Family-Focused Intervention: A Functional Model

for Planning, Implementing, and Evaluating

Individualized Family Services in Early Intervention

Donald B. Bailey, Jr.

Rune J. Simeonsson
Pamela J. Winton
Gail S. Huntington
Marilee Comfort
Patricia Isbell
Karen J. O’Donnell
James M. Helm

The provision of Individualized services to families with young handicapped children has been hampered
by the lack of a practical model. This article describes a functional model for assessing family needs,
specifying family goals, implementing family services, and evaluating effectiveness. The model draws on
the "goodness-of-fit" concept to individualize family services in order to optimize the "fit" between family,
child, and services provided.

0 The importance of family involvement is a working with their handicapped brother or

recognized principle in early intervention.
Even though a recent meta-analysis of re-
search suggests that empirical data to sup-
port this statement are lacking (Casto &
Lewis, 1984), individual studies have demon-
strated that when specific aspects of family
involvement are targeted for intervention,
positive effects are obtained. Documented ef-
fects include improved teaching skills of par-
& habilitative Services, U.S. Department of Education, Con-
ents (Rosenberg, Robinson, Beckman,
1984), changes in child behavior as a result of
improved teaching skills (Filler & Kasari,
1981), improved social interactions between
caregivers and infants (Kelly, 1982; Mc-
Collum & Stayton, 1985), successful parent
training of spouses or other parents
(Adubato, Adams, & Budd, 1981; Bruder &
Bricker, 1985), increased skills in siblings
sister (Schreibman, O’Neill, & Koegel, 1983),
and reduced stress reported by parents
(Vadasy, Fewell, Meyer, Schell, & Green-
berg, 1984).
In addition to describing the effects of se-
lected interventions with families, the profes-
Preparation of this manuscript was supported by Spe-
cial Education Programs, Special Education and Re-
tract Number 300-82-0366. The opinions expressed do not
necessarily reflect the position or policy of the U.S. De-
partment of Education, and no official endorsement by the
U.S. Department of Education should be inferred.
The authors express their deep appreciation to the
many professionals working in North Carolina’s Early
Childhood Intervention Services program, a statewide
home-based intervention program serving handicapped
infants and their families, for their contributions of time,
comments, and commitment to this project.

156
sional literature has documented the effects
on the family of raising a handicapped child
(e.g., Beckman-Bell, 1981; Blacher, 1984;
Gallagher, Beckman-Bell, & Cross, 1983;
Simeonsson & Simeonsson, 1981), suggested
models for providing family services (e.g.,
Affleck, McGrade, McQueeney, & Allen,
1982; Foster, Berger, & McLean, 1981), and
described theoretical models for understand-
ing families and the problems they must face
(e.g., Beavers & Voeller, 1983; Crnic,
Friedrich, & Greenberg, 1983; McCubbin &
Patterson, 1983; Tseng & McDermott, 1979).
Despite the large number of publications re-
garding families and their needs, few have
offered models for interventionists seeking to
plan and implement a comprehensive pro-
gram of services designed to meet family
needs (Bailey & Simeonsson, 1984). Al-
though we presently have adequate models
and procedures for assessing child needs,
the assessment of family needs has not been
elaborated well. Given that early interven-
tionists generally receive little training in
working with families in comparison to train-
ing received in working with children, the
need for a practical model becomes even
more pressing.
The purpose of this article is to describe a
functional model for planning, implementing,
and evaluating services to families with
young handicapped children. The model, re-
ferred to as Family-Focused Intervention,
has evolved out of research conducted by the
F.A.M.I.L.I.E.S. Project, a statewide collab-
orative study of the effects of early interven-
tion on families. Family-Focused Interven-
tion builds on the goodness-of-fit concept and
involves assessing family needs, planning
goals for families, providing services for fam-
ilies, and evaluating family outcomes.
THE GOODNESS-OF-FIT CONCEPT
One enigma in early intervention is the find-
ing of both favorable and poor outcomes for
different families facing essentially the same
set of circumstances. Any approach to work-
ing with families, therefore, must embrace a
conceptual framework which accounts for
such variability in outcome. A framework
with such potential is the &dquo;goodness-of-fit&dquo;
concept described in the longitudinal re-
search of Thomas and Chess (1977). Accord-
ing to the goodness-of-fit concept, outcome is
best predicted by the match or &dquo;fit&dquo; between
the unique characteristics of child and family
as they interact with the demands, expecta-
tions, and/or opportunities of the environ-
ment. A recent finding supporting the good-
ness-of-fit concept was reported by
Sprunger, Boyce, and Gaines (1985), who
found that the match or congruence between
family routines and infant rhythmicity was
more predictive of family adaptation to an in-
fant than either family routines or infant
rhythmicity alone.
The relevance of the goodness-of-fit con-
cept with families is that the goal of interven-
tion shifts from a focus on children or fami-
lies alone to an emphasis on the degree of
consonance or &dquo;fit&dquo; between characteristics
of children and families and the coping de-
mands which they experience (Simeonsson,
Bailey, Huntington, & Comfort, in press).
The interventionist’s task thus becomes one
of individualizing services to families in order
to optimize the &dquo;fit&dquo; between coping de-
mands and family characteristics.
FAMILY-FOCUSED INTERVENTION
In aprevious paper (Bailey & Simeonsson,
1984), we suggested three factors which
characterize the &dquo;ideal&dquo; family: (a) support
for the role and development of each family
member, (b) resources to cope with internal
and external stress, and (c) mutually enjoy-
able within-family interactional patterns.
However, each family differs in the manner
in which these ideals are pursued or
achieved. Although these broad dimensions
provide general direction to an interven-
tionist’s efforts, specific services must be tai-
lored according to characteristics which dif-
ferentiate families. These may include family
structure, family interactional patterns, fami-
ly functions, and family life cycle (Turnbull,
Summers, & Brotherson, 1984), as well as
family resources, family definitions of events,
and family coping strategies (McCubbin &
Patterson, 1983). Drawing from the good-
ness-of-fit concept, Family-Focused Inter-
vention rests on the fundamental assumption
that services for families with young handi-
capped children must be individualized. This
individualized approach to planning, imple-
menting, and evaluating the family compo-
nent of early intervention has four specific
goals:
157
 (1) To help family members cope with the
unique needs related to caring for and rais-
ing a child with a handicap. The needs may
range from the very specific (e.g., How do I
teach my child to feed himself?) to the very
global (e.g., How can I cope with the stress
and worry associated with raising this
child?).
(2) To help family members grow in their
understanding of the development of their
child both as an individual and as a member
of the family. Activities related to this goal
range from providing information about
handicapping conditions or child develop-
ment to organizing and running a support
group for siblings.
(3) To promote parent-child interactions
which are (a) of sufficient quantity, sen-
sitivity, and warmth, (b) mutually enjoyable,
and (c) appropriately stimulating at the
child’s developmental level.
