Section of Supportive Hospice and Palliative Medicine

Department of Family and Community Medicine

University of the Philippines Philippine General Hospital
Manila

SHPM PROGRAM DOCUMENT (CFAT 012011-5)

COMPENDIUM OF FILIPINO ASSESSMENT TOOLS FOR CLINICAL PRACTICE & RESEARCH

CHILDRENS BIOPSYCHOSOCIAL SURVEY (CBS)

AUTHOR/S: Manuel Medina Jr. and the Section of Supportive Hospice and Palliative Medicine (SHPM)
FILIPINO VERSION: The Filipino and English Versions were developed simultaneously.
PURPOSE: To assess the health related quality of life of children with severe illnesses, such as cancer.
DESCRIPTION: The CBS was developed by M. Medina, Jr. M.D. and the Section of Supportive Hospice and Palliative Medicine, University
of the Philippines Philippine General Hospital (SHPM, UP-PGH). It was initially used as part of a program to improve supportive care
services for childhood survivors of cancer; as well as a survey instrument in a study of children with cancer. Findings from these studies were
used to develop a valid and reliable Filipino measure of childrens HRQL which can be used in both clinical and research settings. It is
primarily intended for family medicine and palliative medicine physicians. The items used in the construction of the CBS were directly based
on a review of relevant international tools and research, and the opinion and experience of the Section of SPHM in the biopsychosocial
assessment of children. The brief 23 item CBS includes 4 subscales representing 4 domains: Physical (11 items), Emotional (4 items), SocialPeer (4 items), and Cognitive-School (4 items) subscales. The CBS was created for use in children who are already attending school - 4 or 5
years old to 18 years old. It can be answered by the family caregivers of younger children, or answered directly by older children and
adolescents - the actual method that was used should be specified by the researcher or clinician.
SCORING: Each item is scored on a 0 to 3 basis using the following key: never happens = 3, seldom happens = 2, frequently happens = 1,
constantly happens = 0. The scores for the all the items are summed resulting in scores for the four CBS subscales (Physical, Emotional,
Social-Peer, and Cognitive-School) and a total score for the entire CBS. Higher scores reflect lesser problems and difficulties, and better
HRQL; while lower scores reflect more problems and difficulties, and poorer HRQL. The subscale scores range from 0 to 33 for the Physical
subscale; 0 to 12 for the Emotional, Social-Peer, and Cognitive-School subscales; and 0 to 69 for the entire CBS. The scores for the
Emotional, Social-Peer and Cognitive-School subscales can be summed to form the Psychosocial subscale which will range between 0 and
36.
For regular clinical use and research, the total CBS scores can be converted to range between 0 100. This can be done by dividing the total
score by 69 and multiplying by 100 (total score / 69 * 100). HRQL measures are not normally simplified by grouping results; the author/s of
the CBS do not recommend the use of simplified classification systems for the CBS.
Alternative Scoring System: Another method of scoring uses the mean or average score (total score divided by the number of items). The
Subscale or Domain Score will be the mean or average score for each domain or subscale will range from 0 to 3 (total score divided by 4
items per subscale). The Score for the Psychosocial Scale and the entire CBS Scale will be the mean or average score for each domain or
subscale divided by the number of domains (sum of the average scores of the component domains divided by 3 domains for the Psychosocial
Scale; or divided by 4 domains for the entire CBS scale). The results will range from 0 to 3. These results may also be further converted to
range between 0 100 by dividing the results by 3 and multiplying by 100.
RELIABILITY: In a study of children with cancer, the CBS (Filipino Version) has excellent internal consistency. Cronbach alpha for the
entire scale was 0.90. Alpha for the subscales were: Physical Subscale (0.90), Emotional Subscale (0.79), Social-Peer Relation Subscale
(0.78), Cognitive-School Performance Subscale (0.80). Further reliability studies are ongoing and/or planned by the author/s.
VALIDITY: Preliminary evaluation of the CBS (Filipino Version) in families of children with cancer shows that it has good correlation with
general family function and satisfaction with family function as measured by the Filipino version of the original 5 item Family APGAR;
adequacy of family resources, and the psychological impact of illness on the child and family caregiver. Construct validity was also achieved
through the process of tool development and item selection based on expert opinion and the review of relevant international recognized tools
and research. The empirical factor structure was generally consistent with the original conceptual and theoretical structure and supported
construct validity. Further validation studies are ongoing and planned by the author/s.

