FITT

 

FITT Model: Impact on the Family

  • Summary
  • Assessment Measures
  • Interventions
  • References

 

Summary

Families exposed to urban poverty face a disproportionate risk of exposure to trauma and of becoming trauma-organized systems. Families living in urban poverty often encounter multiple traumas over many years in addition to the daily burdens associated with their lack of resources. Repeated exposures can lead to severe and chronic reactions in multiple family members with effects that ripple throughout the family system and, ultimately, society. Although some families show resiliency, many families living under chronically harsh, traumatic circumstances have difficulties adapting. These families struggle to maintain healthy structure, relations, and coping. Widely utilized measures, including The Family Adaptability and Cohesion Evaluation Scales (FACES) and The Family Assessment Device (FAD), have been used to assess family functioning across a variety of traumatic circumstances. Family Processes is a measure that specifically examines family functioning in ethnic minority families living in urban poverty (Smith, Prinz, Dumas, & Laughlin, 2001). The erosion in adaptive family functioning related to trauma and urban poverty jeopardizes the ability of families to make effective use of structured treatment approaches and limits the success of treatments that require family support. There are few well-developed, standardized and empirically supported family therapies for treating trauma in this population.

 

Assessment Measures

Note: We offer two options for assessment of the family based on the provider's interest and consistency with intervention strategies used. We are not enthusiastic about either instrument and feel that development of a family trauma assessment instrument would be an important contribution to the field.

Name of Instrument Author(s) Domains Assessed Age Range  Source/Form (self report, lab, observation, other) # of items Time Cost Training Required Where to obtain  Psychometric Properties Other comments:  
Family Empowerment Scale Koren, DeChillo, Friesen, 1992 Assesses parent and caregiver beliefs regarding their roles and responsibilities in addition to how they provide advocacy for their child.  18 and up Caregiver report 34 15 minutes Unable to locate Familiarity w/administration, scoring guidelines, and interpretation Unable to locate  Some evidence for reliability and validity  Caregivers complete the tool directly by providing rankings of statements from 1 to 5, with 1 standing for "not true at all" and 5 as "very true". Revised version 9/19/03
Family Adaptability and Cohesion Scale (FACES IV) Olson, D.H., Gorall, D., & Tiesel, J., 2007 Based on the Circumplex model. Revised version includes six subscales: two assess the mid-ranges of adaptability and cohesion, and four assess the extremes (rigid, chaotic, disengaged, and enmeshed).  12 and up Self-administered instrument, each family member can complete 42 (+ 10 item Family Comm. Scale, and 10 item Family Satisfaction Scale)  20-30 minutes $95 FACES IV package with unlimited use Familiarity w/administration, scoring guidelines, and interpretation Life Innovations Link: Click Here Strong evidence for reliability and validity   
Family Assessment Device (FAD) Epstein, N., Baldwin, L., &Bishop, D. 1983 Designed to measure family functioning based upon the McMaster Model. The instrument provides scores for 7 scales, including problem-solving, communication, roles, affective responsiveness, affective involvement, behavior control, and overall functioning. 12 and up Self-administered instrument 60 15 minutes $41.95 for book, Evaluating and Treating Families, which includes permission to make copies of measure  Familiarity w/administration, scoring guidelines, and interpretation Brown University/Butler Hospital Family Research Program. Email: familyresearch@lifespan.org Strong evidence for reliability and validity Items are scored on a 4-point scale from 1 "Strongly disagree" to 4 "Strongly agree" Clinical cutoff scores indicating healthy versus unhealthy functioning have been established with sensitivity and specificity.
Family Processes Smith, Prinz, Dumas, & Laughlin, 2001 Cohesion, Structure,  Beliefs, Defiant Beliefs  Adult Self-administered instrument 35 10-15 minutes Unable to locate Familiarity w/administration, scoring guidelines, and interpretation Unable to locate Some evidence for reliability and validity  Items were taken from popular family assessment measures including the FACES and FAD.
APGAR Smilkstein, 1978 Measure assesses a family member's perception of satisfaction with family relationships including five dimensions: Adaptability, Partnership, Growth, Affection, and Resolve. Adult Self-administered instrument 5 less than 1 minute Free Familiarity w/administration, scoring guidelines, and interpretation Available in the public domain. Also included in the original reference.  Strong evidence for reliability and validity  Items are rated on 3-point scales ranging from 0 (hardly ever) to 2 (almost always). Has also been shown to be useful and valid with adolescent populations.
Family Advocacy and Support Tool (FAST) Lyons, 2005 The Family Assessment and Support Tool (FAST) is the family version of the Child and Adolescent Needs and Strengths (CANS) for family of planning and outcome management tools. It has 4 domains:  Family Together, Caregiver's Status, Youth's Status, and Advocacy Status. Adult Clinician administrated 38 n/a Free  Training Recommended  Available from the Buddin Praed Foundation. Direct link to measure: Click Here New or promising measure Open domain tool; training and certification recommended.
Family Environment Scale Moos & Moos, 1994 Perception of actual environments, perception of ideal family environments, and expectations of what family environments will be like under anticipated family changes. Subscales of cohesion, expressiveness, and conflict, independence, achievement orientation, intellectual-cultural orientation, active-recreational orientation, and moral-religious emphasis, organization/control, and system maintenance.  Family members age 11 through adult Self-administered 26 15-20 minutes $40 manual & sampler set. $1 per form, or less if purchased in quantities greater than 100.  Familiarity w/administration, scoring guidelines, and interpretation Mind Garden Link: Click Here Strong evidence for reliability and validity   
Family Crisis Oriented Personal Evaluation Scales (F-COPES) McCubbin, Olson, & Larsen, 1991 Five subscales: obtaining social support, redefinition of the problem, seeking spiritual support, mobilization of the family to obtain and accept formal support, passive appraisal of the crisis.  Family members age 12+ Self-administered 30 10-15 minutes Unable to locate Familiarity w/administration, scoring guidelines, and interpretation Unable to locate Strong evidence for reliability and validity  
California Inventory for Family Assessment Werner & Green, 1996 Assesses cohesion-enmeshment domain of family functioning re: intrusiveness (blurring or violation of boundaries) and closeness-caregiving (relationship-enhancing behaviors such as warmth and nurturance).  Assesses dyadic relationship behavior (e.g., wife-husband; brother-sister) rather than behavior at the level of the family as a whole. Family members Self administered 182 25-30 minutes Free Demonstration of appropriate qualifications and approval from primary authors for use.  Link to access manual: Click Here Strong evidence for reliability and validity Only used for research purposes to this point, authors unsure if measure can be used in a strictly clinical context. Studies have been conducted with ethnically diverse samples.

