Family Assessment

Since the last half of the twentieth century there has been a growing interest in the empirical study of the family. Family assessment has been undertaken by social scientists who examine various dimensions of family life. Assessment may also be undertaken by mental health professionals with the goal of obtaining information about the families who seek their assistance in order to determine the necessary interventions and the methods of evaluating their outcomes.

Many of the objectives of family assessment are similar to assessment of individuals and their personalities. Issues about what is being assessed may be primary but when, where, how, and why the assessment is taking place may all be relevant.

Why a Family Assessment?

The whole family is not equivalent to the sum of its individual and dyadic parts. Adults in intimate relationships may consider each other as their "whole" family. But with the birth of a child, a mother-father-child triad transforms the adult dyad into a larger family system with new and multiple role demands. For even young children, being with both parents together means coping with the dynamics of the marital relationship, and family (including marital) life after the birth of a second child may change even more profoundly. Further, family cohesiveness, warmth, and flexibility may be essential for optimal child as well as adult development, and serve as resources and buffers against stressful life events. Assessment of the many family subsystems may be necessary but each may be understood best only in the context of the family as a whole.

What, Where, and How of Family Assessment

Questionnaires, structured and unstructured interviews and tasks, descriptions of observations in naturalistic settings and in the laboratory, and scoring systems have been developed to assess family life and describe the family along many different dimensions. One dimension could be a global one, for example, placing the family along a continuum of competence. Is this family functioning optimally, is it functioning adequately, or is it severely dysfunctional (Beavers and Hampson 1993)? Descriptions and reviews of the reliability, validity, and in some cases, clinical utility of a large number of these methods and scoring manuals can be found in the following books: W. Robert Beavers and Robert B. Hampson (1990); Anne E. Copeland and Kathleen M. White (1991); Harold D. Grotevant and Cindy I. Carlson (1989); Theodore Jacob and Daniel L. Tennenbaum (1988); Patricia K. Kerig and Kristin M. Lindahl (2001); Luciano L'Labate and Dennis A. Bagarozzi (1993); Richard H. Mikesell, Don-David Lusterman, and Susan H. McDaniel (1995); David H. Olson, Candyce S. Russell, and Douglas H. Sprenkle (1989); Barry F. Perlmutter, John Touliatos, and Murray A. Straus (2000); Irving E. Sigel and Gene H. Brody (1990); and Froma Walsh (1993).

Social scientists and mental health professionals often study the dimension of family structure. Family structure is characterized by the roles and relationships among the individual members of the family. Who disciplines the children? Who provides leadership and helps in problem solving? Who does one turn to for support and encouragement? The family may include one or several male and/or female adults of various ages, in varying biological relationships with one or several male and/or female children of various ages from infancy through adulthood. Each child and adult has varying physical, cognitive, emotional, and social characteristics and possible problems in living that he or she brings to daily family life. Assessment of family structure and its changes over time may be made to understand, for example, general and specific effects of age, education, marital status, socioeconomic and other social conditions, developmental processes, roles, culture and the acculturation process, and religious beliefs and practices.

Assessment may be made of the dimension family dynamics. Family dynamics consist of the sequence of interactions (parent-child exchanges) and transactions (parentA-child-parentB-child-parentA exchanges); their synchrony, reciprocity, and patterns of mutual influence. When a child hits a sibling, does the mother or father respond first or not at all until one of the sibling cries? What does mother say and do? If the father is present, what does he say or do after watching? Is he silent throughout the encounter? What does each of the children say or do next in response to their mother and/or father? What does the mother and/or father say or do in response to the children's next words or actions? Is there a pattern, across parent-child or sibling-sibling conflicts, especially over time, in how the family acts? Study also may be made of how these interactions and transactions affect family structure and the family subsystem relationships. These patterns may affect individual child, marital, and family characteristics, and these, too, may change over time. These analyses may provide information about family cohesion and intimacy, distribution of power in the family, decision making, family flexibility, and family competence and adjustment.

