Understanding and Enhancing Occupational Therapists’ Use of Standard Family-Centered Measures

Abstract

Importance: The use of standard family-centered measures (FCMs) is imperative to guide family-centered care (FCC) interventions and monitor their outcomes.

Objective: To measure the frequency of FCM use and evaluate the effectiveness of experiential learning and reflection to increase their use.

Design: Descriptive and two-group pre–post comparative training study.

Setting: Continuing education center.

Participants: Phase 1 included 145 health care providers. Phase 2 included 44 school-based occupational therapists who participated in Phase 1.

Intervention: Phase 2 participants enrolled in 30-hr FCC training that included a 2-hr workshop on FCM. One group (n = 22) conducted an FCM with a family and wrote a reflective report.

Outcomes and Measures: All participants completed the Measure of Processes of Care–Service Provider (MPOC–SP) questionnaire and reported how frequently they used FCMs.

Results: FCM use rates were low (50%, not at all; 26%, to a very small extent). The extent of FCC was correlated with FCM use (r = .24–.30, p < .01). A Wilcoxon signed-rank test demonstrated that participants who administered an FCM with a family and reflected on this experience showed significant increases (Z = 176.0, p = .001) in FCM use compared with participants who were only instructed about available FCM. A Mann–Whitney U test confirmed the difference (U = 3.54, p = .012).

Conclusions and Relevance: FCM use is sparse, but experiential and reflective activities are simple keys to promoting FCC and integrating FCM into practice.

What This Article Adds: Training designers, educators, and managers should consider integrating experiential learning to enhance providers’ expertise and quality of care.

This study supports the promotion and integration of standard family-centered measures (FCMs) into practice to enhance providers’ expertise and quality of care and to guide family-centered care (FCC) interventions and monitor their outcomes.

Families shape the context of their child’s health and development. Thus, family-centered care (FCC) is recognized as a best practice in child and family care (American Occupational Therapy Association, 2020; Kokorelias et al., 2019; Nickel et al., 2018). The universal core aspects of FCC are collaboration and communication between families and professionals, exchange of knowledge and education, consideration of family contexts, and supportive policies and procedures (Kokorelias et al., 2019), all of which are needed to establish partnerships in the child’s care. Effective FCC involves continuity across all aspects of care from initial contact with a family through examination, diagnosis, intervention planning, intervention delivery, and discharge from services (King & Chiarello, 2014).

Family-centered measures (FCMs) can facilitate providers’ abilities to learn about a family’s contexts, needs, priorities, strengths, expectations, and perceptions of the care they receive. Yet, FCMs are not routinely used in practice and research, limiting the ability to characterize family needs and desires and evaluate the effectiveness of interventions (Kokorelias et al., 2019). FCMs include process and outcome measures. Process measures assess the quality of the FCC services provided, including family–provider communications and shared decision making (King et al., 2004; Woodside et al., 2001). Outcome measures include semistructured interviews to set shared intervention goals (e.g., Honaker et al., 2012; Law et al., 2019) and questionnaires that identify parents’ expectations and perceptions of goal achievement (e.g., Waldman-Levi et al., 2017) or the family’s concerns and strengths (e.g., Crnic & Booth, 1991; Fingerhut, 2013; Freiberg et al., 2014). The Appendix includes more details on the FCMs used in this study.

Despite the importance of standardized measures, they are not frequently integrated into general practice (Duncan & Murray, 2012; Romli et al., 2019), demonstrating the difficulty of translating theory into practice. Workshops are reported to increase awareness and provide knowledge of instruments, but they are only a first step in closing the gap between knowing and doing (Ketelaar et al., 2008). Experiential learning may reduce this gap, foster skill acquisition, and enhance self-efficacy for health care providers, including occupational therapists (Coker, 2010; Park et al., 2018). Experiential learning incorporates active experience to apply skills, reflect on the process, and learn from the results (Bandura, 1986; Knecht-Sabres, 2013; Kolb et al., 2014).

In this study, we measured the rate of FCM use and evaluated the effectiveness of experiential learning and reflection in increasing the use of FCMs. In Phase 1, we measured pediatric providers’ family centeredness and their routine use of standardized FCMs. In Phase 2, we evaluated whether experience in administering FCMs would be more effective in changing providers’ FCC practices than knowledge acquisition alone.

Method

This was part of a larger study (Gafni-Lachter & Ben-Sasson, 2022) approved by the Ethics Committees of the University of Haifa (Approval 263/16) and the Israel Ministry of Education (Approval 9750). Phase 1 was descriptive, and Phase 2 was a two-group, preintervention–postintervention design.

Participants

Phase 1 included 135 practitioners: 88 occupational therapists, 29 speech-language pathologists, 14 physical therapists, and 4 art therapists, working in pediatric settings. Seventy (52%) worked in schools, 61 (45%) in outpatient clinics, and 4 (3%) in other settings (hospital or hostel). Practitioners had an average 9.6 yr (SD = 7.15, Mdn = 8, range = 1–35) of clinical experience. Participants were recruited from among providers enrolled in workshops offered by a continuing education center.

