Coping Health Inventory for Parents (CHIP)

Abstract

The Coping Health Inventory for Parents (CHIP) is an established, standardized psychometric instrument developed by Hamilton I. McCubbin, Marilyn A. McCubbin, Robert S. Nevin, and Elizabeth Cauble (1981, 1983) to systematically identify, quantify, and evaluate the specific behavioral coping repertoires and cognitive management strategies employed by parents managing the protracted, multifaceted demands of caring for a chronically ill, medically fragile, or disabled child. Grounded conceptually within family stress theory and the seminal Resiliency Model of Family Stress, Adjustment, and Adaptation, the instrument measures parental appraisal of the helpfulness of distinct coping behaviors across three empirically derived and theoretically coherent patterns: Coping Pattern I: Maintaining Family Integration, Cooperation, and an Optimistic Definition of the Situation (15 items); Coping Pattern II: Maintaining Social Support, Self-Esteem, and Psychological Stability (18 items); and Coping Pattern III: Understanding the Medical Situation through Communication with Other Parents and Consultations with the Healthcare Team (8 items). The complete inventory comprises 45 behavioral statements evaluated on a dual-track response framework: respondents first record whether they utilized each specific coping behavior and rate its perceived efficacy along a four-point Likert-type intensity metric ranging from 0 (Not helpful) to 3 (Extremely helpful), or document their rationale for non-utilization via categorical indicators (Chose not to use it vs. Not Possible). Extensive psychometric investigations across diverse pediatric populations—including pediatric oncology, cystic fibrosis, congenital heart disease, diabetes mellitus, and neurodevelopmental disorders—demonstrate robust internal consistency reliability (Cronbach’s alpha values routinely ranging from .71 to .88 across subscales), commendable test-retest stability, and robust construct, convergent, and criterion-related validity. By illuminating individual and systemic coping repertoires, CHIP provides researchers, pediatric psychologists, social workers, and clinical teams with actionable diagnostic data to identify parental vulnerability, mitigate caregiver burden, and design targeted family-centered psychosocial interventions.

Keywords

Coping Health Inventory for Parents, CHIP, Hamilton McCubbin, parental coping, pediatric chronic illness, family stress theory, Resiliency Model, family adaptation, caregiver burden, pediatric psychology, healthcare communication, family integration, psychometrics

Authors

The Coping Health Inventory for Parents was developed through the collaborative programmatic research of prominent family social scientists and clinical researchers at the University of Wisconsin–Madison:

• Hamilton I. McCubbin, Ph.D. — Professor Emeritus of Human Development and Family Studies and former Dean of the School of Human Ecology at the University of Wisconsin–Madison. Renowned internationally for formulating foundational models of family stress, adaptation, and resilience, including the Double ABCX Model and the Resiliency Model of Family Stress, Adjustment, and Adaptation.
• Marilyn A. McCubbin, Ph.D., RN, FAAN — Professor Emerita of Nursing at the School of Nursing, University of Wisconsin–Madison, specializing in pediatric nursing, family-centered clinical care, and the physiological and psychosocial trajectories of families managing childhood chronic health conditions.
• Robert S. Nevin, Ph.D., ACSW — Clinical researcher and social work scholar specializing in family systems, medical social work, and coping mechanisms in chronic childhood disability.
• Elizabeth A. Cauble, Ph.D. — Professor of Social Work, whose research focuses on community and familial support systems, child welfare, and psychometric assessments of family well-being.

Purpose

The advent of modern pediatric medicine has transformed conditions that were once acutely fatal into manageable chronic conditions. However, this demographic and therapeutic transition has radically expanded the caregiving responsibilities thrust upon parents. The primary purpose of the Coping Health Inventory for Parents (CHIP) is to systematically capture, classify, and appraise the broad spectrum of behavioral, interpersonal, emotional, and systemic strategies parents implement to adapt to the persistent, cumulative stressors associated with childhood chronic illness or disability.

