Professional Documents
Culture Documents
12 October 2011
Introduction
Family centred practice
In recent years there has been a shift in the underlying
principles and practices utilized within early childhood
intervention frameworks. In many services, Family
Centred Practice (FCP) principles have been adopted in
service provision for children with special needs (Dunst
2002; Edwards et al. 2003; Dodd et al. 2009; Epley et al.
2010). The FCP is based upon the foundational understanding that effective service delivery for children
extends beyond individual child-based therapy, requiring the child to be viewed within the context of the family unit. Parents and service providers are viewed as
equal partners in the decision-making process of determining interventions and the direction of the childs
care (Rosenbaum et al. 1998; Turnbull et al. 2000). As a
framework, FCP has influenced the design and implementation of services provided for young children with
disabilities in health care, early intervention, early childhood services, special and general education (Dempsey
& Keen 2008; Jeffries 2009).
2012 Blackwell Publishing Ltd
Results Four key themes emerged including: (i) the facilitation of goal setting, (ii) strengths-based focus, (iii) family centred processes and (iv) family empowerment.
Conclusions Both parents and service providers were
positive about the FGST. Insights into barriers to holistic
goal setting and the clinical utility of the tool are
described. Further refinement of the tool and trial in a
range of early intervention contexts is required.
Keywords: early intervention, family centred practice,
goal setting, qualitative study
Spastic quadriplegic
cerebral palsy
Down Syndrome and
heart condition
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Down Syndrome
Joiner
All ten members of the Family and Early Childhood Service Team were invited to participate in a focus group
to discuss their perceptions of the utility of the FGST.
All had used the tool during the 6-month period of data
collection and consented to participate in the focus
group. One team member consented to participate in an
individual interview as she was unable to attend the
focus group. A training session on use of the FGST was
provided by the tools designer (JJ) prior to use with
families. Participants consisted of two occupational therapists (OT), two speech and language pathologists (SLP),
one physiotherapist (PT), one psychologist (PSYC), two
social workers (SW) and two programme officers (PO).
(Programme officers hold a tertiary qualification in
health education social welfare and provide family, programme and resource support.) All participants were
women and aged between 24 and 55 years old. Each
had been employed within the service team for at least
12 months at the time of the focus group, and had
between 3 and 27 years (mean = 14 years) experience in
working with children. Regarding participation in goal
setting meetings prior to use of the FGST, four service
providers had undertaken less than five meetings, three
between 10 and 20 meetings, and three more than 20
meetings. In terms of use of the FGST, service providers
experience ranged between 1 and 6 times.
Participant group 2
Unemployed
Participant group 1
Participants
Instruments
The FGST used in the study was developed by the final
author (JJ) in 20092010 to aid in the process of developing annual FTPs with families. It was first used systematically during the first half of 2010 when this study
was undertaken. An audit of FTPs from 2005 to 2009
led to a list of 4045 potential goals that could be
depicted as cards used in a sorting process. These were
then supplemented by additional goals based upon the
clinical knowledge and experience of the developer. A
number of these goals reflected the developers understanding of the potential impact of disability on family
life, relationships and well-being, and so targeted needs
beyond the child with the disability. In addition
inspired by research using the Measures of the Processes of Care (MPOC) (King et al. 1995) parents needs
for provision of information were also addressed. It
was believed that although some goals were beyond the
scope of direct therapy services, identifying and discussing the range of issues at the heart of family concerns provided the potential for facilitating problem
solving, prioritization for within team social work and
psychology support and linkage with services and service providers beyond the team. Cards were developed
to depict each goal (activity skill task issue) and
included a written descriptor and an illustration using
Board Maker (Mayer-Johnson, Pittsburgh, PA, USA)
Symbols (See Figure 1). A blank card with the title
something else was also included to ensure parents
were invited to add goals not encapsulated by the other
cards. Three coloured base plate cards labelled yes
Figure 1 Depicts a selection of the FGST cards, as used in goalsetting with families during the research trial.
2012 Blackwell Publishing Ltd, 25, 360371
(green), no (red) and maybe (orange) to aid the sorting process and a suggested script, with summary card
to assist a consistent approach by service users, were
also included (See Figure 2). The cards were then circulated within the team to identify gaps, determine potential areas of confusion or need for clarity, for comment
on the wording symbols and to indicate any unnecessary goal cards. As a result, extra cards were added to
the tool leading to the final count of 78 cards (including
something else). A number of graphics words were
also changed to allow a clearer depiction of the card
theme or content. The 77 cards within the FGST were
classified according to seven domains namely: (i) information, resources and support for parents carers, (ii)
inclusion of child family in community participation,
(iii) social relational support, (iv) daily living skills, (v)
communication, (vi) gross motor mobility and (vii) play
and early academic skills.
After a discussion regarding the purpose of the
Annual FTP families were provided with the option of
using the FGST to assist them in goal setting. Families
were presented with the cards and asked to place each
in one of three piles yes, indicating they were interested in pursuing that activity skill issue topic in the
short to medium term; maybe, indicating the activity skill issue topic depicted on the card was a potential area of concern interest that needed to be discussed
or re-considered in the future; and no, indicating they
were not interested or had no immediate desire need to
pursue that particular goal. The blank something else
card was positioned as the last card in the pack. The
process of sorting the cards frequently led to discussion
process. All transcripts were de-identified and participants provided with numeric codes.
