There is a need for a measure of outcome in systemic family and couples therapy (SFCT) that reflects current theory and practice. To meet the needs of SFCT practice the measure needs to use self-report by family members, take a short time to complete and be easy to understand. The development of such a measure, called the SCORE, is reported in this article. Substantial piloting, consultation and review in terms of clinical judgement led to the construction of the SCORE 40 which has forty items about how the family functions, rated by family members over 11 years of age on a Likert scale, in addition to independent ratings of the family and its difficulties. The SCORE 40 is shown to be a viable instrument but is too substantial for everyday clinical use. In a research project to reduce and refine the measure and determine its psychometric properties the SCORE 40 was administered to 510 members of 228 families at the start of their first appointment for family therapy at clinics throughout the UK. The scale has good psychometric properties and could operate with either three or four dimensions. The analyses of these data, combined with data from a convenience sample of 126 non-clinical families, allowed a reduction to fifteen items while retaining most of the information provided by the SCORE 40. This version is offered with three dimensions of: (1) Strengths and adaptability; (2) Overwhelmed by difficulties; and (3) Disrupted communication. It is hoped that the ready availability of the SCORE 15 will encourage routine evaluation of outcomes in clinics as well as the SCORE being used flexibly for both therapy and research.

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In this study a 29-item version of the systemic clinical outcome and routine evaluation (SCORE), which contained all items from the SCORE-15 and SCORE-28, was used to develop norms for both the 15 and the 28 versions of the SCORE from the same sample. In a random digit dialling telephone survey, a stratified national random sample of 403 adults living in the Republic of Ireland and Northern Ireland completed the SCORE and brief measures of family and personal adjustment. Using receiver operating characteristic curve analyses, cut-off points for the SCORE-28 and 15 were found to identify families of children with significant emotional and behavioural problems. We also established 90 th percentile points and percentages of cases falling above each scale point for both versions of the SCORE. Confirmatory factor analyses showed that, for both versions of the SCORE, the data fit the three factor solutions found in previous studies. The SCORE scales also had significant correlations with measures of family, parental and child adjustment, and negligible correlations with socioeconomic variables and social desirability response set.

The SCORE index of family functioning and change is an established measure, with strong psychometric properties, of the quality of family life. We report the sensitivity to therapeutic change of the short form, the SCORE-15. Data are reported from 584 participants aged above 11 years, representing 239 families. All couples and families had been referred for systemic couples and family therapy, completing the form at start of the first session and close to the fourth. The SCORE-15 is shown to be acceptable with strong consistency and reliability. Change over only three sessions was highly statistically significant. Further validation is provided by improvements in quantified scores correlating significantly with independent measures provided by family members and by their therapists. The SCORE-15 is a proven measure of therapy and of therapeutic change in family functioning. It is therefore a routinely usable tool applicable to service evaluation, quality improvement, and to support clinical practice. Practitioner Points• The SCORE provides practitioners with brief descriptions of varied aspects of family interaction that have proven significance for many families who present for therapy. • SCORE-15 can be used with confidence to monitor and report proven indicators of progress in systemic therapy. • Because SCORE identifies clinically significant issues of family interaction it has many potential uses in therapy. • There are many new possibilities for therapists to undertake collaborative research.

This article describes the development, in an Irish context, of a three‐factor, twenty‐eight‐item version of the Systemic Clinical Outcome and Routine Evaluation (SCORE) questionnaire for assessing progress in family therapy. The forty‐ item version of the SCORE was administered to over 700 Irish participants including non‐clinical adolescents and young adults, families attending family therapy, and parents of young people with physical and intellectual disabilities and cystic fibrosis. For validation purposes, data were also collected using brief measures of family and personal adjustment. A twenty‐eight‐item version of the SCORE (the SCORE‐28) containing three factor scales that assess family strengths, difficulties and communication was identified through exploratory principal components analysis. Confirmatory factor analysis showed that the factor structure of the SCORE‐28 was stable. The SCORE‐28 and its three factor scales were shown to have excellent internal consistency reliability, satisfactory test‐retest reliability and construct validity. The SCORE‐28 scales correlated highly with the General Functioning Scale of the Family Assessment Device, and moderately with the Global Assessment of Relational Functioning Scale, the Kansas Marital and Parenting Satisfaction Scales, the Satisfaction with Life Scale, the Mental Health Inventory – 5, and the total problems scale of the Strengths and Difficulties Questionnaire. Correlational analyses also showed that the SCORE‐28 scales were not strongly associated with demographic characteristics or social desirability response set. The SCORE‐28 may routinely be administered to literate family members aged over 12 years before and after family therapy to evaluate therapy outcome.

