Assessment of the Clinical Utility of a Family Adaptation Model

Linda McDonald, Gerard Kysela, Jane Drummond, Cathy Martin, & Wendy Wiles

University of Alberta

Edmonton, Alberta

This research was supported by a Research Grant from the Children's Mental Health Unit, Health Canada, Ottawa, Ontario and with support from the Center for Research in Applied Measurement and Evaluation, The University of Alberta, Edmonton, Alberta.

Abstract

The purpose of this study was to assess the clinical utility of a Family Adaptation Model. The model was utilized to help families of young children with developmental disabilities organize family assessment information into a Family Profile that was then used to develop an Individual Family Plan (IFP). Nine families completed family assessment measures prior to and following the development of an IFP. They assessed the clinical utility of the Family Adaptation Model by completing a posttest survey. Survey results indicated that parents were pleased with the process and found the Family Profile helpful in the development of an IFP. Results of the family assessment measures were consistent with the model. Implications for professionals are provided.

Key Words: family adaptation, family assessment, early intervention Assessment of the Clinical Utility of a Family Adaptation Model

Family assessment measures play an important role in the identification of strengths and needs in families of children with disabilities. These measures have been used for a variety of purposes including: pre and posttest measures for evaluating various types of interventions; screening criteria to identify families who qualify for specific services, treatment programs, or financial assistance; and as sources of information prior to the development of an Individual Family Plan (IFP) (Dunst, Trivett, & Deal, 1988; McClellan, 1990; Olson & Kwiatkowski, 1992). Although the use of family assessment measures has been well documented in the literature, there are two important issues relating to the practice of family assessment that require further attention.

First, there is a need for more information on how to assess the strengths and needs of family members and provide clear, practical and nonjudgmental feedback about the outcome of the assessments. Concerns raised in the literature include feelings of loss of privacy, raising family members' expectations about the availability of resources to unreasonable levels, conveying unintentional messages about dysfunction within the family, interference with the development of effective partnerships between parents and professionals, and inappropriate identification of problems within the family (Bernheimer, Gallimore, & Weisner, 1990; Goodman & Hover, 1992; Slentz & Bricker, 1992).

A second issue is that there is little written about how the practice of assessing family strengths and needs relates to an overall vision or philosophy of family functioning. Without a clear and comprehensive model with which to guide the gathering and analysis of family assessment information, it is possible to misinterpret assessment data, or inappropriately focus on only one or two aspects of family functioning. For example, in the past, when parents received high scores on surveys that measured the construct of stress, it was assumed that they were not adjusting well to the presence of a child with disabilities in their family. More recently, studies have shown that high levels of stress experienced by these parents do not necessarily mean that dysfunction or pathology exists within the family system (Dyson, 1991; Redington, Kysela, & McDonald, 1995).

Assessing the Strengths and Needs of Families

Family assessment measures play an important role in the development of IFPs (Beckman & Bristol, 1991). Researchers have indicated that these measures provide information on the family's resources, priorities, concerns and unique characteristics, identify the programs and services that would be most beneficial to children with disabilities and their families, help professionals evaluate the effectiveness of their intervention, ensure that the IFP accurately reflects family goals, help in the evaluation of services, and ultimately lead to greater benefits for the child (Bailey & Simeonsson, 1988; Dunst et al., 1988; Garshelis & McConnell, 1993; Olson & Kwiatkowski, 1992; Whitehead, Deiner, & Toccafondi, 1990).

Although a wide variety of family assessment measures have been used and advocated, research documenting the utility of these measures has been very limited (Bailey & Blasco, 1990). Bailey (1987) called for specific, practical methods of incorporating family assessment data into IFP goals. Slentz and Bricker (1992) highlighted the need to identify and use only those instruments that lead directly to the delivery of appropriate services for children with disabilities and their families.

Family Assessment within the Context of Family Centered Practice

Family centered practice is based on the premise that children's abilities to learn and develop are "inextricably intertwined" with the strengths, needs and philosophies of their parents and other family members. A guiding principle of family centered practice is the belief that parents are the experts regarding their family's needs and priorities (Singer & Powers, 1993). An equally important principle is that families who have a member with a special need or disability have more in common with families who do not have a child with a special need or disability than they have differences (Mahoney, O'Sullivan, & Robinson, 1992). Assessing the strengths and needs of family members within the context of a family centered approach acknowledges the critical role that family members play in the life of the child with special needs or disabilities, and recognizes that the needs of these families are in many ways similar to the needs of any family.

