Family Assessment Device

Submitted by mholliday on Thu, 09/19/2013 - 16:40

Overview

Acronym: 
FAD
Author(s): 
Nathan Epstein, Lawrence Baldwin, & Duane Bishop
Citation: 

Epstein, N. B., Baldwin, L. M., Bishop, D. S. (1983). The McMaster family assessment device.  Journal of Marital and Family Therapy. 9, (2), 171-180.  

Obtain(Email/Website): 

Available online at http://web.up.ac.za/UserFiles/FAD.pdf or from the authors at the Family Research Program, Butler Hospital, 345 Blackstone Boulevard, Providence, RI 92906.
 

Cost: 
Free
Copyrighted: 
No
Measure Description: 

Based on the McMaster Model of Family Functioning (MMFF), the FAD measures structural, organizational, and transactional characteristics of families.  It consists of 6 scales that assess the 6 dimensions of the MMFF - affective involvement, affective responsiveness, behavioral control, communication, problem solving, and roles - as well as a 7th scale measuring general family functioning.  The measure is comprised of 60 statements about a family; respondents (typically, all family members ages 12+) are asked to rate how well each statement describes their own family.  The FAD is scored by adding the responses (1-4) for each scale and dividing by the number of items in each scale (6-12).  Higher scores indicate worse levels of family functioning.
   
The FAD has been widely used in both research and clinical practice.  Uses include: (1) screening to identify families experiencing problems, (2) identifying specific domains in which families are experiencing problems, and (3) assessing change following treatment.  
 

Domain(s) Assessed : 
Parent, Caregiver, Family Mental Health & Functioning
Language(s) : 
English
Arabic
Armenian
Chinese
Dutch
French
Hungarian
Italian
Japanese
Spanish
Thai
Turkish
Age Range: 
12 years +
Measure Type: 
Screening
# of Items: 
60
Measure Format: 
Questionnaire
Average Time to Complete (min): 
15-20
Reporter Type: 
Self
Average Time to Score (min): 
10-15
Periodicity: 
Not specified. The FAD can be used to evaluate the effectiveness of an intervention, in which case it should be administered before and after the family recieves the service.
Response Format: 

The FAD utilizes a 4 point Likert scale, with answer choices “strongly agree,” “agree,” “disagree,” and “strongly disagree.”  Answers are coded 1 - 4 with higher numbers indicating more problematic functioning.
 

Materials Needed: 
Paper/Pencil
Sample Item(s): 
Scales
Sample Items
General Family FunctioningPlanning family activities is difficult because we misunderstand each other.
CommunicationYou can't tell how a person is feeling from what they are saying.
Affective ResponsivenessWe are reluctant to show our affection for one another.
Problem SolvingWe usually act on our decisions regarding problems.
Behavior ControlW have rules about hitting people.
Affective InvolvementWe show interest in each other when we can get something out of it.
RolesWhen you ask someone to do something, you have to check that they did it.
Information Provided: 
Continuous Assessment

Parallel/Alternate Forms

Parallel Form: 
No
Different Age Forms: 
No
Describe Alternative Forms: 

The General Functioning Scale can be used as a brief stand-alone measure of family functioning (FAD-12).  This scale/measure has solid psychometric properties.

 

Psychometrics

Clinical Cutoffs: 
Yes
If Yes, Specify Cutoffs: 
General family functioning: 2.00 Communication, affective responsiveness, problem solving: 2.20 Roles: 2.3 Behavior control: 1.9 Affective involvement: 2.10 (Epstein, Baldwin, & Bishop, 1983)
Reliability: 
Type:RatingStatisticsMinMaxAvg
Test-Retestacceptablealpha0.660.760.71
Internal ConsistencyacceptableChronbach's alpha0.720.920.78
Inter-rater (rater pair: mother & father)correlation (r)0.240.530.33
Inter-rater (rater pair: mother & child aged 7-11)correlation (r)-0.010.240.19
Inter-rater (rater pair: mother & child aged 12-17)correlation (r)0.000.360.16
Number of Test-retest Days: 
7
References for Reliability: 

NOTES: In a study comparing mother vs. father scores, scores on 5 out of the 7 FAD scales were significantly correlated (Akister & Stevenson-Hinde, 1991). 