(4) To preserve and reinforce the dignity of
families by respecting and responding to
their desire for services and incorporating
them in the assessment, planning, and eval-
uation process. This requires active efforts to
avoid creating dependency or learned help-
lessness in families by teaching, encourag-
ing, and reinforcing advocacy and independ-
ent decision-making skills.
The goals of Family-Focused Intervention
are accomplished through a sequence of spe-
cific activities related to planning, imple-
menting, and evaluating family services. As
displayed in Figure 1, the model consists of
STEPS IN FAIvAILY-FOCUSED INTERVENTION MODEL
158
six steps: assessing family needs and re-
sources, generating initial hypotheses re-
garding family needs, planning and conduct-
ing a focused interview, specifying objectives
for families, planning and implementing
services for families, and evaluating program
effectiveness.
Assessing Family Needs
Assessment of skills and deficits is the first
step in planning programs for children; like-
wise, assessment of family needs and re-
sources is the first step in planning services
for families. Unfortunately, the functional as-
sessment of family needs has virtually been
ignored. The result is that services are often
either the same for all families or based on
the interventionist’s clinical impressions of
family needs derived from informal contacts
and relatively unsystematic assessments.
When more formal assessment procedures
are incorporated, they may include either
general measures of constructs such as
stress, support, or locus of control or locally-
developed surveys which may or may not be
valid indicators of family needs.
In the Family-Focused Intervention model
initial assessment procedures are based on
two assumptions. First, both family and in-
terventionist perceptions are considered val-
id sources of information. Assessments
should, therefore, incorporate self-rating and
self-report activities by parents as well as
&dquo;objective&dquo; ratings by the interventionist.
Second, Family-Focused Intervention is not
synonymous with intervention focused on the
mother alone. Information should therefore
not come solely from mothers, since other
family members may have different concerns
or prefer alternate strategies for meeting
needs (Wandersman, Wandersman, & Kahn,
1980). In our application of the model, fathers
and mothers (or other primary caregivers)
separately complete all measures. Shared
concerns becomehigh priorities for family-
focused services, whereas unique concerns
form the basis for further discussions in a
joint interview or become the focus of indi-
vidualized goals for specific family members.
While we recognize that many dimensions
of family functioning can be assessed, three
seem essential: (1) child variables relevant to
family functioning, (2) family needs for sup-
port, information, or training, and (3) parent-
child interaction. Some of the information
obtained concerns target variables, those
identified for intervention. Other information
concerns mediating variables, factors which
influence the manner and degree to which
intervention is effective.
Child Variables. Although families with
handicapped children often have been de-
scribed as a homogeneous group in the liter-
ature, considerable variation exists in their
ability to adapt and cope with having a
handicapped child. This variability is un-
doubtedly due in part to family charac-
teristics, such as personal beliefs or percep-
tions of support, and in part to characteristics
of the child. Although there is some evidence
supporting the notion that stress varies as a
function of the child’s diagnosis (e.g., Cum-
mings, 1976; Holroyd & McArthur, 1976), the
specific behavioral characteristics of children
relate most highly to stress (Bristol, in press).
Beckman (1983), for example, found that
child responsiveness, temperament, re-
petitive behavior patterns, and the presence
of additional or unusual caregiving demands
were significantly related to the amount of
stress reported by mothers. The number of
additional caregiving demands was most
highly related to stress. Hinde, Easton,
Meller, and Tamplin (1982), as well as our
own findings (Huntington, Bailey, Sim-
eonsson, & Comfort, 1986), indicate that tem-
perament characteristics of infants and pre-
school children are associated with parent-
child interaction.
In our application of the model, assess-
ment of child variables is based on the Car-
olina Record of Individual Behavior (CRIB)
(Simeonsson, Huntington, Short, & Wares
1982) and a temperament measure. The
CRIB assesses behavioral characteristics
of children, including state variability, devel-
opmental characteristics (e.g., social ori-
entation, motivation, consolability), non-
developmental characteristics (e.g., activity,
frustration, attention span, responsiveness to
caretaker), and repetitive behavior patterns.
This measure is completed by the interven-
tionist based on objective observation of spe-
cific behavioral characteristics. The one-
page General Impression Inventory of care
and McDevitt’s (1978) Infant Temperament
Questionnaire assesses the parent’s perspec-
tive of the child’s behavioral style. These two
assessments provide the interventionist with
specific information helpful in formulating
objectives and services. As such, the infor-
mation could be viewed as a mediating vari-
able used to understand the demands with
which a family must cope, or it could provide
a specific objective for families. For example,
interventions to ensure more regularity in
the infant’s sleep/wake cycle could not only
change the infant’s behavior but also reduce
stress in a family.
Family needs. Although the birth of any
child creates additional needs for support
and increases stress in families (Power &
Parke, 1984; Wandersman, Wandersman, &
Kahn, 1980), the birth of a handicapped child
creates unique needs for support, assistance,
and information. As a group, families with
handicapped children appear to be particu-
larly susceptible to increased stress
(Gallagher, Beckman, & Cross, 1983), expe-
rience frequent difficulties in obtaining serv-
ices (e.g., babysitter, dental care, day care,
public school programs) (Blackard & Barsch,
1982), suffer isolation from friends, neigh-
bors, and extended family members (Dar-
ling, 1979), experience pressure to be more
actively involved in their child’s education
(Winton & Turnbull, 1981), and have height-
ened concerns about the future. How are
these concerns best assessed?
Much of the research in this domain has
relied on well-established standardized
measures of stress, such as the Question-
naire on Resources and Stress (Holroyd,
1974) or the Parenting Stress Index (Abidin,
159
1983). Measures such as these can be very
useful in pre-post research designs to docu-
ment change in perceived stress. However,
they are less useful as clinical tools for deter-
mining the specific needs of individual fami-
lies. In our research program, we have been
unable to find a criterion-referenced meas-
ure which provides adequate information for
identifying important family goals in early in-
tervention. As a result, we have developed
and are field-testing two assessment proce-
dures. The first consists simply of an open-
ended question to families: &dquo;What are your
greatest problems as a family?&dquo; to which
family members either write or verbally indi-
cate up to five problem areas. Second, we
are field-testing a 35-item &dquo;Survey of Family
Needs&dquo; (Bailey & Simeonsson, 1985). The
items, all of which begin &dquo;I need ...&dquo; or
&dquo;Our family needs ... ,&dquo; are organized into
six categories: (1) needs for information (e.g.,
information related to disability, teaching
techniques, or child development); (2) needs
for support (e.g., to meet and talk with other
parents or a counselor, reading material
about other families, or more time to talk
with the child’s teacher or therapist); (3) ex-
plaining to others (e.g., siblings, grand-
parents, strangers, friends, and peers); (4)
community services (e.g., locating a physi-
cian, dentist, day care center, or babysitter);
(5) financial needs (e.g., for therapy, special
equipment, toys); and (6) family functioning
(e.g., discussing problems, providing sup-
port, performing household chores). Each
item is rated as either 1 (I definitely do not
need help with this), 2 (Not sure), or 3 (1 defi-
nitely need help with this). Items rated as
&dquo;3&dquo; may form the basis for some objectives
and services for families.
