1Test-Retest Reliability of The Family Paradigm Assessment Scale (F-PAS) Ariel Adams1BJ Arnold2Renee Smith2Brittany Reed21Department of Hearing, Speech, and Language SciencesGallaudet University2Department of Speech-Language PathologyUniversity of Central Arkansas
2Resources transformed for goals. ControlHow do important things get done?TimeHow is it used?FamilyMembers may act as one entity, in small groups, individually, according to theirSpaceHow are physical and personal space used?AffectHow are caring & support expressed?EnergyHow much effort to get things done?Family-centered evidence-based practice (EBP) is an approach to intervention in which the clinician considers the research, her clinical experiences, and the family’s values and preferences while making clinical decisions.Speech-language pathology and audiology professionals can look to family science for models and tools to help families discuss their values and encourage family-centered EBP.…MeaningWhat do you value?family paradigmMaterialHow are possessions viewed?ContentHow do you determined what is real?
3There are four paradigms: Closed Random Open Synchronous Family Paradigm = family’s view of the world.Each family's behavior is guided by its paradigm(s).There are four paradigms: Closed Random Open SynchronousFamily Paradigms describe the family’s view of the world – or how they prefer to use their resources to meet their goals.Paradigms guide the way families do everything. Each one represents different decision-making processes that a family might use.The four paradigms are closed, random, open, and synchronous.
4Stability through continuity & tradition Family Paradigm = family’s view of the world.Each family's behavior is guided by its paradigm(s).There are four paradigms: Closed Random Open SynchronousStability through continuity & traditionFamilies that are particularly closed-paradigmatic prefer stability through continuity and tradition.they stick to a schedule and do the things they have always done
5Free exploration through intuition & innovation Family Paradigm = family’s view of the world.Each family's behavior is guided by its paradigm(s).There are four paradigms: Closed Random Open SynchronousFree exploration through intuition & innovationFamilies of the random paradigm prefer free exploration through intuition and innovation.act in spontaneous and individual ways to reach individual goals.
6Adaptation through consensus Family Paradigm = family’s view of the world.Each family's behavior is guided by its paradigm(s).There are four paradigms: Closed Random Open SynchronousAdaptation through consensusFamilies of the open paradigm prefer adaptation through consensus.make their decisions as a group and change if the group sees fit.
7Harmony through identification Family Paradigm = family’s view of the world.Each family's behavior is guided by its paradigm(s).There are four paradigms: Closed Random Open SynchronousHarmony through identificationFamilies of the synchronous paradigm prefer harmony through identification.know and understand what they do and why without a need to communicate with each other because the “just know.”
8Some families use multiple paradigms Family Paradigm = family’s view of the world.Each family's behavior is guided by its paradigm(s).There are four paradigms: Closed Random Open Synchronous Some families use multiple paradigmsIt is important to remember that families can have members that use different paradigms, or use a combination of paradigms as a family.
9The Family Paradigm Assessment Scale (F-PAS) (Imig, 1998)Used to identify paradigmsPaper and pencil instrument10 multi-part questions using a 0-10 rating scale1 question per resource1 question to rank resources1 question per goal1 question to rank goalsCurrent and IdealThe tool designed to identify paradigms is called the Family Paradigm Assessment Scale.It is a paper and pencil instrument used to help identify individual paradigms. It consists of 10 two part questions using a zero to ten rating scale. An answer of 0 indicates that the participant’s family would never use that strategy, and an answer of 10 indicates that the participant’s family uses that strategy the most. Each question calls for two answers, one for how the family currently operates and one for how they would ideally operate.
10The Family Paradigm Assessment Scale (F-PAS) Cluster ScoresCalculated from the F-PASRange from 0-50 – family never uses this paradigm5 – family uses this paradigm most oftenDefine cluster scoresReporting on C&I overall – future analysis for rest
11Research AimTo measure test-retest reliability of the F-PAS overall cluster scores.The aim of my research project was to measure the test-retest reliability of the Family Paradigm Assessment Scale.
12Participants (N=51) Gender: Age: Race/ethnicity: Education level: 34 females, 17 malesAge:Mean Age 30 yearsRange fromRace/ethnicity:2% American Indian18% African American81% CaucasianEducation level:2% High school graduate39% Some college31% College graduate18% Some graduate school10% Advanced degreeFamily roles:26 spouses11 parents3 grandparents20 offsprings23 siblingsYears in family:53% entire life29% five years or more10% less than five years8% less than one year
13Procedures Recruitment: flyers, word of mouth Each participant completed the F-PAS twice, demographics, no major change,Data entered into Excel spreadsheet which calculated F-PAS cluster scoresTest-Retest Reliability of the overall F-PAS cluster scores for each paradigm was calculated using weighted kappas (k) with 95% confidence intervals (CI)<0.00 poorslightfairmoderatesubstantialalmost perfect(Byrt, 1996)Recruiting was really the hardest part: I sent out and posted flyers, I told my friends, told them to tell their friends, etc.Participants completed the F-PAS once and then again two weeks later.They also filled out a demographics form and reported any major change in the two week period. (death in a family or loss of job that might explain any major difference in results)The scores were then calculated and compared using weighted kappas with 95% confidence intervalsA weighted kappa score was determined for each of the four paradigms.A kappa is a way of measuring reliability using a full credit system. The scores are either the same, or they are not.A weighted Kappa is a little bit more complicated in that it measures reliability using a “partial credit” system for having similar scores. So if they have a 5 on the initial test and a 4 on the retest, it would get a score of like, .8 whereas in a Kappa system it would get 0, because it did not match exactly.
