Content uploaded by Marilyn Espe-Sherwindt
Author content
All content in this area was uploaded by Marilyn Espe-Sherwindt on Oct 09, 2018
Content may be subject to copyright.
FAMILY-CENTRED PRACTICE
Family-centred practice:
collaboration, competency
and evidence
MARILYN ESPE-SHERWINDT
In the 1990s, the developing field of early intervention
with young children with disabilities and their families
adopted family-centred practice as its philosophical
foundation. Family-centred practice includes three key
elements: (1) an emphasis on strengths, not deficits;
(2) promoting family choice and control over desired
resources; and (3) the development of a collaborative
relationship between parents and professionals. During
the last two decades, the field of early childhood dis-
ability has successfully defined the working principles
of family-centred practice for practitioners. Although
research has acknowledged that the paradigm shift to
family-centred practice is neither simple nor easy, a
substantive body of evidence demonstrates that (a)
family-centred practice can be linked to a wide range of
demonstrated benefits for both children and families,
and (b) families are more satisfied and find family-
centred practice to be more helpful than other models
of practice.
Keywords: intervention, collaboration, family-centred
practice.
Family-centred practice is a term not unfamiliar to profes-
sionals who educate and support children and adults with
special educational needs. In essence, family-centred prac-
tice is a systematic way of creating a partnership with
families that (a) treats them with dignity and respect, (b)
honors their values and choices, and (c) provides supports
that strengthen and enhance their functioning as a family
(Dunst, Trivette and Hamby, 2007a). At this point in time,
we know a great deal about family-centred practice: its
history, its principles and its impacts, all of which will be
discussed in this article. By its very definition, however, any
overview of family-centred practice is incomplete without
the voice of families guiding our way:
When my son was born in 2004, I was thrilled beyond belief
as I finally had my little boy. Someone I could teach to play,
if he wanted to, the sports I so loved as a child: baseball,
football, basketball and hockey. I had my little buddy.
All along he wasn’t a happy little boy. It started right away:
when we’d take him for a ride in his car seat, he would just
scream. It got so that we started feeling a lot of anxiety when
we thought about having to go someplace as a family. This
was the start of our family life taking a turn we hadn’t
expected it would. Then he actually turned over onto his
tummy, and he seemed to sleep better. Finally we were
turning the corner. Yes, we were – just not the way we had
hoped.
Our son wasn’t pointing, nor did he have any vocabulary.
When his typical peers were babbling, we got none of that
from him. Nothing like his big sister, but boys are different
than girls, we were told. We called his name, and he acted as
if he didn’t hear us. We had hearing tests and initially he
failed. However, when we did a more comprehensive one he
passed.
Finally, our pediatrician told us that he thought he might
have autism. We scheduled an appointment for a develop-
mental pediatrician in the summer of 2006. It was the day
the world became a very sad place for me and my family. It
was the day our son was formally diagnosed with autism.
Things that were important to me before, no longer seemed
to be very important. Gardening, which I really loved, no
longer meant anything to me. Our beds, flowers, roses
became overgrown, and honestly I didn’t care.
We struggled to find meaning to this: why us, why our son?
There were no answers. The treatment options were even
less optimistic. We could do a program at a well known
nearby hospital for $70,000 per year and go bankrupt in the
process. We could also do some early intervention through
our county, although there were waiting lists, which seemed
to be the case everywhere we went. When our son turned
two, we finally got into our local early intervention
program. They did the best they could under the circum-
stances; they were understaffed, under-funded and not
really fully prepared to deal with kids on the spectrum.
© 2008 The Author(s). Journal compilation © 2008 NASEN. Published by Blackwell Publishing, 9600 Garsington Road, Oxford OX4 2DQ, UK and
350 Main St, Malden, MA, 02148, USA.
Yet we struggled in trying to find the best treatment for our
son. It just so happened that our service coordinator knew of
this facility that worked with a lot of kids on the spectrum.
They had an early intervention program but of course it
had...youguessed it...awaiting list. Finally we got in
and met with them on what was the snowiest day of the
season; we had over 12 inches of snow that day. And when
we left our house, I thought, “Tell me again why we are
going all the way to this place?” It’s over 22 miles one way,
and took us over an hour to get to.
When we got there, I realized why. It truly was a center not
only for the child but also a center that worked to develop a
partnership and strategy to help heal the whole family. We
felt like we had just been rescued by the Coast Guard, after
being left out adrift for almost a year, by someone who
understood and who could provide us the much needed
assistance to make our lives and my son’s life infinitely
better.