The barriers to effective family assessment may be overcome by implementing sound, family centered practices in the assessment process (Bailey & Simeonsson, 1988). Several factors may influence how successfully assessment data are transformed into functional IFP goals. First, it is vital that those who complete the assessment measures are fully aware of how the information on these measures will be used (Dunst et al., 1988). Second, information about the assessments (e.g., what they measure, how they will be used) before the assessments are used may help parents to see the positive aspects of the assessment process. The more favorably parents view the assessment tools, the more likely they are to find the information provided within these assessments and surveys as useful (Bailey & Blasco, 1990). Third, parents should be able to choose the assessment measures they wish to complete without jeopardizing their program placement (Bailey & Blasco, 1990). Finally, written assessments of family strengths and needs must be complemented by observation, open-ended conversations and the development of a mutually supportive relationship between parents and professionals (Bailey et al., 1989; Dunst et al., 1988; McGonigel, Kaufmann, & Johnson, 1991; Olson & Kwiatkowski, 1992). Family centered assessment helps to ensure that families do not feel overwhelmed by the assessment process.

The Need for a Family Adaptation Model

Given the complexity of family assessment within the context of family centered practice, there is a need for a multidimensional framework that will facilitate the assessment of family functioning along several dimensions at the same time. The T-Double ABCX model has been demonstrated to be well suited for the dual purposes of integrating research and guiding clinical practice with families (e.g., Bristol, 1987; Gallagher & Bristol, 1989; Kysela, McDonald, & Brenton-Haden, 1992; Lavee, McCubbin, & Olson, 1987; Redington et al., 1995). Essentially, this model views the family's experience of stress, crises, and adaptation as a dynamic and ongoing process. Emphasis is placed on the family's efforts to manage the demands faced from various stressors with the resources and capabilities the family members have for meeting those demands. This process is mediated by the family's appraisal of the situation and available coping strategies. The objective of these family efforts is to achieve a balance in family adaptation and functioning (McCubbin & McCubbin, 1991).

The Double ABCX model has served as the basis for our model and was developed by McCubbin and Patterson (1981) as an extension of Hill's classic family stress theory and ABCX family crisis model. In this model, the letters ABCX represent the stressor event (A), the family's crisis-meeting resources (B), the family's definition or interpretation of the crisis event (C), and the family crises itself (X). McCubbin and Patterson (1981) extended Hill's model to address the issue that no event occurs in isolation and introduced the concept of "pile-up" of stressors. Thus, the ABCX model allows the professional to consider both the presence and impact of these variables on family adaptation. More recently, McCubbin and McCubbin (1991) proposed the Resiliency Model of Family Stress, Adjustment, and Adaptation. They directed our attention towards critical elements of family functioning during illness or stressful times.

The McCubbin ABCX model has attempted to examine the relationship between family functioning variables over time. Previous studies with families of children with special needs or disabilities which made use of this model include Bristol (1987), Gallagher and Bristol (1989), Lavee et al. (1987), Reddon, McDonald, and Kysela (1992), and Redington et al., (1995). In each of these studies, the dimensions of the model were found to be helpful in explaining some of the ways in which families coped with stressors and demands. They each reported mediating effects of family supports and parental appraisals when considering the effects of demands and stressors on family adaptation. Huang (1991) recommended that further studies using the T-Double ABCX model should consider the relationship between stressors, resources, perceptions, and adaptation measures among other populations.McCubbin and McCubbin (1991) have suggested that pile-up of demands and the family's capability to meet those demands are dynamic and interactional dimensions. We have developed the Family Adaptation Model, a derivative of models such as T-Double ABCX, in order to characterize the ways families meet the demands placed upon them. The Model, shown in Figure 1, identifies family appraisals, personal and social supports and family coping strategies as mediating dimensions between demands/stressors and family adaptation (Kysela, McDonald, Brenton-Haden, Alexander, & Cunningham, 1996).

Figure 1 - Family Adaptation Model

The Family Adaptation Model characterizes how demands/stressors affect family adaptation through family coping processes; these processes involve parental use of personal and social supports and are directed by global and specific appraisals of their situation. Family coping is seen as the process of using these supports and appraisals to reduce the effects of demands and stressors on family functioning and subsequent adaptation. One assumption of this model is that this is an ongoing process of family adaptation in response to demands and stressors of varying magnitude and intensity. Unlike the T-Double ABCX model, there is only one proposed process of family adaptation rather than an adjustment and adaptation phase. Measures of these five dimensions developed by other family researchers are utilized to assess parental perceptions of each dimension. Another assumption of the model is that the process moves from left to right and when satisfactory adaptation is attained, the cycle reiterates back to the beginning involving a consideration of new demands or stressors on family capabilities.