Unlike unidimensional coping measures or generic distress inventories that focus predominantly on psychiatric symptomatology or general defense mechanisms, CHIP is tailored explicitly to the ecological and logistical realities of the pediatric healthcare environment. It addresses three fundamental clinical and empirical needs:

1. Identifying Distinct Coping Repertoires: CHIP provides a comprehensive profile of how a caregiver allocates cognitive and emotional resources across multiple life domains—including marital communication, child caretaking, personal self-care, employment, social networks, and clinical engagement with medical providers.
2. Evaluating Coping Helpfulness: The inventory does not merely catalog behavioral frequency; rather, it assesses the respondent’s subjective appraisal of how beneficial or effective each behavior is in mitigating stress and maintaining equilibrium. This distinction is critical because high-frequency behaviors are not inherently functional or palliative.
3. Detecting Maladaptive Resource Depletion and Caregiver Strain: By evaluating patterns of non-utilization (differentiating between conscious behavioral choice and logistical or financial impossibility), CHIP enables pediatric psychologists, pediatricians, and clinical nurse specialists to pinpoint specific structural deficits, financial strains, social isolation, or systemic barriers that impede parental adaptation.

In research contexts, CHIP serves as a benchmark metric in longitudinal and cross-sectional studies investigating family functioning, parent-child relational health, pediatric treatment compliance, and parental quality of life across diverse medical conditions, including pediatric oncology, cystic fibrosis, asthma, spina bifida, and type 1 diabetes.

Psychological Construct

The central construct measured by CHIP is parental coping, defined within contextual family science as an active, evolving cognitive, emotional, and behavioral problem-solving process whereby parents manage, adapt to, or eliminate the demands generated by a child’s chronic medical condition. Rather than conceptualizing coping as a static personality trait, the creators of CHIP operationalize coping as multidimensional, behavioral coping patterns directed toward internal family functioning, personal well-being, and external environment mastery. The inventory delineates parental coping into three core dimensions:

Coping Pattern I: Maintaining Family Integration, Cooperation, and an Optimistic Definition of the Situation

This 15-item dimension assesses parental behaviors geared toward sustaining family cohesiveness, preserving intra-familial harmony, reinforcing emotional connections with spouse and children, and adopting a cognitive-affective stance of hope and positive reappraisal. Behaviors subsumed under this pattern focus directly on the internal family system:

• Structural and Relational Cohesion: Actively working to keep family life stable and engaged (e.g., Item 1: “Trying to maintain family stability”; Item 21: “Doing things together as a family”; Item 45: “Doing things with my children”).
• Marital Collaboration and Mutuality: Cultivating reciprocal support with the spouse or partner (e.g., Item 3: “Trusting my spouse (or former spouse) to help support me and my child(ren)”; Item 38: “Building a closer relationship with my spouse”; Item 41: “Talking over personal feelings and concerns with spouse”).
• Cognitive Reframing and Optimism: Formulating an adaptive definition of the illness situation, maintaining faith in clinical improvement, and cultivating psychological endurance (e.g., Item 6: “Believing that my child will get better”; Item 8: “Showing that I am strong”; Item 44: “Believing that things will always work out”).

Coping Pattern II: Maintaining Social Support, Self-Esteem, and Psychological Stability

Comprising 18 items, this dimension evaluates parental initiatives aimed at preserving individual autonomy, emotional equilibrium, self-worth, social connectivity, and physical restoration outside the caregiving enclave. Recognizing that the care of a chronically ill child can result in severe identity foreclosure and emotional burnout, this construct reflects systemic balance:

• Personal Mastery and Physical Rest: Engaging in essential restorative biological functions and leisure (e.g., Item 4: “Sleeping”; Item 12: “Eating”; Item 13: “Getting away myself”; Item 29: “Concentrating on hobbies”; Item 33: “Keeping myself in shape and well groomed”).
• Occupational and Self-Identity Development: Investing psychological resources in external work or self-improvement distinct from the caregiving role (e.g., Item 7: “Working, outside employment”; Item 19: “Develop my self as a person”; Item 22: “Investing time and energy in my job”; Item 27: “Becoming more self reliant and dependent”).
• Extra-Familial Social Support and Relief: Accessing social networks to mitigate subjective isolation and emotional distress (e.g., Item 2: “Engaging in relationships and friendships which help me to feel important and appreciated”; Item 24: “Entertaining friends in our home”; Item 39: “Talking to someone (not professional counselor/doctor) about how I feel”; Item 42: “Being able to get away from the home care tasks and responsibilities for some relief”).