Recognising family-centred practice
References to family-centred practice can be found as early
as the 1950s; in the mid-1970s, Bronfenbrenner (1975)
described the impact of family involvement on the develop-
mental and educational outcomes of children. However, the
concept did not become part of widespread conversations
about practice with children with disabilities and their fami-
lies until the late 1980s, when the Association for the Care
of Children’s Health (ACCH) published the core elements
of family-centred practice in the care of children with
special health care needs (Shelton, Jeppson and Johnson,
1987). These core elements included the following:
●recognising that the family is the constant in the child’s
life;
●facilitating parent–professional collaboration at all
levels, from individual care to programme development/
implementation/evaluation to policy formation;
●honouring the racial, ethnic, cultural and socio-
economic diversity of families;
●recognising family strengths, individuality and differ-
ent methods of coping;
●continually sharing complete and unbiased information
with parents in supportive ways;
●encouraging family-to-family support and networking;
●creating systems that incorporate the developmental
needs of children and their families;
●implementing comprehensive policies and programmes
that provide emotional and financial support to meet the
needs of families;
●designing accessible service systems that are flexible,
culturally competent, and responsive to family-
identified needs.
In essence, family-centred care was defined as:
a philosophy of care in which the pivotal role of the
family is recognized and respected...[inwhich] fami-
lies should be supported in their natural caregiving and
decision-making roles...[inwhich] parents and profes-
sionals are seen as equals.
(Brewer, McPherson, Magrab and Hutchin, 1989,
p. 1056).
In the 1990s, the developing field of early intervention with
young children with disabilities and their families adopted
family-centred practice as its philosophical foundation.
Family-centred practice was (and continues to be) defined
as:
a combination of beliefs and practices that define particu-
lar ways of working with families that are consumer
driven and competency enhancing.
(Dunst, Johanson, Trivette and Hamby, 1991, p. 115).
Family-centred practice recognises that, if working with
families is to have positive effects, then how intervention is
provided is as important as what is provided (Henneman and
Cardin, 2002; Trivette and Dunst, 2000). Family-centred
practice includes three key elements: (1) an emphasis on
strengths, not deficits; (2) promoting family choice and
control over desired resources; and (3) the development of a
collaborative relationship between parents and professionals
(Dunst, Trivette and Deal, 1994).
What does this model look like in day-to-day practice? How
can family-centred practice be distinguished from other
models? Professional practices have been described as
falling along a continuum, from a professionally-centred
model at one end to a family-centred model at the other; the
models on the continuum are distinguished by the roles, use
of expertise, and decision-making power of families (Dunst,
Johanson, Trivette and Hamby, 1991):
●Professionally-centred model: Professionals are the
experts who determine what the child and family needs
and how to meet those needs. Families are expected to
rely and depend upon the professional, who is the
primary decision-maker.
●Family-allied model: Professionals view families as
being able to implement intervention, but the needs of
the child and family and intervention continue to be
identified by the professionals.
●Family-focused model: Professionals view families as
consumers who, with assistance, can choose among the
various options identified and presented to the family
by the professionals.
●Family-centred model: Professionals view families as
equal partners. Intervention is individualised, flexible
and responsive to the family-identified needs of each
child and family. Intervention focuses on strengthening
and supporting family functioning. Families are the
ultimate decision-makers.
Multiple studies have demonstrated that these categories
of models can successfully be used by raters to distinguish
the variations in help-giving practices among individual
© 2008 The Author(s). Journal compilation © 2008 NASEN Support for Learning · Volume 23 · Number 3 · 2008 137
professionals (Dunst, 2002; O’Neil, Palisano and Westcott,
2001), programme models and practices (Dunst, Boyd, Triv-
ette and Hamby, 2002; Trivette, Dunst and Hamby, 1996),
and government agency policies and procedures (Dunst,
Johanson, Trivette and Hamby, 1991). Families who are
receiving services can recognise the differences among the
models as well; the differences identified appear to be the
result of the differing practices associated with the pro-
gramme models, and not the result of characteristics of the
families receiving services (Dunst, Boyd, Trivette and
Hamby, 2002; Trivette, Dunst, Boyd and Hamby, 1995;
Trivette, Dunst and Hamby, 1996) or the severity of their
child’s disability (O’Neil, Palisano and Westcott, 2001;
Trivette, Dunst, Boyd and Hamby, 1995). Families are more
satisfied and find family-centred practice to be more helpful
than other models of practice (Judge, 1997; King, King,
Rosenbaum and Goffin, 1999; Law et al., 2003; Neff et al.,
2003; Trivette, Dunst and Hamby, 1996; Wade, Mildon and
Matthews, 2007).
The program models either implicitly or explicitly
adopted by helpgiving organizations and agencies mat-
tered a great deal in terms of how professionals were
judged by people they were attempting to help.
(Dunst, Boyd, Trivette and Hamby, 2002, p. 227).
During the last two decades, the field of early childhood
disability has worked hard to define the working principles
of family-centred practice for practitioners. In the recom-
mended practices publication of the Division for Early
Childhood (DEC) of the Council for Exceptional Children
(CEC) (Sandall, McLean and Smith, 2000), family-based
practices are defined in the following way:
Family-based practices provide or mediate the provision
of resources and supports necessary for families to have
the time, energy, knowledge and skills to provide their
children with learning opportunities and experiences that
promote child development. Resources and supports
provided...are done in a family-centered manner so
family-based practices will have child, parent and family
strengthening and competency-enhancing consequences.