Parent-child interaction. Social interac-
tions between handicapped children and
their parents constitute an important domain
for assessment. More specifically, parents
may need help reading and responding to
their child’s communicative attempts (Als,
Tronick & Brazelton, 1980; Crawley &
Spiker, 1983; Goldberg, 1977), interacting
with their children in a positive fashion (Kel-
ly, 1982; Kogan, 1980; Stoneman, Brody, &
Abbott, 1983), developing and maintaining a
strong and appropriate attachment rela-
tionship (Cicchetti & Serafica, 1981), or
teaching their child specific skills (Filler &
Kasari, 1981; McCollum, 1984). Although par-
160
ents can and should be asked whether they
desire help in these areas, parent-child inter-
action should also be assessed by the early
interventionist through direct observation,
since it is difficult to be objective in rating
one’s own behavior in the context of an inter-
personal relationship.
Many different approaches have been
proposed for assessing the various compo-
nents of parent-child interaction (Towle, Far-
ran, & Comfort, manuscript submitted for
publication). These include hierarchical de-
scriptions of parental involvement with the
child, such as Bromwich’s (1981) Parent Be-
havior Progression, various coding systems
for assessing teaching behaviors (Rosenberg,
Robinson, & Beckman, 1984; Weitz, 1981), or
various event-sampling procedures individu-
alized to assess the unique aspects of specific
families (e.g., Bruder & Bricker, 1985; Kelly,
1982; McCollum & Stayton, 1985). In our ap-
plication of Family-Focused Intervention we
have chosen to use a rating system, the Par-
ent/Caregiver Involvement Scale (PCIS)
(Farran, Kasari, Comfort & Jay, 1986). The
PCIS consists of 16 items, with the first 11
being physical involvement, verbal involve-
ment, responsiveness of caregiver to child,
play interaction, teaching behavior, control
over child’s activities, directives, relationship
among activities, positive statements, nega-
tive statements/discipline, and goal setting.
Each of the behaviors is rated on three di-
mensions : amount (quantity or level of the
behavior), quality (warmth and acceptance,
intensity, contingency), and appropriateness
(degree to which interaction is matched to
the child’s development, interest level, and
motoric capabilities). In addition, five items
allow the rater to make a global assessment
or general impression of the interactions:
availability of parent to child (degree to
which child has access to parent’s attention
and involvement), general acceptance and
approval manifested by parent (extent to
which parent seems to like the child), gener-
al atmosphere of parent-child interactions,
enjoyment, and provision of a learning en-
vironment (time, space, attention, and adap-
tation that supports child’s optimum con-
centration on a single task). The scale has
been found to be reliable both across raters
and over time (Comfort & Farran, man-
uscript in preparation) and useful in provid-
ing a broad picture of parent-child interac-
tion, as well as in facilitating the specification
of family goals in this domain.
Generating Initial Hypotheses
Assessment procedures in the three domains
form the basis for the second step in the
model, generating initial hypotheses regard-
ing family needs. Initial hypotheses are
drawn from two sources. First, each individ-
ual measure is examined and high-priority
needs identified. For example, any items
rated as &dquo;3&dquo; (1 definitely need help with this)
by either father or mother on the Family
Needs Survey are listed. Items or clusters of
items receiving low scores on the Parent/
Caregiver Involvement Scale are identified.
Child behaviors, demand characteristics, or
temperament styles with potential family im-
pact are specified.
Second, the interventionist completes the
critical events checklist displayed in Table 1.
The checklist draws from the work of Bray,
Coleman, and Bracken (1981), Wikler,
Wasow, and Hatfield (1981), McKeith (1973),
and others who suggest that certain events
TABLE 1
Critical Events Checklist
have a high probability of being unusually
stressful for families with handicapped chil-
dren. Some of these events represent mark-
ers in normal development and are stressful
because they highlight discrepancies in a ’
child’s development. Other crises are non-
developmental in nature and may occur or
reoccur at any time. The checklist serves to
alert the interventionist to recent or upcom-
ing events which may be stressful for fami-
lies. These events then become topics for dis-
cussion in the focused interview and may
also form the basis for one or more family
goals. For example, knowing that the child
will be making a program transition (e.g.,
from a home-based program to a center-
based program) in the near future could be
discussed with parents and result in a goal in
which parents and interventionist together
visit and evaluate several center-based op-
tions.
The Focused Interview
The third step in Family-Focused Interven-
tion involves the focused interview. Although
161
paper-and-pencil measures as well as direct
observational procedures provide important
information about a family, used alone they
provide an incomplete picture of needs and
resources. Additional information is best ob-
tained through a face-to-face interview with
both mother and father. Not only does the in-
terview provide a context for elaboration of
needs, it can also facilitate discussion of dis-
crepancies in perceptions between mothers
and fathers. The purpose of the interview is
to clarify and validate family needs, to pri-
oritize those needs, and to give parents the
opportunity to provide input regarding serv-
ices.
The principles, techniques, and strategies
of the art of interviewing have been studied
and described extensively (Garrett, 1972;
Gorden, 1969; Hepworth & Larsen, 1982;
Ivey & Authier, 1978). The focused interview
is a particular interview form (Denzin, 1970;
Gorden, 1969; Maccoby & Maccoby, 1954;
Selltiz, Jahoda, Deutsch, & Cook, 1965) that
is useful for an individualized approach to
family intervention. The interviewer employs
an interview guide (a list of topic areas) in
order to plan in advance the specific areas of
concern he/she will explore with the parents
during their discussion. However, the inter-
viewer has considerable latitude within the
framework of the interview to refine the
process to fit each family situation. The value
of the focused interview for gathering infor-
mation on parents’ perspectives has been
demonstrated previously in studies with fam-
ilies of handicapped children (Bernheimer,
Young, & Winton, 1983; Winton & Turnbull,
1981).
Planning for the focused interview in-
volves consideration of two concepts. The
first is derived from the ABCX Model of
Family Coping developed by Hill (1958) and
extended by McCubbin & Patterson (1983).
According to the ABCX Model, a family’s
ability to cope with stressful events, such as
those which might be associated with having
a handicapped family member, depends
upon the family’s current resources, and
their definition and perceptions of the
stressful event. It is the interactions among
resources, perceptions, and coping strategies
that account for differences in the reactions
of families to what appears to-be the same
stressful event. The second pertinent con-
cept draws from certain components of fami-
162
ly theory elaborated by Turnbull, Summers,
and Brotherson (1984). According to this
model, all families engage in at least seven
basic functions: financial, rest and rel~xa-
tion, socialization, physical (caretaking), af-
fectional, self-definitional, and educational.
