21 years” (Wong, 2002).

How the WeeFIM is Used

As an international tool developed from the WHO’s model of disability, the WeeFIM is used by inpatient and outpatient facilities around the world. It provides them an easily understandable record of a child’s progress in therapy, which parents can then use in support of reimbursement claims to their respective local systems of care.

The WeeFIM is used to:

• Track functional improvement and goal attainment for individuals or groups of children
• Evaluate the effectiveness and efficiency of the care individual facilities provide by comparing facility outcomes to national benchmarks
• Predict the burden of care at discharge
• Network with other pediatric rehabilitation providers

How the Family Hope Center Uses the WeeFIM

The Family Hope Center conducts a full WeeFIM® assessment of each child at each appointment. Clinical staff assess each child’s degree of need and independence in 18 abilities across the three domains (self-care, mobility, and cognition). For each function, a child is assigned a number from 1 to 7 – with 1 meaning the child cannot perform the function independently at all and 7 meaning the child can fully perform the function without assistance.

With the first assessment creating a baseline, subsequent assessments allow for the measurement of each child’s progress toward these abilities over the course of their treatment.

The data from these assessments are then logged into the UDSMR database. UDSMR organizes the data, aggregates it, and prepares quarterly and annual reports. These reports show how well each child is doing – both individually and compared to averages for all other facilities in the database.

Parents receive a record of their child’s levels of function (in the form of a polar graph like the sample shown below). These graphs illustrate the level of the child’s degree of ability in each of the 18 functions. The parents, in turn, can provide copies of these graphs and raw scores of WeeFIM assessments to local systems as proof of their child’s response to therapeutic intervention and for support when seeking reimbursement for their efforts.

The WeeFIM Accreditation Process

• Every WeeFIM outpatient clinic must be accredited and pass the credentialing exam every two years.
• Facilities that participate in the WeeFIM submit data to UDSMR after being trained and credentialed.
• Facilities receive a customized report years comparing them to the national average on 18 functional abilities according to each category of disability.

The Family Hope Center’s Accreditation History

The FHC is currently accredited and was originally accredited in 2002. As an accredited clinic, we are required to pass an extensive credentialing exam every two years.

The Family Hope Center’s WeeFIM Results

• The FHC’s WeeFIM results are consistently higher than the national average benchmarks
• Each child’s WeeFIM results demonstrate that parents, with proper education, guidance, and support, can implement therapeutic interventions in their homes with fidelity and achieve results consistent with – and surpassing – standard therapy options.
• Further, the results demonstrate that parents can improve their child’s functional independence through home-based therapy.

General

• Slomine B. (2011) Functional Independence Measure for Children. In: Kreutzer J.S., DeLuca J., Caplan B. (eds) Encyclopedia of Clinical Neuropsychology. Springer, New York, NY
• Ottenbacher, K. J., Msall, M. E., Lyon, N., Duffy, L. C., Ziviani, J., Granger, C. V., … & Feidler, R. C. (2000). The WeeFIM instrument: its utility in detecting change in children with developmental disabilities. Archives of physical medicine and rehabilitation, 81(10), 1317-1326
• Ottenbacher, K. J., Msall, M. E., Lyon, N., Duffy, L. C., Ziviani, J., Granger, C. V., & Braun, S. (2000). Functional assessment and care of children with neurodevelopmental disabilities. American journal of physical medicine & rehabilitation, 79(2), 114-123
• Sperle, P. A., Ottenbacher, K. J., Braun, S. L., Lane, S. J., & Nochajski, S. (1997). Equivalence reliability of the Functional Independence Measure for Children (WeeFIM®) administration methods. American Journal of Occupational Therapy, 51(1), 35-41

Psychometric Properties of:

• Department of Employment Affairs and Social Protection (Ireland). Measuring Care Dependence – WeeFIM Nov 2012 
• McDowell, I. (2006). Measuring health: a guide to rating scales and questionnaires. Oxford University Press,USA
• Chen, C. C., Bode, R. K., Granger, C. V., & Heinemann, A. W. (2005). Psychometric properties and developmental differences in children’s ADL item hierarchy: A study of the WeeFIM® instrument. American journal of physical medicine & rehabilitation, 84(9), 671-679

Original Publications:

• Granger, C. V., Hamilton, B. B., Keith, R. A., Zielezny, M., & Sherwin, F. S. (1986). Advances in functional assessment for medical rehabilitation. Topics in geriatric rehabilitation, 1(3), 59-74
• Msall, M. E., DiGaudio, K., Rogers, B. T., LaForest, S., Catanzaro, N. L., Campbell, J., … & Duffy, L. C. (1994). The Functional Independence Measure for Children (WeeFIM) conceptual basis and pilot use in children with developmental disabilities. Clinical Pediatrics, 33(7), 421-430
• Msall, M. E., DiGaudio, K., Duffy, L. C., LaForest, S., Braun, S., & Granger, C. V. (1994). WeeFIM: normative sample of an instrument for tracking functional independence in children. Clinical Pediatrics, 33(7), 431-438

Compared with other Pediatric Developmental Assessment Tools:

• Ottenbacher, K. J., Msall, M. E., Lyon, N., Duffy, L. C., Granger, C. V., & Braun, S. (1999). Measuring developmental and functional status in children with disabilities. Developmental medicine and child neurology, 41(3), 186-194
• Willis, C. D., Gabbe, B. J., Butt, W., & Cameron, P. A. (2006). Assessing outcomes in paediatric trauma populations. Injury, 37(12), 1185-1196

About the WeeFIM (UDSMR Resources):

• Uniform Data System for Medical Rehabilitation (UDSMR)
• The FIM Instrument: Its Background, Structure, and Usefulness
• The WeeFIM II ® System and Instrument

International Use of the WeeFIM:

• Wong, V., Wong, S., Chan, K., & Wong, W. (2002). Functional independence measure (WeeFIM) for Chinese children: Hong Kong cohort. Pediatrics, 109(2), e36-e36
• Serghiou, M. H., Rose, M. W., Pidcock, F. S., Esselman, P. C., Engrav, L. H., Kowalske, K. J., & Lezotte, D. C. (2008). The WeeFIM [R] instrument–a paediatric measure of functional independence to predict longitudinal recovery of paediatric burn patients. Developmental neurorehabilitation, 11(1), 39-50
• Tur, B. S., Küçükdeveci, A. A., Kutlay, Ş., Yavuzer, G., Elhan, A. H., & Tennant, A. (2009). Psychometric properties of the WeeFIM in children with cerebral palsy in Turkey. Developmental Medicine & Child Neurology, 51(9), 732-738