(Trivette and Dunst, 2000, p. 39)
Seventeen evidence-based, family-centred practices are
identified and grouped into four categories (Trivette and
Dunst, 2000):
1. Families and professionals share responsibility and
work collaboratively: This group of practices focuses
on the development of relationships, shared power and
control, and professionals’ complete sharing of infor-
mation so that families can make informed decisions.
2. Practices strengthen family functioning: This group of
practices emphasises providing supports and resources
in ways that build parents’ sense of confidence and
competence, using not only formal but informal sup-
ports and resources, and enhancing families’ abilities to
have what Carpenter (2007) describes as ‘a normal life’.
3. Practices are individualised and flexible: This group of
practices underscores the importance of shaping inter-
vention to fit the needs, priorities and values of each
child and family; of not making assumptions about the
family’s beliefs and values; and of providing supports
and resources in ways that do not add stress.
4. Practices are strengths-based and assets-based: This
group of practices stresses not only identifying the
strengths of each child and family, but using those
strengths as the building blocks for intervention.
Does family-centred practice make
a difference?
In addition to there being a strong rationale for family-
centred practice, a growing body of research has tied the use
of family-centred practice to positive child and family out-
comes (Dunst and Trivette, 2005; King, King, Rosenbaum
and Goffin, 1999; Trivette, Dunst, Boyd and Hamby, 1995;
Trivette, Dunst and Hamby, 1996; Wilson, 2005). Results of
a meta-analysis of 18 studies indicate that the use of
family-centred practice was strongly related to self-efficacy
beliefs, programme satisfaction, parent perceptions of child
behaviour and functioning, and parenting behaviour (Dunst,
Trivette and Hamby, 2006). A subsequent meta-analysis of
47 different studies from seven different countries links
family-centred practice to greater family satisfaction, stron-
ger family beliefs of self-efficacy and sense of control, and
greater family perceptions of helpfulness of programme
supports and services (Dunst, Trivette and Hamby, 2007a).
Family-centred practice also is related to parent perceptions
of their child’s behaviour (more positive, less negative),
perceptions of their family’s well-being, and feelings of
parenting competence and confidence (both of which in turn
significantly impact on child development). The efficacy of
family-centred practice has been shown across types of pro-
grammes (hospitals, mental health settings, early childhood
settings, rehabilitation settings, schools) (Dunst, Trivette
and Hamby, 2007a; Reich, Bickman and Heflinger, 2004) as
well as across a diversity of families, including those with
parents with intellectual disabilities (Wade, Mildon and
Matthews, 2007), parents with children at a variety of ages
(Dempsey and Dunst, 2004), parents from differing eco-
nomic backgrounds (Law et al., 2003; Trivette, Dunst, Boyd
and Hamby, 1995; Trivette, Dunst and Hamby, 1996), and
parents across cultures (Dempsey and Dunst, 2004). When
practices are family-centred, outcomes tend to be broader
based with regard to child, parent and family benefits
(Dunst, 2002; Trivette, Dunst, Boyd and Hamby, 1995).
Which aspects of family-centred practice are
likely to make a difference?
Research has identified two related but distinctly different
components of family-centred practice: (1) relational
and (2) participatory help-giving practices (Dunst, Boyd,
138 Support for Learning · Volume 23 · Number 3 · 2008 © 2008 The Author(s). Journal compilation © 2008 NASEN
Trivette and Hamby, 2002). Relational practices are made
up of those interpersonal behaviours such as warmth, active
listening, empathy, authenticity and viewing parents in a
positive light. These are the behaviours used by profession-
als to build effective relationships with families (Dempsey
and Dunst, 2004; Dunst, Boyd, Trivette and Hamby, 2002).
Such behaviours have been widely studied, particularly in
the mental health literature (Trute and Hiebert-Murphy,
2007), and the strength of the ‘working alliance’ between
parents and professionals has been shown to be related to
positive outcomes in a recent meta-analysis (Martin, Garske
and Davis, 2000). Participatory behaviours, on the other
hand, are more action-oriented, and encompass control and
ways of sharing: professionals share all information from
families, professionals encourage parents to make their own
decisions, professionals encourage families to use their
existing knowledge and capabilities, and professionals help
families learn new skills (Dempsey and Dunst, 2004; Dunst,
Boyd, Trivette and Hamby, 2002).
