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Young Exceptional Children
http://yec.sagepub.com/ Developing Meaningful IFSP Outcomes Through a Family-Centered Approach Using the Double ABCX Mod
Yaoying Xu
Young Exceptional Children 2008 12: 2
DOI: 10.1177/1096250608323993
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What is This? Downloaded from yec.sagepub.com at SAN DIEGO STATE UNIV LIBRARY on August 21, 2013 YEC Developing Meaningful IFSP
Outcomes Through a
Family-Centered Approach
Using the Double ABCX Model PHOTO DOI: 10.1177/1096250608323993
http://yec.sagepub.com
© 2008 Division for Early Childhood Yaoying Xu, PhD
Virginia Commonwealth University 2 YOUNG EXCEPTIONAL CHILDREN Jing-Jing is a 2-and-a-half-year-old girl
who was just found to be eligible for
early intervention services because of
developmental delays. Jing-Jing started
walking after she was 2 years old, and
she has not started speaking two-word
sentences except repetitions such as
“da-da” or “la-la.” Jing-Jing’s hearing
ability is considered normal. Jing-Jing’s
parents, Mr. and Mrs. Zhu, left the first
Individualized Family Service Plan (IFSP)
meeting with some concerns that they
did not share with the team. One of
the decisions made by the team was
for Jing-Jing to receive speech and
language therapy once a week, and
her parents would embed working on
Jing-Jing’s speech and language goals
into family routines and daily activities
at home. Although Mr. and Mrs. Zhu
did not oppose this decision during the
meeting, they were not sure this was
what they wanted for Jing-Jing at this
point. They had more urgent concerns
related to the basic needs and wellbeing of the whole family. Three months
later, another IFSP meeting was held
and the service coordinator was
disappointed that Mr. and Mrs. Zhu
had not incorporated Jing-Jing’s goals
into their daily routines. Jing-Jing had
made minimal improvement in her
language development. Vol. 12, No. 1, December 2008 Downloaded from yec.sagepub.com at SAN DIEGO STATE UNIV LIBRARY on August 21, 2013 Developing Meaningful IFSP Outcomes / Xu Background “ One challenge of identifying
family concerns,
priorities, and resources
is the unique
characteristics of each
family, especially families
with culturally and linguistically diverse backgrounds. ” Supporting the family of the
child with a disability with
appropriate resources is the
emphasis for early intervention (EI)
services (Vaughn, Bos, & Schumm,
2007). Young children’s
development can be greatly affected,
in either a positive or a negative
way, by the quality of home
environments and interactions with
others in natural settings (Filler &
Xu, 2006; Parish, Pomeranz, Hemp,
Rizzola, & Braddock, 2001).
Having a child with a disability
affects the whole family system;
therefore, EI services are provided
within the family context with
family members partnering with
professionals in program
development and delivery (Dunst &
Bruder, 2002; Parish et al., 2001;
Turnbull, Turnbull, Erwin, &
Soodak, 2006). One challenge of
identifying family concerns,
priorities, and resources is the
unique characteristics of each
family, especially families with
culturally and linguistically diverse
backgrounds. Each family may
perceive its needs differently and
thus may seek different resources.
Additionally, the family’s belief
systems may also play an important
role in how to determine priorities
and use of available resources
(Bruder, 2000; Noonan &
McCormick, 2006).
Although many professionals
recognize the importance of
identifying family priorities and
concerns, it is often more difficult to
identify and access family resources.
