The Score Family Assessment Questionnaire: A Decade of Progress

• Published date: 01 June 2017
• Date: 01 June 2017
• DOI: http://doi.org/10.1111/famp.12280
• Author: Alan Carr,Peter Stratton

The Score Family Assessment Questionnaire: A

Decade of Progress

ALAN CARR*

PETER STRATTON

†

This paper reviews a decade of research (2006–2016) on a family assessment instrument

called the Systemic Clinical Outcome and Routine Evaluation (SCORE). The SCORE was

developed in Europe to monitor progress and outcome in systemic therapy and has been

adopted by the European Family Therapy Association as the main instrument for assessing

the outcome in systemic family and couple therapy. There are currently six main versions

of this instrument: SCORE-40, SCORE-15, SCORE-28, SCORE-29, Child SCORE-15, and

Relational SCORE-15. It has also been translated into a number of European languag es.

Fifteen empirical studies of the SCORE “family of measures” have been conducted. Most

have aimed to establish psychometric properties of these instruments in English and other

languages. Others have used the SCORE to document the level of family adjustment in

clinical samples or evaluate outcome in treatment trials. There is now sufficient evidence

for the reliability and validity of the SCORE to justify the use of brief versions of this

instrument to monitor progress and outcome in the routine practice of systemic therapy.

Keywords: Fa mily Assessment; Systemic Assessment; Systemic Clinical Outcome and

Routine Evaluation

Fam Proc 56:285–301, 2017

INTRODUCTION

This paper presents a review of research on a family assessment instrument called the

Systemic Clinical Outcome and Routine Evaluation (SCORE), which was developed to

meet the increasing need for systemic therapy to demonstrate its effectiveness (Carr,

2014a, 2014b, 2016; Stratton, 2014a; Stratton et al., 2015). The SCOR Eor System icCOR E

was modeled on the Clinical Outcomes and Routine Evaluation (CORE; Barkham et al.,

1998; Evans et al., 2000), an instrument widely used in the UK for assessing the outcome

in individual psychotherapy. Like the CORE, the SCORE contains questions about clini-

cally meaningful issues that change over the course of therapy. The SCORE is a multi-

item self-report instrument, for completion by literate family members 7 years and older.

There are currently six main versions of the SCORE (SCORE-40, SCORE-15, SCORE-28,

SCORE-29, Child SCORE-15, and Relational SCORE-15). All contain between 15 and 40

items, each of which describes an aspect of family functioning (e.g., “In my family we talk

to each other about things that matter to us”). Responses to items are given on five- or six-

point Likert scales ranging from 1 =describes my fam ily very or extremely well,to5or

6=describes my family—not at all. Items in the 15-, 28-, 29-, and 40-item versions of the

SCORE are given in Table S1. In addition to these descriptive items, all versions contain

*School of Psychology, University College Dublin, Dublin, Ireland.

†

Leeds Family Therapy and Research Centre, University of Leeds, Leeds, UK.

Correspondence concerning this article should be addressed to Alan Carr, School of Psychology,

University College Dublin, Dublin 4, Ireland. E-mail: alan.carr@ucd.ie

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Family Process, Vol. 56, No. 2, 2017 ©2017 Family Process Institute

doi: 10.1111/famp.12280

an item which asks respondents to write down what they think is the biggest problem or

challenge in their family at the moment and to rate its severity on a 10-point scale. During

the development of the SCORE open-ended questions about family life, the impact of fam-

ily problems, therapeutic needs, and opinions about completing the SCORE have also been

included in the assessment instrument. There was provision to respond to these items

with written statements or by using 10-point or visual analog scales.

The SCORE contains positively and negatively worded items. It is keyed so that low

scores indicate better adjustment. Total and subscale scores are the mean for items in

the scale, so that scores range from one to five or one to six depend ing on whether

response to items are given on a five- or six-point Likert scale. Factor analytic stud ies,

described below, have shown that the SCORE-15 and SCORE-28 each have a 3-factor

structure: family strengths, difficulties, and communication (Cahill, O’Reilly, Carr, Doo-

ley, & Stratton, 2010; Fay et al., 2013; Hamilton, Carr, Cahill, Cassells, & Hartnett,

2015; Stratton, Bland, Janes, & Lask, 2010). Thus, the SCORE-15 and SCORE-28 yield

indices of family strengths, difficulties and communication, and overall family adjust-

ment. In addition, all versions of the score yield a rating on a 10-point scale of the sever-

ity of the main problem.

The original 40-item version and the shorter 15-item version were developed by a UK

group in which Peter Stratton played a key role (Stratton et al., 2010). The 15-item ver-

sion was specifically designed as a measure that could be rapidly completed in routine

clinical practice. Concurrently, with the same aim in mind, a 28-item version was devel-

oped by Alan Carr’s research team in Ireland (Cahill et al., 2010). Items from the 15- and

28-item versions were combined by this team into a 29-item version, primarily for use in a

series of studies on the psychometric properties of the SCORE-15 and SCORE-28 (Fay

et al., 2013; Hamilton et al., 2015; O’Hanrahan et al., 2017). The Child SCORE, which

contains linguistically simplified items from the SCORE-15, was developed for completion

by children aged 7–10 years (Jewell, Carr, Stratton, Lask, & Eisler, 2013). The Relational

SCORE-15 (R-SCORE-15) is an adaptation of the SCORE-15 suitable for completion by

lesbian, gay, and bisexual (LGB) adults (Teh et al., 2017).

The SCORE has been adopted by the UK Association for Family Therapy (AFT) and the

European Family Therapy Association (EFTA) as the main instrument for assessing the

outcome in systemic family and couple therapy. The SCORE-15 has been translated into a

number of languages including Chinese, Czech, Dutch, Finnish, Flemish, French, Ger-

man, Greek, Hindi, Hungarian, Icelandic, Italian, Norwegian, Polish, Portuguese, Roma-

nian, Serbian, Spanish, Swedish, Transylvanian, Turkish, and Welsh. Translations are

available at http://www.aft.org.uk/view/15101224f1e.html.

In a review of family therapy self-report instruments, Hamilton and Carr (2016) con-

cluded that compared with other available scales, the SCORE may be particularly suited

for use in routine clinical practice. The SCORE may therefore be of particular interest to

busy family therapists. It is sensitive to change, easy to complete and score, and less com-

plex to use than well-established measures such as Family Adaptability and Cohesion

Evaluation Scales (FACES-III; Olson, 1986) and the Family Assessment Device (FAD;

Ryan, Epstein, Keitner, Miller, & Bishop, 2005). The studies summarized in this paper

show that it is acceptable to therapists and clients working in a European context. How-

ever, it may well be suitable for use internationally.

IDENTIFICATION OF STUDIES

In this paper, studies of the SCORE conducted between 2006 and 2016 are reviewed.

Studies were identified through the SCORE network of practitioners and researchers and

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