Ethical Practice Dilemmas

in Early Childhood: Views

from the Trenches
Harriet Able, Ph.D.
School of Education
University of North Carolina at
Chapel Hill
National Inclusion Institute,

Assistance from:
Chih Ing Lim and Tracey West
And the many practitioners who shared their dilemmas and wisdom with us

Focus Group Method

8 focus groups conducted (3 rural; 5 urban areas)

Focus Groups ranged from 6 21 participants

Audiotaped and transcribed verbatim

Member Check Procedure

Focus Group Demographics

Gender
Female
Male

Age
20-30
31-40
40+

87
3

26
56
18

Ethnicity
African American
19
Caucasian
Other

66
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Child Rearing Values and

Practices

The Greenfeather family has chosen

to have their 18 month old child with
severe cerebral palsy undergo a
sweat lodge ceremony. They believe
this is the best option for their child
rather than enrolling him in the local
early intervention program in order
to receive physical therapy.

Values, Morality, and Ethics

Values are central to decision making they provide a context

within which people make decisions and choices.

Morality Persons beliefs about what is right or wrong; good

or bad

Ethics The study of right and wrong or duty and obligation

Intervention Implies
Change

Early intervention , by definition, is

intrusive. It provides something a
family may or may NOT want. It is
something a family does not
expect to have.

Sample Conflicts

Convenient Services Versus What

is Best for the Child
Alternative Therapies and
Treatments
Child Versus Family Centered
Professional Whistle Blowing

Service Accessibility

Unequal Access to Resources for Families

There are children who are undocumented residents. They are
from low income families but they cant get Medicaid because
they have no social security numbers. So, its hard to get them
through the system.

Disjointed Services
We can have a team of professionals working with a child, and
theres no funding to pay everyone for talking to each other.
And a child could potentially wind up getting four different
services from four different providers OR not getting services at
all because there are too many gatekeepers.

Service Accessibility

We were serving a child with spina

bifida whose only needs were
physical because he had a single
mother whose transportation was
limited he was bussed to the
special education preschool where
he was placed with children with
developmental delays.

Alternative Therapies and

Treatments

A mother asked me if I would

participate in her childs patterning
therapy.
We had a child who came to
preschool weak and nauseated
everyday because he was not getting
any lactose or wheat in his diet. He
had no energy to do anything!

Alternative Interventions
Parental and Professional Conflicts

Mom was going to autism support groups and there were

many different ideas out there, and she decided to take him
off foods with wheat and lactose. And for young children, this
isnt a good thing as its hard to find replacements. He would
come to school and be very pale and would be throwing up. It
was hard for me. I didnt know the right thing to do.

Parent Versus Child

Centered: Ricardo Case
Ricardo is a five year old who has been enrolled in early
Study
intervention services since he was 14 months old. Ricardo has
cerebral palsy and needs physical and speech and language
therapy. The local early intervention and preschool teams have
extensive records regarding Ricardos developmental progress
and needs. The parents and early intervention team have had
many disagreements about what is best for Ricardo. The
parents, who are Mexican immigrants, are now moving out of
state to a rural area. They view their move as giving their
family and Ricardo a second chance so he wont be labeled in
kindergarten. Consequently, his parents have requested that
his school records not be sent to the receiving school district.
They prefer that the school district not know anything about
Ricardos early intervention services.

Ricardo Case Study

Childs Needs Versus Parents Rights

It is a moral question to me, as a teacher, to know that I have this
information that will help this child but I have to protect the childs and
familys confidentiality too.
In this case you have to choose to be the child or the parent advocate

Ricardo Case Study

Confidentiality
Confidentiality is a big issue because the parents dont want you
sharing information with the next team about Ricardo because they
dont want the kindergarten team to have preconceived notions about
him. I would want to help the next team and give them information
BUT the parents have asked that the information not be shared!

Kindergarten Teacher's and

Other Children's Rights

Ricardo is going to compromise the ability of the kindergarten

teacher to address the needs of the other children in her
kindergarten class. As a parent, I think I have a right not to
have my child's kindergarten experience compromised by
Ricardo's needs particularly if he has to go through the referral
process to special education again.

Conflict Resolution

Parental Informed Decision Making

One way to approach the parents is to try to help them
understand that if their child goes to a new school without any
assistance the child is really going to be at a disadvantage
the first day. He is not going to have the help he needs so he
is going to fall further behind and then there will be a delay
before he will have the supports to do his best work again.