The purpose of this study, then, was to test the clinical utility of this comprehensive model for assessing family strengths and needs focusing on healthy adaptation of families with a child who has special needs or a disability. The Family Adaptation Model was used as a framework in which to pilot a process whereby assessment information was reviewed with parents within the context of the Model, and then used by parents and professionals (family consultants) to develop an IFP.

Method

Participants

Potential research participants were identified from two groups of families, one rural and one urban. These families were involved in two previous studies that examined the impact of a child with disabilities on the family (Foster, 1994; Redington et al., 1995). Parents who obtained high scores on the Parenting Stress Index (Abidin, 1986) or high scores on the Family Assessment Measure III (Skinner, Steinhauer, & Santa Barbara, 1984) were invited to participate in this study. High scores on the PSI indicated that parents were reporting significant levels of stress. High scores on the FAM indicated that there could be some difficulty in family adaptation.

Fmilies meeting the above criteria were contacted by their local health units and informed of the study. Five rural and six urban families consented to participate following telephone contact from a research assistant. One of the urban families withdrew prior to the first home visit and one of the rural families withdrew following the first home visit. Both families indicated that other time commitments and personal reasons prevented them from continued participation in the study.

Demographic data on the nine participating families are presented in Table l. Participants were all parents of preschool children with a disability ranging from mild to profound. All families were being served by a health unit associated with the provision of family and early childhood preventative health and support services.

Table 1 - Demographic Information on Participating Families (n = 9)

Parents in the Home	Annual Income- a	Parent Age- b	Child Age- c	Severity of Disability	# of Siblings
Rural (n=4) two parent (3) single parent (1)	37 (14 - 55)	31 (24 - 34)	42 (38 - 46)	mild (2) severe (1) profound (1)	1 (1) 2 (3)
Urban (n=5) two parent (4) single parent (1)	33 (12 - 47)	31 (23 - 36)	24 (19 - 33)	mild (1) moderate (3) severe (1)	0 (2) 1 (2) 2 (1)

a- Annual income is in thousands of dollars.

b- Parent age (in years) is reported as means and ranges.

c- Child age (in months) is reported as means and ranges.

Procedure

Participants were visited monthly by one of two family consultants over a 4 month period. One consultant visited the rural families (n = 4) and a second consultant visited the urban families (n = 5). Both had extensive experience working with families in family centered early intervention programs. The visits ranged in duration from 30-120 minutes. During each home visit, the consultants followed a home visit protocol (see Appendix 1) based on sound family centered guidelines (Bailey & Simeonsson, 1988; Dunst et al., 1988; Olson & Kwiatkowski, 1992). Through this protocol, the consultants promoted positive child, parent, and family functioning by working within existing family functioning styles in order to enhance the family's ability to become more self-sustaining. Over the course of the monthly visits, parents were introduced to the Family Adaptation Model, reviewed a Family Profile developed from assessment information collected during a previous study, and developed an IFP.

Developing the Family Profile. Prior to the first visit, the consultants reviewed the assessment information for the participating families collected during the previous studies (Foster, 1994; Redington et al., 1995). These measures assessed each of the dimensions of the Family Adaptation Model presented in Figure l. The Child Characteristics Domain of the Parenting Stress Index (PSI; Abidin, 1986) and Family Stressors Index (FSI; McCubbin, 1991a) were used to assess the Demands/Stressor dimension of the model. The Family Inventory of Resources for Management (FIRM; McCubbin & Comeau, 1991) and Social Support Inventory (SSI; McCubbin & Thompson, 1987) were used to assess the Family and Social Support dimension. The Reframing and Passive Appraisal scales of the Family Crises Oriented Personal Evaluation Scales (F-Copes; McCubbin, Olson, & Larson, 1991) as well as the Life Orientation Test (LOT; Scheier & Carver, 1985) evaluated the Appraisals dimension. The Coping Health Inventory for Parents (CHIP; McCubbin, 1991b) assessed the Coping dimension, and the Family Assessment Measure (FAM III; Skinner et al., 1984) assessed the Adaptation dimension of the model. Descriptions of these measures as well as reliability and validity data are presented in Appendix 2.