Why is the distinction between relational and participatory
behaviours so important? First, it appears to be the use of
participatory behaviours that are particularly distinctive of
family-centred practice when compared to other models
along the continuum (Dunst, 2002). For example, when
parents receiving services from professionally centred,
family-allied or family-centred programmes rated the prac-
tices used by professionals, not surprisingly professionals in
professionally centred programmes were rated as poor
in using relational or participatory practices, professionals
in family-allied programmes received higher ratings for
relational than participatory behaviours, and professionals
in family-centred programmes were highly rated for their
use of both relational and participatory behaviours (Dunst,
Boyd, Trivette and Hamby, 2002). Even when examining
the variations among family-centred programmes them-
selves, it is the use of participatory practices, not relational
practices, that distinguishes between ‘low’ and ‘high’
family-centred programmes (Dunst, Boyd, Trivette and
Hamby, 2002). Second, relational and participatory prac-
tices impact differently upon outcomes (Dunst, Boyd,
Trivette and Hamby, 2002; Trute and Hiebert-Murphy,
2007).
There are value-added benefits of participatory practices
beyond those attributable to relational practices, at least
in terms of certain parent and family outcomes.
(Dunst, Boyd, Trivette and Hamby, 2002, p. 227)
In other words, being warm and caring and using excellent
communication skills does not automatically mean that a
professional or programme is family-centred; it is not
enough to be ‘nice’. Professionals and programmes seeking
to be family-centred must not only establish a trusting rela-
tionship with families; they must also consciously use
specific practices that equalise the balance of power such
that families become the ultimate decision-makers and
agents of change.
Has family-centred practice been
widely adopted?
More than 20 years ago, Healy, Keesee and Smith (1989)
predicted the challenges to widespread adoption of family-
centred practice in early intervention. They suggested that
the difficulty would not be in teaching professionals
discipline-specific skills to work with children, but rather in
teaching professionals the skills required to work with fami-
lies in a family-centred way (or, in the words of a quoted
administrator, in ‘a very inconvenient’ way). Since that time,
studies have consistently shown that professionals are less
family-centred than they think, whether they are working
with infants and toddlers with disabilities or with school-age
children (Dunst, 2002).
Professionals struggle to include families at the most basic
levels, let alone to implement not only relational but also
participatory family-centred practices (Campbell and
Halbert, 2002; Dunst, 2002; Mahoney and Filer, 1996;
McBride and Peterson, 1997; McWilliam, Tocci and Harbin,
1998). One recent study surveying 241 early intervention
professionals from a variety of disciplines suggested that
many practitioners still are unlikely to adopt and implement
family-centred practice, despite the evidence supporting its
efficacy (Campbell and Halbert, 2002). Simply put: ‘family-
centred early intervention remains an elusive goal for our
field’ (Bruder, 2000, p. 105).
Multiple reasons have been proposed to explain the lag in
implementation (Bruder, 2000; O’Neil, Palisano and West-
cott, 2001). A frequently cited reason has to do with the gap
between research and practice. On the one hand, research-
ers often describe variables and results rather than concrete
practices that practitioners can put into use; on the other
hand, professionals may not have the time for or interest in
reading research (Bruder, 2000; McWilliam, 1999). McWil-
liam (1999) further speculates that professionals who do
have the time and inclination to keep up with published
research often tend to believe only the research that supports
their values. A second reason appears to be a lack of effective
and available training in family-centred practice at both
preservice and inservice levels; training tends to focus on
discipline-specific skills and credentials and may include
little direct contact with families (Bailey, Aytch, Odom,
Symons and Wolery, 1999; Bruce et al., 2002; Bruder, 2000;
Gallagher, Malone, Cleghorne and Helms, 1997). Third,
federal and state rules and regulations have tended to focus
time and attention more on billable services for the child
than family-centred practice (Bruder, 2000; Shannon,
2004); professionals describe being caught up in paperwork
and productivity (O’Neil, Palisano and Westcott, 2001).
Fourth, professionals trained in and committed to family-
centred practice have encountered obstacles in day-to-day
implementation due to limited understanding and lack of
support from colleagues and administrators (Murray and
Mandell, 2006). Finally, professional attitudes can make it
difficult to view families as ‘experts’and ‘equal’ members of
© 2008 The Author(s). Journal compilation © 2008 NASEN Support for Learning · Volume 23 · Number 3 · 2008 139
the team. Unfortunately, attitudes not only impact child and
family outcomes, but are at times almost impossible to
change (Affleck et al., 1989; Trivette, Dunst, Boyd and
Hamby, 1995).
Although the concept of family-centred practice continues
to accumulate evidence supporting its impact on child and
family outcomes, the sad reality is that family-centred prac-
tice can be characterised as having a ‘slow rate of adoption’.
Despite the emphasis on and efforts to define and opera-
tionalise family-centred practice, certain aspects continue to
be used infrequently by professionals (Crais, Roy and Free,
2006).
Family-centred practice as ‘flawless
consulting’
Every professional reading these words can identify with the
temptation to adopt the role of the knowledgeable decision-
maker and to encourage the parent to adopt the role of the
passive recipient. Studies repeatedly have demonstrated that
professionals appear to be far better at utilising relational
skills than participatory skills (Dunst, 2002; McBride,
Brotherson, Joanning, Whiddon and Demmitt, 1993; Wade,
Mildon and Matthews, 2007).