In a study exploring the use of the FAD with school age children, inter-rater reliability was calculated for 2 groups of mother-child dyads: those with a child aged 7 - 11 and those with a child aged 12 - 17.  Young children’s FAD scores showed good agreement with maternal scores; scores on 6 out of the 7 FAD scales were significantly correlated.  In contrast, older children’s scores on only 2 of the 7 scales significantly correlated with maternal scores.  This suggests that, while some rater pairs demonstrate good inter-rater reliability, other raters have unique perspectives on family functioning.  The authors suggest that this reflects the adolescent developmental stage as well as decreased physical proximity to the family as the child grows up (Bihun et al., 2002).  

Akister, J. & Stevenson-Hinde, J.  (1991). Identifying families at risk: Exploring the potential of the McMaster Family Assessment Device.  Journal of Family Therapy, 13, 411-421.

Bihun, J.T., Wamboldt, M.Z., Gavin, L.A., & Wamboldt, F.S.  (2002).  Can the Family Assessment Device (FAD) be used with school aged children?  Family Process, 41, 723-731.

Epstein, N., Baldwin, L., & Bishop, D. (1983). The McMaster family assessment device. Journal of Marital and Family Therapy, 9, 19-31.

Miller, I.W., Epstein, N.B., Bishop, D.S., & Keitner, G.I.  (1985). The McMaster Family Assessment Device: Reliability and validity.  Journal of Marital & Family Therapy, 11(4), 345-356.

 

Content Validity Evaluated: 
No
Construct Validity Evaluated: 
Yes
Construct Validity: 
Validity TypeNot knownNot foundNonclincal SamplesClinical SamplesDiverse Samples
Convergent/ConcurrentXX
DiscriminantXX
Sensitive to ChangeXX
Intervention EffectsXX
Longitudinal/Maturation EffectsX
Sensitive to Theoretically Distinct GroupsXX
Factorial ValidityXX
References for Construct Validity: 

Akister, J. & Stevenson-Hinde, J.  (1991). identifying families at risk: Exploring the potential of the McMaster Family Assessment Device.  Journal of Family Therapy, 13, 411-421.

Clark, M.S., Rubenach, S., & Winsor, A.  (2003). A randomized controlled trial of an education counseling intervention for families after stroke.  Clinical Rehabilitation, 17, 703-712.

Evans, R.L., Matlock, A.L., Bishop, D.S., Stranahan, S., & Pederson, C.  (1988). Family intervention after stroke: Does counseling or education help?
Fristad, M.A.  (1989).  A comparison of the McMaster and Circumplex family assessment instruments.  Journal of Marital & Family Therapy, 15(3), 259-269.

Kabacoff, R.I., Miller, I.W., Bishop, D.S., Epstein, N.B., & Keitner, G.I.  (1990).  A psychometric study of the McMaster Family Assessment Device in psychiatric, medical, and nonclinical samples.  Journal of Family Psychology, 3(4), 431-439.

Joffe, R., Offord, D., & Boyle, M. (1988).  Ontario Child Health Study: Suicidal behavior in youth age 12-16 years.  American Journal of Psychiatry, 145, 1420-1423.

Maziade, M., Cote, R., Boutin, P., Bernier, H., & Thivierge, J.  (1987).  Temperament and intellectual development: A longitudinal study from infancy to four years.  American Journal of Psychiatry, 144, 144-150.

Miller, I.W., Epstein, N.B., Bishop, D.S., & Keitner, G.I.  (1985).  The McMaster Family Assessment Device: Reliability & validity.  Journal of Marital & Family Therapy, 11(4), 345-356.