The information provided by the assessment instruments was then summarized within a Family Profile (see Figure 2 below).

MEANING OF LIFE AND SITUATIONAL EVENTS (appraisals)
PILE-UP OF STRESSORS (demands)	FAMILY ADAPTATION	PROBLEM SOLVING (coping)
COMMUNITY AND FAMILY STRENGTHS AND RESOURCES (support)

Figure 2. Family Profile

During the first visit, the parents were provided with a description of the Family Adaptation Model as well as the process that would be used to develop an IFP. The parents were then presented with a Family Profile summarizing their previous assessment results within the framework of the model. Parents were encouraged to ask any questions they might have about the information in the profile or the process in general. During the discussion, parents were asked whether or not the profile depicted an accurate picture of their family. This step was important given that some of the parents had completed the assessments as long as 12 months prior to the first home visit. If either parent felt that the profile was inaccurate, they were offered an opportunity to repeat any of the assessment measures, or point out exactly which aspects of the profile were no longer accurate. Necessary changes to the profile were made at this time. Parents and family consultants worked together to ensure that the Family Profile presented an accurate picture of the family prior to the development of the IFP.

Developing an IFP. After the Family Profile was presented to parents and they agreed that the description was accurate, parents were asked to complete the IFP form (see Figure 3 below). The IFP identified family strengths, goals, activities to achieve the goals, individuals responsible for helping to achieve the goals, and timelines.

Individual Family Plan Date:

Names of Family Members:

Strengths and resources we have as a family are:

Things that would be helpful to us as a family are:

One thing we would find helpful is:

We can get this done by doing the following:

Tasks will be accomplished by:

Figure 3. Individual Family Plan

During the subsequent monthly visits, the family consultants and parents discussed progress made towards their goals following the protocol outlined in Appendix 1. Parents were encouraged to amend their goals as family circumstances changed. The specific topics discussed during these visits varied from family to family and included topics such as child placement, division of household responsibilities, assignment of responsibility for dealing with professionals, and how to access family relief services. During the discussions, parents identified issues of importance to them at the time of the visit. The consultants did not participate in the accomplishment of any of the goals identified in the IFP. Family members were encouraged to use resources within their communities (e.g., community programs, information, and people) in order to help them achieve the IFP goals. Eight families completed the process described above in four monthly home visits. The remaining family completed the process in three visits.

Prior to the final visit, parents were invited to complete the family assessment measures administered in the previous studies (Foster, 1994; Redington et al, 1995). These assessments were collected during the final visit. As well, any additional issues the parents had were addressed, and they were asked to complete a survey evaluating the usefulness of the process used to develop their IFP. The brief survey consisted of eight close-ended questions and two open-ended questions. A comment section was provided following each close-ended question.

Results and Discussion

Thirteen of the 16 parents completed both the survey and the posttest assessment measures. Three rural fathers indicated that they were minimally involved in the process and did not wish to complete the final measures. Bailey and Blasco (1990) recommended that parents should be able to choose which assessment measures they would like to complete without jeopardizing services or program placement. The three rural fathers chose to complete the family assessment measures in the earlier studies, participated to some degree in the development of the IFPs, but declined to complete any of the posttest measures in the present study.

Parent Survey

A summary of responses to the close-ended questions in the parent survey may be found in Table 2 (below).

Table 2 -Summary of Survey Responses (N = 46)

Question	S/A	A	N/S	D	S/D
1. I found the information from the assessments helpful.	4	8	-	1	-
2. I do not think that the information on the assessments indicated our family's strengths.	-	-	1	8	4
3. I think the family profile accurately reflected our family's concerns.	2	9	1	1	-
4. I feel less stress now that I have participated in the project.	4	5	4	-	-
5. I feel more confident when talking with people who work with my child since participating in the project.	-	5	6	2	-
6. I feel more stress now that I have participated in the project.	1	-	-	11	1
7. I see a clear connection between the family assessments and the information written in the IFP.	-	10	3	-	-
8. I was able to reach most of the goals listed on the IFP.	-	-	11	1	1

Note: S/A = Strongly Agree; A = Agree; N/S = Not Sure; D = Disagree; S/D = Strongly Disagree.