Family needs and stresses are then inter-
preted in regards to their impact on major
family functions.
During the focused interview, the inter-
ventionist explores areas of strength and
needs related to the family functions while
remaining open to unanticipated areas of
concern. Drawing from the goodness-of-fit
concept, interactions between areas of need,
family resources, and family perceptions are
examined. The final product to emerge from
the interview is a list of family-focused goals
and strategies for their implementation. In
some cases the goals will be agreed upon
jointly by family and interventionist and in
other cases the goals will be generated by
the interventionist alone.
The effectiveness of the focused interview
as a family assessment measure depends
substantially on the communication skills of
the interventionist. It has been demonstrated
that communication techniques and strat-
egies can be taught (Ivey & Authier, 1978;
Hepworth & Larsen, 1982), and inservice
training in communication skills is a neces-
sary prerequisite to this step of family inter-
vention. Skills essential in conducting a
focused interview include:
1. responding empathetically to family con-
cerns ;
2. following feelings expressed by family
members;
3. probing for details in a sensitive fashion;
4. utilizing both open- and closed-ended
’
questions effectively; .
5. focusing in depth on issues of particular
concern;
6. utilizing strengthsto reinforce family
members’ efforts and provide a basis for
suggestion;
7. summarizing topics discussed as well as
future plans; and
8. artfully blending all of these skills into a
naturally-flowing, comfortable interview.
Advantages of the focused interview relate
to its combination of flexibility and structure.
First, families are allowed to &dquo;tell their
story,&dquo; highlighting what they feel to be
important aspects of their situation. This
might include information on family
strengths or unusual resources or coping
strategies that might not have been detected
by standardized measures. This approach to
data collection has been described as yield-
ing rich and valid information (Gordon, 1969;
Glaser & Strauss, 1967; Wilson, 1977). It is
also important in enhancing the respondents’
feelings of self-worth by giving value to their
opinions. Second, families are provided with
feedback from the standardized measures.
The interview is a way of letting families
know that the forms they completed provide
important information for planning services.
Finally, the interview format is structured to
the extent that interventionists can be
trained in its use, yet it is flexible enough to
be adapted to individual differences and
style among families and interventionists.
Formalizing a Plan
The process of gathering data, generating
hypotheses, and conducting a focused inter-
view culminates in the formalization of a plan
of services. This process is analogous to for-
malizing a treatment plan for children in
which goals are set and needs are pri-
oritized. In the Family-Focused Intervention
model, three guidelines are important.
(1) Needs identified by families should be
addressed tvhen possible. It is quite possible
that a family will identify and prioritize needs
which are different from those identified by
the interventionist (Cadman, Goldsmith, &
Gashim, 1984). Family-identified needs
should be given high priority for several rea-
sons. Since family members are actually ex-
periencing the problems, they should be able
to identify their sources of greatest irritation
or stress. Given the value-laden nature of
many family outcomes, the interventionist
must take care not to impose goals which &dquo;ei-
ther do not fit the family’s value system or
are counterproductive given the existing
family arrangement, allocation of roles, and
beliefs and values&dquo; (Bailey & Simeonsson,
1984, p. 42). Furthermore, if goals which are
high priorities for families are targeted first,
family members may be more invested in
their attainment and thus more likely to
work to achieve them. Successful attainment
of those goals may build a trusting rela-
tionship between family and interventionist
and facilitate the later attainment of other
goals not initially viewed as important by
family members.
(2) The interventionist may target addi-’
tional goals. Although we emphasize the im-
portance of focusing on family-identified
needs and avoiding value judgements about
what is good for a given family, it must be
recognized that many situations exist where
it is permissible and even important for inter-
ventionists to select other goals for families.
One such situation is the case in which the
family cannot see a particular problem be-
cause of other more immediate problems.
For example, the mother who is still grieving
or spending considerable time and energy in
searching for an alternate explanation for
her child’s problems may not be interested in
improving interaction patterns with her
child, even though the child desperately
needs a modified routine. Another pertinent
situation is the family in which the parents
are limited in their ability to identify or ex-
press their needs. Finally, in some cases the
interventionist’s goals may actually go
against parent preferences. For example,
the interventionist may feel it is important to
change a situation in which the father re-
fuses to interact with the handicapped infant
or will not help with caretaking tasks which
are stressful to the mother.
Under what conditions is it appropriate to
set such goals? Should parents be informed
of those goals or can they be addressed in a
covert fashion? Clearly these are complex
questions, the answers to which must be de-
termined on a case-by-case basis. Similar
questions are being raised in the field of fam-
ily and marital therapy as well (Margolin,
1982). In the long run these are questions
that must be addressed as a part of a larger
concern about ethical issues in early inter-
vention. It is our belief, however, that in
some cases interventionists have a responsi-
bility to set alternative goals in the best inter-
est of the child or family and that informing
parents of those goals should be attempted
whenever possible.
(3) Goals and expected outcomes should be
operationalized. Although we have learned
to write objectives for children in behavioral
terms, it is often difficult to specify behavior-
al outcomes for families, since goals may re-
flect changes such as reducing stress or in-
creasing sources of support. However, if
163
individualized family services are to be im-
plemented and evaluated to the fullest ex-
tent, specification of family outcomes is es-
sential.
In our application of the Family-Focused
Intervention model we have adopted Goal
Attainment Scaling (Kiresuk & Sherman,
1968) as the format for specifying outcomes.
Goal Attainment Scaling (G.A.S.) is a
straightforward method for evaluating indi-
vidual progress toward unique goals. The
G.A.S. process consists of seven steps. First,
a set of goals is specified for the client, in this
case the family or a family member. Second,
each goal is weighted according to priority.
Third, a continuum of outcomes possible by
the end of an intervention period is specified.
This continuum consists of five steps, each of
which is assigned a numerical value: Worst
Expected Outcome (-2), Less Than Ex-
pected Outcome (-1), Expected Outcome
(0), More Than Expected Outcome (+1), and
Best Expected Outcome (+2). Fourth, cur-
rent or initial performance is determined on
each objective. Fifth, intervention is con-
ducted for a specified period. Sixth, at the
end of the specified intervention period, at-
FIGURE 2. Sample Goal Attainment Scale for Family-Related Goals
164
tained performance on each objective is de-
termined. Finally, the extent to which goals
are attained is evaluated through simple vis-
ual analysis or through statistical analysis via
either a standardized T-score or a weighted
percentage improvement score. A sample
Goal Attainment Scale demonstrating a vari-
ety of family objectives is displayed in Figure
2.
