The FOCUS was developed over a 13 year time span. It was developed with parent and clinician input at 11 partner sites in 5 Provinces across Canada.
Parents of 210 preschool children and their clinicians were asked to describe the changes they observed following treatment (Thomas-Stonell et al., 2009). The comments aligned with the World Health Organization’s ICF-CY framework (WHO, 2007). FOCUS items were developed using the parents’ own wording.
The FOCUS measure was tested three times with 165 families and their clinicians. It was revised after each test phase using measurement science and parent/clinician feedback. Using this process, the FOCUS measure was reduced from 103 to 50 items. As the FOCUS was revised, most of the Body Function items were eliminated. There was an increased emphasis on ICF-CY Activities and Participation domain, especially performance items (Thomas-Stonell et al, 2010).
How was the FOCUS-34 developed?
In response to clinician and parent requests, we investigated the possibility of increasing the clinical efficiency of the FOCUS by reducing the total number of items while retaining its validity as a change detecting measure.
FOCUS change data on approximately 18,000 children were reviewed. Items that were less sensitive to change, were answered similarly for all children (i.e. didn’t discriminate well) or were strongly correlated to each other were removed, leaving 34 items. The FOCUS-34 change scores were found to predict change scores from the original FOCUS almost perfectly. The FOCUS-34 preserves the clinical integrity, internal consistency, reliability, and validity of the full FOCUS.