Overall, the results of the survey were encouraging. Families were presented with a Family Profile to assist them with the development of IFPs within the context of family centered practice. Parents agreed on the benefits of a process in which the assessment measures and results were clearly explained to them and linked to the development of an IFP. This finding highlights the need to work within a family centered context (Singer & Power, 1993), and ensure that parents are fully aware of how the information will be used (Dunst et al., 1988) and how this information can help identify family strengths and needs in order to develop an IFP.

Comments made following each close-ended question reinforced the usefulness of the process for these parents. One parent indicated, "It really gave us a lot of insight about our family, our strengths, etc." Another parent pointed out, "It made me talk about what I have been experiencing candidly to someone who could be completely impartial." Parents commented on the importance of emphasizing family strengths: "Yes, it was good to hear from someone outside of the family that we are doing okay with our child."; and, "In fact, the assessments indicated strengths we weren't sure we had." One parent was surprised that the assessment information was so accurate: "Assessments were accurate which was a surprise because the questions were poorly worded."

Parents also provided examples of how their stress levels had been reduced following participation in the study. One parent wrote, "There have been some changes made - example: having our son baby-sat...Also just discussing some of the problems with the researcher has helped so much." Another parent indicated, "(The process) made me see what was wrong. I was putting the blame on myself. I was being harder on myself than I should be." Finally, one parent wrote, "Stress does not come from opening up and learning to make changes, only when you are not willing to make a change."

Parents indicated that they were able to see a connection between assessment data and the IFP: "I see that it's good to figure out when (our) answers don't mesh on the family adaptation data so we can talk about it and work out our different perceptions of our relationship through goals on the IFP." This parent also pointed out the need for couples to discuss differences in appraisals when developing IFP goals.

Parents indicated ways in which the process could be improved in the open-ended questions. One parent wrote, "I would like more time devoted to this task (setting goals) with (the family consultant)." Another parent suggested, "Have spouses separately rank the family's goals or priorities then compare the lists." A third parent expressed this frustration, "You have to make sure that services are available before people do an IFP. If someone thinks that the services are out there and think that the IFP is going to help and relieve stress, when they have trouble getting the services or find out they don't exist, people suffer more stress than before." This statement identifies one of the problems with the assessment process identified by Slentz and Bricker (1992) - unfairly raising family expectations regarding the availability of services. A fourth parent indicated that he would like "more self-help literature, outside help if necessary and access to information."

Formal Assessment Measures

A summary of the results of the formal assessments may be found in Table 3 below. Dyson (1991) pointed out that families with relatively high scores on measures of stress may be adapting quite well. The results of the PSI and FSI indicated that these families had mean scores at the high end of the normative range on both the initial and final assessments. In fact, the mean score for the rural sample on both measures increased on the final assessment. In spite of these findings, the families scored within the normative range on the adaptation measure (FAM) on both initial and final assessments, which is consistent with the findings of previous investigations (Reddon et al., 1992; Redington et al., 1995). These findings also support one of the premises of family centered practice - families of children with disabilities are similar in many ways to families of children without disabilities (Mahoney et al., 1992).

Table 3 - Summary of Formal Assessment Measures

Measure	Normative Range	Initial	Final
PSI Child Characteristics Domain	78-116	Urban 116 (80-143) Rural 114 (92-143)	112 (74-143) 117 (102-138)
FSI	3-18	Urban 16 (4-30) Rural 17 (4-36)	14 (0-30) 20 (4-32)
FAM	40-59	Urban 46 (37-63) Rural 52 (40-59)	46 (36-58) 52 (48-56)
LOT	15-25	Urban 20 (7-28) Rural 20 (8-28)	22 (13-27) 21 (7-27)
F-Copes Reframing	25-35	Urban 30 (26-37) Rural 30 (21-37)	33 (25-40) 32 (25-35)
Passive Appraisal	7-20	Urban 17 (10-20) Rural 18 (11-20)	17 (13-20) 18 (14-20)
FIRM	90-150	Urban 106 (63-129) Rural 108 (59-118)	110 (91-139) 113 (69-127)
CHIP   (I)     (II)   (III)	25-55 16-40 8-22	Urban 40 (29-53) Rural 44 (26-55) Urban 28 (16-41) Rural 34 (25-43) Urban 13 (7-19) Rural 18 (9-22)	42 (35-51) 41 (28-53) 32 (21-40) 32 (22-40) 15 (6-23) 18 (14-20)

Review of the results of the appraisal measures (LOT, F-COPES) revealed normative levels of global and situational appraisals for both the LOT and the Reframing subscale of the F-COPES. On the Passive Appraisal subscale, the parents indicated active levels of perceiving and addressing difficulties in their families. The appraisal process was a strength in these families, supporting findings from prior research (Reddon et al., 1992; Redington et al., 1995). The FIRM provided an indication of family and social supports with the results showing normative levels of support for most of these parents on initial and final assessments. All of the urban parents were in the normative range on the final assessment. This finding again shows family strengths and suggests that perhaps family and social supports may mediate the effects of stressors found on the PSI as they affect family adaptation. This possibility could be addressed in future research.

