Coping Health Inventory for Parents (CHIP)

Abstract

The Coping Health Inventory for Parents (CHIP) is a specialized psychological instrument designed to assess the coping strategies utilized by parents who are managing the challenges associated with caring for a child with a chronic or long-term medical condition. Developed within the framework of Family Stress Theory, the CHIP identifies specific behavioral and cognitive patterns that parents employ to maintain family stability, secure social support, and effectively manage the demands of the healthcare situation. The scale comprises 45 items grouped into three main dimensions of parental coping, providing researchers and clinicians with a comprehensive measure of adaptive responses to medical stress.

Keywords

Parental coping, chronic illness, family assessment, family stress theory, psychological adaptation, behavioral inventory, family integration.

Authors

Hamilton I. McCubbin, Marilyn A. McCubbin, R. Nevin, E. Cauble.

Purpose

The primary purpose of the CHIP is to systematically measure the repertoire of coping behaviors used by parents when they are confronted with the ongoing demands of a child’s illness. Unlike general coping scales, CHIP specifically targets the unique stressors inherent in pediatric chronic illness, focusing on behaviors that help parents maintain personal well-being, manage household tasks, and engage effectively with the medical system.

The instrument is crucial for understanding how families define and react to stressful circumstances, allowing healthcare providers and family therapists to tailor interventions that bolster effective coping mechanisms and reduce familial strain. The scale not only identifies strategies that are currently employed but also assesses how helpful the parents perceive those strategies to be.

Construct

The CHIP measures parental coping, which is conceptualized as the cognitive and behavioral efforts made to manage the internal and external demands of caring for a child with a chronic condition. The scale is empirically derived and structured around three major dimensions, reflecting a holistic view of the family’s response to stress:

• Family Integration, Cooperation, and Optimism: Measures strategies related to maintaining internal family cohesion, defining the situation positively, and promoting a sense of hope and mutual support.
• Maintaining Social Support, Self-Esteem, and Psychological Stability: Focuses on individual coping efforts, including seeking external relationships, engaging in self-care (e.g., sleeping, eating, hobbies), and preserving personal identity and self-esteem despite the demands of caregiving.
• Understanding the Health Care Situation: Assesses active information-seeking and communication strategies, including interacting with the medical team, talking with other parents in similar situations, and adhering to prescribed medical treatments.

These dimensions reflect the complex interplay between individual, marital, and systemic coping efforts within the family unit.

Validity

The validity of the CHIP has been supported through extensive research, particularly concerning its ability to distinguish between adaptive and maladaptive coping patterns in families dealing with chronic pediatric conditions. Content validity was established during development, ensuring that the items comprehensively cover the range of coping behaviors relevant to this specific population, as confirmed by clinical and expert consensus.

Construct validity is evidenced by the scale’s factor structure, which consistently aligns with the theoretical dimensions proposed by the Family Stress Theory (specifically, the Double ABCX Model). Studies have shown that scores on the CHIP dimensions correlate logically with measures of family adjustment, parental depression, and overall quality of life, further confirming its theoretical grounding and practical utility.

Reliability

The CHIP demonstrates acceptable to strong internal consistency across its various dimensions. Reliability studies using Cronbach’s alpha have consistently reported coefficients ranging generally between .70 and .85 for the subscales, indicating that the items within each factor measure a unified construct. Test-retest reliability has also been established, suggesting that parental coping patterns, as measured by the CHIP, remain relatively stable over short periods, reflecting consistent behavioral strategies in response to ongoing stress.

Factor Analysis

The CHIP consists of 45 items derived from the initial research into family coping mechanisms. Factor analysis, typically using principal components analysis with rotation, consistently yields a three-factor solution, which corresponds to the conceptual dimensions outlined by McCubbin and colleagues. These three factors account for a significant portion of the variance in parental coping responses:

1. Family integration, cooperation, and optimism Definition of the Situation: This factor includes items related to internal family strength and positive outlook (e.g., Items 1, 3, 6, 8, 11, 13, 23, 26, 31, 36, 38, 41, 43, 44, and 45).
2. Maintaining social support, self-esteem, and psychological stability: This factor focuses on personal and external resource utilization (e.g., Items 2, 4, 7, 9, 12, 14, 17, 19, 22, 24, 27, 29, 32, 33, 34, 37, 39, and 42).
3. Understanding the health care situation through communication with other parents and communication with the health care team: This factor emphasizes information management and professional interaction (e.g., Items 5, 10, 15, 20, 25, 30, 35, and 40).

Instrument

Test Type: Self-Report Inventory / Psychometric Scale

Format: 45 items rated on a 4-point Likert scale (0 = Not helpful, 3 = Extremely helpful). Respondents are also asked to indicate why they did not use a behavior (Chose not to use it or Not Possible).

Language Available: English (Original), adapted versions exist (e.g., Iranian CHIP).

Population Group: Parents (Mothers and Fathers) of children with chronic medical conditions.

Age Group: Adult parents (typically 18+).

Population Details: Specifically designed for parents facing high levels of stress due to the long-term illness or disability of a child, such as those with cystic fibrosis, cancer, diabetes, or other complex health issues.