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ADMINISTRATION: The tool can be answered by adults and older children (preadolescents and adolescents); patients and/or family
caregivers. Just like the original Family APGAR, it can be used on one or more members of the same family. It can be administered in a
number of formats, including traditional paper and pencil format (either self-administration or research-staff interview face to face,
telephone, or internet based interview) and electronic formats and Web-based applications.
PRIMARY REFERENCES: 1) M Medina and the Section of Supportive Hospice and Palliative Medicine (SHPM). The Childrens
Biopsychosocial Survey (CBS). SHPM, DFCM, UP-PGH. 2010. 2) M. Medina, A Martin, A Panganiban-Corales, L Nicodemus, and A
Bausa. Impact of Illness Using the Biopsychosocial Perspective: Development and Evaluation of the Childrens Biopsychosocial Survey and
the Psychosocial Reaction to Illness Scale. SHPM Research Document (CHILD 102010-2). Section of Supportive Hospice and Palliative
Medicine (SHPM), DFCM, UP-PGH. 2010.
In addition to the primary reference, this document can be cited as follows: M. Medina and the Section of Supportive Hospice and Palliative
Medicine (SHPM). Childrens Biopsychosocial Survey (CBS). SHPM Program Document. Compendium of Filipino Assessment Tools for
Clinical Practice & Research (CFAT 012011-5). SHPM, DFCM, UP-PGH. 2011.
AVAILABILITY: Permission to use the CBS should be obtained from the author/s. The CBS is in an early stage of development. In order to
maintain an organized program for further development and ensure appropriate use, use of the CBS is mainly restricted to programmed
studies within the SHPM. However, the authors also recognize the severe lack of easily available Filipino measures to assess the HRQL of
children with severe illnesses such as cancer. Therefore, the author/s are amenable to the use of the CBS in studies outside of SHPM as long
as permission is obtained. Requirements include: submission of program / project / research plan or proposal to the author/s, changes or
modifications to the plan or proposal as required by the author/s; regular updates; citation of the role of the author/s in the program / project /
research, and as co-author; and submission of the final draft of report or paper for suggestions prior to final approval. No fees apply to nonfunded clinical and research programs. No changes or modifications to the content, format, scoring and interpretation of scores of this
assessment tool are allowed by the author/s.

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CHILDRENS BIOPSYCHOSOCIAL SURVEY (CBS) FILIPINO

Nangyari
sa lahat
ng
panahon

Tungkol sa bata na may sakit

Madalas
nangyari

Madalang
nangyari

Hindi
nangyari

Madaling mapagod at nanghihina

Sumasakit ang katawan
Sumasakit ang ulo
Hinihingal o nahihirapang huminga
Walang ganang kumain

A Nasusuka
Nahihilo
Sumasakit ang tiyan
Nahihirapang matulog
Nagtatae o diarrhea
Nahihirapang dumumi o constipation
Nakakaramdam ng pangamba at takot

Nakakaramdam ng lungkot
Nakakramdam ng galit
Nakakaramdam ng inis
Hindi nakakasundo o nakakaaway ang ibang bata

Iniiwasan ng ibang bata at ayaw makipagkaibigan sa kanya

Niloloko o tinutukso ng ibang mga bata
Nahihirapang maki-salimuha at makipagkaibigan sa ibang bata
Nahihirapan sa pag-intindi ng mga tinuturo sa paaralan
Nakakalimot ng mga bagay na napag-aralan

D Nahihirapan sa paggawa ng mga homework

Napipilitang mag-absent dahil sa sakit o masama ang
pakiramdam

FOR THE DOCTOR

A: PHYSICAL
B: EMOTIONAL
C: SOCIAL / PEER RELATIONS
D: COGNITIVE / SCHOOL

PSYCHOSOCIAL = (B+C+D)
HRQL (0-69) = TOTAL
HRQL (0-100) = (TOTAL / 69)*100

Manuel Medina Jr. MD and the Section of Supportive Hospice & Palliative Medicine, University of the Philippines-Philippine General Hospital, Manila. 2010.

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CHILDRENS BIOPSYCHOSOCIAL SURVEY (CBS) ENGLISH

Constantly Frequently
happens
happens

About the child who is sick

Seldom
happens

Never
happens

Easy fatigability / Gets tired easily

Body aches and pains
Headaches
Shortness of breath
Loss of appetite / anorexia

A Nausea / vomiting
Dizziness
Abdominal pains
Difficulty sleeping
Diarrhea
Constipation
Feels anxiety or fear

Feels sad or depressed

Feels angry
Feels irritated or annoyed

Doesnt get along with or gets into fights with other children
Avoided by other children; or other children do not want to be
friends with the child
Teased by other children
Difficulty interacting with other children; or difficulty in making
friends with other children
Difficulty understanding lessons in school
Difficulty remembering what was learned in school
Difficulty in doing school assignments or homework
Misses school days; or had to be absent from school

FOR THE DOCTOR

A: PHYSICAL
B: EMOTIONAL
C: SOCIAL / PEER RELATIONS
D: COGNITIVE / SCHOOL

PSYCHOSOCIAL = (B+C+D)
HRQL (0-69) = TOTAL
HRQL (0-100) = (TOTAL/69)*100

Manuel Medina Jr. MD and the Section of Supportive Hospice & Palliative Medicine, University of the Philippines-Philippine General Hospital, Manila. 2010.

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