14Current Closed Paradigm Retest54321Test1115In this chart, the rows represent the first f-pas cluster scores (the test)And the columns represent the second f-pas cluster scores (the retest)The numbers in each box represent the number of participants with that score. (for instance, we have 3 in the 5-4 box – this means that three people had the current-closed paradigm score of 5 on the first f-pas and 4 on the first f-pas.)Numbers on the yellow line are considered to have perfect reliability. those near but outside the yellow boxes, have better reliability than those in the outside 5-0 or 0-5 boxes. (in the top right or bottom left corners)k = % CI (.30,.70)Moderate
15Current Random Paradigm Retest54321Test1816k = % CI (.09,.52) Fair
16Current Open Paradigm 21 10 6 8 Retest 5 4 3 2 1 Test Test211068k = % CI (.03,.50) Fair
17Current Synchronous Paradigm Retest54321Test16k = % CI (.38,.69)Moderate
18Ideal Closed Paradigm 9 7 11 8 Retest 5 4 3 2 1 Test Test97118k = % CI (.33,.70) Moderate
19Ideal Random Paradigm 16 6 8 Retest 5 4 3 2 1 Test Test1668k = % CI (.05,.49) Fair
20Ideal Open Paradigm 33 8 Retest 5 4 3 2 1 Test Test338k = % CI (.24,.71) Moderate
21Ideal Synchronous Paradigm Retest54321Test149k = % CI (.16,.56) Fair
23Clinical Implications Test-retest reliability OK for clinical useClinicians can use the F-PAS to:Determine paradigms of clients and their familiesProvide services that best fit client/familyImprove family-centered practicesHelp families better understand how intervention affects their family functioningFair to moderate test-retest reliability is not a clinical issue because the results can be validated through discussion.Can be used by clinicians to determine paradigms of the families they are working with.This will help them to provide services best fitting each client and therefore improve the overall quality of therapyIt can also help families understand how intervention affects their family functioning.
24Future Research Analyze reliability of individual cluster scores Need to evaluate ways to improve reliabilityWording of questionsData collection methodUse family paradigm model of resources and goals in researching family-centered practicesAlthough the Family paradigm assessment scale can be used in clinic, Test-retest reliability should be improved for research purposes.We need to evaluate new ways to improve reliability. These could include the wording of the questions and the data collection method used – possibly making the F-PAS more “user friendly.”Once that is done, the F-PAS can be used in researching family-centered practices
25What we learned… There are no short cuts Nothing is as easy as it appears to beDouble check EVERYTHINGEverybody needs a teamResearch is fun“Welcome to research”No short cuts – everything must be done the right way – and that usually means the long way.Nothing is easy – recruitment sounds easyDouble check everything – proofread before you send things out (with a typo) data entry (much easier to fix now than find it later) THE LITTLE DETAIL MATTERTeam – helped recruit – even moreso when I was in a bind, help with abstract (which I had never written before) peer-editing group, moral support systemResearch is fun – fun to learn, interesting to see how everything fits together. I’ve read many many research articles for classes and never really understood what they meant until I understood the research process. I learned so much information that I didn’t know before.And when all else fails, “welcome to research”
26Acknowledgements Those who participated Faculty mentor: Dr. Mary Jo Cooley HideckerF-PAS creator: Dr. David R. ImigResearch team members: BJ Arnold, Morgan Poole, Brittany Reed, Megan Scott, Sara Shaw, Renée Smith, Tammy Soileau and Kara TaylorUCA Sponsored Programs Office (SPO)This research was funded by the Arkansas Department of Higher Education and the University of Central Arkansas Speech-Language Pathology Department
27For more information:Byrt, T. (1996). How good is that agreement? Epidemiology, 7(5), 561. Constantine, L. L. (1986). Family paradigms: The practice of theory in family therapy. New York: Guilford. Constantine, L. L. (1993). The structure of family paradigms: An analytical model of family variation. Journal of Marital and Family Therapy, 19(1), Hidecker, M. J. C. (2004). An exploratory study of the associative relationships between family paradigms and augmentative and alternative communication satisfaction in families with young Children. Unpublished Thesis (Ph. D.), Michigan State University. Dept. of Audiology and Speech Sciences, Hidecker, M. J. C., Jones, R. S., Imig, D. R., & Villarruel, F. A. (2009). Using family paradigms to improve evidence-based practice. American Journal of Speech Language Pathology, 18(3), Imig, D. R. (1993). Family stress: Paradigms and perceptions. Family Science Review, 6, Imig, D. R. (2000). A conversation about interpersonal relationships, family systems and paradigms. Venice, CA: ETEXT.net Electronic Textbook Publishing. Imig, D. R. (2005). Family paradigms, interpersonal relationships, and family systems. Venice, CA: ETEXT.net Electronic Textbook Publishing. Imig, D. R., Pate, S. M., Mitchell, M. M., David, D. A., Pegorraro, C., Barton, E. R., et al. (1996). Paradigmatic family systems theory: Applications and praxis. Paper presented at the 58th Annual Conference Education & Enrichment Section, Kansas City, MO. Imig, D. R., & Phillips, R. G. (1992). Family theory: The family regime assessment scale (FRAS). Family Science Review, 5, Kantor, D., & Lehr, W. (1975). Inside the family (1st ed.). San Francisco: Jossey-Bass.Add
28The Family Paradigm Assessment Scale (F-PAS) Cluster ScoresTwo cluster scores for each paradigmCurrent & Ideal overallCurrent & Ideal timeCurrent & Ideal spaceCurrent & Ideal energyCurrent & Ideal materialCurrent & Ideal controlCurrent & Ideal affectCurrent & Ideal meaningCurrent & Ideal contentCalculated from the F-PASRange from 0-50 – family never uses this paradigm5 – family uses this paradigm most oftenDefine cluster scoresReporting on C&I overall – future analysis for rest