Family-centered care (FCC) is an approach to providing healthcare to clients that takes into consideration the entire family unit. Collaboration and information sharing with the patient/client and their family is a seen as a priority. When implementing FCC, the healthcare practitioner seeks to honor and respect the values, beliefs, priorities, and desires of the client and their family.
While working with pediatric and adolescent populations, employing FCC acknowledges the unique role the family unit plays in a child’s development, participation, and well-being. Health care practitioners (especially occupational therapists) should always take into account a child's environment–including family and home life–by engaging and collaborating with the family and supporting their needs as a unit. Government guidelines endorse FCC for practitioners servicing children. However, practitioners are presented with a lack of literature and resources to support the implementation of FCC and are faced with a variety of barriers to providing such care. A qualitative secondary analysis of family-clinician interactions in pediatric OT found that 56% of practitioners did not describe examples of implementing FCC elements during their interactions with caregivers. A 2013 study on the implementation of FCC interviewed OT practitioners in home-based, clinic-based, and school-based settings. Respondents cited their biggest barriers to implementing FCC as lack of time, characteristics of the family (such as culture, language, and personal stressors), and characteristics of the practice setting (such as budget cuts, high caseloads, guidelines, and differences in practice culture). Many steps can be taken to facilitate OT practitioners in implementing FCC with families.
A deeper understanding of the unique challenges faced by the families served: In order to assist practitioners in implementing elements of FCC, they must be seek a deeper understanding of the unique challenges and needs of the children and caregivers that they serve.
Training on importance of FCC and FCC modes: Practitioners must be trained on the value of FCC to their clients and equipped with a variety of FCC modes to implement in their therapy. FCC is vital as the members within a family unit have an impact on each other’s occupational participation. FCC modes include simple strategies, such as:
Viewing the parents/caregivers as a member of the professional team and seeking their input regarding decision making, assessment, and treatment.
Employing simple communication techniques and therapeutic use of self, such as actively listening to the caregivers, trying to understand their perspective, providing positive feedback, having a genuine and empathetic disposition, and providing individualized services.
Equipping families with resources and education in order to increase caregiver comprehension, skills, and ability to manage and advocate for the child’s needs. Practitioners can also equip families with needed support through group-based interventions.
Striving to address the unique barriers within a practice setting: Every OT setting has its own unique characteristics that may hinder FCC. Creativity, advocacy, team work, and proactivity are necessary to identify these potential barriers and creatively address them to facilitate FCC.
REFERENCES
Dorsey, S., Pullmann, M. D., Berliner, L., Koschmann, E., McKay, M., & Deblinger, E. (2014). Engaging foster parents in treatment: a randomized trial of supplementing trauma-focused cognitive behavioral therapy with evidence-based engagement strategies. Child Abuse & Neglect, 38(9), 1508–1520. https://doi.org/10.1016/j.chiabu.2014.03.020
Fingerhut, P. E., Piro, J., Sutton, A., Campbell, R., Lewis, C., Lawji, D., & Martinez, N. (2013). Family-centered principles implemented in home-based, clinic-based, and school-based pediatric settings. American Journal of Occupational Therapy, 67, 228–235. http://dx.doi.org/10.5014/ajot.2013.006957
Hebert, C. G., & Kulkin, H. (2018). An investigation of foster parent training needs. Child & Family Social Work, 23(2), 256–263. https://doi.org/10.1111/cfs.12413
McAnuff, J., Boyes, C., & Kolehmainen, N. (2015). Family–clinician interactions in children’s health services: a secondary analysis of occupational therapists’ practice descriptions. Health Expectations : An International Journal of Public Participation in Health Care and Health Policy, 18(6), 2236–2251. https://doi.org/10.1111/hex.12194
Mirza, M., Krischer, A., Stolley, M., Magaña, S., & Martin, M. (2018). Review of parental activation interventions for parents of children with special health care needs. Child: Care, Health and Development, 44(3), 401–426. https://doi.org/10.1111/cch.12554
Precin, P., Timque, J., & Walsh, A. (2010). A Role for Occupational Therapy in Foster Care. Occupational Therapy in Mental Health, 26(2), 151–175. https://doi.org/10.1080/01642121003736085
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