Goal Attainment Scaling has been used ex-
tensively in mental health settings (e.g.
Cytrynbaum, Ginath, Birdwell, & Brandt,
1979), and recent publications have sug-
gested its use in evaluating services for ex-
ceptional children (Maher, 1983; Sim-
eonsson, Huntington, & Short, 1982).
Examples of its use with pregnant teenagers
(Enos & Hisanaga, 1979) and in evaluating
family therapy outcome (Woodward, Santa-
Barbara, Levin, & Epstein, 1978) suggest its
potential value with families of handicapped
children.
Implementing Services
The fifth step in Family-Focused Interven-
tion is implementing the formalized plan. It is
important to note that this model constitutes
a fundamental change in the perceived role
of the early interventionist. Historically, the
role has been to provide direct services to in-
fants and preschoolers with handicaps. Al-
though parent involvement has been a major
part of that effort, families generally have not
been viewed as the primary target for serv-
ices, except in the case where targeting par-
ents or siblings may have a direct impact on
the handicapped child (e.g., training parents
or siblings in behavior management skills)
(Wiegerink & Comfort, in press). The model
proposed here rests on the assumption that
the family is also to be viewed as a target cli-
ent and thus the recipient of services in its
own right. -
-
Unfortunately, most academic training
programs have not adequately prepared ear-
ly interventionists to provide comprehensive
services to families. Although unique training
models exist (e.g., Bailey, Farel, O’Donnell,
Simeonsson, & Miller, in press; Geik, Gilker-
son, & Sponseller, 1982; Pecora, Delewski,
Booth, Haapala, & Kinney, 1985), the focus
of training has been primarily child-oriented.
The provision of social support and its rela-
tionship to stress and coping is a complex
theoretical and practical issue that has been
the focus of many varied studies and papers
(e.g., Barrera & Ainlay, 1983; McCubbin &
Patterson, 1983; Schilling, Gilchrist, &
Schinke, 1984; Thoits, 1982). It is clear that
support for families through the provision of
early intervention services may be imple-
mented in many ways. Accordingly, the fol-
lowing supportive principles are important:
(1) The family is a system nested within
systems. Bronfenbrenner’s (1976) description
of the ecological nature of intervention high-
lights the concept of the family as a system
nested within other systems. This notion re-
quires the recognition that intervening with
one part of a system will affect not only the
intervention target, but also the system as
well. Furthermore, the effects of any serv-
ices provided will be mediated or enhanced
by related systems. Services therefore need
to be designed taking into account the imme-
diate as well as the broader community, so-
cial, economic and religious context of the
family.
(2) The interUentionist’s role will vury. An
important consideration in working with fam-
ilies is a realistic appraisal of the interven-
tionist’s skills and the problems that can be
solved. In some cases the interventionist will
provide direct support to families. This sup-
port may take the form of inforntationad sup-
port (providing information to family mem-
bers or teaching family members specific
skills), instrumental support (helping families
achieve certain tasks or functions, such as
respite care), or socio-emotional support (lis-
tening and responding to family concerns)
(Bailey & Winton, 1986). In other instances .
the interventionist may serve more as a facil-
itator or case manager of services. For exam-
ple, the interventionist might facilitate the or-
ganization of a parent support group, help a
family seek and secure counseling or thera-
py, locate and train appropriate babysitters,
or facilitate meeting a need for transporta-
tion, housing, or food stamps. Effective
provision of services depends upon the inter-
ventionist’s ability to recognize when he or
she does not have the skills necessary to
solve certain problems or provide certain.
services (e.g., counseling or therapy) and a
willingness to obtain the appropriate training
or to refer families to service providers who
’
are prepared to meet those needs.
(3) Families should be involved in planning
services. Just as families have preferences
for goals, they also frequently have prefer-
ences for services or strategies designed to
meet those goals. When possible, service
strategies should be individualized and par-
ent preferences for services identified.
Evaluation .
The final step in the model is evaluation. The
purposes of this step are twofold: to deter-
mine the effectiveness of services provided
and to revise services or establish new goals
and services. Although evaluation can be
carried out in many ways, at least three
strategies are recommended as a part of
Family-Focused Intervention.
The first strategy is reassessment using
some or all initial assessment instruments.
For example, if a goal of intervention was to
improve parent-child interaction, then the
parent-child interaction assessment proce-
dure should be readministered. Since many
of the measures incorporated in the assess-
ment battery may not have normative data
available, analyses to determine functioning
relative to some norm are precluded. Criteri-
165
on-referenced judgments of changes in items
themselves will therefore have to be used to
determine intervention effectiveness. Inter-
ventionists interested in evaluation proce-
dures using more standardized measures
concerning family stress, for example, should
incorporate measures such as the Question-
naire on Resources and Stress (Holroyd,
1974) the Parenting Stress Index (Abidin,
1983) or the Impact on Families Scale (Stein
& Reissman, 1980) on a pre-post test basis.
The second strategy is to determine the ex-
tent to which goals are attained using Goal
Attainment Scaling. This task may be accom-
plished in two ways. The simplest and most
straightforward method is simply to plot ini-
tial and attained levels of performance on
each goal using a chart with an ordinate on
which values range from - 2 to + 2. A sam-
ple chart displaying initial and attained
scores on selected family goals is provided in
Figure 3. Remembering that the &dquo;0&dquo; level re-
FIGURE 3. Chart Displaying Initial and Attained Goal Attainment Scores for a Hypothetical
Family
166
flectsexpected progress, this particular hy-
pothetical family met or exceeded all of the
specified goals. A numerical way of sum-
marizing goal attainment is to convert per-
formance levels to a standardized T-score,
with a mean of 50 and a standard deviation
of 10. The formula for calculating this T-
score can be found in numerous publications
(e.g., Kiresuk & Sherman, 1968; Sim-
eonsson, Huntington, & Short, .1982). In in- .
terpreting the T-score, it is helpful to realize
that if a client attained the &dquo;0&dquo; or expected
level on each goal, the resulting T-score
would be 50. The T-score for the data dis-
played in Figure 3 is 66 indicating that, on
the average, the family met or exceeded all
of its goals. The disadvantage of the T-score,
as with any simple summary statistic, is that
it does not reflect variability in attainment
across goals. However, it may be useful in
summarizing goal attainment across many
families, each-of which has unique goals.