Fnally, results from the Family Coping measures [CHIP- (I) Family Integration, (II) Support and Esteem, and (III) Medical Consultation] revealed mean scores within the normative range, suggesting that these parents made use of effective coping strategies to mediate stress and promote adaptation. The results suggested, overall, that these families do experience stresses and demands in their lives. The effects of these demands, however, may be mediated by effective coping strategies, use of personal and social supports, and positive appraisals. Future research should examine these relationships in an attempt to clarify which dimensions of the model function as mediators of family stress. These analyses would also aid professionals in family centered practice to identify strengths and needs of parents and families when planning IFPs and goal attainment strategies.

Implications for Professionals

There were limitations to this study. Data were collected from a small group of parents in rural and urban settings in a relatively small demographic area. All of the families were receiving services through their local health units. All but two of the families were two-parent families, and the mean income for both the rural and urban families was quite high. Finally, three of the rural fathers declined to complete the final assessment measures. In spite of these limitations, the results of this study have implications for professionals working with families of young children with disabilities. First, although stressed by family needs and issues, participating parents seem to be adapting well to the vagaries of their lives. This finding should help to dispel the stereotype of these families as being dysfunctional or in turmoil. If the assumption is that most families of children with disabilities are making positive adaptations, then the role of the professional becomes one of support and encouragement rather than direct intervention. In fact, family consultant may be a more appropriate job title than "interventionist" - a term typically found in the literature and used in practice. The term "consultant" suggests more of a collaborative relationship with families and seems more appropriate than the term "interventionist" or "early interventionist" within the context of family centered practice

Second, it seems that supports, appraisals, and family coping strategies are important areas of strength that may mediate stress in families of children with disabilities and promote adaptation. The present research presents one method of assessing these variables using a multidimensional approach within a family centered framework. Future research may examine other assessment tools or informal assessment procedures (e.g., structured conversation, open-ended questions) in order to determine if there are more appropriate ways to assess these dimensions. For example, some parents objected to the wording of some of the questions in the measures used in this study (e.g., the term Acceptability on the PSI). Other parents commented on the specific recording procedures used in some of the measures. Professionals may wish to find a variety of ways to address these areas of family functioning in a family-sensitive manner.

Third, the Family Profile and the IFP used in this study seemed to adequately portray family functioning and adaptation and could be used by professionals involved in family centered services. The use of these approaches along with a family problem-solving strategy could be used with individual families and studied within a single subject research design. This approach would allow for analysis of the family strengths and needs, using the Family Adaptation Model as a means of implementing family centered early intervention.

Conclusion

This study examined the clinical utility of a family adaptation model. Parents indicated that this model provided a useful way of organizing assessment information for the purposes of identifying family strengths and needs and developing an IFP. Further research is needed in this very important area of family centered practice.

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McCubbin, H. I., & Patterson, J. M. (1981). Systematic assessment of family stress, resources, and coping: Tools for research, education, and clinical intervention. St. Paul, MN: Department of Family Social Science.

McCubbin, H. I., & Thompson, A. I. (1987). Family stress theory and assessment: The T Double ABC Model of family adjustment and adaptation. In H. I. McCubbin & A. I. Thompson (Eds.), Family assessment inventories for research and practice (pp. 3-32). Madison, WI: University of Wisconsin-Madison.

McGonigel, M.J., Kaufmann, R.K., & Johnson, B.H. (1991). A family-centered process for the individualized family service plan. Journal of Early Intervention, 15, 46-56.

Olson, J., & Kwiatkowski, K. (1992). Planning family goals: A systems approach to the IFSP. Tucson, AZ: Communication Skill Builders.

Reddon, J. E., McDonald, L., & Kysela, G. M. (1992). Parental coping and family stress I: Resources for the functioning of families with a preschool child having a disability. Early Child Development and Care, 83, 1-26.

