When taken together, the elements of family-centered service delivery result in policies and practices in which the pivotal role of the family is recognized and respected. Families are supported in their care-giving roles by building on their unique strengths as individuals and families. Opportunities are created for families to make informed choices for their children, and, more importantly, these choices are respected by the IFSP team. To ensure this is appropriately occurring, families are asked about their satisfaction via family surveys. Click each of the eight elements of family-centered care to learn about the element and practice considerations.
Element 1: Recognize the Family is the Constant in the Child's Life
This element recognizes that the family is the constant in the child's life while services and personnel may change. The ultimate responsibility for managing a child's health, developmental, social and emotional needs lies with the family. Therefore, providers must work to support the family in their efforts to be primary decision makers, caregivers, teachers, and advocates for their child. Practice Considerations
- Acknowledge the key family members.
- Ask families what they value.
- Ask families about a typical day to dentify family routines.
- Recognize the expertise of families as full-fledged members of the IFSP team
- Listen to and respect the family's ideas and opinions.
- Partner with the family to develop the IFSP in accordance with the family's strengths, needs, concerns, priorities and resources.
- Support families over time as they strive to cope with and address their child's special needs
Element 2: Facilitate Family and Professional Collaboration at all Levels
Providers must involve parents and other primary caregivers as partners at all levels of service delivery. Practice Considerations
- Listen to families and follow their lead.
- Be accessible to families.
- Build confidence and competence in families, and tell them often what they do well, especially those strengths related to caring for the child and supporting his/her development.
- Share new strategies to support child development and help families practice these new strategies within their family routines and activities.
- Support families in their role as an advocate for their child.
- Problem solve with families and helpCreate win-win solutions.
- Create family options; be sensitive to family members' capacity to handle an issue or task at a given time.
- Assist families to learn how to be good historians, keepers of information, and care coordinators.
- Inform parents about opportunities to affect policy at the community, state, and national level.
Services for the child are greatly enhanced when both the provider and the family value and appreciate the unique types of expertise that each has to offer. Family-centered care requires an attitude shift in the way in which we think and feel about one another as parents and professionals. It requires a climate of mutual trust and respect that will result in the provider and the family uniting in the best interest of the child.
Element 3: Share Complete and Unbiased Information Family members are best prepared to make decisions about their child when they have full knowledge and understanding about the condition of that child. Professionals have always been faced with the dilemma of how best to deliver diagnostic and developmental information to the family. It is important to remember that it is the family's hope for the child that enables them to face the day-to-day challenges of parenting a child with special needs. Family members who have met this challenge repeatedly state that how information is given to the family is as crucial as what information is given. Ideally, families want the provider to share relevant information in a caring and compassionate manner and to assist them in making choices with respect to the well-being of their child. Practice Considerations
- Explain to the family the purpose for requesting information or performing procedures/evaluations.
- Encourage families to write down information, questions, and suggestions before meetings.
- Avoid making assumptions or speaking in jargon.
- Offer opinions, but be sure the family understands all options.
- Clearly provide critical information, expectations, and next steps.
- Invite questions and expressions of concern, repeating as needed.
- Provide resources via written information, videotapes, audiotapes, or illustrations when possible and appropriate.
- Be available for follow-up discussions.
- Schedule adequate time to talk with the family.
Family members may "shut down" when difficult information is being delivered about their child and consequently hear only part of what is being said. It is important for the professional to realize that this is a natural coping strategy and does not necessarily mean that the family is in denial about their child's condition. Rather, it means that they need more time to understand and assimilate what is being said. Providers should not censor information out of doubt or fear that the family is unable to handle bad news. It is crucial for family members to be made aware of all information and options, verbally and in writing, so that they can begin the process of adjusting their lives to meet the needs of the child and ultimately make informed decisions about the supports and services they need.
Element 4: Honor the Diversity of Families
This element recognizes that each family is unique. In a family-centered approach, families are valued for their unique qualities and differences. Providers are encouraged to creatively meet the needs of the child and family as they demonstrate sensitivity to the racial, ethnic, cultural, linguistic, and socioeconomic diversity of the family. Accordingly, family members are not judged for their different parenting styles, nor are they expected to conform to an "ideal" approach to child rearing. Rather, providers strive to promote family independence. Practice Considerations
- Learn about other cultures; ask questions.
- Be aware of your own values and beliefs and how they help shape your actions and decisions.
- Respect family values and beliefs, including interest in alternative remedies.
- Be nonjudgmental.
- Provide educational materials in multiple languages as needed, and offer translation and interpreter services.
- Recognize the nonverbal behaviors you are communicating to the family and vice versa.
The philosophical framework of family-centered care emphasizes the value of respecting diversity in families. The underlying assumption of service delivery should be that every family member is doing the best he or she can at that point in time. The provider has the challenge of assisting the family to meet the unique needs of the child. This challenge must be met with an emphasis on the strengths and resources within the family. Accordingly, great care must be taken to protect the dignity and cultural identity of the family. Providers must develop a keen sense of the cultural values and beliefs within the community if they are to adequately serve families within the framework of family-centered care.