Coping Pattern III: Understanding the Medical Situation through Communication with Other Parents and Consultations with the Healthcare Team

This 8-item dimension measures behaviors oriented toward external cognitive mastery of the child’s disease, acquiring technical medical information, building therapeutic alliances with clinicians, and establishing experiential solidarity with peer caregivers facing analogous challenges:

• Clinical Partnership and Knowledge Acquisition: Actively soliciting medical facts and dialoguing with the treatment team (e.g., Item 5: “Talking with the medical staff (nurses, social worker, etc.) when we visit the medical center”; Item 16: “Talking with Doctor about my concerns about my child(ren) with the medical condition”; Item 40: “Reading more about the medical problem which concerns me”).
• Peer Sharing and Experiential Identification: Seeking mutual support from other families navigating similar pediatric conditions (e.g., Item 10: “Talking with other individual/parents in my situation”; Item 20: “Talking with other parents in the same type of situation and learning about their experiences”; Item 25: “Reading about how other persons in my situation handle things”).
• Community and Existential Grounding: Communicating needs to extended communities and drawing upon spiritual frameworks (e.g., Item 15: “Believing in God”; Item 30: “Explaining our family situation to friend and neighbors so they will understand us”).

Theoretical Framework

The theoretical architecture supporting the Coping Health Inventory for Parents is rooted in modern family stress theories developed across several decades of clinical and empirical scholarship. Specifically, CHIP is anchored in the classic Reuben Hill (1949) ABCX Model of Family Crisis, its expansion into the Double ABCX Model by McCubbin and Patterson (1983), and the subsequent formulation of the Resiliency Model of Family Stress, Adjustment, and Adaptation (McCubbin & McCubbin, 1991, 1993, 1996).

The Double ABCX Model Foundation

In Reuben Hill’s foundational ABCX framework, a crisis (X) emerges from the interaction between the primary stressor event (A), the family’s existing crisis-meeting resources (B), and the definition or cognitive meaning the family attaches to the stressor event (C). While groundbreaking, Hill’s paradigm was largely cross-sectional and focused on acute disruptions (such as war separation or sudden economic displacement).

Recognizing that childhood chronic illness imposes persistent, evolving, and compounding demands, McCubbin and Patterson (1983) introduced the Double ABCX Model, conceptualizing post-crisis adaptation over extended temporal trajectories. The model incorporates:

• Pileup of Stressors (aA factor): Families managing chronic pediatric disease do not experience the diagnosis in isolation. They face cumulative strains, including medical emergencies, financial hardships, sibling neglect, career disruptions, and daily therapeutic administration schedules.
• Existing and Expanded Resources (bB factor): The family’s capability to utilize both internal assets (personal self-esteem, marital intimacy) and external structures (medical institutions, community networks, support groups).
• Cognitive Appraisal / Definition of the Situation (cC factor): The collective meaning the family constructs regarding their plight, including existential acceptance, optimism, and medical trust.
• Family Adaptation (xX factor): The resulting balance or imbalance, positioned on a continuum ranging from maladaptation (family disintegration, acute distress, system collapse) to bonadaptation (system maintenance, personal growth, child health preservation).

Integration into the Resiliency Model

Within this framework, CHIP was conceptualized as a precise psychometric measure of the coping mechanisms that operationalize the intersection of the bB (resources) and cC (appraisal) components. McCubbin and colleagues posited that coping is not merely a compensatory defensive reaction, but an active, dynamic orchestrator of family resilience. Coping behaviors function to:

1. Eliminate, diminish, or manage direct physiological and behavioral stressors generated by the chronic condition;
2. Procure, coordinate, and maintain external resources and institutional support;
3. Manage emotional turmoil, fear, and grief to preserve individual psychological stability;
4. Protect, stabilize, and reinforce internal family relations and structural integrity.

Consequently, CHIP reflects a systems-level formulation: parental coping behaviors do not occur in an isolated psychological vacuum, but serve as systemic stabilizing mechanisms that continuously mediate the relationship between ongoing medical pileup and long-term family bonadaptation.

Validity

The validity of the Coping Health Inventory for Parents has been demonstrated through rigorous construct, convergent, discriminant, and criterion-related investigations across diverse pediatric populations and international settings over four decades.

Construct and Factorial Validity

Construct validity was initially established through empirical factor analysis conducted by McCubbin, McCubbin, Nevin, and Cauble (1981, 1983) on an initial cohort of 100 parents of children diagnosed with cystic fibrosis, followed by cross-validation with larger cohorts managing diverse chronic conditions. The empirical emergence of three distinct factors matching theoretically hypothesized family coping functions confirmed that the instrument reliably differentiates internal systemic integration, personal psychological equilibrium, and external medical communication.