In Phase 2, 44 Phase 1 participants enrolled in an FCC training and were assigned to two cohorts on the basis of their choice of training times. All were female occupational therapists working primarily in the school system. Group 1 had an average of 13.9 yr (SD = 8.1, range = 1–27) of experience, and Group 2 had 12 yr (SD = 8.03, range = 1–33) of experience. All participants completed the training.

Instrument

The Measure of Processes of Care–Service Provider (MPOC–SP; Woodside et al., 2001) is a 27-item self-report questionnaire that assesses health care providers’ perceptions regarding their use of family-centered behaviors. The MPOC–SP evaluates showing interpersonal sensitivity, communicating specific information about the child, treating people respectfully, and providing general information. The frequency of each behavior is rated on a scale ranging from 1 (not at all) to 7 (very great extent). The Hebrew MPOC–SP used in this study was validated and had good internal consistency across domains (α = .65–.89) in Schenker et al. (2016) and in this study (α = .71–.86). Participants were also asked to rate how often they use standard FCMs, using the same 7-point scale.

Procedure

Participants attending the continuing education workshop were invited to enroll in Phase 1. Consenting participants completed a paper form of the Hebrew MPOC–SP and rated how frequently they used FCMs. In Phase 2, 44 of the Phase 1 participants were enrolled in a 30-hr continuing education training titled “Better Together” (Gafni-Lachter & Ben-Sasson, 2022). The training was delivered in two cohorts (22 participants in each cohort). Part of the Better Together training included a 2-hr workshop on FCMs in which participants were introduced to seven FCMs (see the Appendix). The FCMs were selected on the basis of the availability of purchasing licensure or author approval. Participants received the forms and guidelines for each measure and were asked to consider their clients and rate each measure’s usefulness for them. Finally, participants met in small groups and debated the benefits and challenges of using FCMs in their practices. Table 1 presents the clinical reasoning questions used to analyze each FCM.

Table 1.

Clinical Reasoning Questions Used to Evaluate an FCM

This Measure . . .	FCM
This Measure . . .	1	2	3	4	5	6	7
Promotes understanding of the parent and their needs.
Promotes the parent as an expert on the child.
Promotes partnership between the family and me.
Helps to set goals collaboratively.
Is appropriate for the client population I see.
Takes a reasonable amount of time for my clients.
Promotes my clinical thinking.
Can be useful for the intervention.

Note. Each FCM is rated on a scale ranging from 0 (not at all) to 5 (strongly agree). FCM = family-centered measure. See the Appendix for examples of FCMs to evaluate.

Cohort 1 participants (the experimental group) had an additional experiential task: they were required to select one FCM, administer it to a family in their care, and submit a report based on three reflective questions:

What did you learn from administering the measure?

How does this experience align with your previous perceptions of FCM use and FCC?

How will these lessons inform your future work with families?

Cohort 2 participants (the control group) did not complete the experiential task. One month after the conclusion of the training, all Phase 2 participants completed a posttest MPOC–SP and reported their frequency of FCM use.

Data Analysis

Data were analyzed using IBM SPSS Statistics (Version 25). Spearman’s ρ was used to identify correlations between scores. Phase 2 data were analyzed using the related-samples Wilcoxon signed-rank test to determine the change in FCM use in each group. A Mann–Whitney U test was used to compare changes between groups.

Results

Table 2 presents participants’ mean scores on the four MPOC–SP domains and their frequency of FCM use. Most participants reported using FCMs not at all (50%) or to a very small extent (26%). Only 13% reported using FCMs to a fairly great or very great extent, and 11% reported using them to a small extent. Correlations between frequency of FCM use and all MPOC–SP domains were weak but significant. Exploratory analysis to examine whether FCM use was associated with participant demographics demonstrated no significant correlation with years of experience or across practice settings.

Table 2.

MPOC–SP, FCM Use, and Spearman Correlations

Results	M (SD)	Score Range (min–max)	Correlation Between MPOC–SP and Frequency of FCM Use^a
MPOC–SP domains
Showing Interpersonal Sensitivity	5.01 (0.85)	2.30–6.80	.30
Communicating Specific Information	5.44 (1.07)	1.67–7.00	.29
Providing General Information	3.59 (1.25)	1.00–6.75	.18
Treating People Respectfully	5.64 (0.72)	3.78–7.00	.24
FCM use	2.28 (1.60)	1–7

Note. FCM = family-centered measure; MPOC–SP = Measure of Processes of Care–Service Provider.

All ps < .01.

On the basis of the Wilcoxon signed-rank test, Group 1’s median posttest rankings were higher than their pretest rankings (Z = 176.0, p = .001; 17 participants had a significant increase). Pretest-to-posttest differences were not significant for Group 2 (the control group; Z = 68.5, p = .98; 8 participants had a significant increase). Mann–Whitney U test results confirmed that the difference score was greater for Group 1 (U = 3.54, p = .012; Table 3).

Table 3.