A wide variety of chronic or acute stresses may affect family structure and dynamics including, for example, violence between the adults in the home, separation and/or divorce of the parents, and the illness, injury, or death of a child, parent, grandparent, or animal companion.

The assessor decides whether the focus should be on the whole family or one or more of its subsystems: parental, marital, or sibling. One or more family members' individual attitudes, values, and perceptions of family life and relationships may be the focus. Description and ratings of family life may also be made after whole family interviews. Family behavior may also be observed, described, and scored in the home (e.g., at dinner); or coded from videotapes made of the family dinner or in a laboratory (e.g., planning a menu); or by a mental health professional after, for example, hearing an hour-long argument about the lack of manners or a child's refusal to eat at the dinner table. The information obtained from different persons (inside or outside the family), from different methods (objective or subjective), and in different social contexts may be similar, but each may be unique, and all may be relevant for more complete and useful understanding (Hayden et al. 1998; Snyder et al. 1995).

Selection of Assessment Methods

The choice of tasks reflects the purposes of the assessment. A family member's responses to sentences in a questionnaire may provide the necessary and sufficient information about perceptions of a wide spectrum of family dimensions and characteristics. But if the main interest is studying conflict resolution strategies, for example, observation may be necessary. In addition, observing a number of interactions in naturalistic, laboratory, and office settings may allow the assessor to obtain more valid and representative samples of behavior.

There are, of course, significant differences between infants, school-age children, and adolescents. The child's as well as the adult's ages, developmental stages, and cognitive, linguistic, and physical abilities and limitations affect role and task assignments in the family and the ability to complete questionnaires and engage in discussions and tasks.

Self-Report Questionnaires

Questionnaires may be completed at home, in a school or college classroom, or in a waiting room. (For example, the Family Adaptability and Cohesion Evaluation Scale [FACES III: Gorall and Olson 1995; Olson 1986], the McMaster Family Assessment Device [FAD: Epstein, Baldwin, and Bishop 1983], the Family Environment Scale [FES: Moos and Moss 1994], and the Self-Report Family Inventory [SFI: Beavers and Hampson 1995; Hampson, Hulgus, and Beavers 1991].)

Questionnaires have been created to assess a wide variety of family dimensions including:

• Family cohesion: Items that refer to the degree of emotional bonding, closeness, and togetherness. For example, "There is closeness in my family but each person is allowed to be special and different." Responses to sentences may lead to hypotheses about whether the family is perceived as disengaged, separated, connected, or enmeshed.
• Family flexibility/adaptability: Items that refer to the amount of or degree of change occurring in family leadership, role relationships, and relationship rules especially under stress. For example, "It is hard to know who is the leader in my family." Answers may lead to hypotheses about whether the family is perceived as rigid, structured, flexible, or chaotic.
• Family problem solving: Items that refer to the ability to resolve both instrumental and affective issues to the level that maintains effective family functioning. For example, "We argue a lot and never solve problems."
• Family roles: Items that refer to the current or changing roles and patterns of behavior that facilitate family functioning, including those that meet basic needs, that designate responsibilities for household tasks, maintain appropriate family boundaries, provide nurturance to family members, and assess the existence of alliances and coalitions in the family. For example, "We usually blame one person in our family when things aren't going right."
• Affective responsiveness: Items that refer to the family's ability to experience and express an appropriate range, quantity, and quality of feeling. For example, "Family members pay attention to each other's feelings."
• Affective involvement: Items that refer to the extent to which family members are perceived to be interested, be concerned, and to value each other. For example, "In our home, we feel loved."
• Behavior control: Items that refer to the perceived rules and standards for behavior maintained by the family for all its members. For example, "It is hard to know what the rules are in our family because they always change."
• Family conflict: Items that refer to the presence of stressful encounters and styles and strategies for resolving them. For example, "When things go wrong we blame each other."
• Family warmth: Items that refer to the overt and explicit presence and expression of affection and nurturance. For example, "Our family members touch and hug each other."
• Communication: Items that refer to listening and speaking skills with each other including variations in the clarity and directness of messages in both instrumental and affective exchanges of information among family members. For example, "Family members pay attention to each other and listen to what is said."
• Overall family functioning: Items that ask for a global assessment of the family's ability to accomplish its basic everyday tasks across domains. For example, "On a scale of 1–5, I would rate my family as (1) My family functions very well together . . . (5) My family does not function well together at all. We really need help."