The purpose of this article is to
discuss the application of the double
ABCX model (McCubbin & Patterson, 1982), a family-centered
model, to assist in developing
meaningful IFSP outcomes based on
family concerns and priorities. In
this model, family needs are
identified from the individual
family’s perspective. Early
interventionists are not the sole
experts to make decisions for the
child and the child’s family; instead,
the child’s and family’s strengths are
emphasized and parents play an
active role in facilitating their child’s
development as well as the overall
functioning of their family (Dunst,
Hamby, Trivette, Raab, & Bruder,
2000; Dunst, Trivette, Davis, &
Cornwell, 1988; Vaughn et al.,
2007). In the following sections, the
characteristics of IFSP outcomes are
described briefly. Then the
development of meaningful IFSP
outcomes using the double ABCX
model is discussed, followed by a
description of how to include family
concerns and priorities in IFSP
outcome statements. Finally,
suggestions for early interventionists
to apply the double ABCX model
are provided. IFSP Outcomes
A key to effective IFSPs is
including outcomes that address the
entire family’s well-being and not
only outcomes designed to benefit
the child’s development. Thus, the
expected IFSP outcomes may include
family outcomes in addition to child
outcomes (Noonan & McCormick,
2006). To develop family outcomes,
the multidisciplinary IFSP team
needs to identify the family’s
concerns, priorities, and resources
from the family’s perspectives. In Vol. 12, No. 1, December 2008 YOUNG EXCEPTIONAL CHILDREN Downloaded from yec.sagepub.com at SAN DIEGO STATE UNIV LIBRARY on August 21, 2013 3 Developing Meaningful IFSP Outcomes / Xu “ Family-oriented
interventions that build
on the family’s strengths
and resources, with
emotional, material, and
informational supports,
are more likely to increase
positive outcomes for both
the child with a disability
and the family. ” 4 YOUNG EXCEPTIONAL CHILDREN other words, a priority identified by
professionals without the family’s
input may not necessarily meet a
family’s immediate need unless it is
a concern shared by the family. As
the introductory case study
indicates, even though developing
language skills is critical for JingJing, it may not be an immediate
need for the Zhu family at this
point, because it has more urgent
family concerns that need to be
addressed before Jing-Jing’s
language needs can take top priority.
If an IFSP outcome statement
includes only the child’s
developmental needs from a
professional’s perspective, the EI
service is less likely to be effective
and likely will have reduced effect
on child outcomes.
Despite the legal requirements of
the Individuals with Disabilities
Education Act (IDEA) and evidence
from research showing benefits of
family-centered services, many IFSP
documents are written by focusing
primarily on the child’s
developmental needs and parental
needs that are directly related to
parenting a child with a disability. Vol. 12, No. 1, December 2008 The IFSP outcome statements often
do not reflect family issues or
concerns, such as access to service
locations, transportation, financial
support, or time (Ridgley & Hallam,
2006; Vaughn et al., 2007). Family
concerns are often not addressed by
the IFSP team, nor are they included
in the IFSP outcome statements, even
if the family has shared its concerns
in the IFSP meetings (Jung & Baird,
2003; Jung & Grisham-Brown,
2006). Therefore, in reality, many
IFSPs still reflect what the
professionals determine to be a need
instead of what the family believes its
needs are.
In addition to professional
resources, such as information and
financial support, informal resources
that provide emotional support
should be included as part of the EI
services when necessary. Research
has shown that family-oriented
interventions that build on the
family’s strengths and resources,
with emotional, material, and
informational supports, are more
likely to increase positive outcomes
for both the child with a disability
and the family (e.g., Bailey, Bruder,
& Hebbeler, 2006; Bruder, 2000;
Jung & Grisham-Brown, 2006;
Trivette & Dunst, 2000). Also, how
a family adapts to a stressful
situation relates to factors such as
how the family defines a stressful
event, what resources are available,
and how these factors interact with
each other (Saloviita, Italinna, &
Leinonen, 2003; Winton, 1990).
IFSP outcomes that are based on
family priories, resources, and
concerns and knowledge of the
child’s functioning in daily life tend
to be more effective than those
focusing only on the child’s Downloaded from yec.sagepub.com at SAN DIEGO STATE UNIV LIBRARY on August 21, 2013 Developing Meaningful IFSP Outcomes / Xu Figure 1
Components of the Double ABCX Model bB:
Existing and
adaptive
resources
aA:
Event and
pile-up
events xX:
Family
adaptation
cC:
Family
perception SOURCE: Adapted from the double ABCX model by McCubbin and Patterson (1983). development (Hoffman, Marquis,
Poston, Summers, & Turnbull,
2006; Jung & Grisham-Brown,
2006; Ridgley & Hallam, 2006). Developing Meaningful
IFSP Outcomes Using
the Double ABCX Model
The focus of the double ABCX
model is on the family’s efforts to
adapt to an unexpected situation or
stressful event, such as meeting the
special needs of a child with a
disability (Heflinger, Northrup,
Sonnichsen, & Brannan, 1998;
McCubbin, Patterson, Bauman, &
Harris, 1981). As a family-centered
approach, the double ABCX model
has been considered a framework to
examine family outcomes (Bristol,
1987; Flynt & Wood, 1989; Minnes,
1988; Nachshen & Minnes, 2005;
Willoughby & Glidden, 1995).