 The third evaluation strategy is to deter-
mine the extent to which family members are
satisfied with the services they have re-
ceived. Satisfaction measures have been ma-
ligned because of the frequent finding that
parents report satisfaction with services, re-
gardless of the nature or level of service pro-
vided (Bornstein & Rychtarik, 1983). Howev-
er, satisfaction measures are important
because they give families a sense of
ownership and control over the services
made available to them, particularly when
evaluation results are used to make program
modifications. In addition, if properly de-
signed, satisfaction measures can provide
important information about the program
that the interventionist cannot obtain objec-
tively. When designing a satisfaction compo-
nent of the evaluation plan, several guide-
lines are important. General levels of
satisfaction with the overall program should
be assessed using standardized satisfaction
measures such as the brief Client Satisfaction
Questionnaire reported by Larsen, Att-
kisson, Hargreaves, & Nguyen (1979), thus
allowing for comparison across other service
delivery systems. When the purpose of the
satisfaction measure is to obtain more specif-
ic information relevant to program modifica-
tion, one useful strategy is to have parents
rate specific aspects of the program rather
than overall satisfaction. Also, a scale which
forces respondents to rank-order services or
to sort services into categories such as
&dquo;needs improvement&dquo; is more likely to pro-
vide helpful information related to improving
the quality of services delivered. Finally,
Bornstein & Rychtarik (1983) recommend
that for optimal effectiveness
(a) surveys should be presented by inde-
pendent evaluators, (b) clients must be
sured of anonymity, (c) appropriate ra-
tionales should be provided, and (d)
explanations offered as to how data will be
used in future program planning (p. 204).
SUMMARY
Working with families of infants and pre-
schoolers with handicaps is one of the most
challenging tasks facing the early interven-
tionist. It is a critical task because of the
powerful relationship between parents and
children, because the family must learn to
function as asystem, and because of the ex-
traordinary needs of many parents with
handicapped children. To perform the task
effectively, the early interventionist often is
placed in the multifaceted role of teacher,
therapist, counselor, advocate, friend, and
social worker. Without a systematic ap-
proach to working with families, the inter-
ventionist is likely to feel a certain degree of
frustration in not being able to meet impor-
tant family needs effectively.
’
This article describes a functional model
for Family-Focused Intervention which re-
sembles the diagnostic/prescriptive model
used in Special Education for children. The
model draws from the goodness-of-fit con-
cept and family systems theory to reflect an
individualized approach to working with
families. The model guides interventionists in
using systematic
and comprehensive assess-
ment information to specify individualized
objectives and develop an appropriate plan
of services to meet those objectives.
The model is presently being tested in the
context of a statewide home-based infant in-
tervention program to determine its utility. It
has not as yet been tested with families of
preschool-aged children (3-5 years); howev-
er, the principles and components should ap-
ply to this group as well. In addition, it
should be noted that although specific assess-
ment tools have been described, other in-
struments may be equally appropriate. The
three domains for assessment (child vari-
ables, family needs, and parent-child interac-
tion), however, are considered essential, as
is the focused interview and a systematic
plan for evaluation.
In conclusion, the child is and will remain
the primary target for services. However,
the family is also a consumer of early inter-
as-
vention services, indirectly as those services
pertain to the child, and directly as family
members attempt to meet their own needs as
individuals and as a living, growing system.
In carrying out this important service role in
early intervention, the need for a systematic,
functional model of family services becomes
critical.
REFERENCES
,
Abidin, R. (1983). Parenting stress index.
Charlottesville, VA: Pediatric Psychology
Press.
167
Adubato, S. A., Adams, M. K., & Budd, K.
S. (1981). Teaching a parent to train a
spouse in child management technique.
Journal of Applied Behavior Analysis, 14,
193-203.
Affleck, G., McGrade, B. J., McQueeney,
M., & Allen, D. (1982). Promise of rela-
tionship-focused early intervention in de-
velopmental disabilities. Journal of Special
Education, 16, 413-430.
Als, H., Tronick, E. & Brazelton, T. B.
(1980). Affective reciprocity and the devel-
opment of autonomy. Journal of the Ameri-
can Academy of Child Psychiatry, 19, 22-
40.
Bailey, D. B., Farel, A., O’Donnell, K., Sim-
eonsson, R. J., & Miller, C. A. (in press).
Preparing infant interventionists: Inter-
departmental training in Special Education
and Maternal and Child Health. Journal of
the Division for Early Childhood.
Bailey, D. B., & Simeonsson, R. J. (1985).
Family needs survey. Chapel Hill:
F.A.M.I.L.I.E.S. Project, Frank Porter
Graham Child Development Center, Uni-
versity of North Carolina.
Bailey, D. B., & Simeonsson, R. J. (1984).
Critical issues underlying research and in-
tervention with families of young handi-
capped children. Journal of the Division
for Early Childhood, 9, 38-48.
Bailey, D. B., & Winton, P. J. (1986). The
family and the exceptional child. In N. G.
Haring & L. McCormick (Eds.), Excep-
tional children and youth (4th Edition). Co-
lumbus : Charles E. Merrill.
Barrera, M., & Ainlay, S. L. (1983). The
structure of social support: A conceptual
and empirical analysis. Journal of Commu-
nity Psychology, 11, 133-143.
Beavers, W. R., & Voeller, M. N. (1983).
Family models: Comparing and contrasting
the Olson Circumplex Model with the
Beavers Systems Model. Family Process,
, 85-98.
23
Beckman, P. J. (1983). Influence of selected
child characteristics on stress in families of
handicapped infants. American Journal of
Mental Deficiency, 88, 150-156.
Beckman-Bell, P. (1981). Child-related stress
in families of handicapped children. Topics
in Early Childhood Special Education,
1(3), 45-53.
Bernheimer, L., Young, M., & Winton, P.
(1983). Stress over time: Parents with
168
young handicapped children. Developmen-
tal and Behavioral Pediatrics, 4
(3), 177-181.
Blacher, J. (1984). Sequential stages of pa-
rental adjustment to the birth of a child
with handicaps: Fact or artifact? Mental
Retardation, 22, 55-68.
Blackard, M. K. & Barsh, E. T. (1982). Par-
ents’ and professionals’ perceptions of the
handicapped child’s impact on the family.
TASH Journal, 7, 62-70.
Bornstein, P. H., & Rychtarik, R. G. (1983).
Consumer satisfaction in adult behavior
therapy: Procedures, problems, and future
perspectives. Behavior Therapy, 14,
191-208.
Bray, N. M., Coleman, J. M., & Bracken, M.
B. (1981). Critical events in parenting
handicapped children. Journal of the Divi-
sion for Early Childhood, 3, 26-33.
Bristol, M. M. (in press). The home care of
developmentally disabled children: Some
empirical support for a conceptual model
of successful coping with family stress. In
P. Vietze & S. Landesman-Dwyer (Eds.),
Environments for developmentally disabled
persons. Washington, D.C.: American As-
sociation on Mental Deficiency.
Bromwich, R. M. (1981). Working with par-
ents and infants: An interactional ap-
proach. Baltimore: University Park Press.
Bronfenbrenner, U. (1976). The experimen-
talecology of education. Educational Re-
searcher, 5-15.
Bruder, M. B., & Bricker, D. (1985). Parents
as teachers of their children and other par-
ents. Journal of the Division for Early
Childhood, 9, 136-150.