Redington, C., J., Kysela, G. M., & McDonald, L. (1995). Adaptation and functioning in families of children with special needs: A rural perspective. Exceptionality Education Canada, 5, 57-85.

Scheier, M. F., & Carver, C. S. (1985). Optimism, coping, and health: Assessment and implications of generalized outcome expectancies. Health Psychology, 4, 219-247.

Singer, G. H. S. , & Powers, L. E. (1993). Contributing to resilience in families. An overview. In G. H. S. Singer & L. E. Powers (Eds.), Families, disability and empowerment. Active coping skills and strategies for family interventions (pp.1-26). Baltimore, MD: Paul H. Brookes.

Skinner, H. A., Steinhauer, P.D., & Santa Barbara, J. A. (1984). The family assessment measure: Administration and interpretation guide. Unpublished manuscript.

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Protocol for the Home Visits

Purpose of the Initial Home Visit:

1. To meet parents.
2. To discuss any issues regarding the research project (e.g., voluntary participation, right to withdraw, confidentiality).
3. To review family assessment information as summarized on the Family Profile.
4. To introduce the IFP form and invite parents to complete.

Activities:

• Introductions. Explain purpose of the visit (listed above).
• Confirm informed consent to participate in the study.
• Review information on the Family Profile.
• Present completed Family Profile.
• Refer to these results as "a picture of your family."
• Encourage family members to "make sure the picture looks right."
• Discuss reactions to the information in order to obtain an accurate representation of the family.

Completing the IFP Form:

• Ask family members what goals they would like to work towards, and write these down.
• Ask family members if these could be goals on the IFP.
• Complete the IFP form.

Concluding Activities:

Express appreciation and recognition of family members' contributions.
Purpose of the Follow Up Visits:

1. To ask parents how the goals listed on their IFP fit their current needs.
2. To discuss possible adaptations to the IFP if indicated by the family members.
3. To review the goals listed on the IFP and discuss progress towards goal achievement.
4. To answer any questions regarding the IFP form or process.

Activities:

1. Explain purpose of the visits (listed above).
2. Discuss possible adaptations to the IFP if indicated by the family members.
3. Review the goals listed on the IFP and discuss progress towards goal achievement.

Purpose of the Final Home Visit:

1. To invite parents to complete family assessment measures and survey.
2. To ask parents if they have any questions or would like further follow-up to this process.
3. To thank parents for their contribution to this study.

Activities:

1. Invite parents to complete family assessment measures and survey. Offer them choice of:
   1. Completing the measures at home during the last visit either independently or with questions being read by the research assistant (with parent response sheet obscured); or
   2. Completing the measures in their own time and return them to the research assistant in the self addressed stamped envelope provided.
2. Ask parents if they have any questions or would like further follow-up to this process.
3. Thank parents for their contribution to this study.

(Adapted from Olson & Kwiatkowski, 1992, pp. 64-65)

Appendix 2- A Brief Description of the Instruments Used to Measure the Dimensions of Family Functioning

Parenting Stress Index (PSI)
Summary

• a screening and diagnostic instrument, designed to provide a "measure of the relative magnitude of stress in the parent child system" (Abidin, 1986, p.3)
• - uses a Likert scale format. Total scale has 101 items and child domain has 50 items. Yields individual subscale scores, domain scores, and a total stress score. The Child Domain was utilized to give an indication of demands relative to the parent-child relationship. The Child Domain has six subscales (adaptability, acceptability, demandingness, mood, reinforcement and distractibility of the child).
• - normed on 534 mothers from central Virginia. Normative data for fathers reveal lower mean scores than mothers, father's mean=92.9 and mother's mean=98.4 respectively.

Psychometric Properties

• evidence of content validity is provided by the author. Reliability coefficients for the Child Domain are reported by Abidin (1986) as ranging from .62 to .70.

Family Stressors Index (FSI)

Summary

• identifies the number of normative life events and changes experienced by the family in the preceding twelve months. These changes or events were regarded as rendering the family vulnerable to the impact of subsequent stresses or changes (McCubbin & Thompson, 1991).
• uses a yes/no format. Total scale has 10 items. Yields total family stressor score which can be compared with family life cycle normative data.
• normed on 1000 families.

Psychometric Properties

• psychometric properties reported include a validity coefficient with original FILE of .60 (McCubbin &Patterson, 1981). The overall scale reliability of the FILE is .81.

