Facts, Optimism, Cope, Understanding, Solve (FOCUS)

Man in hospitalPurpose

FOCUS was developed to assist individuals who assume caregiver roles when family members acquire a sudden and severe disability (e.g., spinal cord injury, brain injury) in which personal, social and vocational roles are disrupted.


By using the components of the FOCUS acronym, the model is designed to assist caregivers in prioritizing the many problems that typically occur in the wake of acquired disability

FOCUS Approach to Problem Solving

Facts/Problem Definition
The objective is to clearly state the problem and break it into manageable parts. Present facts in unambiguous, concrete terms, separate from assumptions, and differentiate relevant from irrelevant information. Seek all available facts to answer who, what, when, where, why, and how of the situation. Conduct thoughtful assessment of caregiver problems and use procedures to assist in prioritizing their importance.

Optimism/Problem Orientation
The objective is to develop a sense of optimism regarding problem-solving ability. This includes instilling a belief that one is sufficiently skilled to solve problems, as well as instilling a sense of motivation to engage in problem-solving process while simultaneously regulating emotional experiences to maintain a sense of confidence. Normalize the experience of multiple problems, decisions, and challenges associated with disability. Help caregiver understand that these can be addressed with a systematic problem-solving approach.

Creativity/Generation of Alternative Solutions
The objective is to actively brainstorm multiple solutions to the problem of highest priority. Caregivers are instructed to think of multiple solutions and write each down. It is crucial that judgments be withheld at this point in the process.

The objective is to outline the process needed to make an informed, wise, and appropriate choice that maximizes the probability of a positive outcome. Making a decision about the “best” strategy to try and solve the problem requires a thoughtful consideration of gains and benefits of the best available strategies.

Solve/Implementation & Verification
The objective is solving the problem and then systematically reviewing the outcome to determine how the solution worked and the degree to which the actual outcome approximates the expected one. This self-monitoring is crucial for learning what made a solution effective or ineffective and how to implement a similar solution or use a different solution in the future

Target Population

Caregivers of persons who acquire sudden and severe disabilities

Research Outcomes

FOCUS has been applied successfully through face-to-face, telephone and videoconferencing sessions

Outcomes Research References

Berry, J. W., Elliott, T., Grant, J., Edwards, G., & Fine, P. R. (2012). Does problem solving training for family caregivers benefit care recipients with severe disabilities? A latent growth model of the Project CLUES randomized clinical trial. Rehabilitation Psychology, 57, 98-112.

Elliott, T., & Berry, J. W. (2009). Brief problem-solving training for family caregivers of persons with recent-onset spinal cord injury: A randomized controlled trial. Journal of Clinical Psychology, 65, 406-422

Elliott, T., Berry, J. W., & Grant, J. S. (2009). Problem-solving training for family caregivers of women with disabilities: A randomized clinical trial. Behaviour Research and Therapy, 47, 548-558

Elliott, T., Brossart, D., Berry, J. W., & Fine, P. R. (2008). Problem-solving training via videoconferencing for family caregivers of persons with spinal cord injuries: a randomized controlled trial. Behaviour Research and Therapy, 46, 1220–1229.

Pfeiffer, K., Beische, D., Hautzinger, M., Berry, J. W., Wengert, J., Hoffrichter, R., Becker, C., van Schayck, R., & Elliott, T. (2014). Telephone-based problem-solving intervention for family caregivers of stroke survivors: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 82, 628-643.

Rivera, P., Elliott, T., Berry, J., & Grant, J. (2008). Problem-solving training for family caregivers of persons with traumatic brain injuries: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 89, 931–941.

Clinical Approach References

Kurylo, M., Elliott, T., & Shewchuk, R. (2001). FOCUS on the family caregiver: a problem-solving training intervention. Journal of Counseling and Development, 79, 275–281.

Rivera, P., Shewchuk, R., & Elliott, T. (2003). Project FOCUS: Using videoconferencing to provide problem solving training to family caregivers of persons with spinal cord injuries. Topics in Spinal Cord Injury Rehabilitation, 9(1), 53-62