Questionnaires may be completed twice, first with the instructions "Describe your family now" and then "Ideally, how would you like your family to be." The discrepancy between scores has been used as an indicator of satisfaction and the reduction of the discrepancy as an indicator of successful intervention (Gorall and Olson 1995). Scoring of responses can also allow the assessor to place the family into different categories or typologies, for example, centrifugal or centripetal; balanced or unbalanced; severely disturbed, borderline, midrange, adequate, optimal (Beavers and Hampson 1990) or rigidly enmeshed or flexibly connected (Olson 1993). Different family members may view the family differently and these differences may need to be confronted during interventions.

Focused Interviews and Discussion Tasks

Focused interviews are designed to obtain information about specific issues of interest. The whole family may be asked to fill out the questionnaire together—after or instead of individual completions—to come up with one family answer to each of the items, and then asked, as a whole, to provide details of events that led to the family answer. Similar kinds of information may also be obtained by having every family member complete a child behavior checklist with respect to a specific child—including individual administration to a child too young to read. The family is then asked, as a whole, to come up with one answer for each sentence and then to discuss specific events leading to the family answer. Again, differences in perceptions of child behavior and its possible causes, correlates, and consequences may become the focus of interventions.

Focused family interviews may also be conducted by behavioral scientists to obtain information related to theoretically important dimensions related to child and family development and not necessarily related to possible child or family problems. For example, to assess family cohesion and family flexibility the family may be asked to discuss such general issues as time, space, friends, and interests; what a typical day, evening, or week is like; how they handle their daily routines; and family strengths (Epstein, Baldwin, and Bishop 1982; Hayden et al. 1998; Thomas and Olson 1993). More clinically relevant, a family may be asked to identify what they believe to be the most important problems for their family from among a list of common areas of conflict (e.g., bedtime, homework, television, chores, allowances, sibling or peer fighting, drinking, or school). From these lists, the assessor could choose the highest-ranking area of conflict that all members identify as a problem for their family. The family is then asked to discuss this problem and attempt to come to a solution. Many of the discussion tasks are similar to those described by Michael S. Robbins and his colleagues (2001):

• "Each of you tell about the things everyone does in the family: the things that please you the most and make you feel good, and also the things each one does that make you unhappy or mad. Everyone try to give her or his own ideas about this. Go ahead."
• "In every family things happen that cause a fuss now and then. Discuss and talk together about an argument you had, a fight or argument at home that you can remember. Talk together about it, like what started it, who was in on it. See if you can remember what it was all about. Take your time. Go ahead."
• "Suppose all of you had to work out a menu for dinner tonight and would all like to have your favorite foods for dinner, but you can only have one meat, two vegetables, one drink, and one dessert. Talk together about it, but you must decide on one meal you would all enjoy and that has one meat, two vegetables, one drink, and one dessert. Remember you must end up agreeing on just one meal that everyone would enjoy. Okay, go ahead."

Tasks for Families with Very Young Children

With children who do not have the ability to complete a questionnaire because of their age or other factors, other family tasks may be completed. During these tasks, these children's words and actions—including those of an infant—on family behavior may be illuminating. A wide variety of family tasks, especially in a playroom with many age-appropriate toys, can be found in Gary E. Stollak, Anat Barlev, and Ioanna D. Kalogiros (2000) and Kerig and Lindahl (2001). Free play for a period of time allows all family members (which may include a toddler and school-aged and adolescent children) to group themselves as they wish, interact with and/or avoid whomever they choose, and address any topic they want, all without the direction of the assessor. After a period of time, the parents receive instructions to cease free play and to begin other tasks. For example, they are given pencils and crayons and asked to create a family drawing with instructions such as: "Please draw a picture of your family doing something. Try to draw whole people, not cartoon or stick people. Remember, make a picture of your family doing something— some kind of action."