Miller, I.W., Kabacoff, R.I., Epstein, N.B., Bishop, D.S., Keitner, G.I., Baldwin, L.M., et al.  (1994). The development of a clinical rating scale for the McMaster Model of Family Functioning.  Family Process, 33, 53-69.   

Tonge, B., Brereton, A., Kiomall, M., MacKinnon, A., King, N., & Rinehart, N.  (2006).  Effects on parental mental health of an education and skills training program for parents of young children with autism: A randomized controlled trial.  Journal of the American Academy of Child and Adolescent Psychiatry, 45(5), 561-569.
 

Criterion Validity Evaluated: 
Yes
Criterion Validity: 
Not KnownNot FoundNonclinical SamplesClinical SamplesDiverse Samples
Predictive Validity:XX
Postdictive Validity:
References for Criterion Validity: 

NOTES: Nonclinical samples consisted of non-psychiatric medical patients and their families

Predictive Validity:
clinical samples, nonclinical samples
(Arpin, Fitch, Browne, & Corey, 1990; Bishop et al., 1987; Browne, Arpin, Corey, Fitch, & Cafni, 1990; Joffe et al., 1988; Maziade et al., 1985, 1987)

Concurrent Validity: clinical samples, nonclinical samples (Miller, Epstein, Bishop, & Keitner, 1985; Miller et al., 1994)

Sensitivity: Sensitivity and specificity were calculated based on clinician interview ratings matched with FAD assessments.  FAD cutoffs have sensitivity rates of 57%-87%.  The authors assert that these rates are similar to other assessments including some lab tests. (Miller, Epstein, Bishop, & Keitner, 1985)

Specificity:
Sensitivity and specificity were calculated based on clinician interview ratings matched with FAD assessments.  FAD cutoffs have specificity rates of 64%-79%.  The authors assert that these rates are similar to other assessments including some lab tests. (Miller, Epstein, Bishop, & Keitner, 1985)

 

Arpin, K., Fitch, M., Browne, G., & Corey, C.  (1990). Prevalence and correlates of family dysfunction and poor adjustment to chronic illness in speciality clinics.  Journal of Clinical Epidemiology, 43, 373-383.

Bishop, D., Evans, R., Minden, S., McGowan, M., Marlowe, S., Andreoli, N., Trotter, J., & Williams, C.  (1987).  Family functioning across different chronic illness/disability groups.  Archives of Physical Medicine and Rehabilitation, 68, 79-87.

Brown, G., Arpin, K., Corey, P., Fitch, M., & Cafni, A.  (1990). Individual correlates of health service utilization and the cost of poor adjustment to chronic illness.  Medical Care, 28, 43-58.

Joffe, R., Offord, D., & Boyle, M. (1988).  Ontario Child Health Study: Suicidal behavior in youth age 12-16 years.  American Journal of Psychiatry, 145, 1420-1423.

Maziade, M., Caperaa, P., Laplante, B., Boudreault, M., Thivierge, J., Cote, R., et al.  (1985).  Value of difficult temperament among 7-year-olds in the general population for predicting psychiatric diagnosis at age 12.  American Journal of Psychiatry, 142, 943-946.

Maziade, M., Cote, R., Boutin, P., Bernier, H., & Thivierge, J.  (1987).  Temperament and intellectual development: A longitudinal study from infancy to four years.  American Journal of Psychiatry, 144, 144-150.

Miller, I.W., Epstein, N.B., Bishop, D.S., & Keitner, G.I.  (1985). The McMaster Family Assessment Device: Reliability and validity.  Journal of Marital & Family Therapy, 11(4), 345-356.

Miller, I.W., Kabacoff, R.I., Epstein, N.B., Bishop, D.S., Keitner, G.I., Baldwin, L.M., et al.  (1994). The development of a clinical rating scale for the McMaster Model of Family Functioning.  Family Process, 33(1), 53-69.
 

