How Do Pediatric Occupational Therapists Implement Family-Centered Care?

PURPOSE: Family-centered care (FCC) relies on understanding the family occupations in addition to the child occupations and is an important aspect of pediatric occupational therapy (DeGrace, 2003; Fingerhut, 2013). Using FCC principles, such as collaboration through shared decision making and goal setting, promotes improved quality of life for the child and the child’s family (Hanna & Rodger, 2002). However, there remain noted discrepancies in how FCC is implemented in practice. This research study describes how pediatric occupational therapists implement FCC principles through interactions with clients and their families in diverse pediatric settings.

DESIGN: This mixed-methods research was conducted with a national sample of pediatric occupational therapists. Participants were recruited randomly using the American Occupational Therapy Association’s (AOTA’s) list rental service and via convenience sampling at the 2016 AOTA Annual Conference & Expo. A questionnaire was administered online via electronic survey and in person via a semistructured interview. A phenomenological approach was used to analyze text and verbal narratives. Descriptive statistics were used to analyze participant responses to questions with a Likert scale. Occupational therapists were included in the study if they identified themselves as a currently practicing pediatric occupational therapist, regardless of the age range of their clients, years of practice, or practice setting.

METHOD: Fifty-four pediatric occupational therapy practitioners participated in this research study. The participants completed a questionnaire either online or through a semistructured interview. A team of six researchers independently coded text narratives from the online questionnaire. Verbal narratives from the semistructured interviews were transcribed verbatim before two researchers independently completed line-by-line coding. Triangulation of the data was achieved by collecting multiple sources of data and using multiple researchers to analyze each form of data. Peer debriefing was used and group discussion was held until agreement on bracketed ideas and themes was reached. Likert-scale responses were analyzed in Excel using descriptive statistics.

RESULTS: Two themes were evident from the pediatric occupational therapist participants. First, parents and therapists worked together to promote FCC in supporting parent and child occupational roles and values. Most (88.89%) pediatric occupational therapists either “agreed” or “strongly agreed” with feeling comfortable with the implementation of family-centered practice; however, only 48.18% of participating therapists “almost always” implemented FCC. Second, the environment influenced the interactions among the parent, child, and therapist. About half (53.7%) of participants either agreed or strongly agreed that barriers influenced the implementation of FCC.

CONCLUSION: An understanding of how family-centered care is implemented offers valuable experiences on which to base supportive strategies and overcome barriers to increase the frequency of family-centered care implementation. The experiences of pediatric occupational therapists form a foundation on which further inquiry can guide the development of a theory for practical implementation promoting the effectiveness of FCC.

IMPACT STATEMENT: This research summarizes the experience of pediatric occupational therapists implementing FCC in daily practice. The findings are significant for future science and policy initiatives to promote effective client-centered occupational therapy services intended to promote participation in childhood occupations.

References

Degrace, B. W. (2003). Occupation-based and family centered-care: A challenge for current practice. American Journal of Occupational Therapy, 57, 347–350. https://doi.org/10.5014/ajot.57.3.347

Fingerhut, P. E. (2013). Life participation for parents: A tool for family-centered occupational therapy. American Journal of Occupational Therapy, 67, 37–44. https://doi.org/10.5014/ajot.2013.005082

Hanna, K., & Rodger, S. (2002). Towards family-centred practice in paediatric occupational therapy: A review of the literature on parent–therapist collaboration. Australian Occupational Therapy Journal, 49, 14–24. https://doi.org/10.1046/j.0045-0766.2001.00273.x