Dealing with illness is associated with the adaptability to life events and healthy families, who have better functioning style, are able to adjust better or overcome it easier. Understanding a patient’s emotional state and social situation, including physical problems, provides many advantages whenever a patient visits a primary care physician. A tool is that makes it possible to evaluate functional factors, including emotional problems undiagnosed by imaging finding such as X-ray, computed tomography, and magnetic resonance imaging, within a short outpatient consultation time (5–10 minutes) is required [1].

Family members have the biggest influence over a patient’s emotions [2]. That’s why it is crucial to build up a desirable home environment for their developmental stages and behavioral patterns [2,3].

In order to assess a patient’s emotional factors decisively affected by their familial relationships, we need to initially implement a family relationship assessment. Many researchers have conducted family function assessments to examine the relationship among family members and each patient. Recently authoritative reviews also stated the most widely used self-reported measuring tools for studying cases of couples and family therapy research. The tools are as follows: the McMaster Family Assessment Device (FAD); Circumplex Model Family Adaptability and Cohesion Evaluation Scales (FACES); Beavers Systems Model Self‐Report Family Inventory (SFI); Family Assessment Measure III (FAM III); Family Environment Scale (FES); Family Relations Scale (FRS); Systemic Therapy Inventory of Change (STIC); and Systemic Clinical Outcome Routine Evaluation (SCORE) [4,5].

However, some of these measurement tools were developed decades ago and they have low reliability and validity for evaluating the functions of modern family [6].

The FACES tool developed by David H. Olson in 1991, the world’s most commonly used tool, was based on the Circumplex Mode l in 1979. This tool has been developed and revised for more than 30 years as the FACES series (I, II, III, and IV). In 1978, the original measurement tool was a 111-item instrument that was shortened to 50 items and 30 items. A third version, FACES-III was revised with 20 items in 1985 and FACES-IV in 2011 comprised of 62 items [7]. The FACES series is used in more than 1,200 dissertations and research papers [8]. FACES-III is easy to investigate, but it does not include a measure of family communication [9]. Good communication skills are the most important aspect, to solve problems between individuals as a primary intervention which reinforces the importance of studies on the types of home communication [10]. Olson and Goral [11]. developed the FACES-IV package, as a family assessment tool to overcome the shortcomings of the previous version, FACES-III. However, there are many items in FACESIV to fill out in a short time [11]. Besides it is difficult to apply them to elderly patients and those who did not establish a good relationship with their doctor. In Korea, the studies using the FACES series as a research tool use FACES-III to simply assess family functions rather than FACES-IV [8].

SCORE was based on the Clinical Outcomes and Routine Evaluation studied by Evans et al. [12] in 2000, which assessed family functions. The tool has 40 items to assess the sensitivity of changes in family functions following family therapy by the British group, in which Peter Stratton played a key role. Later in 2010, Stratton et al. [13] introduced the 15-item instrument, as the ‘most practical version for clinical use,’ and the United Kingdom has frequently used this tool to evaluate family function after psychotherapy. Since then, it has been translated into other languages in the United States and European countries, where its reliability and validity have been verified and used in clinical practice [12-14]. SCORE has currently six main versions (SCORE-40, SCORE-15, SCORE-28, SCORE-29, child SCORE-15, and relational SCORE-15). SCORE-15 is a compact scale that contains the most critical family functional assessment tools including assessment of the strengths, adaptability, and communication among family members, and it consists of a small number of questions that can increase the ease of investigation in various areas [14]. The purpose of this study was to verify the reliability and validity of SCORE-15 with a small research population and justify its applicability in Korea. In this study, SCORE-15 was translated into Korean for the first time according to the translation guidelines.