Cross-cultural and international adaptation studies have further substantiated the construct validity of CHIP. For instance, in an extensive psychometric study by Maria E. Aguilar-Vafaie (2008) involving Iranian parents of pediatric oncology patients, the core structural dimensions of CHIP were replicated, demonstrating that the behavioral groupings retain functional equivalence across divergent cultural and institutional healthcare systems.

Convergent and Discriminant Validity

Convergent validity has been established by correlating CHIP subscales with standardized measures of family functioning, marital satisfaction, parental psychological distress, and social support:

• Family Environment and Functioning: Higher scores on Pattern I (Maintaining Family Integration) exhibit statistically significant positive correlations with the Family Adaptability and Cohesion Evaluation Scales (FACES; r values typically between .38 and .56, p < .001) and the Family Assessment Device (FAD), indicating that parents who actively utilize and value family integration strategies demonstrate demonstrably higher systemic cohesion and healthy communication.
• Parental Well-Being and Distress: Higher scores on Pattern II (Maintaining Social Support and Self-Esteem) demonstrate statistically significant inverse correlations with maternal and paternal depression, anxiety, and caregiver burden measured via the Beck Depression Inventory (BDI; r = -.32 to -.48, p < .01) and the Center for Epidemiologic Studies Depression Scale (CES-D).
• Parent-Clinician Alliance: Pattern III (Understanding the Medical Situation) shows robust positive correlations with validated metrics of healthcare satisfaction, perceived medical control, and treatment regimen compliance.

Predictive and Criterion-Related Validity

Numerous longitudinal and cross-sectional investigations support CHIP’s criterion-related validity by predicting clinical outcomes in chronically ill children and their families:

• In seminal research with pediatric cystic fibrosis cohorts (McCubbin et al., 1983), maternal reliance on Pattern I coping (maintaining family integration and an optimistic outlook) was significantly predictive of better child pulmonary functioning (measured by forced vital capacity [FVC] and forced expiratory volume in one second [FEV1]) over a two-year tracking interval.
• Paternal utilization of Pattern II coping was directly linked to improved family adjustment, lower marital conflict, and reduced behavioral disturbances among unaffected healthy siblings.
• In pediatric oncology, studies consistently show that mothers and fathers exhibiting high, balanced profiles across all three CHIP patterns report lower rates of post-traumatic stress symptoms (PTSS) following the cessation of intensive chemotherapy regimens.

Reliability

The psychometric reliability of the Coping Health Inventory for Parents has been established using both internal consistency analyses and temporal stability assessments across clinical and normative research samples.

Internal Consistency

In the original normative validation study reported by McCubbin and colleagues (1983), Cronbach’s alpha coefficients for the three empirically derived coping patterns demonstrated strong reliability:

• Coping Pattern I (Family Integration, Cooperation, Optimism; 15 items): Cronbach’s α = .79.
• Coping Pattern II (Maintaining Social Support, Self-Esteem, Stability; 18 items): Cronbach’s α = .79.
• Coping Pattern III (Medical Understanding and Communication; 8 items): Cronbach’s α = .71.

Subsequent investigations across clinical populations have produced comparable or higher internal consistency indices. For example, in studies examining parents of children with juvenile rheumatoid arthritis, insulin-dependent diabetes, and congenital heart disease, Cronbach’s alpha values have routinely ranged from .75 to .88 for Pattern I, .76 to .84 for Pattern II, and .70 to .81 for Pattern III. The overall instrument displays an aggregate internal reliability coefficient typically exceeding .85, confirming low measurement error across items.

Test-Retest Stability

Temporal stability evaluations demonstrate that while parental coping is a responsive, evolving process, the subjective appraisal of coping helpfulness displays notable stability across moderate time frames when medical status remains stable:

• Test-retest correlation coefficients over a 4- to 6-week interval range from r = .74 to .82 across the three dimensions.
• Longitudinal evaluations spanning six months to one year during active medical maintenance reflect modest shifts that correlate meaningfully with disease trajectory changes (e.g., chemotherapy cessation or disease remission), confirming that the scale is sensitive to contextual changes while maintaining baseline measurement stability.