Cadman, D., Goldsmith, C., & Bashim, P.
(1984). Values, preferences, and decisions
in the care of children with developmental
disabilities. Developmental and Behavioral
Pediatrics, 5, 60-64.
Carey, W. B., & McDevitt, S. C. (1978). Revi-
sion of the Infant Temperament Question-
naire. Pediatrics, 61, 735-738. ,
Casto, G., & Lewis, A. C. (1984). Parent in-
volvement in infant and preschool pro-
grams. Journal of the Division for Early
Childhood, 9, 49-56.
Cicchetti, D. & Serafica, F. C. (1981). Inter-
play among behavioral systems: Illustra-
tions from the study of attachment, affilia-
tion, and warnings in young children with
Down’s syndrome. Developmental Psychol-
ogy, , 36-49.
17
Comfort, M. & Farran, D. C. (manuscript in
preparation). Systematic assessment of ma-
ternal interactions with handicapped in-
fants. University of North Carolina at
Chapel Hill.
Crawley, S. B. & Spiker, D. (1983). Mother-
child interactions involving two-year-olds
with Down syndrome: A look at individual
differences. Child Development, 54, 1312-
1323.
Crnic, K. A., Friedrich, W. N., & Green-
berg, M. T. (1983). Adaptation of families
with mentally retarded children: A model
of stress, coping, and family ecology.
American Journal of Mental Deficiency,
88, 125-138.
Cummings, S. T. (1976). The impact of the
child’s deficiency on the father: A study of
fathers of mentally retarded and/or chron-
ically ill children. American Journal of Or-
thopsychiatry, 46, 246-255.
Cytrynbaum, S., Ginath, Y., Birdwell, J., &
Brandt, L. (1979). Goal attainment scaling:
A critical review. Evaluation Quarterly, 3,
5-40.
Darling, R. B. (1979). Families against soci-
ety: A study of reactions to children with
birth defects. Beverly Hills, CA: Sage Pub-
lications.
Denzin, N. (1970). The research act: A theo-
retical introduction to sociological methods.
Chicago: Aldine Publishing Co.
Enos, R., & Hisanaga, M. (1979). Goal setting
with pregnant teenagers. Child Welfare,
58, 541-551.
Farran, D. C., Kasari, C., Comfort, M., &
Jay, S. (1986). Parent-Child Interaction
Scale—II. Honolulu, HI: Center for Devel-
opment of Early Education, Kamehameha
Schools, Kapalama Heights.
Filler, J., & Kasari, C. (1981). Acquisition,
maintenance, and generalization of parent-
taught skills with two severely handi-
capped infants. Journal of the Association
for the Severely Handicapped, 6(1), 30-38.
Foster, M., Berger, M., & McLean, M.
(1981). Rethinking a good idea: A reassess-
ment of parent involvement. Topics in Ear-
ly Childhood Special Education, 1(3), 55-65.
Gallagher, J. J., Beckman-Bell, P., & Cross,
A. H. (1983). Families of handicapped chil-
dren : Sources of stress and its ameliora-
tion. Exceptional Children, 50, 10-19.
Garrett, A. (1972). Interviewing: Its princi-
ples and methods (2nd Ed.). New York:
Family Service Association of America.
Geik, I., Gilkerson, L., & Sponseller, D. B.
(1982). An early intervention training
model. Journal of the Division for Early
Childhood, 5, 42-52.
Glaser, B., & Strauss, A. (1967). Discovery of
grounded theory. Chicago: Aldene.
Goldberg, S. (1977). Social competence in in-
fancy : A model of parent-infant interac-
tion. Merrill-Palmer Quarterly, 23, 163-177.
Gorden, R. (1969). Interviewing: Strategies,
techniques, and tactics. Homewood, Illi-
nois : Dorsey Press.
Hepworth, D. H. & Larsen, J. A. (1982). Di-
rect social work practice: Theory and
skills. Homewood, Illinois: The Dorsey
Press.
Hill, R. (1958). Generic features of families
under stress. Social Casework, 49, 139-150.
Hinde, R. A., Easton, D. F., Meller, R. E., &
Tamplin, A. M. (1982). Temperament char-
acteristics of 3-4 year-olds and mother-
child interaction. Temperament differences
in infants and young children. London:
Pitman.
Holroyd, J. (1974). The Questionnaire on Re-
sources and Stress: An instrument to
measure family response to a handicapped
member. Journal of Community Psycholo-
gy, 2, 92-94.
Holroyd, J., & McArthur, D. (1976). Mental
retardation and stress on the parents: A
contrast between Down’s syndrome and
childhood autism. American Journal of
Mental Deficiency, 80, 431-436.
Huntington, G. S., Bailey, D. B., Sim-
eonsson, R. J., & Comfort, M. (1986). Child
characteristics related to maternal involve-
ment with a handicapped infant. Man-
uscript submitted for publication. ,
Ivey, A. E. & Authier, J. (1978). Microcoun-
seling: Innovations in interviewing, coun-
seling, psychotherapy and psychoeducation.
Springfield, Illinois: Charles C. Thomas.
Kelly, J. F. (1982). Effects of intervention on
caregiver-infant interaction when the in-
fant is handicapped. Journal of the Divi-
sion for Early Childhood, 5, 53-63.
Kiresuk, T. J., & Sherman, R. E. (1968).
Goal attainment scaling: A general method
for evaluating comprehensive community
mental health progress. Community Men-
tal Health Journal, 4, 443-453.
Kogan, K. L. (1980). Interaction systems be-
169
 tween preschool handicapped or develop-
mentally delayed children and their par-
ents. In S. Goldberg, D. Stern, T. Fields,
& A. M. Sostek (Eds.), High-risk infants
and children: Adult and peer interactions.
New York: Academic Press.
Korn, S. J. (1984). Continuities and discon-
tinuities in difficult/easy temperament: In-
fancy to young adulthood. Merrill-Palmer
Quarterly, 30, 189-199.
Larsen, D., Attkisson, C., Hargreaves, W., &
Nguyen, T. (1979). Assessment of client pa-
tient satisfaction: Development of a gener-
al scale. Evaluation and Program Plan-
ning, 2, 197-207.
Maccoby, E. & Maccoby, N. (1954). The in-
terview : A tool for social service. In G.
Lindzey (Ed.) Handbook of social psycholo-
gy, Vol. 1, Cambridge: Addison-Wesley
Publishing Co.
Maher, C. A. (1983). Goal Attainment Scal-
ing : A method for evaluating special edu-
cation services. Exceptional Children, 49,
529-536.
Margolin, G. (1982). Ethical and legal consid-
erations in marital and family therapy.
American Psychologist, 37, 788-801.
McCollum, J. (1984). Social interaction be-
tween parents and babies: Validation of an
intervention procedure. Child: Care,
Health and Development, 10, 301-315.