Specifically, components of the double ABCX model include aA,
unexpected situation or event and
pile-up of events as a result of the
unexpected situation; bB, family’s
existing and adaptive resources; cC,
family definition or perception of the
situation or the meaning of the event
to the family; and xX, family
adaptation to the unexpected
situation and pile-up of events
(McCubbin et al., 1981; Nachshen &
Minnes, 2005). In this model, the bB
and cC are the influencing factors;
the family’s adaptation (xX) is the
outcome factor. The capitalized
letters A, B, C, and X refer to factors
preceding the event; changes in those
elements over time are depicted as a,
b, c, and x. It is worth mentioning
that family adaptation is seen as a
continuum of outcomes ranging from
balanced positive adaptation to
negative maladaptation (Renty &
Roeyers, 2007). As illustrated in
Figure 1, the aA element may lead
directly to family adaptation; it also
affects how the family perceives the Vol. 12, No. 1, December 2008 YOUNG EXCEPTIONAL CHILDREN Downloaded from yec.sagepub.com at SAN DIEGO STATE UNIV LIBRARY on August 21, 2013 5 Developing Meaningful IFSP Outcomes / Xu 6 YOUNG EXCEPTIONAL CHILDREN situation (cC) and what resources
they would seek (bB). Although bB
and cC do not lead directly to family
adaptation, they influence the effects
of aA on family adaptation by
interacting with each other. In other
words, the more positively the family
perceives the situation, the more
effectively they will seek resources; as
a result, the better the family will
function in adapting to the situation.
The double ABCX model has been
used for evaluating family adaptation
to an event such as having a child
with a disability. It has been applied as
an effective model to explain family
adaptation to numerous situations,
including having a preschool-age child
with a disability (Reddon, McDonald,
& Kysela, 1992), having a child
with intellectual impairment (Orr,
Cameron, & Day, 1991), having a child with autism (Bristol, 1987),
having a child with Asperger
syndrome (Pakenham, Sofronoff, &
Samios, 2004), and living with adults
with autism (Renty & Roeyers, 2007).
Strong relationships have been found
between the variables in the model.
For example, Orr et al. (1991)
examined families of children with
developmental disabilities and found
that the event (aA) significantly affects
the family’s perceptions of the event
(cC) and the family’s use of resources
(bB). All three of these factors
influenced the family adaptation to
the event.
The interactions between factors
influence family adaptation to the
new event. That is, the situation can
turn out to be a positive (although
this does not mean less challenging)
experience with use of effective Both Mr. and Mrs. Zhu work at
the family restaurant owned by Mr.
Zhu’s parents. Mrs. Zhu does not
drive, so every day, her husband
drives her back and forth between
home and the restaurant. Mr. Zhu’s
parents did not hire any other
employees except for a kitchen
helper. Therefore, when Jing-Jing
was diagnosed as having
developmental delays, their first
concern was the time demand.
They could not stay at home
because the restaurant was the only
source of financial support for this
three-generation family. When Mr.
and Mrs. Zhu were at work, their
12-year-old son, Shan, was often
assigned to babysit Jing-Jing.
Time was the most obvious and
immediate concern the family had
to consider. Yet there was another
concern the family was not willing or ready to share with other
people, especially with the
interventionists, who were from
different cultural backgrounds. Mr.
and Mrs. Zhu and their parents all
believed that having a child with a
disability was a punishment from
the heavens for some wrongdoing
by themselves or their ancestors.
Therefore, the only way to deal
with the disability was to work
harder and repent. They did not
believe that they had the power to
change or improve Jing-Jing’s
condition. They all believed they
should take care of and protect her
but not try to improve her ability.