 

References

Epstein, N. B., Baldwin, L. M., & Bishop, D. S. (1983). The McMaster family assessment device. Journal of Marital & Family Therapy, 9, 171-180.

Koren, P. E., DeChillo, N., & Friesen, B. J. (1992). Measuring empowerment in families whose children have emotional disabilities. Rehabilitation Psychology, 37, 305-21.

Lyons, J. (2005) Family Advocacy and Support Tool: A family planning and outcome tool for understanding family circumstances and assisting in planning for services and reunification. Buddin Praed Foundation. Available http://www.praedfoundation.org/index.html

McCubbin, H. I., Olson, D. H., Larsen, A. S., Corcoran, K., & Fischer, J. (2000). Measures for clinical practice: A sourcebook. 3rd Ed. (2vols.). NY, Free Pr. V. 1, Pg. 294-297.

Moos, R. & Moos, B. (1994). Family Environment Scale Manual: Development, Applications, Research - Third Edition. Palo Alto, CA: Consulting Psychologist Press.

Olson, D. H., Gorall, D. M., & Tiesel, J. W. (2007) FACES IV Manual. Minneapolis, MN: Life Innovations.

Shapiro, J., Neinstein, L. S., & Rabinovitz, S. (1987). The Family APGAR: Use of a simple family-functioning screening test with adolescents. Family Systems Medicine, 5, 220-227.

Smilkstein, G. (1978). The Family APGAR: A proposal for family function test and its use by physicians. Journal of Family Practice, 6, 1231-1239.

Smith, E. P., Prinz, R. J., Dumas, J. E., & Laughlin, J. (2001). Latent models of family processes in African American families: Relationships to child competence, achievement, and problem behavior. Journal of Marriage & the Family, 63, 967-980.

Werner, P.D. & Green, R. J. (1996). California Inventory for Family Assessment. Available at: http://sites.google.com/site/californiainventoryforfamilyassessment/Home.

 

Interventions

Treatment Name

Developer(s)

Essential Elements

Research Evidence & Outcomes

URL for Additional Information

Family Resolution Therapy (FRT)

Saunders & Meinig (2000)

Follows a series of procedures designed for intervention to create strong family relationships in spite of long-term traumatic impact. Focuses on creating or rebuilding safe family structures that can continue to function following professional involvement.

A promising treatment; no controlled studies of efficacy.

http://colleges.musc.edu/ncvc/grants/2005
_presentations/bes_jun05_curthink1.pdf

Intensive Family Preservation Services (IFPS)

Tracy,  Haapala, Kinney, & Pecora (1991)

Family-focused and community-based crisis intervention services that strive to maintain family unity and prevent the removal of children from the home. Hallmarks include small caseloads for clinicians, who provide short lengths of service; 24-hour staff availability; and provision of services directly in the home.