Element 5: Recognize Family Strengths
This element also recognizes the importance of respecting the unique aspects of the individual family. Therefore, providers must develop creative ways of addressing the circumstances surrounding the child if the service demands of that child are to be appropriately met in partnership with the family. The philosophy of family-centered care acknowledges that each family is diverse in its structure, roles, values, beliefs, and coping styles. Respect for this diversity in families places great emphasis on the strengths and resources within the family unit. In contrast to the traditional approach where providers were taught to determine the weakness of the family and to resolve issues for the family, a family-centered approach requires that providers reach a solution with the family. Professionals are encouraged to move away from the belief that it is their responsibility to fix the family's problems. Rather, the provider should accept the opinions and beliefs of the family and assist the family in building upon the existing strengths in an effort to achieve their goals for the child. Practice Considerations
- Look for and identify strengths: communication, participation, interest, knowledge, parenting style, support systems, culture, and spiritual values.
- Ask families o What are your strengths? Concerns? o What are your child's likes? Dislikes? o What is the best way to approach your child? o What do you want? Need? o What has worked in the past? What might work now? o What are your opinions and needs in the current situation?
- Develop the IFSP to build on family strengths.
Providers are encouraged to listen to the family and ask how the family is coping with the needs of their child. Each family will cope with the challenge of a child with special needs in a different way. It is important that the provider be accepting and nonjudgmental about where the family is in the process of meeting these challenges. Family members should never be judged for where they are in the process. Further, families should not be told that they have unrealistic expectations for their child since it is often those expectations that provide the family with the necessary strength and hope to meet the day-to-day challenges of caring for a child with special needs.
Element 6: Encouragement of Parent-to-Parent Support and Networking
This element recognizes parent-to-parent support as one of the cornerstones of family-centered care. In a system that is family-centered, professionals look beyond the needs of the child and assist the family to identify and link to ongoing support systems in the community. The premise of parent-to-parent support is that family members are better able to meet the complex needs of the child if they are afforded the opportunity to network with others who are facing similar challenges. Many family members who have taken advantage of and actively participated in community support networks benefit greatly. Practice Considerations
- Be sensitive to family needs and the need for support.
- Describe the value of parent-to-parent support.
- Provide information about resources.
- Be informed about area support groups and/or encourage families to create support groups, if possible.
- Recognize the support needs of other family members (grandparents, siblings).
- Refer family members to support networks.
- Respect the family's decision whether to participate in community groups
Providers can play a vital role by explaining the importance of parent-to-parent support to the family, offering options of available resources, and facilitating their involvement in local support networks.
Element 7: Implement Comprehensive Policies and Programs
This element recognizes the importance of implementing policies and programs that are comprehensive and that provide emotional and other necessary supports to the family. Providers play an important role in that they can not only refer the family for comprehensive services, but they can also serve as a voice for families in the development of additional resources which will meet the ongoing needs of the family. Practice Considerations
- Ask families what they need (a checklist can help).
- Inform families of available programs and resources; keep brochures and applications on hand.
- Support the development of a parent advisory board at the local level.
A family-centered approach recognizes that the needs of the child cannot adequately be met unless the overall daily needs of the family are addressed. Accordingly, providers now play a vital role in the development of comprehensive services for the family which support them in meeting the specific needs of the child.
Element 8: Design Accessible Systems that are Flexible, Culturally Competent, and Responsive to Family Needs
This element recognizes that it is crucial for the system to remain flexible, accessible, and responsive to the needs of the family. Traditionally, family members have had to adapt their lives to meet the scheduling requirements and regulations of the system. The pressure of having to comply with the inner workings of such a complex system often creates undue stress on the family. In a family-centered approach, family members are provided with options and choices about when, where, and how to access services. A system that is flexible in meeting the needs of the child and responsive to the challenges of the family as a whole will ultimately result in less stress on the family, more family involvement in the early intervention process, and better results for the child. The team-based primary service provider (PSP) approach aims to provide the coordinated and comprehensive care that a family needs to support the child's overall development by taking advantage of naturally occurring teachable moments within everyday activities, routines, and places. This lessens the burden on the family to create "extra" learning opportunities within their busy schedules.
Practice Considerations
- Be available (flexible hours, evening hours, and weekend hours).
- Consider transportation needs and options for families seeking services.
- Use service coordination services to help families gain access to needed community-based services such as Medicaid, Supplemental Security Income, and Children's Medical Services, in order to eliminate financial barriers.
A family-centered approach provides family members with control over their own lives. Parents who have children with special needs often feel that they have little or no choice about when appointments are made, which providers they see, or what services they receives. In a system that is family-centered, the family is the driving force of service delivery. All disciplines come together with the family to develop a comprehensive plan that addresses the concerns, resources, and priorities of the family.
