The Family Assessment Form

1
The Family Assessment Form

• Insert Agency/Program Name
• Date of Training

2
Objectives

• To understand purpose and theory underpinning
  development of the FAF
• To become familiar with FAF structure
• To practice using the FAF

3
A Brief History

• Developed between 1986-1990 at Childrens Bureau
  of Southern California, a non-profit agency
  providing child abuse treatment and prevention
  services.
• Created by a team of staff home visitors,
  supervisor, developmental psychologist, and
  research consultants.
• Used in several program evaluation studies and a
  major controlled research study in Los Angeles
  County.

4
Research/Evaluation Findings

• Highlights
• FAF is valid and reliable measure of family
  functioning good inter-rater reliability within
  1/2 point
• Families served by Childrens Bureau changed most
  in areas of caregiver/child interactions and
  least in caregiver/caregiver interactions
• Families most likely NOT to change exhibited
  common characteristics
• Serious problems in caregivers own histories
• Serious problems in current functioning (i.e.
  substance abuse, mental illness, domestic
  violence, etc.)
• Serious problems in multiple family functioning
  factors

5
FAF Development Goals

• Thorough Family Assessments
• Focused Goals and Service Plans
• Orientation for New Staff
• Identification of Training Needs
• Consistent and Efficient Documentation
• Program Evaluation

6
Thorough Family Assessment

• Challenge of home visitation
• multiple distractions and crises can interfere
  with understanding core issues
• worker not in control of environment
• family problems can be overwhelming
• Importance of the Big Picture
• need to understand family dynamics, short and
  long-term needs, stresses, etc.
• good assessments take time time well spent
• Focus on family strengths
• need structured way to emphasize strengths

7
Focused Goals and Service Plans

• Goals and service plans need to be linked to
  assessment
• Cannot address everything need to be
  thoughtfully selective in goal setting
• Service plan needs to be realistic and unique to
  the family situation
• Assessment informs HOW you work with a family as
  well as what you work on
• unique family strengths
• impact of personal characteristics and/or history

8
Orientation and Training

• FAF helps clarify expectations and scope of work
  for new staff
• Points to areas of individual or team training
  needs
• Helps structure individual supervision and case
  presentations
• FAF is a tool to teach assessment and service
  planning
• FAF provides objective language for report
  writing

9
Documentation

• Consistency of documentation across workers,
  program sites, etc.
• Short-hand method for home visitor casework
  documentation
• Easy to review by others (i.e. supervisor,
  back-up home visitor)
• FAF takes a snapshot of the family
• FAF takes the place of a written, narrative
  assessment

10
Program Evaluation

• Provides immediate feedback to worker on
  individual family change
• Valid, reliable measure of family functioning in
  six key areas
• Aggregate data can be used to report on program
  outcomes

11
Philosophical Approach

• Practice First
• first and foremost a practice tool that has to
  work for the home visitor
• not designed to structure family sessions, rather
  to document differently what is learned about the
  family

12
Philosophical Approach

• Ecological/Systems Theory
• Problems are not within individuals rather in the
  fit between parts of the system
• FAF addresses physical environment, social
  support, caregiver child interactions, caregiver
  functioning and child behavior
• Intervention might be targeted at a misfit in
  the system
• i.e., childs school problem may be related to
  parent/teacher communication
• Change in one part of the system will change
  another part
• i.e., improved parenting skills will improve
  child development

13
Philosophical Approach

• Emphasize Family Strengths
• need a disciplined way to see strengths in
  families with complex problems
• FAF rating scale forces identification of
  strengths

14
FAF Overview

• Family Functioning Factors
• Personal Characteristics and History
• Child Behavior/Observation Checklist
• Service Plan
• Contacts
• Closing Summary

15
Family Functioning Factors

• Six Outcome Measures of Family Functioning - 38
  items total
• A. Living Conditions - 6 items
• B. Financial Conditions - 5 items
• C. Supports to Caregivers - 5 items
• D. Caregiver/Child Interactions - 12 items
• E. Developmental Stimulation - 4 items
• F. Caregiver Interactions - 6 items

16
Personal Characteristics/History

• Two Adult Assessment Factors - not used as
  outcome measures because not expected to change
  or could get worse (i.e., learn more about
  someones history)
• G. Caregiver History - 8 items
• F. Personal Characteristics - 12 items

17
Child Behavior/Observation Checklist

• Child Specific Categories - optional items not
  used for outcome measurement
• I. Acting Out Behaviors - 7 items
• J. Inner Directed Behaviors - 9 items
• K. School Behaviors - 4 items
• L. Health and Development - 7 items
• M. Temperament - 4 items

18
Service Plan

• Components
• FAF items indicating strengths
• FAF items of concern
• Goals related to areas of concern
• Methods for addressing each goal
• Frequency and duration of contact

19
Contacts

• Components
• Who, what, when, where
• Intervention Lists
• Teaching and Demonstrating
• Counseling/Issues Addressed
• Case Management/Advocacy
• Concrete/Practical
• Progress/Homework/Follow-up Tasks
• Referrals

20
Closing Summary

• Case Result (i.e., completed, dropped, lost,
  child placed, etc.)
• Outcome on Individual Family Goals
• Outcome of Referrals
• Summary Progress Notes

21
FAF Process

• Meaning of Scores
• FAF Ratings
• FAF as Initial Assessment
• FAF at Termination of Services

22
Meaning of Scores - found on Help Menu

• 1. Above average. Positive influences/traits that
  have a strengthening effect on the family and/or
  child.
• 2. Generally Adequate. Minor problems within
  normal limits not necessarily nonexistent, but
  do not create problems for caregivers or
  children. Treatment or intervention not
  necessary, but may be desired by caregivers to
  improve parenting.
• 3. Problems of a moderate nature. Negative impact
  on the welfare of children or put the family at
  risk. Counseling, intervention, or parent
  education are indicated.
• 4. Problems of a major nature. Significant
  negative influence on children or caregivers
  well-being. Intervention required.
• 5. Situation is endangering to childrens health,
  safety, and well-being. May call for removal of
  child intervention and monitoring required.

