1. Findings from Taylor & Jason (2001) study Taylor, R.R. & Jason, L.A. (2001). Sexual abuse, physical abuse, chronic fatigue, and chronic fatigue syndrome: A community-based study. Journal of Nervous and Mental Disease, 189, 709-715.

2. Objectives of Our Study In a random community sample unbiased by help-seeking behavior or self-selection… Do rates of abuse vary among individuals with different conditions involving chronic fatigue and healthy controls? Do individuals with CFS demonstrate an increased likelihood to report histories of childhood sexual, physical, and death threat abuse?

3. Methods A random community sample of 18,675 adults was screened for CFS symptoms. A subset of participants with chronic fatigue and healthy controls underwent full psychiatric and medical evaluation, which included a structured interview assessing childhood and adulthood history of sexual abuse, physical abuse, and death threat.

4. Diagnoses from Physician Review Panel 32 chronic fatigue syndrome (CFS) 45 idiopathic chronic fatigue (ICF) 56 psychiatrically explained chronic fatigue (CF-Explained-Psychiatric) 33 medically explained chronic fatigue (CF-Explained-Medical) 47 controls Methods

5. Question 1 Do rates of abuse vary among healthy controls and medically diagnosed fatigue groups? Multinomial logistic regression was used to examine the relationship between abuse history and chronic fatigue group outcomes while controlling for the effects of sociodemographic variables.

6. Results Childhood Sexual Abuse significantly predicted diagnoses of: idiopathic chronic fatigue chronic fatigue explained - psychiatric chronic fatigue explained - medical None of the abuse history types significantly predicted a diagnosis of chronic fatigue syndrome.

7. Results Childhood Sexual Abuse CFS ICF CF-Psych CF-Med Control 16.1% 34.1%** 28.8%* 21.2%* 2.2%

8. Do individuals with CFS demonstrate an increased likelihood to report histories of childhood abuse? A one-way Chi-square test was performed within the CFS group comparing presence versus absence of childhood sexual, physical, and death threat abuse. Question 2

9. CFS Group Results Present Absent X 2 Sexual Abuse 16.1% 83.9% 14.23** Physical Abuse 29.0% 71.0% 5.45* Death Threat 6.5% 93.5% 23.52**

10. Taken together, findings from medical samples (Doyle et al., 1999; Tiersky et al., 1998) and this random epidemiological sample indicate that histories of childhood sexual, physical, or death threat abuse are not implicated in the etiology of chronic fatigue syndrome. Other risk factors may be involved in the etiology of CFS, and further research is necessary to explore alternative hypotheses. Conclusions

11. Impairment The ADA definition of impairment is: 1. A major physical or mental impairment that substantially limits one or more major life activities. 2. Having a record of such impairment, such as educational, medical, or employment records. 3. Being “regarded” as having such an impairment.

12. What does “substantially limits a major life activity” mean? Being unable to perform one of the following major life activities: breathing, walking, sitting, standing, lifting, reaching, performing manual tasks, caring for oneself, learning, working, etc.

13. CFS Physical and Mental Impairments A person with CFS may have a physical impairment because CFS substantially limits her ability to stand, walk, lift, care for herself, or breathe. A person with CFS may have a mental impairment because CFS substantially limits her ability to learn, concentrate, and retain new information.

14. Social Security Administration In April, 1999, SSA issued new regulations defining medically determinable impairment requirements for CFS.

15. Outcomes of a Consumer- Driven Rehabilitation Program for Individuals with CFS: A Randomized Clinical Trial U.S. Department of Education (H133G000097)

17. CFS Empowerment Project

18. Study Design and Assessment Intervals 4 Months Post Baseline 12 Months Post Baseline 16 Months Post Baseline 24 Months Post Baseline RecruitmentScreening Baseline Assessment Follow-up Assessment 4 Post 1:1 Assessment 3 Post-Group Assessment 2 Treatment Post-Group Assessment 4 Baseline Assessment 3 Baseline Assessment 2 Control Randomization

19. Goal Setting

20. Peer Counseling: Group Phase

21. Peer Counseling: One-on-One Phase

22. Focus on Empowerment

23. Independent Living Philosophy

24. Project Goals

25. Interdisciplinary Collaboration Professional Resources Community Resources Project Physician Biostatistician Center for Independent Living Local CFS Self Help Grp University Researchers

26. Program Evaluation

27. Findings from the Taylor (in press) study Taylor, R.R.. (in press). Quality of Life and Symptom Severity for Individuals with Chronic Fatigue Syndrome: Findings from a Randomized Clinical Trial. American Journal of Occupational Therapy.

28. Characteristics of the Sample (N = 7)

29. Characteristics of the Sample

30. Assessments Baseline: CFS screening interview, SCID Repeated outcome measures: Quality of Life Index, Craig Handicap Assessment & Reporting Technique, Chalder Scale, CFS Symptom Rating Form, Illness Management Questionnaire, Service Utilization Checklist, Conservation of Resources Scale

31. Measures Used Quality of Life Index (Ferrans & Powers, 1992) CFS Symptom Rating Form (Jason et al., 1997) Conservation of Resources Scale (Hobfoll,1998)

32. Overall Quality of Life

34. Symptom Severity

36. Evaluating CIL Integration