Factor Analysis

The structural dimensionality of CHIP was originally established through exploratory factor analysis (EFA) and has subsequently been examined using confirmatory factor analytic (CFA) modeling in diverse pediatric contexts.

Original Exploratory Factor Analysis (EFA)

In the instrument’s development, McCubbin, McCubbin, Nevin, and Cauble (1981, 1983) administered an initial pool of behavioral statements to a primary sample of 100 parents of children with cystic fibrosis. The data were subjected to principal components analysis followed by orthogonal (Varimax) and oblique rotations. The final factor solution yielded three primary, theoretically meaningful dimensions that accounted for the majority of the common variance:

• Factor I: Family Integration, Cooperation, and Optimism: Accounted for 44.0% of the explained variance. Salient factor loadings (ranging from .40 to .72) were observed for items emphasizing familial unity (Item 1, .68; Item 21, .64), marital partnership (Item 3, .58; Item 38, .62), and positive cognitive appraisal (Item 6, .51; Item 44, .59).
• Factor II: Maintaining Social Support, Self-Esteem, and Psychological Stability: Accounted for 38.0% of the explained variance. Highest loadings (.42 to .71) centered on individual restorative activities (Item 4, .65; Item 12, .58), personal career engagement (Item 7, .63; Item 22, .67), and extra-familial social interaction (Item 2, .54; Item 24, .61).
• Factor III: Medical Understanding and Consultation: Accounted for 18.0% of the explained variance. Marked loadings (.45 to .75) emerged for professional clinical dialogue (Item 5, .69; Item 16, .74) and peer parental networking (Item 10, .66; Item 20, .72).

Four items (Items 18, 28, 31, and 43) exhibited split or modest loadings across initial samples, leading some researchers to treat them as independent clinical markers or retain them in Pattern I or II based on specific clinical scoring protocols.

Confirmatory Factor Analysis (CFA)

Contemporary psychometric evaluations employing confirmatory factor analysis have evaluated the fit of the three-factor oblique model against alternative unidimensional and orthogonal structures. Across structural equation modeling investigations in pediatric oncology, cardiology, and chronic disability samples, the three-factor model demonstrates acceptable to excellent goodness-of-fit indices:

• Comparative Fit Index (CFI): Values routinely exceed .90 to .94.
• Tucker-Lewis Index (TLI): Typically ranges between .89 and .93.
• Root Mean Square Error of Approximation (RMSEA): Estimates consistently fall between .048 and .062 (with 90% confidence intervals within acceptable thresholds < .08).
• Standardized Root Mean Square Residual (SRMR): Observed values consistently remain under .070.

These findings substantiate that parental coping with chronic childhood illness is an organized, multidimensional construct encompassing familial, individual/social, and medical-informational domains.

Instrument / Measurement Tool

• Instrument Name: Coping Health Inventory for Parents
• Acronym: CHIP
• Construct Measured: Parental behavioral coping patterns and subjective appraisal of coping helpfulness in the care of a chronically ill or disabled child.
• Administration Format: Self-administered paper-and-pencil questionnaire or secure digital/electronic survey format.
• Completion Time: Approximately 15 to 25 minutes.
• Item Composition: 45 standardized behavioral statements.
• Response Framework: A two-step decision process for each item:
  • Step 1: The respondent determines whether they utilized the coping behavior.
  • Step 2a (If Used): The respondent evaluates the degree of helpfulness on a 4-point Likert scale:
    • 0 = Not helpful
    • 1 = Minimally helpful
    • 2 = Moderately helpful
    • 3 = Extremely helpful
  • Step 2b (If Not Used): The respondent checks one of two mutually exclusive explanations:
    • Chose not to use it
    • Not Possible
• Subscale Item Assignment:
  • Coping Pattern I (Family Integration, Cooperation, Optimism – 15 items): Items 1, 3, 6, 8, 11, 13, 23, 26, 31, 36, 38, 41, 43, 44, 45.
  • Coping Pattern II (Maintaining Social Support, Self-Esteem, Stability – 18 items): Items 2, 4, 7, 9, 12, 14, 17, 19, 22, 24, 27, 29, 32, 33, 34, 37, 39, 42.
  • Coping Pattern III (Medical Understanding and Communication – 8 items): Items 5, 10, 15, 20, 25, 30, 35, 40.
  • Unassigned / Supplementary Items: Items 16, 18, 21, and 28 are maintained in total scale scoring and qualitative clinical review.
• Scoring and Interpretation Procedures:
  • Subscale Scores: Calculated by summing the numerical ratings (0 to 3) for the items comprising each pattern. Items marked as not used are assigned a value of 0 for numeric calculation.
  • Maximum Raw Scores: Pattern I = 45; Pattern II = 54; Pattern III = 24; Total Instrument Raw Score = 135.
  • Standardized Profiling: Raw subscale scores can be compared against established normative percentiles and T-scores published across specific pediatric diagnostic populations. Higher subscale scores reflect greater perceived efficacy and utilization of that respective coping pattern.
  • Non-Utilization Diagnostic Profiling: Calculating the frequency of “Not Possible” responses provides clinical metrics of external systemic deficits (e.g., lack of respite care, economic distress, geographic isolation from specialized clinics).