Provide parents with information and options

I would tell the parents what to look for during the first
months of school and how to get services in the school if they
change their minds.

Parental and Professional

Conflicts

Child Rearing Practices

I visited a home where the mother has her child in a play pen all day
long, without any stimulation. She jokingly says hes in prison.I felt
so sorry for the child that I wanted to pick him up and run away.

Parental Misuse of Services

Where do we draw the line when a family behaves inappropriately?
They say theyll be home, and you keep coming and they are not
home.

Cultural Differences

Language Barrier
My biggest challenge is providing a good service when I do
not speak the language or have an understanding of the
familys background. Im not sure if the use of a translator is
ethical because you are not sure what message is being
sent to the family. So, for me, its an ongoing challenge
whether Im providing a good service or is it better than
nothing.

Cultural Differences

Expectations and Priorities

We had a little guy from an Eastern European country and the
cultural expectation was that the family would continue to do a lot of
what we think of as independence skills like self feeding. I think their
expectation really was that they would continue to feed him until he
was three. I think that was more their cultural norm and value.

Cultural Differences

Child Rearing Practices

One of the parents was upset when one of the therapists criticized
her for spanking her child. And she seemed to want me to tell her it
was okay. And I really didnt know how to address that. I could tell it
really bothered her because the therapist made her feel bad.

Professional Conflicts

Different Standards of Care

Private therapists recommend to the parent that the only
model of therapy that really works is pull the child out and
drill, drill, drill but we do integrative therapy so Im playing
in the classroom and thats a hard thing to explain without
putting down another professional.

Professional Conflicts

Different Professional Opinions about Childs Needs or

Services
I have challenges getting doctors to agree that an evaluation needs to
be done on a child. They see the child for 20 minutes, and I see the
child two to three times a week, and even if the parents want it, its a
challenge getting that need met.

Professional Conflicts

My colleagues gives parents all

these home activities to do the
parents talk to me about how
overwhelmed they are with their
pages of worksheets to do with
their child.

Professional Conflicts

This therapist does not give

parents enough information she
makes decisions for them and tells
them what should be done for their
child regarding medical treatments
AND therapies.

What practice dilemmas have

you encountered in your work
with families and children?

Conflict Resolution
Strategies

Administrative and Peer Support

We have been good at setting aside time in our staff meetings for
staff to discuss common issues like no shows. These opportunities help
us decide what action were going to take. Together with HIPA and
center guidelines as well as professional ethics, these help us decide
which side of the fence to sit on.

Conflict Resolution
Strategies

Open Communication
You have to have an atmosphere of trust where people can
feel comfortable to say things and know there are no
repercussions. Its amazingly difficult because people have
individual styles. Some are confrontational, others keep it all
in. So you need to know how to get everyone to share openly.

Conflict Resolution
Strategies

Respect for Parents

I think, in our work, we always have to respect, ultimately, the
opinions of the parent. Realizing that the parent knows their child best,
and has their best interest in mind and that any decision they make, in
regard to what is shared about their child is the right decision.

Family Informed Decision

Making
1. Full Information
2. All the options for services and
supports
3. Our role is to inform/ educate
familys role is the decision maker

Conflict Resolution
Strategies

Confronting Ones Biases

You need to take time to reflect on your own values, your own
wishes, your own desires, your own biases. So when you get into a
situation, you can stop and think: Am I somebody whos going to
tell this mother about what is right or wrong for her child? Is that
appropriate?

What conflict resolution strategies

or guidelines do you use?

What principles and guidelines

should guide our decision
making?

Parental Autonomy

Informed Consent

Equality

Ethical Decision Making

Professional Values and Standards

Personal Values and Standards

Careful Consideration and Reflection of

All Viewpoints

Third Space

Division for Early

Childhood Code of Ethics

The principles and guidelines for practice

include:

I. Professional Practice;
II. Professional Development and Preparation;
III. Responsive Family Practices; and
IV. Ethical and Evidence Based Practices.
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Code of Ethics is Available

at:

http://dec-sped.org/uploads/docs/a
bout_dec/position_concept_papers/C
ode%20of%20Ethics_updated_Aug2009
pdf
Permission to copy not required
distribution encouraged.
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