KEMPE Family Stress Inventory

Inter-rater Reliability

Family Name and ID #: ______FSW: ______

Domains / FSW Scores / Supervisor/Reviewer Scores
1. Childhood History / ______MOB ______FOB ______SO / ______MOB ______FOB ______SO
2. Substance use, Mental Health, Criminal Activity / ______MOB ______FOB ______SO / ______MOB ______FOB ______SO
3. Past or Current Child Welfare Involvement / ______MOB ______FOB ______SO / ______MOB ______FOB ______SO
4. Self-esteem, Available lifelines, Social Isolation / ______MOB ______FOB ______SO / ______MOB ______FOB ______SO
5. Stressors, Concerns / ______MOB ______FOB ______SO / ______MOB ______FOB ______SO
6. Potential for Violence / ______MOB ______FOB ______SO / ______MOB ______FOB ______SO
7. Expectations for Infant / ______MOB ______FOB ______SO / ______MOB ______FOB ______SO
8. Discipline / ______MOB ______FOB ______SO / ______MOB ______FOB ______SO
9. Perception of Infant / ______MOB ______FOB ______SO / ______MOB ______FOB ______SO
10. Bonding / ______MOB ______FOB ______SO / ______MOB ______FOB ______SO
Total Score / ______MOB ______FOB ______SO / ______MOB ______FOB ______SO

1. Is there inter-rater reliability?

Do FSW and reviewer scores fall within the same scoring range: 0-20; 25-35; 40+ or is there no more than a 5 point difference?

MOB: Yes No FOB/SO: Yes No (Please circle one)

2. Is this a complete assessment?

Are there no more than 1 Unknown for MOB or 2 Unknowns for FOB/SO?

MOB: Yes No FOB/SO: Yes No (Please circle one)

(Note: Turn form over to complete the tool)

3. Documentation comments:

Does the FSW follows the assessment format, are only objective facts given, are results quantified, is the assessment thorough, are strengths identified?

______

4. Review with FSW:

Discuss comfort level, barriers, problem solve ways to ask questions, referrals & follow-up

______

FSW Signature ______Date ______

Supervisor Signature ______Date ______

OCCF/InterraterReliabilitySupForm/SR 7-01-08