23
FAF Ratings

• Each item is rated on a 1-5 scale
• option to rate 1.5, 2.5, etc.
• Each item has an operational definition, based on
  the overall meaning of scores, to guide rating
  selection
• it is VERY important to follow the definitions
• definitions are examples of the kinds of things
  you might see, hear, etc. use them as a guide
• refer to overall meaning of scores to help with
  rating decisions as needed

24
FAF as Initial Assessment

• FAF serves as only form of assessment
  documentation
• rule of thumb is to complete within 3-4 visits
  including service plan
• rate items following each visit with a family
• review FAF areas not assessed yet in preparation
  for subsequent visits
• Do not change ratings following this established
  baseline period

25
FAF at Termination

• Re-rate FAF at termination of services prior to
  completing the closing summary
• this should not require a special visit with the
  family as the worker already knows the family
  well
• termination rating should take about 1/2 hour
• Programs may wish to re-rate FAF at additional
  intervals (i.e., annually)

26
Key Points for Using FAF

• FAF is a framework for approaching assessment NOT
  a structured interview or questionnaire
• FAF is a psychosocial assessment documented
  differently
• Obtain FAF data by asking and observing

27
Key Points for Using FAF

• Use the operational definitions and overall
  meaning of scores to determine ratings
• this is key to maintaining inter-rater
  reliability
• Brief narrative comments are essential
• helps explain scores and uniqueness of each
  family
• Remember to tie goals directly to assessed areas
  of concern

28
Exercise 1

• Practice Rating Living and Financial Conditions
  Factors
• Think of a home you know well. It could be your
  own, the one you grew up in, or a clients. Get a
  good picture of it in your head.
• With a blank FAF and pencil, rate sections A and
  B.
• Debrief as a group

29
Exercise 2

• Mock Interview
• Divide into small groups no larger than 5
• Each group gets a Script and blank FAF
• Group members take turns reading the two parts in
  the Script - worker and mother
• Stop, discuss and rate the FAF as indicated on
  the Script
• Continue working through Script
• Debrief as a large group

30
Goal Setting

• What is a goal?
• the end toward which an effort is directed -
  Websters New Collegiate Dictionary
• a future state of being
• what will the family situation look like when you
  have finished your work together
• what will be different?

31
Goal Setting

• What factors contribute to goal setting?
• Input from the family
• Presenting problem by referral source
• FAF assessment
• Other?
• Art is in blending these together into meaningful
  goals that the client is willing to work towards

32
Goal Setting Guidelines

• Specific and Clear
• Measurable and Observable
• Accomplishments - state positively
• To practice active listening skills vs. to reduce
  level of arguing
• Use active voice
• Parents will clean the house once a week
• Realistic based on resources - yours and the
  familys
• Timeframe for achievement

33
Sample Goals

• Problem Cleanliness/orderliness inside home
  (dirty dishes, trash overflowing, soiled diapers
  on floor)
• Goal Parents to demonstrate understanding of
  hygiene for childrens health and safety by
  maintaining a clean home (i.e., doing dishes
  daily, taking out trash weekly, etc.)
• Method Teach parents about connection between
  health and hygiene using videos and handouts
  help develop cleaning schedule provide start-up
  cleaning products

34
Sample Goals

• Problem Appropriateness of discipline (only use
  corporal punishment with shoes and belt)
• Goal Parents to verbalize and implement timeout
  technique correctly
• Method Teach and demonstrate time-out provide
  timer coach and support parents in explaining
  new rules and consequences with children

35
Sample Goals

• Problem Bonding style to children (parent pushes
  baby away and believes he is crying intentionally
  to anger parent)
• Goal Parent to respond positively to childs cry
  for comfort parent to verbalize understanding of
  child development and reasons for crying
  behaviors
• Methods Provide and review child development
  information explore parents feelings
  demonstrate how to comfort baby develop options
  for parent so childs needs are met

36
Service Planning Exercise

• Divide into small groups no larger than 5
• Each group member gets a sample completed FAF
  with ratings and comments
• Each group gets a flip chart size piece of paper
  and markers
• Each group gets assigned sections of the FAF to
  work on (i.e., group 1 gets section A, group 2
  gets section B, etc.)

37
Service Planning Exercise

• Ask each group to
• list on the flip chart paper the strengths
  identified in their assigned section
• list on the flip chart paper the concerns
  identified in their assigned section
• develop at least one well stated goal addressing
  one of the concerns
• identify what methods the group might use to
  address this goal

38
Service Planning Exercise

• Debrief Exercise
• Have each group present their thinking related to
  their section
• Engage group in constructively critiquing the
  goals and methods
• Reinforce how to use the family strengths to
  address the concerns

39
Final Comments

• Reinforce important messages
• Questions and Answers
• Plan for Next Steps in Implementation of FAF in
  your agency
• Participant satisfaction/feedback surveys