Karen S. Wampler and her colleagues (1989) described several construction tasks including asking the family to build two houses out of various materials (for example, Lincoln Logs and Legos); the first to match a model house and the second, any other structure they wanted to build.

Other activities could include family reading of a story book, playing simple musical instruments or dancing together to recorded music, and playing board games (such as Chutes and Ladders or Candyland) in which parents and child roll dice or turn over cards, move pieces according to directions on each card or space, and attempt to reach a goal. Families with very young children are asked to play "peek-a-boo" and blow up and pop soap bubbles. As noted above, mealtime provides an excellent opportunity to observe the family, and if home observation is not practical, observation of mealtime dynamics and family structure are made in the playroom. After completion of the family drawing or other tasks, the family is offered food, and asked to spend some time eating together before proceeding with the assessment. Or, refreshments are simply left on a table in the playroom before the family enters and no further instructions given. Finally, a clean-up task provides a good conclusion to a play session.

Rating Family Behavior

At the conclusion of family interviews or observations of the family in the home, in the laboratory or playroom, or in an office, ratings can be made of the same dimensions of family functioning assessed by questionnaires as well as of many other characteristics (Kerig and Lindahl 2001). Such ratings of family dynamics from family insiders and outsiders and in different social contexts can, of course, be similar in one or more ways and divergent and conflicting in significant ways. These similarities and differences may have great significance for determining and evaluating interventions that would reduce complaints by individuals within and outside the family.

Limitations and Cautions

The multitude of empirical methods and ratings made from standardized family assessments has increased our understanding of important dimensions of family life. Using the results of standardized theoretically and empirically based methods of assessment to determine and implement specific interventions is difficult but ongoing (Beavers and Hampson 1990; Olson, Russell, and Sprenkle 1989; Snyder et al. 1995).

Caution is always needed in interpreting information from the use of any method of assessment when families are from different structures (e.g., single parent, gay, lesbian, foster, or blended families) and cultures, especially applying norms derived from assessment of families in majority cultures and from traditional families. Although questionnaires have been translated into languages other than English and completed by persons of various cultures (Olson 1995), observation, description, and empirical scoring of family life across different cultures has not received equal attention.

Assessors must become as knowledgeable as possible of the values and attitudes unique to the family being encountered and informed of their individual life histories, family traditions, and culture—before and even during the assessment. For example, such variables may affect willingness and ease of parents' talking about family (and any marital) matters with the children present, discussing family secrets, accepting the advice from someone from another culture or religion, or accepting the need for the family to change. Behavioral scientists and therapists have become increasingly aware that each family must be viewed as "a unique system and assessed and treated with regard to its unique conditions and relationships" (Olson 1995, p. 231).

The diversity of family life across communities and nations and the importance of understanding culture and minority status has increasingly affected judgments about family structure and dynamics, family psychopathology, and family therapy (Boyd-Franklin 1989; Flores and Carey 2000; McGoldrick, Giordano, and Pearce 1996; Pedersen 1997; Szapocznik and Kurtines 1993).

Empirical study of the similarities and differences of diverse families across the multitude of the world's cultures will lead to greater understanding of human and social development and provide clearer guidelines for those attempting to change family life and educate those who will become parents.

See also:Family Diagnosis/DSM-IV; Family Diagrammatic Assessment: Ecomap; Family Diagrammatic Assessment: Genogram; Research: Family Measurement; Therapy: Family Relationships; Therapy: Parent-Child Relationships

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gary e. stollak