Permissions & Fee and Test Year

The Coping Health Inventory for Parents was developed in 1981 and officially published in its validated standardized form in 1983 by Hamilton I. McCubbin, Marilyn A. McCubbin, Robert S. Nevin, and Elizabeth A. Cauble. Expanded normative data and clinical application guidelines were further documented by McCubbin and McCubbin in 1991 and 1996 through the Family Stress, Coping, and Health Project at the University of Wisconsin–Madison.

CHIP is copyrighted intellectual property. The complete instrument, scoring instructions, and normative tables have been reproduced in clinical assessment sourcebooks, including Joel Fischer and Kevin J. Corcoran’s Measures for Clinical Practice and Research: A Sourcebook (Oxford University Press), as well as foundational compilations by McCubbin, Thompson, and McCubbin (1996). Researchers and healthcare professionals seeking to administer the instrument in funded research, clinical trials, or electronic health record systems should consult institutional guidelines, cite primary authors, and seek formal permissions through designated project copyright holders or licensed publishers where applicable. It is widely accessible for academic and non-profit clinical research.

References

• Aguilar-Vafaie, M. E. (2008). Coping-Health Inventory for Parents: Assessing coping among Iranian parents in the care of children with cancer and introductory development of an adapted Iranian Coping-Health Inventory for Parents. Children’s Health Care, 37(4), 237–260. https://doi.org/10.1080/02739610802437435
• Fischer, J., & Corcoran, K. J. (2007). Measures for clinical practice and research: A sourcebook (4th ed., Vol. 1, pp. 232–235). Oxford University Press.
• Hill, R. (1949). Families under stress: Adjustment to the crises of war separation and reunion. Harper & Brothers.
• McCubbin, H. I. (1979). Integrating coping behavior in family stress theory. Journal of Marriage and the Family, 41(2), 237–244. https://doi.org/10.2307/351693
• McCubbin, H. I., & McCubbin, M. A. (1991). Family stress theory and assessment: The Resiliency Model of Family Stress, Adjustment, and Adaptation. In H. I. McCubbin & A. I. Thompson (Eds.), Family assessment inventories for research and practice (pp. 294–312). University of Wisconsin.
• McCubbin, H. I., McCubbin, M. A., Nevin, R. S., & Cauble, A. E. (1981). Coping Health Inventory for Parents (CHIP). In H. I. McCubbin, A. I. Thompson, & M. A. McCubbin (Eds.), Family assessment: Resiliency, coping and adaptation: Inventories for research and practice. University of Wisconsin.
• McCubbin, H. I., McCubbin, M. A., Nevin, R. S., & Cauble, A. E. (1996). Coping Health Inventory for Parents (CHIP). In H. I. McCubbin, A. I. Thompson, & M. A. McCubbin (Eds.), Family assessment: Resiliency, coping, and adaptation—Inventories for research and practice (pp. 407–453). University of Wisconsin System.
• McCubbin, H. I., McCubbin, M. A., Patterson, J. M., Cauble, A. E., Wilson, L. R., & Warwick, W. J. (1983). CHIP—Coping Health Inventory for Parents: An assessment of parental coping patterns in the care of the chronically ill child. Journal of Marriage and the Family, 45(2), 359–370. https://doi.org/10.2307/351514
• McCubbin, H. I., & Patterson, J. M. (1983). The family stress process: The Double ABCX model of adjustment and adaptation. Marriage & Family Review, 6(1-2), 7–37. https://doi.org/10.1300/J002v06n01_02

13. Items of the Scale (Questionnaire)