Why are participatory skills so challenging? Professionals
adopting a family-centred model are asked to replace the
role of decision-maker, agenda-setter, advice-prescriber and
expert with the more challenging role of partner, listener,
facilitator and consultant (Mikus, Benn and Weatherston,
1994). Even professionals highly motivated to engage in
family-centred practice can find this paradigm shift to be a
challenge. We hear the voices of families describing how
they are ‘adrift’, and we want to be of assistance to them;
nevertheless, being a help-giver comes with its own set of
challenges:
●The tendency to be too ‘impatient’. The more eager we
are to assess and intervene, the less helpful we become.
‘Curing’ others should not be our intent (Maslow,
1962).
●The tendency to focus on being too ‘clever’. We tend to
use words as techniques to move others in the direction
we have chosen, to convince families that our perspec-
tive is right (Block, 1981).
●The tendency to be too ‘helpful’. We tend to believe that
we know and the other does not. As Henning (2001)
points out, ‘It is our instinct to control that actually
interferes with change.’
●The tendency to promote ‘codependence’. When we see
others as needing our expert help, we can make the
mistake of creating needs in order to justify our role in
their lives (Markowitz, 2001a).
●The tendency to be too ‘invested’. Help-givers often
feel responsible for the other’s ‘progress’. However, we
cannot assume that our advice will lead to change. ‘We
are no more responsible for...improvements than
for...setbacks’ (Markowitz, 2001a).
Family-centred practice focuses on the interpersonal rela-
tionship between the family and the professional (O’Neil,
Palisano and Westcott, 2001). A model of ‘flawless consult-
ing’ that focuses on a similar relationship between the
consultant and the client has been proposed by Peter Block
(1981), a well-known consultant and author in the business
field. Block makes a key distinction between being a ‘con-
sultant’ and being a ‘manager’:
Every time you give advice to someone who is faced with
a choice, you are consulting. When you don’t have direct
control over people and yet want them to listen to you
and heed your advice, you are face-to-face with the
consultant’s dilemma...Aconsultant is a person in a
position to have some influence over an individual, a
group, or an organization, but who has no direct power to
make changes or implement programs. A manager is
someone who has direct control over the action. The
moment you take direct control, you are acting as a
manager. This distinction is important.
(Block, 1981, pp. 1–2).
When professionals ask questions such as ‘How can I get
the family to see this?’ or ‘Why won’t the family follow
through?’ they are really asking questions about power and
control. The underlying questions (‘How can I have power
over the family?’ or ‘How can I get the family to do what
I think they should do?’) are questions related to partici-
patory practices and the paradigm shift from manager to
consultant.
From the perspective of ‘flawless’ consulting, a relationship
characterised by control of the other must be replaced with
a relationship characterised by ‘engagement’. The question
is no longer ‘How do I get my own way?’ but instead ‘How
do we commit to working together?’ and ‘How can we have
faith in each other’s capacity to contribute to change?’
(Henning, 2001). In this kind of relationship, although we
care about the other person, we are not responsible for what
the other does with our expertise and information; the other
has a right to fail.Weare responsible, however, for how we
act in the relationship: our behaviour, our way of working, to
what degree we are being authentic (Block, 1981).
The pursuit of flawless consulting, like family-centred prac-
tice, is more than a simple technique. It requires the
systematic use of specific ways of being with others in a
relationship (Block, 2001):
●recognising the others as individuals capable of defin-
ing meaning and making choices;
●focusing on commitment and shared purpose rather
than compliance;
●resisting taking over, giving prescriptive advice, threats
and promising more than we can deliver;
140 Support for Learning · Volume 23 · Number 3 · 2008 © 2008 The Author(s). Journal compilation © 2008 NASEN
●choosing to tell the truth, confess doubts, and forgive;
●not giving up when faced with hostility, indifference or
rejection;
●accepting shades of grey;
●paying attention to our own behaviours in the relation-
ship (i.e. the only behaviours that we can control).
Flawless consulting and family-centred practice both com-
prise relational and participatory components. Flawless
consulting and family-centred practice both recognize that
trust and confidence in the capacity of the other are critical,
since trying to change others means that we have lost faith in
them. Flawless consulting and family-centred practice both
recognize (a) that there is a significant difference between
making something happen and letting it happen, and (b) that
we need to abandon control and judgment (Markowitz,
2001b). Flawless consulting and family-centred practice
both require ‘a capacity to care deeply from an objective
place’ (Arrien, 1993, quoted in Barbeau, 2001, p. 181).
When we apply flawless consulting to family-centred prac-
tice, the key questions now become (Barbeau, 2001):
●How can I stand beside the [family] with whom I am
working?
●How can I care about the [family] without forgetting
whose work this really is?
●How can I support the [family] during the painful and
messy times without trying to make everything clean,
neat and free of stress?
