Patricia E. Fingerhut, Jocelyn Piro, Ashley Sutton, Rachel Campbell, Christy Lewis, Dilshad Lawji, Nicole Martinez; Family-Centered Principles Implemented in Home-Based, Clinic-Based, and School-Based Pediatric Settings. Am J Occup Ther 2013;67(2):228-235. doi: 10.5014/ajot.2013.006957.
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© 2018 American Occupational Therapy Association
OBJECTIVE: The goal of this study was to determine whether pediatric occupational therapy practitioners implemented family-centered principles in their practice.
METHOD: Twenty-eight occupational therapy practitioners were interviewed in three practice settings: home based, clinic based, and school based. A grounded theory approach was used to analyze the results. Responses were compared across respondents and across practice settings.
RESULTS: Responses varied among practitioners and, more significantly, practice settings. A continuum of family-centered practice was demonstrated, with home-based practice as the most family centered, school-based practice as the least family centered, and clinic practice varying in between.
CONCLUSION: Occupational therapy practitioners are familiar with most principles of family-centered practice. However, implementation of those principles differs significantly across practice settings.
Families are essential members of the treatment team because they know their children best.
Intervention needs to be flexible and tailored to the unique characteristics and identified needs of the family.
Intervention needs to be focused on supporting and strengthening family functioning.
I think I really try and listen to parents’ needs and concerns and try to make goals to help address their concerns. Because I’ve learned that if you make goals that aren’t important to family there will be little to no carryover.
That’s one of the areas [in which] I think schools are particularly lacking… . I think that there are a lot of things that are lacking that [occupational therapists] could help with but maybe just can’t because of limitations of practice in the schools.
I’ve had such a high caseload that it has been very difficult for me to also be the case manager, which is really the go-to person for the family… . I don’t feel I can get to the meat of being a therapist, which is what I want to do.
You only have 1 hour to do an evaluation, so you are really focused on the child, what he can do and, yeah, you might get some information from the parents about their life, but you don’t get that until there’s a relationship with the parents… . It usually takes a little while.
We’re moving towards more of a model as a company [in which parent in session] becomes the culture and the norm for treatment sessions. We don’t want the session to be, Drop your child off and come back to get them in an hour. [However,] for some people it is literally the only hour they have without their child.
I think my interventions, like it says, need to be designed for family carryover. When I’m doing stuff, my laser beam is on that teacher and less on the family. I think that the families should be more involved, but how that’s supposed to look—I’m completely unclear about that one, for sure.You have so many kids on the caseload, so I think some of that’s slipping. We’re not having that access in the home as we used to.
I think my interventions, like it says, need to be designed for family carryover. When I’m doing stuff, my laser beam is on that teacher and less on the family. I think that the families should be more involved, but how that’s supposed to look—I’m completely unclear about that one, for sure.
You have so many kids on the caseload, so I think some of that’s slipping. We’re not having that access in the home as we used to.
We’re working with our students on increasing their independence, especially as related to self-care tasks … [and helping] the parents both in their parental role and also in freeing up their time to do whatever else they need to do around the house.
Those children are not going to do well in a community, in a mother’s day out or a church nursery. They don’t play well with things that move, like balls and swings, so [occupational therapy] could help enormously with that. He’s so much more willing and happier to go out into the world, and that changes everything for the family.
You can see it in her face when she says, “He put his shirt on by himself this morning.” “Oh yes, you got your cup of coffee, too, this morning cause you had time, huh?” You can see it in her eyes—oh, the best morning ever.
Probably one of the big things is, “Oh, the child’s sleeping through the night, so now I’m getting adequate rest” or if the parent says, “We’re able to go to Chuck E. Cheese as a family,” or “I can go into Wal-Mart now, I can take him with me when I do my grocery shopping.” So those kinds of things are usually noted in the SOAP note.
That would be huge. Especially if I had something the parent could fill out, because there is only so much time in each treatment session.I think that would be helpful if we had a form to address that. … There’s not really anything we are giving to the parent to look at ahead of time so they have time to think about it and consider it.
That would be huge. Especially if I had something the parent could fill out, because there is only so much time in each treatment session.
I think that would be helpful if we had a form to address that. … There’s not really anything we are giving to the parent to look at ahead of time so they have time to think about it and consider it.
It might help to know if there were underlying issues with the parents; that way I would be able to know what his or her expectations were for that child. I would incorporate more of the parents’ goals into the therapy session.
I think it would be very beneficial as far as knowing what the client’s needs [are] in real life. A lot of times you’re asking about the developmental milestones and other things that a child needs to function, but at the same time there are community settings such as working, doing errands that a person would be expected to participate in.
There are probably many, many things that these parents are going through that we don’t always get all the information. We’d definitely get a more well-rounded picture and possible strategies that we could work on that correlate to the school setting but also [that correlate] to more independence out in the community.
A gap between research and practice
Lack of therapist education in FCP
Federal and state rules and regulations
Limited support from administrators and colleagues
Professional attitudes about the therapist’s and the parent’s roles.
Do I understand the principles of FCP and what the literature says about effective implementation of these principles?
Am I comfortable in a collaborative role with families?
How am I facilitating communication with families? How can I make this communication more efficient and effective?
What are the unique needs of this family? With what level of involvement are they comfortable? How can I facilitate involvement that is more effective?
What are the systematic and cultural barriers to FCP in my practice setting? How can these barriers be modified to facilitate best practice?
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