 

 



 

Overall Psychometric Limitations: 

(1) Some studies have called the FAD’s 7 factor structure into question.  One study  suggests that a 2 factor model (comprised of connection and commitment factors), rather than the 7 factor McMaster Model, provides a better fit for the data used to develop the FAD (Ridenour, Daley, & Reich, 1999).  Cross-cultural research has also challenged the 7 factor structure of the FAD.  However, rather than reflecting poorly on the original FAD, it is possible that these cross-cultural differences in factor structure reflect different cultural norms and expectations for family functioning.

(2) The McMaster Model proposes that the 7 dimensions of family functioning are subsumed by an underlying health-pathology dimension; it follows that the 7 dimensions will be intercorrelated.   This has led to criticism that the scales are not adequately independent and should not be considered discrete dimensions.

(3) Acceptable psychometric properties have been demonstrated using primarily white, middle class samples; however, additional psychometric studies with racially, ethnically, and socioeconomically diverse samples are warranted.

(4) Additional psychometric research is essential to establish the reliability and validity of several of the FAD translations.

(5) The FAD’s utility is limited by the lack of adequate standardization and norms.

 

Translation Quality

Language(s) Other Than English: 
Language:TranslatedBack TranslatedReliableGood PsychometricsSimilar Factor StructureNorms AvailableMeasure Developed for this Group
1. EnglishX
2. SpanishXXX
3. FrenchXX

Population Information

Population Used For Measure Development: 

The FAD was developed using a sample of 503 individuals drawn from both the general U.S. population as well as various clinical populations.  The sample included 209 undergraduate students, 9 advanced psychology students and their families, 6 families of patients in a stroke rehabilitation unit, 4 families with children in a psychiatric day hospital, and 93 families with an adult in a psychiatric hospital.  The adult inpatient members represented a variety of diagnoses, including adjustment disorders, major depressive disorder, bipolar disorder, personality disorders, substance use disorders, schizophrenic disorders, somatoform disorders, and mental retardation.  Demographic characteristics (i.e., race/ethnicity, gender, SES) of the development sample are not reported (Epstein, Baldwin, & Bishop, 1983).

Measure has demonstrated evidence of reliability and validity in which populations?: 
Other

Pros & Cons/References

Pros: 

(1) The FAD is based on the McMaster Model of Family Functioning, a multi-dimensional clinical model with constructs derived from clinical experience. 

(2) The FAD’s 6 domains (problem solving, communication, roles, affective responsiveness, affective involvement, and behavior control) and overall        functioning domain provide a comprehensive picture of family functioning in multiple areas.

(3) The FAD is a multi-informant assessment designed to be completed by all family members over age 12.  This provides insight into multiple perspectives on family functioning.

(4) The FAD has considerable clinical utility.  The FAD and FAD-12 can be used to screen for families with problematic functioning; the FAD can also be used to identify specific areas of problematic family functioning and to assess changes post intervention.
 

Cons: 

(1) The FAD’s clinical utility is limited by the lack of a manual, adequate standardization, and instructions for interpreting multiple family member perspectives. 

(2) Historically, the FAD has been used primarily with white, middle-class families.  Additional research with diverse racial/ethnic and socio-economic groups is needed to establish utility with these populations.

(3) While the FAD has been translated into 14 languages, these translations have varying levels of reliability and validity and warrant further study.

(4) The FAD scales are correlated with – rather than independent of – one another.  Thus, families with problematic functioning in one area are likely to experience problems in other areas as well.
 

References: 

Akister, J. & Stevenson-Hinde, J.  (1991). Identifying families at risk: Exploring the potential of the McMaster Family Assessment Device.  Journal of Family Therapy, 13, 411-421.

Arpin, K., Fitch, M., Browne, G., & Corey, C.  (1990). Prevalence and correlates of family dysfunction and poor adjustment to chronic illness in speciality clinics.  Journal of Clinical Epidemiology, 43, 373-383.