Some final thoughts
Family-centered care is neither a destination nor some-
thing that one instantly becomes. It is a continual
pursuit of being responsive to the priorities and choices
of families.
(Bissell, n.d.)
We also know that professionals and programmes engaged
in this pursuit may not be as family-centred as they believe
themselves to be (Dunst, 2002). If one of the principles
of family-centred practice is to involve families at all
levels, including programme development/implementation/
evaluation, then we should be asking families to help us
determine the extent to which we are using family-centred
practice. Crais, Roy and Free (2006) point out that we
should be using not only satisfaction surveys, but also tools
that parents can use to rate specific family-centred practices.
Dunst, Trivette and Hamby (2007b) have published several
scales that can be used by families to rate the extent to which
specific family-centred practices are used by the profession-
als with whom they work.
Family-centred practice is neither simple nor easy (Henne-
man and Cardin, 2002); the shift from ‘expert manager’ to
‘flawless consultant’ is a significant shift indeed. Even pro-
fessionals who are committed to family-centred philosophy
and skilled in its relational and participatory components
have identified barriers to its adoption and implementation.
We should be neither surprised nor discouraged by the fact
that progress is not as rapid as we would like.
Getting a new idea adopted, even when it has obvious
advantages, is difficult. Many innovations require a
lengthy period of many years from the time when they
become available to the time when they are widely
adopted.
(Rogers, 2003, p. 1)
Family-centred practice is a specific and systematic way of
working with families that has a thorough rationale, obvious
advantages and a wide range of demonstrated benefits
(Centre for Community Child Health, 2003). At its heart is
the aim ‘not to identify the perfect set of practices but to
recognize the family’s role in helping decide on those prac-
tices’ (Crais, Roy and Free, 2006). The model of ‘flawless
consulting’ reminds us that we when we join families, we
are joining ‘a drama already in progress’ (Markowitz,
2001b, p. 105). In our desire to help others, we must remem-
ber the fine line between managing and consulting, between
controlling and having confidence in the capacity of the
other.
Carpenter (2007, p. 667) poses the following questions:
How can we help families to rebuild expectations, give
them back hope, and create dreams (that may be realized
differently)? How can we help families (including the
child with a learning disability) reclaim their ordinary
life in the long term as well as in the short term?
Or, in the words of the father who introduced this article,
how can we help heal the family who has been left adrift?
More than 20 years of implementation and research suggest
that the model of family-centred practice contains the
answers.
Acknowledgements
Special thanks to Luke Bottorff for his assistance in the
preparation of this article, and to John Tisevich, whose
story keeps us focused on the importance of family-centred
practice.
References
AFFLECK, G., TENNENT, H., ROWE, J., ROSCHER, B., WALKER, L.
and HIGGINS, P. (1989) Effects of formal support on mother’s adap-
tation to the hospital-to-home transition of high risk infants: the benefits
and costs of helping. Child Development, 60, 488–501.
BAILEY, D. B., AYTCH, L. S., ODOM, S. L., SYMONS, F. and
WOLERY, M. (1999) Early intervention as we know it. Mental Retar-
dation and Developmental Disabilities Research Reviews, 5, 11–20.
BARBEAU, R. (2001) Balancing competence with consciousness. In P.
Block (ed.) The Flawless Consulting Fieldbook and Companion (pp.
179–186). San Francisco, CA: Jossey-Bass/Pfeiffer.
© 2008 The Author(s). Journal compilation © 2008 NASEN Support for Learning · Volume 23 · Number 3 · 2008 141
BISSELL, C. (n.d.) Family-Centered Care. Palmer, MA: Massachusetts
Community Gateway. [Online at http://communitygateway.org/faq/
fcc.htm#key].
BLOCK, P. (1981) Flawless Consulting: a guide to getting your expertise
used. San Diego, CA: University Associates.
BLOCK, P. (ed.) (2001) The Flawless Consulting Fieldbook and Compan-
ion. San Francisco, CA: Jossey-Bass/Pfeiffer.
BREWER, E. J. Jr., MCPHERSON, M., MAGRAB, P. R. and HUTCHIN,
V. L. (1989) Family-centered, community-based, coordinated care for
children with special health care needs. Pediatrics, 83, 1055–1060.
BRONFENBRENNER, U. (1975) Is early intervention effective?. In M.
Guttentag and E. Struening (eds.) Handbook of Evaluation Research
(Vol. 2) (pp. 519–603). Newbury Park, CA: Sage.
BRUCE, B., LETOURNEAU, N., RITCHIE, J., LAROQUE, S., DENNIS,
C. and ELLIOTT, M. (2002) A multisite study of health professionals’
perceptions and practices of family-centred care. Journal of Family
Nursing, 8, 408–429.
BRUDER, M. B. (2000) Family-centered early intervention: clarifying our
values for the new millennium. Topics in Early Childhood Special
Education, 20, 2, 105–115.