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 languages. 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.

Determining the efficacy of therapeutic interventions is becoming an increasing political and ethical necessity. Comparative therapeutic outcome trials are most powerful when there is a precise specification, or manualization, of the forms that therapies took. Manuals have begun to be developed for structural/behavioural family therapy and couple therapy. The development of these manuals is often reliant on experts' self‐report, rather than a systematic analysis of the therapeutic process as it happens. This can limit their validity and applicability to standard clinical practice. In addition, no manuals exist which reflect less structured forms of family therapy aimed at incorporating systemic, postmodern and narrative frameworks. The feasibility of producing a workable manual that reflects the fluidity of such practices has been questioned. A research project to systematically create and test such a manual is reported. Multiple data sources and research methods, primarily qualitative, were applied to generate a rich specification of the therapy. In reporting these results the contents of various aspects of the final manual are indicated. Procedures to ensure that the prescribed practice is consistent with a widely used approach to systemic family therapy are also described. The manual will be an important tool for outcome research and therapeutic practice. The account of the research process should be helpful to researchers engaged in constructing a manual for other models of family therapy based on a rigorous analysis of actual practice. The manual itself is available for use by outcome researchers who wish to evaluate this widely used form of systemic family therapy.

SUMMARY Four tests of associated movement—modified version of Zazzo's finger‐lifting test, the Fogs' clip‐pinching test, the feet‐to‐hands test and a new finger‐spreading test—were given to 658 normal children whose age ranged from 4 years 9 months to 15 years 8 months. The incidence of associated movements shows marked changes with age. The various tests are maximally sensitive at different stages in development as follows: clip‐pinching 5–13 years, feet‐to‐hands 8–13 years, finger‐spreading 10 years to beyond the age range studied, finger‐lifting from 5 onwards depending on the finger examined. The correlations between the tests were all positive and largely significant, indicating some common factor underlying the different kinds of performance which were examined. RÉSUMÉ On a essayé sur 658 enfants normaux dont les âges variaient de 4 ans 9 mois à 15 ans 8 mois. les quatre tests de mouvement associé suivants: une version modifiée du test d'élévation des doigts de Zazzo, le pieds à mains, et un nouveau test d'écartement des doigts. L'incidence des mouvements associés change de façon évidente avec l'âge. Les différents tests atteignent leur maximum de sensibilitéà des stades différents du développement de la manière suivante: test de Fogs 5–13 ans; pieds à mains 8–13 ans; écartement des doigts de 10 ans jusqu'après l'âge étudié; élévation des doigts, à partir de 5 ans et variable doigt examiné. Les corrélations entre les tests étaient toutes positives et très significatives, selon le indiquant l'existence d'un facteur commun à la base des différentes sortes de examinées. RESUMEN Se administraron cuatro tests de movimientos asociados a 658 niños sanos de 4 años y 9 meses hasta 15 años y 8 meses. Estos tests comprendían: una versión modificada del test de Zazzo de levantar un dedo, el test de Fogs de apretar una pinza, tests ‘pies a manos’, y un nuevo test de extender y separar los dedos. La frecuencia de movimientos asociados cambia mucho a medida que el niño agrandece. Cada test tiene una sensitividad máxima durante una fase distinta del desarrollo, a saber: el de apretar una pinza de 5 a 13 años, ‘pies a manos’ de 8 a 13 años, separación de los dedos de 10 años hasta una edad mayor que las que se estudiaban, y levantar un dedo de 5 años en adelante, según el dedo de que se trata. Las correlaciones entre los tests eran todas positivas y casi todas significantas, 10 que indica un factor común que explique los tipos distintos de funcionamiento que se estudiaban.