Kirk (2001) retrospective study: IFPS reduced or delayed number of placements of children in welfare system. Highest-risk families experienced improved family functioning.

http://www.childwelfare.gov/supporting/
preservation/services.cfm

Multisystemic Therapy for Maltreated Children and their Families (MST)

Swenson, Henggeler, Taylor, & Addison (2005)

Provision of multiple treatment interventions that target key factors within the family’s social system that create dissidence and problems.

Brunk, Henggeler, & Whelan (1987): comparison of MST and parent training in brief treatment of child abuse and neglect.

http://www.mstservices.com/overview_a.pdf

Alternatives for Families-Cognitive Behavioral Therapy (AF-CBT)

Kolko & Swenson

(2002)

AF-CBT represents an approach to working with children who have been physically abused and their offending caregivers that incorporates therapeutic principles/procedures from several areas, including learning/behavioral theory, family-systems, cognitive therapy, and
developmental victimology.
AF-CBT integrates several behavior therapy and CBT procedures that

target individual child and parent characteristics related to the abusive experience and the larger family context in which coercion or physical force/aggression occurs.

Overall clinical outcomes report significantly greater improvements than routine community services on certain child (i.e., less child-to-parent aggression, child externalizing behavior), parent (i.e., child abuse potential, individual treatment targets reflecting abusive behavior, psychological distress, drug use), and family outcomes(i.e., less conflict, more cohesion.).

http://www.nctsnet.org/nctsn_assets/pdfs/
promising_practices/AFCBT_General.pdf

Contextual Family Therapy

Boszormenyi-Nagy (1987)

Based on the psychodynamic model, this process accentuates the need for trust, loyalty, and mutual support to hold families together. Dysfunction is believed to result from the breakdown of the above elements, which leads to the loss of a sense of fairness. Fairness can be regained through guided discussion of previously avoided emotional conflicts.

Although little empirical attention has been paid to this therapy, development of an action index for this form of therapy is helpful in discerning which areas a therapist should focus on in treatment.

http://www.contextualfamilyservices.org/index.asp

Project FOCUS

Saltzman, Lester, Beardslee,& Pynoos

(2008)

A resilience-based program centered on opening lines of communication between parents and children. In eight sessions, families learn to communicate feelings about difficult life events and acknowledge the uniqueness of each member’s experience.

A promising treatment; Family members reported high levels of satisfaction with the program and positive impact on parent–child indicators. Psychological distress levels were elevated for service members, civilian parents, and children at program entry compared with community norms. Change scores showed significant improvements across all measures for service member and civilian parents and their children.

http://www.semel.ucla.edu/resilience

Attachment Focused Family Therapy

Hughes

(2007)

Works on developing behaviors between children and parents that provide physical and psychological safety for the child. This is achieved through coaching of parents on communication and play and the creation of a safe haven and secure base from which the child can explore the world.

No data available.

http://www.danielhughes.org/treatmentandparent.html

Strengthening Family Coping Resources (SFCR)

Kiser (2006)

Uses family ritual and routine to increase the family’s sense of safety, stability, and ability to cope with crises. Intended to help families regulate their emotions and behaviors and improve family communication about and understanding of the traumas they have experienced. Consists of a 15-week multifamily group process that includes work on storytelling and creation of a family trauma narrative.

Results from open trials suggest Strengthening Family Coping Resources is a feasible intervention with positive effects on children's symptoms of trauma-related distress.

http://fittcenter.umaryland.edu/LinkClick.aspx?fileticket=
Fjo8jg7acyg%3D&tabid=55

Trauma Adapted Family Connections (TA-FC)

Collins, Strieder, Tabor, Hayward, & Davis (2008)

TA-FC builds on the Family Connections (FC) program, an evidence based neglect prevention intervention. Core components of the model include: (1) trauma-focused family assessment and engagement; (2) psycho-education to teach family members about trauma symptomatology; (3) a focus on building safety capacity within the community and immediate environment; (4) trauma informed parenting practices and intergenerational family strengthening and communication; and (5) trauma informed in-depth family and individual work including emergency response to help the family meet the basic needs of their children, advocacy and referral.

A promising treatment; The outcome evaluation for TA-FC includes the use of any of the above listed measures for baseline and follow-up assessments across multiple domains of identified risk and protective factors.  Currently analyses (Collins et al., 2011) show significant changes over time for a variety of domains.  TAFC families show reductions in risk factors, including caregiver trauma symptomatology, caregiver depressive symptoms, caregiver psychological functioning, parenting stress, and child self-report trauma symptomatology.  Significant changes have also been found for protective factors, including parenting sense of competence

http://www.ncbi.nlm.nih.gov/pubmed/22533041