CAMPBELL, P. H. and HALBERT, J. (2002) Between research and prac-
tice: provider perspectives on early intervention. Topics in Early
Childhood Special Education, 22, 4, 213–226.
CARPENTER, B. (2007) The impetus for family-centred early childhood
intervention. Child: Health, Care and Development, 33, 6, 664–669.
CENTRE FOR COMMUNITY CHILD HEALTH (2003) Family-Centred
Practice. Melbourne, Australia: Royal Children’s Hospital. [Online at
http://wch.org.au/emplibrary/ecconnections/
Family_Centred_Practice_presentation.pdf].
CRAIS, E. R., ROY, V. P. and FREE, K. (2006) Parents’ and professionals’
perceptions of the implementation of family-centered practices in child
assessments. American Journal of Speech-Language Pathology,15,
365–377.
DEMPSEY, I. and DUNST, C. J. (2004) Helpgiving styles and parent
empowerment in families with a young child with a disability. Journal
of Intellectual and Developmental Disability, 29, 1, 40–51.
DUNST, C. J. (2002) Family-centered practices: birth through high school.
Journal of Special Education, 36, 3, 139–147.
DUNST, C. J., BOYD, K., TRIVETTE, C. M. and HAMBY, D. W. (2002)
Family-oriented program models and professional helpgiving practices.
Family Relations, 51, 3, 221–229.
DUNST, C. J., JOHANSON, C., TRIVETTE, C. M. and HAMBY, D.
(1991) Family-oriented early intervention policies and practices:
family-centered or not? Exceptional Children, 58, 115–126.
DUNST, C. J. and TRIVETTE, C. M. (2005) Characteristics and conse-
quences of family-centred helpgiving practices. CASEmakers,1,6,
1–4. [Online at http://www.fippcase.org/casemakers/casemakers_
vol1_no6.pdf].
DUNST, C. J., TRIVETTE, C. M. and DEAL, A. (1994) Supporting and
Strengthening Families (Vol. 1): Methods, Strategies and Practices.
Cambridge, MA: Brookline Books.
DUNST, C. J., TRIVETTE, C. M. and HAMBY, D. W. (2006) Family
Support Program Quality and Parent, Family and Child Benefits.
Asheville, NC: Winterberry Press.
DUNST, C. J., TRIVETTE, C. M. and HAMBY, D. W. (2007a) Meta-
analysis of family-centered helpgiving practices research. Mental
Retardation and Developmental Disabilities Research Reviews, 13,
370–378.
DUNST, C. J., TRIVETTE, C. M. and HAMBY, D. W. (2007b) Technical
Manual for Measuring and Evaluating Family Support Program
Quality and Benefits. Asheville, NC: Winterberry Press.
GALLAGHER, P., MALONE, D. M., CLEGHORNE, M. and HELMS,
K. A. (1997) Perceived inservice training needs for early intervention
personnel. Exceptional Children, 64, 19–26.
HEALY, A. L., KEESEE, P. D. and SMITH, B. S. (1989) Early Services for
Children with Special Needs: transactions for family support. Balti-
more, MD: Brookes.
HENNEMAN, E. A. and CARDIN, S. (2002) Family-centered critical care:
a practical approach to making it happen. Critical Care Nurse, 22, 6,
12–19.
HENNING, J. (2001) The power of conversations at work. In P. Block (ed.)
The Flawless Consulting Fieldbook and Companion (pp. 43–64). San
Francisco, CA: Jossey-Bass/Pfeiffer.
JUDGE, S. (1997) Parental perceptions of help-giving practices and control
appraisals in early intervention programs. Topics in Early Childhood
Special Education, 17, 457–476.
KING, G., KING, S., ROSENBAUM, P. and GOFFIN, R. (1999) Family-
centered caregiving and well-being of parents of children with
disabilities: linking process with outcome. Journal of Pediatric Psy-
chology, 24, 1, 41–53.
LAW, M., HANNA, S., KING, G., HURLEY, P., KING, S., KERTOY, M.
and ROSENBAUM, P. (2003) Factors affecting family-centred service
delivery for children with disabilities. Child: Care, Health and Devel-
opment, 29, 5, 357–366.
MAHONEY, G. and FILER, J. (1996) How responsive is early intervention
to the priorities and needs of families? Topics in Early Childhood
Special Education, 16, 437–456.
MARKOWITZ, A. (2001a) Be careful who you ask: the perils of wisdom.
In P. Block (ed.) The Flawless Consulting Fieldbook and Companion
(pp. 81–87). San Francisco, CA: Jossey-Bass/Pfeiffer.
MARKOWITZ, A. (2001b) The case of Priscilla and the red pen. In P.
Block (ed.) The Flawless Consulting Fieldbook and Companion (pp.
97–116). San Francisco, CA: Jossey-Bass/Pfeiffer.
MARTIN, D., GARSKE, J. P. and DAVIS, K. (2000) Relation of the
therapeutic alliance with outcome and other variables: a meta-analytic
review. Journal of Consulting and Clinical Psychology, 68, 438–
450.