Team members were engaged in a focus group discussion facilitated by research team members (SR,
AOK), which was audiotaped then transcribed verbatim
by a research team member. Thomas et al. (1995) suggested that a major advantage of using the focus group
format is that it offers the chance to observe group
dynamics through social interaction that results in data
that are often deeper and richer, compared to those
obtained from one-on-one interviews. Hence, two
researchers facilitated the group with one documenting
observations and taking field notes while the other led
the discussion. Prior to the focus group, team members
completed a demographic information form providing
details regarding qualifications, experience working
within a family centred framework, and the number of
goal setting meetings participated in and use of the
FGST while goal setting with families. A focus group
protocol was developed to facilitate discussion about the
clinical utility of the FGST including the merits, limitations and suggestions for modification. The protocol
specifically addressed overall impressions, process of
using the cards, nature and number of goals identified,
prioritization process and formal documentation of family plans. Both interview protocols can be obtained from
the corresponding author.
Data analysis
The audiotaped interviews were transcribed verbatim
and de-identified by a second research team member
(AOK) and reviewed by the same two independent
researchers (AOK and SR). The use of these two coders
enabled triangulation and peer checking throughout.
This thereby enhanced confirmability and reduced
investigator bias within the analysis (Mays & Pope
1995). Although data saturation could not be conclusively
established due to time constraints, no new relevant
themes emerged during the eighth parent interview.
Conventional content analysis (Hsieh & Shannon
2005) using hand coding was employed. The transcripts
were reviewed by two research team members (AOK)
(SR) to obtain a sense of the whole and to derive codes.
Collaborative discussions ensued regarding the coding
structure with a very high level of consistency between
each researchers interpretations. The individual codes
(53) were grouped into clusters (9) which then formed
themes (4) regarding parents and service providers
experiences of using the FGST. This occurred through a
process of ongoing discussion and consensus.
2012 Blackwell Publishing Ltd, 25, 360371
Results
Four key themes emerged consistently across both participant groups, providing commonalities between the
service providers and families perspectives. These
themes included: (i) the facilitation of goal setting, (ii)
strengths-based focus, (iii) family centred processes, and
(iv) empowerment of families. Some additional considerations are also described. These themes are detailed in
the following sections with supporting direct quotations
(in italics) from both parents and service providers
experiences.
Strengths-based focus
A particular theme that emerged from three of the eight
parent participants and more strongly by service provid-
Additional considerations
Although most of the feedback related to the use of the
FGST was positive, a few additional considerations
were raised. For example, service providers noted that
goal setting meetings potentially detracted from therapy-time with the child. This was also raised by one
parent who explained that the goal setting meeting fell
in her highest priority therapy session (Speech-Therapy). However, overall this issue appeared to be related
more to the planning required for goal setting by the
service as a whole, as opposed to a result of using the
FGST.
A second potential issue was repetition or overlap of
content across the cards, which was raised both by service providers and some parents (e.g. taking turns and
playing with others, or coming for help and telling
me what they want). However, all the parents noted
that this did not detract from the process of goal setting,
with two parents noting I found that there were a lot of
cards however all kids have different needs so it is to be
expected (Parent 2) and There were a lot of cards but you
probably need the amount that they had so that everything is
covered in terms of where goal-setting can go (Parent 7).
The third consideration was related to the potential of
missing need areas of individual families that are not
included in the cards of the FGST. Only one parent
and one service provider raised this, with the parent
relating:
Purely because you are looking through these cards and
flicking through that anything I felt at the time, or
anything that I might have walked in thinking about
was gone because I was just sorting through and working out the cards and what pile I thought was relevant
to my child. And anything else I had before just, yeah,
disappeared (Parent 2).
However, the suggested script used by service providers prompted them to give families a choice about using
the cards at the outset by saying something like, Would
you like to use the cards, or do you think you already
have a pretty clear idea of what goals you want us to
work on? This provided parents with a choice and for
those who used the FGST, the something else card also
provided options for them to raise other issues.
Discussion
This study explored the experiences of parents and early
intervention service providers using the FGST during
annual family goal setting. The analysis identified four
overarching themes including the facilitation of goal setting, a strengths-based approach, empowerment of families and family centred processes. The tool was
perceived positively in providing a holistic approach to
family goal setting and overcoming previously acknowledged barriers. These pilot results indicate that the
FGST is a valuable tool in goal setting from both parents and service providers perspectives. However, due
to the uniqueness of the tool there is, as yet, no gold
standard for comparison in the literature. Thereby the
perceived benefits of the tool will be discussed, in relation to the underlying themes of FCP in early intervention.
A key finding was that the FGST allowed parents a
greater sense of control and ownership over the goal
setting process. This concept of parent empowerment
is essential in promoting a collaborative partnership in
family centred services (Epley et al. 2010). Research
demonstrates that active involvement of parents (or parents as drivers) in goal setting increases feelings of competency and ownership, and views of equal partnership
with service providers (Oien et al. 2009; Broggi & Sabatelli 2010). Furthermore, Rodger & Keen (2010) found
that high levels of family involvement in decision making was associated with increased family satisfaction
and perceived provider competence. This sense of control also appeared to reduce the anxiety felt by some
parents when goal setting, as the FGST cards provided
prompts in determining family driven goals. Previously
this anxiety was fuelled by uncertainty in setting goals,
and caused some parents to question their chosen goals
appropriateness and suitability. Using the FGST was
perceived to increase parents confidence when choosing
individualized goals and communicating their meaning
to service providers. These findings coincide with
research suggesting that parents experience less stress
and have greater feelings of competency when services
Note
Corrections were made to pages 2, 3, 5, 6, 7 and 10
on 21 March 2012 year after first publication online on
6 January 2012. The errors have been corrected in this
version of the article.
Correspondence
Any correspondence should be directed to Sylvia Rodger, Division of Occupational Therapy, School of Health
and Rehabilitation Sciences, The University of Queensland, Brisbane 4072, Qld, Australia (e-mail: s.rodger@
uq.edu.au).
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