With this spiritual belief as well as
the time issue, it was not surprising
that after the professionals left,
they did not implement any of the
suggested interventions in their
family routines. Vol. 12, No. 1, December 2008 Downloaded from yec.sagepub.com at SAN DIEGO STATE UNIV LIBRARY on August 21, 2013 Developing Meaningful IFSP Outcomes / Xu “ Early interventionist’s role
is to empower the family
members by helping the
family identify its resources
and function as a unit with
expanded supports... ” coping strategies that the family has
developed through the process, thus
making the family stronger than
before the event occurred. If on the
other hand, the family perceives the
event (such as relocation, change of
job, or a new health problem) as a
negative experience, this perception
may lead to helplessness and
depression, which may cause other
events, called pile-up of events
(Hill, 1949; McCubbin & Patterson,
1983). It is not uncommon that the
Because of its religious
background, the Zhu family
looked for and used resources
from within the family system
that included the extended family
members. It did not seek support
from other external agencies
except for the EI services
provided under IDEA.
primary event leads to piled-up
events. For example, a family
member is diagnosed as having a
new health problem, which is an
unexpected situation for the family.
This primary event may cause piled-up
events, such as the time needed to
care for the family member, health
insurance issues related to treatment
options, or less money for the whole
family. If the family has limited
existing resources for assistance or
the family is not willing to seek
external assistance, this negative
perception could create more piledup events, such as arguments or
resentment between spouses and/or
siblings. Therefore, how the family
perceives the situation is crucial to
how the family will cope with it. As
mentioned earlier, the early
interventionist’s role is to empower the family members by helping the
family identify its resources and
function as a unit with expanded
supports instead of telling them what
should be done from the
interventionist’s perspective.
More important, a family is a
dynamic system within which
change is the norm. Rarely would
the family stay in a static situation;
instead, it would change for better
or worse. With each change, we
hope the family system will move
toward improvement rather than
cycle toward worsening outcomes.
The double ABCX model focuses
on family coping strategies that
emphasize the strengths of the
family as a system. It can be used as
an effective approach for identifying
family concerns, resources, and
priorities that are the keys to
development and implementation of
meaningful IFSP outcomes. With the
Zhu family as an example, the
application of each variable in this
model is described below in the
process of developing meaningful
IFSP outcomes based on family
concerns, priorities, and resources. aA: Identifying Family
Demands or Concerns—Event
or Pile-Up of Events
Family concerns can be described
as the aA factor in the double ABCX
model. The aA factor reflects the
observation that families rarely deal
with only one stressful event at a time.
In almost all cases, a primary event
would lead to pile-up of related
events. For example, a variety of
family events could be imposed by
having a child with a disability,
including the extra time required from
the parents, extra money for related Vol. 12, No. 1, December 2008 YOUNG EXCEPTIONAL CHILDREN Downloaded from yec.sagepub.com at SAN DIEGO STATE UNIV LIBRARY on August 21, 2013 7 Developing Meaningful IFSP Outcomes / Xu services or respite services, and extra
efforts involved in participating in EI
and related services, which could
create more piled-up events because of
the child’s disability. bB: Access to Family
Resources—Formal and
Informal Support System “ Interventionists, therefore,
should first realize the
importance of internal
family resources and
respect the family’s beliefs
and choices. ” 8 YOUNG EXCEPTIONAL CHILDREN Family resources are the bB
factor of the double ABCX model.
McCubbin and Patterson (1982)
suggested that the resources a family
may bring to the management of an
unexpected situation consist of three
basic kinds: the personal resources
of individual family members,
the internal resources of the family
system, and social support from
resources external to the family.
Personal resources include financial
well-being, physical and emotional
health, education, and personality
characteristics of individual family
members.
This situation is not uncommon
for families who receive EI services.
According to a national study of EI,
parents reported less support from
and participation in community
activities than support received from
family and friends (Bailey et al.,
2005). These researchers also
reported that EI services were less
accessible and effective for families
from diverse cultures. Nevertheless,
informal family support has been
evidenced as a strong predictor for
effective family adaptation (e.g.,
Pakenham, Samios, & Sofronoff,
2005; Renty & Roeyers, 2007).
Interventionists, therefore, should
first realize the importance of
internal family resources and respect
the family’s beliefs and choices.
What seemed to be a problem at
first glance could be strength of the Vol. 12, No. 1, December 2008 family from which the EI services
could start. For example, the grandparents
function as the main support for Mr.
and Mrs. Zhu, as well as Jing-Jing, in
terms of family income, time
commitment, and spiritual beliefs.
Jing-Jing’s brother, Shan, could be
another resource to assist Jing-Jing
during the intervention activities.
Thus, the IFSP outcomes could also
include how to involve Shan in the EI
services to achieve the optimal
outcomes for Jing-Jing and the family.