Test Methodology: The scale is administered via paper-and-pencil or digital format. Scores are calculated by summing the responses for the total scale and for the three individual subscales, yielding a profile of the parent’s primary coping strategies.

Keywords

Pediatric health, caregiving stress, parental adjustment, family resilience, psychological measurement, McCubbin, coping inventory.

Authors

Author ORCID Identifier: N/A (Information not provided in source material)

Affiliation Email addresses: N/A (Information not provided in source material)

Correspondence Address: Correspondence is typically handled through the University of Wisconsin System for original documentation.

Permissions & Fee and Test Year

Test Year: Initial publication/documentation in 1981 (based on 1979 theoretical work).

Permissions: The instrument is generally available for research and clinical use through official sourcebooks and academic publishers, such as those cited below. Users should consult the current copyright holders (often the McCubbin family or associated academic institutions) for formal permissions regarding large-scale use or adaptation.

Fee: Usage fees may apply depending on the context (e.g., commercial or large-scale clinical application).

Reference’s

• McCubbin, H. (1979). Integrating coping behaviour in family stress theory. Journal of Marriage and the Family, 41, 237-244.
• McCubbin, H. I., McCubbin, M. A., Nevin, R., & Cauble, E. (1981). Coping Health Inventory for Parents (CHIP). In M. H.I., A. I. Thompson & M. A. McCubbin (Eds.), Family assessment: Resiliency, coping and Adaptation: Inventories for research and practice. Madison: University of Wisconsin.
• McCubbin, H., & McCubbin, H., Patterson, J. & Cauble, A. (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, 359-370.
• McCubbin, H. I., Cubin, M. A., Patterson, J. M., Cauble, A. E., Wilson, L. R., & Warwick, W. (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, 20, 359-370.
• McCubbin H, McCubbin M. Family stress theory and assessment. In: McCubbin HI, Thomson AI, editors. Family assessment inventories for research and practice. Madison: University of Wisconsin; 1991. p. 294-312.
• McCubbin, H. I., McCubbin, M. A., Nevin, R., & Cauble, E. (1996). Coping Heath Inventory for Parents (CHIP). In M. H.I., A. I. Thompson & M. M.A. (Eds.), Family assessment: Resiliency, coping, and adaptation-Inventories for research and practice (pp. 407-453). Madison: WI: University of Wisconsin System.
• Fischer, Joel., Corcoran, Kevin J. (2007). Measures for Clinical Practice and research: A sourcebook. (4th ed.). NY. Oxford University Pr. Vol. 1, Page (s): 232-235.
• Aguilar-Vafaie, Maria 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.

Items of the Coping Health Inventory for Parents (CHIP)

The CHIP consists of 45 items reflecting various coping behaviors. Respondents rate the helpfulness of each behavior using the following scale: 0 = Not helpful, 1 = Minimally helpful, 2 = Moderately helpful, 3= Extremely helpful. If a behavior was not used, the parent records the reason (Chose not to use it or Not Possible).

1. Trying to maintain family stability.
2. Engaging in relationships and friendships which help me to feel important and appreciated.
3. Trusting my spouse (or former spouse) to help support me and my child(ren).
4. Sleeping.
5. Talking with the medical staff (nurses, social worker, etc.) when we visit the medical center.
6. Believing that my child will get better
7. Working, outside employment
8. Showing that I am strong.
9. Purchasing gifts for myself and/or other family members.
10. Talking with other individual/parents in my situation.
11. Taking good care of all the child’s special needs at home.
12. Eating
13. Getting away myself
14. Getting other members of the family to help with chores and tasks at home
15. Believing in God.
16. Talking with Doctor about my concerns about my child(ren) with the medical condition.
17. Believing that the medical center/hospital has my family’s best interest in mind.
18. Building a closer relationship with people.
19. Develop my self as a person.
20. Talking with other parents in the same type of situation and learning about their experiences.
21. Doing things together as a family (involving all members of the family).
22. Investing time and energy in my job.
23. Believing that my child is getting the best medical care possible.
24. Entertaining friends in our home.
25. Reading about how other persons in my situation handle things.
26. Doing things with family relatives.
27. Becoming more self reliant and dependent.
28. Telling myself that I have many things I should be thankful for.
29. Concentrating on hobbies (art, music, jogging, etc.)
30. Explaining our family situation to friend and neighbors so they will understand us.
31. Allowing myself to get angry.
32. Encouraging child(ren) with medical condition to be more independent.
33. Keeping myself in shape and well groomed.
34. Involvement in social activities (parties, etc.) with friends.
35. Going out with my spouse on a regular basis.
36. Investing myself in my child(ren).
37. Being sure prescribed medical treatments for child(ren) are carried out at home on a daily basis.
38. Building a closer relationship with my spouse.
39. Talking to someone (not professional counselor/doctor) about how I feel.
40. Reading more about the medical problem which concerns me.
41. Talking over personal feelings and concerns with spouse.
42. Being able to get away from the home care tasks and responsibilities for some relief.
43. Having my child with the medical condition seen at the clinic/hospital on a regular basis.
44. Believing that things will always work out.
45. Doing things with my children.