McCollum, J. A., & Stayton, V. D. (1985). In-
fant/parent interaction: Studies and inter-
vention guidelines based on the SIAI
Model. Journal of the Division for Early
Childhood, 9
, 125-135.
McCubbin, H. I., & Patterson, J. M. (1983).
Family transitions: Adaptation to stress. In
H. McCubbin and C. Figley (Eds.), Stress
and the family, Vol. 1: Coping with norma-
tive transitions (pp. 5-25). New York:
Bruner/Mazel.
McKeith, R. (1973). The feelings and behav-
ior of parents of handicapped children. De-
velopmental Medicine and Child Neu-
rology, 15, 524-527.
Moroney, R. M. & Dokecki, P. R. (1984).
The family and the professions: Implica-
tions for public policy. Journal of Family
Issues, 5, 224-238.
Pecora, P. J., Delewski, C. H., Booth, C.,
Haapala, D., & Kinney, J. (1985). Home-
based, family-centered services: The im-
pact of training on worker attitudes. Child
Welfare, 64, 529-540.
170
Power, T. G. & Parke, R. D. (1984). Social
network factors and the transition to par-
enthood. Sex Roles, 10, 949-972.
Rosenberg, S., Robinson, C., & Beckman,
P. (1984). Teaching Skills Inventory: A
measure of parent performance. Journal of
the Division for Early Childhood, 8,
107-113.
Schilling, R. F., Gilchrist, L. D., & Schinke,
S. P. (1984). Coping and support in families
of developmentally disabled children.
Family Relations, 33, 47-54.
Schreibman, L., O’Neill, R. E., & Koegel, R.
L. (1983). Behavioral training for siblings of
autistic children. Journal of Applied Behav-
ior Analysis, 16, 129-138.
Selltiz, C., Jahoda, M., Deutsch, M., &
Cook, S. (1965). Research methods in social
relations. New York: Holt, Rinehart, &
Winston.
Simeonsson, R. J., Bailey, D. B., Hunting-
ton, G. S., & Comfort, M. (in press). Test-
ing the concept of goodness-of-fit in early
intervention. Infant Mental Health Jour-
nal.
Simeonsson, R. J., Huntington, G. S., &
Short, R. J. (1982). Individual differences
and goals: An approach to the evaluation
of child progress. Topics in Early Child-
hood Special Education, 1 (4), 71-80.
Simeonsson, R. J., Huntington, G. S., Short,
R. J., & Ware, W. B. (1982). The Carolina
Record of Individual Behavior: Charac-
teristics of handicapped infants and chil-
dren. Topics in Early Childhood Special
Education, 2 (2), 43-55.
Simeonsson, R. J., & Simeonsson, N. E.
(1981). Parenting handicapped children:
Psychological aspects. In J. Paul (Ed.),
Parents of handicapped children. New
York: Holt, Rinehart, Winston.
Sprunger, L. W., Boyce, W. T., & Gaines, J.
A. (1985). Family-infant congruence: Rou-
tines and rhythmicity in family adaptations
to a young infant. Child Development, 56,
564-572.
Stein, R. E. K., & Reissman, C. K. (1980).
The development of an Impact-on-Family
Scale: Preliminary findings. Medical Care,
18, 465-471.
Stoneman, Z., Brody, G. H., & Abbott, D.
(1983). In-home observations of young
Down syndrome children with their moth-
ers and fathers. American Journal of Men-
tal Deficiency, 87, 591-600.
Thoits, P. A. (1982). Conceptual, meth-
odological, and theoretical problems in
studying social support as a buffer against
life stress. Journal of Health and Social Be-
havior, 23, 145-159.
Thomas, A., & Chess, S. (1977). Tempera-
ment and development. New York: Bruner/
Mazel.
Towle, P., Farran, D. C., & Comfort, M.
(manuscript submitted for publication). De-
scribing parental interactions with handi-
capped children: Are there valid measures
available for the practitioner? University of
North Carolina, Chapel Hill.
Tseng, W. S., & McDermott, J. F. (1979).
Triaxial family classifications: A proposal.
Journal of Orthopsychiatry, 18, 22-43.
Turnbull, A. P., Summers, J. A., & Brother-
son, M. J. (1984). Working with families
with disabled members: A family system
approach. Lawrence: Kansas University
Affiliated Facility.
Vadasy, P. F., Fewell, R. R., Meyer, D. J.,
Schell, G., & Greenberg, M. T. (1984). In-
volved parents: Characteristics and re-
sources of fathers and mothers of young
handicapped children. Journal of the Divi-
sion for Early Childhood, 8, 13-25.
Wandersman, L., Wandersman, A., & Kahn,
S. (1980). Social support in the transition to
parenthood. Journal of Community Psy-
chology, 8, 332-342.
Weitz, S. E. (1981). A code for assessing
teaching skills of parents of developmen-
tally disabled children. Journal of Autism
and Developmental Disorders, 12, 13-24.
Wiegerink, R., & Comfort, M. (in press).
Parent involvement as a means of support
for families of children with special needs.
In D. Powell, H. Weiss, B. Weissbourd, &
E. Zigler (Eds.), Family support programs:
The state of the art. New Haven: Yale Uni-
versity Press.
Wikler, L., Wasow, M., & Hatfield, E. (1981).
Chronic sorrow revisited: Parents vs. pro-
fessional depiction of the adjustment of
parents of mentally retarded children.
American Journal of Orthopsychiatry, 51,
63-70.
Wilson, S. (1977). The use of ethnographic
techniques in educational research. Re-
view of Educational Research, 47(1),
245-265.
Winton, P. J., & Turnbull, A. P. (1981). Par-
ent involvement as viewed by parents of
preschool handicapped children. Topics in
Early Childhood Special Education, 1(3),
11-20.
Woodward, C. A., Santa-Barbara, J., Levin,
S., & Epstein, N. B. (1978). The role of
Goal Attainment Scaling in evaluating fam-
ily therapy outcome. American Journal of
Orthopsychiatry, 48, 464-476.
Donald B. Bailey, Jr., and Rune J. Sim-
eonsson are Co-Investigators of the
F.A.M.I.L.I.E.S. Project, Frank Porter
Graham Development Center, University of
North Carolina at Chapel Hill. Also at the
Frank Porter Graham Development Center
are Pamela J. Winton, Research Associate;
Gail S. Huntington, Research Associate;
Marilee Comfort, Graduate Research As-
sistant;; Patricia Isbell, Graduate Research
sistant
Assistant; Karen J. O’Donnell, Investigator;
and James M. Helm, Graduate Research
Assistant. Requests for reprints should be
addressed to F.A.M.I.L.I.E.S. Project, 300
NCNB Plaza, University of North Carolina,
Chapel Hill, NC 27514.
171