In addition to the informal
family support, the value of social
support from outside the family
system has been emphasized in a
family-centered approach such as
the double ABCX model and
supported by numerous studies on
parental stress and coping (e.g.,
Bailey et al., 2005; Barakat &
Linney, 1992; Flynt & Wood, 1989;
Flynt, Wood, & Scott, 1992). Boyd
(2002) mentioned that mothers of
children with autism who received
more social support related better
emotionally to their children and
were less depressed and anxious
than those with less social support.
The Zhu family’s social support
is limited to that from extended
family resources. After the early
interventionists establish a strong
relationship with the family built on
trust and partnership, they may
consider providing additional
information on other levels of
formal and informal social support,
such as community connections,
parent support groups, and support
from local public schools. Downloaded from yec.sagepub.com at SAN DIEGO STATE UNIV LIBRARY on August 21, 2013 Developing Meaningful IFSP Outcomes / Xu As a starting point, early
interventionists can help family
members identify their existing
resources. Then formal support
from the IFSP team can be
introduced in a proactive way so
the family can play an active role
in the change (adaptive resources)
and not perceive it as criticism of
its competence. As Dunst and
Trivette (1987) suggested in the
enablement model of helping, the
focus of a family-centered
approach to service delivery is on
emphasizing “client responsibility
for acquisition of competencies
necessary to solve problems, meet
needs, realize personal projects, or
otherwise attain goals” (p. 451).
In other words, early
interventionists’ main
responsibility is to help the family
members help themselves by
facilitating them becoming
positive problem solvers with
needed competencies; thus, the
family is enabled and empowered.
Different from the traditional
deficit-oriented approach that
emphasized the problem and the cause for the problem, the double
ABCX model helps the family
identify solutions to the problem
by using formal and informal
support systems.
Instead of telling the Zhu family
to seek additional support, the
IFSP service coordinator
conducted observations at
different times in the family
restaurant. She identified
consistent support from JingJing’s grandparents in different
situations, such as helping in the
kitchen around the busy
lunchtime and babysitting JingJing in early afternoons when
business slowed down. She also
observed that Shan had been a
great help for his parents in
taking care of Jing-Jing after
school or helping clean tables
during the busy time in the
evenings. These resources were
recognized as positive informal
supports that were critical for the
Zhu family. Through these
observations and interactions,
the service coordinator developed
a trusting relationship Both Mr. and Mrs. Zhu are firstgeneration immigrants from
southeastern Asia; their ethnic
background is Chinese. Buddhism
is the religious background of this
family, and they strongly believe
what they do in this world will
determine what they will become
in the other world after they die.
They practice Buddhism regularly
at home. In Jing-Jing’s case, the EI
service coordinator was frustrated
during the first few months
because she believed that Jing-Jing’s language development
would be the highest priority
outcome and that the parents
should focus on promoting JingJing’s speech and language
development. She was very
discouraged when she thought
Jing-Jing was not benefiting from
the EI services because of the lack
of support from her family; she
did not realize that the top
priority for Jing-Jing’s parents was
to provide food on the table for
the whole family. Vol. 12, No. 1, December 2008 YOUNG EXCEPTIONAL CHILDREN Downloaded from yec.sagepub.com at SAN DIEGO STATE UNIV LIBRARY on August 21, 2013 9 Developing Meaningful IFSP Outcomes / Xu with Jing-Jing and her
grandparents. Sometimes, the
service coordinator even stayed to
help during busy hours. Mr. and
Mrs. Zhu became comfortable
enough to share with her what
had worked for their family and
what they still found challenging.
When the IFSP team met again,
the formal support from the IFSP
team became natural because Mr.
and Mrs. Zhu viewed themselves
as important partners. cC: Evaluating Family Priorities
Based on Families’
Perceptions—The Meaning of
Disability and Early Intervention
to the Family
The double ABCX model cC
factor describes family perceptions
of the event or unexpected situation
and the pile-up of events as well as
of interactions between events and
family resources. It may not be the
unexpected situation itself that
makes the difference; rather, it is
how the family perceives the
situation or demands and how the
factors interact with one another
that affect the effectiveness of EI or
special education services. For
example, Pakenham and colleagues
(2004) found that the meaningmaking process (family perception
of its “misfortune”) was highly
related to family approaches to
seeking social support, and it also
positively affected the family
coping strategies. A stressful
event m...