Family Crises Oriented Personal Evaluation Scales (FCOPES)

Summary

• designed to "identify problem-solving and behavioral strategies utilized by families in difficult or problematic situations" (McCubbin & Thompson, 1991).
• uses a Likert scale format. Total scale had 12 items. There are twelve items for the reframing and passive appraisals subsclaes.
• this study used selected items of the F-COPES as suggested by Lavee, McCubbin and Olson (1987). The two subscales selected were the Passive Appraisal and Reframing Subscales. The Passive Appraisal scale examines how parents cope with their problems, while the Reframing scale focuses on whether parents reframe their problems to consider them in an optimistic way. Appraisal may be unrelated to the actual intensity of the stressor. The appraisal of the situation is thought to affect how well the family will ultimately cope with the problem.
• normative data is reported for a sample of 2740.

Psychometric Properties

• evidence of construct validity is provided by the authors. Alpha reliability for the entire scale is reported as being .77. Internal reliability coefficients for the two subscales is reported as being .66 for the Internal Family Coping Patterns and .77 for the External Family Coping Patterns. Subscale coefficients are reported as ranging from .64 to .87.

Life Orientation Test (LOT)

Summary

• was developed to "measure dispositional optimism, assessed in terms of generalized expectations of the occurrence of good outcomes in one's life" (Scheier & Carver, 1985). The LOT provides a measure of the typical manner in which families appraise daily events.
• uses a Likert scale format. Has a total of 12 items.
• normative data is reported for 357 men and 267 women.

Psychometric Properties

• reported psychometric properties include evidence of construct, convergent and discriminant validity. Also included are internal reliability coefficients of .76 and a test-retest reliability of .76 over a four week period.

Family Inventory of Resources for Management (FIRM)

Summary

• was developed to assess the family's repertoire of resources (McCubbin & Thompson, 1991). The FIRM has four subscales: Family Strengths I, Family Strengths II, Extended Family Support Scale III, and the Financial Well-being Scale IV. Subscales I, II, and IV were.
• uses a Likert scale format. Yields five subscale scores and a total resource score. The FIRM has 69.
• normative data are reported for a sample of 322 families with chronically ill children.

Psychometric Properties

• evidence of content and concurrent validity is provided. Internal reliability for the total scale is reported as .89 (Chronbach's alpha).

Social Support Inventory (SSI)

Summary

• was developed for use in assessing the social support of parents at any stage of parenting as well as individuals in general (McCubbin & Thompson, 1991). The SSI examines three specific aspects related to social support: types of support, sources of support, and intensity of support.
• uses a Likert scale format. Yields a support score for each of the 11 sources of support in addition to a total support score.
• normative data is not available

Psychometric Properties

• evidence of construct validity is provided by the authors. Test-retest reliabilities are reported as being .81.

Coping Health Inventory for Parents (CHIP)

Summary

• was developed to assess parent's perceptions of their response to the management of family life when they have a child with special needs (McCubbin & Thompson, 1991). There are three coping patterns in the CHIP which relate to family functioning, CHIP1) Co-operation and definition of the situation, CHIP2) Social support and self esteem, and CHIP3) Understanding medical information and interaction with health care professionals.
• uses a Likert scale format. Yields three subscales scores. Has 45 items in total.
• normative data is derived from a sample of 308 families who had children with chronic illness.

Psychometric Properties

• considerable evidence of validity is provided by the authors. Internal reliability coefficients for each subscale is also provided (.79 for Subscales I and II, and .71 for Subscale III).

Family Assessment Measure (FAM)

Summary

• was designed in such a way as to be able to differentiate between healthy, very healthy and disturbed family functioning. The FAM differentiates between these levels of functioning through a self report measure which provides quantitative indices of family strengths and weaknesses (Skinner, Steinhauer, & Santa Barbara, 1984). The Dyadic Relationship and Self Rating Scales were not used in this study.
• uses a Likert scale format. Yields mean and subscale scores.
• normative Canadian data are provided based upon a sample of 475 families in Toronto, Ontario.

Psychometric Properties

• substantial evidence of validity is provided by the authors. Overall reliability coefficients are reported as .93 for the General Scale, .95 for the Dyadic relationships scale, and .89 for the Self-rating scale. Subscale coefficients range from .60 to .87 for the General scale, .55 to .73 for the Dyadic Relationship scale, and .27 to .58 for the Self-Rating scale.