Most family function assessments that have been currently established are self-reported questionnaires. In general, they contain items such as family communication and problem-solving, family cohesion, family disciplines, family roles, and everyday family life. Recently, Hamilton and Carr [6] conducted a systematic review of self‐reported family assessment measures with references to the psychometric properties, clinical usefulness, and theoretical basis. The eight main tools were as follows: The McMaster FAD; Circumplex Model FACES; Beavers Systems Model SFI; FAM III; FES; FRS; and STIC; and the SCORE [17]. The purpose of this review was to examine self-reported measures to confirm their psychometric characteristics and clinical usefulness to determine the proper measuring methods for monitoring. The results showed that five family assessment scales were suitable for clinical use (FAD, FACES-IV, SFI, FAM III, SCORE) and a new scale (STIC) is currently undergoing validation. SCORE-15 has been adopted by the British Family Therapy Association and European Family Therapy Association as a tool to evaluate family therapeutic effects in families and couples [6]. Currently, SCORE-15 has been translated into English, Chinese, Czech, Dutch, Finnish, Flemish, French, German, Greek, Hindi, Hungarian, Icelandic, Italian, Norwegian, Polish, Portuguese, Romanian, Serbian, Spanish, Swedish, Transylvanian, and Welsh, and the translated version is available for download at http://www.aft.org.uk/view/15101224f1e.html. Our study conducted a Korean translation for the domestic application of SCORE-15 to assess family functions in a short period, supplementing the shortcomings of FACES-III and FACES-IV, which are the most commonly used scales in Korea. Furthermore, the reliability and validity of the SCORE-15 Korean version was assessed to help further studies and clinical practices. This study aimed to confirm the three-factor structure, reliability, and construct validity of SCORE-15 in Korea. In the reliability test of the first Korean-translated SCORE-15, Cronbach’s α was 0.92 indicating that the results was satisfactory. The result value of our study is slightly higher than two other studies, Vilaça et al. [18] in 2014 and Hamilton et al. [19] in 2015, whose Cronbach’s α was 0.84 and 0.90. According to Choi [20] in 2000, a Cronbach’s α value, when used as a tool for group comparisons, is satisfactory from 0.7 to 0.8. Also, the study stated that the value should be beyond 0.9 when clinically applied to an individual patient. Therefore, our result suggests that the Korean-translated SCORE-15 can stand out as a useful family functioning scale for routine use in clinical practice. To assess the concurrent validity of SCORE 15 in Hamilton et al. [19] in 2015, the correlation was compared with a total of five scales, ranging from 0.23 to 0.52 with a median value. The scales examined in the research were Global Assessment of Relative Functioning Scale, Strengths and Differences Questionnaire, Children’s Global Assessment of Functioning Scale, Mental Health Inventory-5, and Global Assessment of Functioning Scale [19]. We conducted a simple regression analysis in our investigation, each item of the SCORE-15 Korean version had an explanatory power of 0.33–0.60 (P<0.001). The correlation between the three-factor structure of SCORE-15 such as FS, FC, and FD and the subscales of FACES-III and IV (family adaptability, family cohesion, and FCS) verified the validation. It was also expected that the correlations between the totals on measures of family and individual adjustment with the SCORE-15 total would be as good as those with the SCORE-15 subscales, as subscales assessed aspects of family functioning rather than overall family function. It suggested SCORE-15 as more suitable for clinical use than FACES-III or IV because of the shorter administration time. Our study has some limitations such as the number of subjects, middle and high school students and adolescents among family members in a small region, which should be comprehensively considered for future studies. In particular, the impact of academic and career stressors that play a variety of roles in the case of middle and high school educated participants could not be estimated as a variable of affecting family functions in this study. However, our study was the first to validate the Korean SCORE-15. Our results will now be considered in the SCORE-28 version by researchers. The SCORE-15 index can also be conducted as an appropriate short-form indicator for evaluating family function and changes in detecting therapeutic improvements. Although the cutoff value of SCORE-15 has not been defined to determine therapeutic intervention for the improvement of family function, it has acceptable psychometric properties. Finally, our study is considerable as a family assessment instrument and as a system for providing routine feedback to physicians on therapeutic progress.