Barroilhet, S., Cano-Prous, A., Cervera-Enguix, S., Forjax, M.J., & Guillen-Grima, F.  (2009).  A Spanish version of the Family Assessment Device.  Social Psychiatry & Psychiatric Epidemiology, 44(12), 1051-1065.

Bihun, J.T., Wamboldt, M.Z., Gavin, L.A., & Wamboldt, F.S.  (2002).  Can the Family Assessment Device (FAD) be used with school aged children?  Family Process, 41, 723-731.

Bishop, D., Evans, R., Minden, S., McGowan, M., Marlowe, S., Andreoli, N., Trotter, J., & Williams, C.  (1987).  Family functioning across different chronic illness/disability groups.  Archives of Physical Medicine and Rehabilitation, 68, 79-87.

Brown, G., Arpin, K., Corey, P., Fitch, M., & Cafni, A.  (1990). Individual correlates of health service utilization and the cost of poor adjustment to chronic illness.  Medical Care, 28, 43-58.

Clark, M.S., Rubenach, S., & Winsor, A.  (2003). A randomized controlled trial of an education counseling intervention for families after stroke.  Clinical Rehabilitation, 17, 703-712.

Epstein, N., Baldwin, L., & Bishop, D. (1983). The McMaster family assessment device. Journal of Marital and Family Therapy, 9, 19-31.

Evans, R.L., Matlock, A.L., Bishop, D.S., Stranahan, S., & Pederson, C.  (1988). Family intervention after stroke: Does counseling or education help?

Fristad, M.A.  (1989).  A comparison of the McMaster and Circumplex family assessment instruments.  Journal of Marital & Family Therapy, 15(3), 259-269. 

Joffe, R., Offord, D., & Boyle, M. (1988).  Ontario Child Health Study: Suicidal behavior in youth age 12-16 years.  American Journal of Psychiatry, 145, 1420-1423.

Kabacoff, R.I., Miller, I.W., Bishop, D.S., Epstein, N.B., & Keitner, G.I.  (1990).  A psychometric study of the McMaster Family Assessment Device in psychiatric, medical, and nonclinical samples.  Journal of Family Psychology, 3(4), 431-439.

Maziade, M., Caperaa, P., Laplante, B., Boudreault, M., Thivierge, J., Cote, R., et al.  (1985).  Value of difficult temperament among 7-year-olds in the general population for predicting psychiatric diagnosis at age 12.  American Journal of Psychiatry, 142, 943-946.


Maziade, M., Cote, R., Boutin, P., Bernier, H., & Thivierge, J.  (1987).  Temperament and intellectual development: A longitudinal study from infancy to four years.  American Journal of Psychiatry, 144, 144-150.

Miller, I.W., Epstein, N.B., Bishop, D.S., & Keitner, G.I.  (1985).  The McMaster Family Assessment Device: Reliability and validity.  Journal of Marital & Family Therapy, 11(4), 345-356.

Miller, I.W., Ryan, C.E., Keitner, G.I., Bishop, D., & Epstein, N.B.  (2000).  The McMaster approach to families: Theory, assessment, treatment and research.  Journal of Family Therapy, 22, 168-189.

Ridenour, T.A., Daley, J., & Reich, W.  (1999).  Factor analyses of the Family Assessment Device.  Family Process, 38(4), 497-510.

Speranza, M., Guenole, F., Revah-Levy, A., Egler, P.J., Negadi, F., Falissard, B., et al.  (2012).  The French version of the Family Assessment Device.  Canadian Journal of Psychiatry, 57(9), 570-577.

Tonge, B., Brereton, A., Kiomall, M., MacKinnon, A., King, N., & Rinehart, N.  (2006).  Effects on parental mental health of an education and skills training program for parents of young children with autism: A randomized controlled trial.  Journal of the American Academy of Child and Adolescent Psychiatry, 45(5), 561-569.
 

Last Updated: 
Thu, 09/19/2013
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