MASLOW, A. (1962) Toward a Psychology of Being (second edition).
New York, NY: D. Van Nostrand.
McBRIDE, S. L., BROTHERSON, J. M., JOANNING, H., WHIDDON,
D. and DEMMITT, A. (1993) Implementation of family-centered ser-
vices: perceptions of family and professionals. Journal of Early
Intervention, 17, 414–430.
McBRIDE, S. L. and PETERSON, C. (1997) Home-based early interven-
tion with families of children with disabilities: who is doing what?
Topics in Early Childhood Special Education, 17, 209–233.
McWILLIAM, R. A. (1999) Controversial practices: the need for a re-
acculturation of early intervention fields. Topics in Early Childhood
Special Education, 19, 3, 177–188.
McWILLIAM, R. A., TOCCI, L. and HARBIN, G. L. (1998) Family-
centered services: service providers’ discourse and behavior. Topics in
Early Childhood Special Education, 18, 206–221.
MIKUS, K. C., BENN, R. and WEATHERSTON, D. (1994) On Behalf of
Families: a sourcebook of training activities for early intervention.
Detroit, MI: Project FIT, Merrill-Palmer Institute, Wayne State
University.
MURRAY, M. M. and MANDELL, C. J. (2006) On-the-job practices of
early childhood special education providers trained in family-centered
practices. Journal of Early Intervention, 28, 2, 125–138.
NEFF, J. M., EICHNER, J. M., HARDY, D. R., KLEIN, M., PERCELAY,
J. M., SIGREST, T. and STUCKY, E. R. (2003) Family-centered care
and the paediatrician’s role. Pediatrics, 112, 691–696.
O’NEIL, M. E., PALISANO, R. J. and WESTCOTT, S. L. (2001) Rela-
tionship of therapists’ attitudes, children’s motor ability, and parenting
stress to mothers’ perceptions of therapists’ behaviors during early
intervention. Physical Therapy, 81, 8, 1412–1424.
REICH, S., BICKMAN, L. and HEFLINGER, A. C. (2004) Covariates of
self-efficacy: caregiver characteristics related to mental health services
self-efficacy. Journal of Emotional and Behavioral Disorders, 12, 1,
99–108.
ROGERS, E. M. (2003) Diffusion of Innovations (fifth edition). New York:
Free Press.
SANDALL, S., MCLEAN, M. and SMITH, B. J. (2000) DEC Recom-
mended Practices in Early Intervention/Early Childhood Special
Education. Longmont, CO: Sopris West.
SHANNON, P. (2004) Barriers to family-centered services for infants and
toddlers with developmental delays. Social Work, 49, 2, 301–308.
SHELTON, T. L., JEPPSON, E. S. and JOHNSON, B. H. (1987) Family-
centered Care for Children with Special Health Care Needs.
Washington, DC: Association for the Care of Children’s Health.
142 Support for Learning · Volume 23 · Number 3 · 2008 © 2008 The Author(s). Journal compilation © 2008 NASEN
TRIVETTE, C. M. and DUNST, C. J. (2000) Recommended practices in
family-based practices. In S. Sandall, M. McLean and B. J. Smith (eds.)
DEC Recommended Practices in Early Intervention/Early Childhood
Special Education (pp. 39–46). Longmont, CO: Sopris West.
TRIVETTE, C. M., DUNST, C. J., BOYD, K. and HAMBY, D. W. (1995)
Family-oriented program models, helpgiving practices, and parental
control appraisals. Exceptional Children, 62, 3, 237–248.
TRIVETTE, C. M., DUNST, C. J. and HAMBY, D. (1996) Characteristics
and consequences of help-giving practices on contrasting human ser-
vices programs. American Journal of Community Psychology, 24, 2,
273–291.
TRUTE, B. and HIEBERT-MURPHY, D. (2007) The implications of
‘working alliance’ for the measurement and evaluation of family-
centered practice in childhood disability services. Infants and Young
Children, 20, 2, 109–119.
WADE, C. M., MILDON, R. L. and MATTHEWS, J. M. (2007) Service
delivery to parents with an intellectual disability: family-centred or
professionally-centred? Journal of Applied Research in Intellectual
Disabilities, 20, 87–98.
WILSON, L. L. (2005) Characteristics and consequences of capacity-
building parenting supports. CASEmakers, 1, 4, 1–3. [Online at
http://www.fippcase.org/casemakers/casemakers_vol1_no4.pdf].
Correspondence
Marilyn Espe-Sherwindt, PhD
Director, Family Child Learning Center
Akron Children’s Hospital and Kent State University
143 Northwest Avenue, Bldg. A
Tallmadge, OH
USA
Email: mespeshe@kent.edu
© 2008 The Author(s). Journal compilation © 2008 NASEN Support for Learning · Volume 23 · Number 3 · 2008 143