C-FOCI: Children's Florida Obsessive Compulsive Inventory

The C-FOCI (Children's Florida Obsessive Compulsive Inventory) is a brief self-report questionnaire for obsessive-compulsive symptoms and their severity in children and adolescents. It has a symptom checklist and a 5-item severity scale.

Who developed the C-FOCI?

The C-FOCI was developed by Eric Storch and colleagues as a brief measure of obsessive-compulsive symptoms in youth, for use in both clinical and community settings ^[1]. It is used to screen for and monitor obsessive-compulsive disorder (OCD).

The C-FOCI is the child-adapted version of the Florida Obsessive Compulsive Inventory (FOCI). Whether a child can complete it alone depends on reading level and cognitive ability. For younger children or those with limited literacy, clinician-administered or parent-assisted administration is recommended.

What does the C-FOCI measure?

The C-FOCI consists of two components:

Part 1, Symptom Checklist

17 common OCD symptoms that the child marks as present ("yes") or absent ("no") over the past month. Items span:

• Contamination obsessions and washing compulsions
• Aggressive obsessions and checking
• Sexual, religious and somatic obsessions
• Symmetry and repeating
• Hoarding

Part 2, Severity Scale (5 items)

Five items, summed to a total of 0–20, assessing:

1. Time occupied by obsessions and compulsions
2. Distress caused by symptoms
3. Degree of control over symptoms
4. Avoidance
5. Interference with daily functioning

Unlike the CY-BOCS, the C-FOCI has no resistance item.

How do you give the C-FOCI?

The C-FOCI is designed as a self-report measure, completed directly by the child or adolescent, and requires minimal administration time. In the original study, 191 adolescents completed it online with little difficulty ^[1]. For younger children or those with limited reading ability, clinician-assisted or parent-assisted administration is recommended to ensure accurate responses.

How do you score and interpret the C-FOCI?

• Symptom Checklist: count of symptoms endorsed (0–17).
• Severity Scale: sum of the five severity items (0–20). Higher scores indicate greater symptom severity.

The original validation did not publish a screening cutoff or severity bands, and its authors noted that the C-FOCI's validity as a screener had yet to be established ^[1]. No score bands are shown here for that reason.

• Tracking. Use the Severity Scale total to track change over time for the same child.
• Confirming. Confirm any concern with a clinical interview such as the CY-BOCS.

Psychometric properties

• Original validation. 82 youth with primary OCD completed the C-FOCI. Construct validity was supported by sensitivity to change after intensive cognitive-behavioural therapy and moderate relations with clinician-rated severity on the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS); internal consistency was acceptable for both the Symptom Checklist and the Severity Scale ^[1].
• Spanish validation. In 94 young people with OCD and 1,068 community controls aged 8–19, the C-FOCI showed two independent factors (symptoms and severity), good internal consistency and temporal stability, and acceptable sensitivity and specificity for detecting OCD ^[2].
• Meta-analysis. Across 20 independent samples, the average KR-20 was 0.74 for the Symptom Checklist and the average α 0.79 for the Severity Scale ^[3].

Limitations

• The C-FOCI is a screening and monitoring tool, not a diagnostic tool. A positive screen should prompt further clinical evaluation.
• The severity scale is particularly useful for tracking treatment response over time.
• Children with limited self-awareness about their symptoms may underreport; parental report and direct observation should supplement self-report data.
• The original validation samples were modest (82 youth with OCD ^[1]), so the evidence base remains limited compared with longer clinician-rated measures such as the CY-BOCS.

Who is the C-FOCI for?

Appropriate when:

• The client is a child or adolescent who can read the items, or has help to complete them
• You are screening for OCD symptom presence or monitoring treatment response
• A brief, self-administered measure is needed in a clinical or research context