Within- and Between-Groups Differences in FCM Use

Comparison and Group	Mdn			Wilcoxon Signed-Ranks (Z)	n ^a		Mann-Whitney U
Comparison and Group	Pretest	Posttest	Difference Score	Wilcoxon Signed-Ranks (Z)	Increase	Decrease	Mann-Whitney U
Within groups
Experimental (n = 22)	1.0	4.0	1.5	176.0*	17	2
Control (n = 22)	3.0	2.5	0	68.5	8	8
Between groups							3.5*

Note. FCM = family-centered measure.

Number of participants with increased posttest or decreased posttest FCM score (remainder of participants were without significant change).

p ≤ .05.

Discussion

Although FCC and use of standard measures are considered best practices in occupational therapy, this is the first study to evaluate a baseline and how to effectively promote FCM use. Our findings demonstrate a major knowledge translation gap between the theory and practice of FCC. Although most providers in our sample considered themselves to be family-centered practitioners, they rarely used FCMs. In our sample, 26% reported using FCMs infrequently, and 13% reported using them often. Our findings are congruent with results showing minimal use of standard measures (Duncan & Murray, 2012). Providers who consider themselves to be more family centered were more prone to use FCMs. The rate of FCM use in the current study did not depend on years of experience or practice setting. We conjecture that infrequent use of FCMs is due to lack of awareness of the relevance and contribution of these measures to practice. Thus, we explored whether experiential learning could enhance the integration of FCMs into practice.

The Phase 2 results confirmed our hypothesis that experiential learning and reflection are likely to lead to the integration of a new skill into practice. Participants who administered a measure and reflected on the experience applied measures in practice more than did participants who were introduced to FCM only via an interactive workshop. These findings are consistent with evidence of the value of experiential learning and reflection (Coker, 2010; Ketelaar et al., 2008; King, 2009; Park et al., 2018).

This study isolated experiential learning as the independent variable in a comparative design between two cohorts. The results were astounding: Only providers who fully administered an FCM to a client and reflected on its value reported a significant increase in the rate of FCM use 1 mo later. In the workshop, all participants actively analyzed and compared several FCMs. However, those who gained first-hand experience administering and analyzing an FCM and recognized its value in enhancing their relationship with the family were more able to integrate these new skills into their practice.

Reflection appears to be the change mechanism that leads to the acquisition of new self-knowledge, content knowledge, and procedural knowledge, which promote expertise and facilitate professional reasoning (Unsworth & Baker, 2016). Health care organizations can promote expertise in FCC by providing knowledge of, access to, and time to administer FCMs and reflect on their use.

This study had several limitations. To accommodate participants’ time preferences, randomization was not possible, which may reduce the study’s internal and external validity. Participants were recruited from a pool of highly motivated professionals who enrolled in the training on the basis of their interest in working with families. The dedication to learning and the changes observed may not predict changes in the general provider population. The measures used to identify changes in the practitioners’ practice relied on self-reports without additional reports from parents, colleagues, or supervisors. It would be important to obtain an external assessment of the carryover of the training into practice.

Future researchers should partner with families, providers, and managers to evaluate means to strengthen FCC at the organizational, provider, and family levels. Qualitative designs can deepen the understanding of mechanisms that enhance reflective practices related to FCC and identify factors that contribute to positive perceptions of FCM use in practice.

Implications for Occupational Therapy Practice

This study has the following implications for occupational therapy practice:

▪ The use of standard FCMs promotes family– provider partnerships and understanding of the family’s needs and priorities.

▪ Providers should use clinical reasoning to judge the relevance of an FCM to their practice.

▪ Simply learning about FCMs is not sufficient for integrating them into practice; providers should administer standard FCMs and reflect on the process individually or in groups.

▪ Although the continuing education workshop took place in person, it could be delivered online with the experiential components applied in each learner’s practice setting.

Conclusions

Experiential learning and reflection are effective and low-cost strategies to enhance the use of FCMs in clinical practice. Managers, educators, training developers, and researchers are encouraged to integrate experiential learning into professional training to achieve effective outcomes that bring real change to practice.

Footnotes

Acknowledgments

This study was made possible thanks to the generous support of the Fulbright Israel foundation.

Appendix.

Family-Centered Measures Used in the Study

Name and FCC Component Evaluated^a	Authors/Date and Country	Measure Type	Aim	Reliability	Validity	Response Scale
20-item Measure of Processes of Care (MPOC–20), Measure of Processes of Care–Service Provider (MPOC–SP; 1, 3, 4)	King et al. (2004); Woodside et al. (2001) Canada	20-item parent questionnaire and parallel 27-item professional self-report	Service outcome: family-centeredness of services, as perceived by parent and health care professionals	MPOC–20: αs = .83–.90; test–retest reliability (ICC): .81–.86 MPOC–SP: αs = .76–.88; test–retest reliability (ICC): .79–.99	The MPOC–20 has good concurrent validity, significant positive correlations with a measure of satisfaction, and a negative correlation with a single-item stress variable (King et al., 2004). The MPOC–SP is a discriminating measure of professional caregiving behaviors (Woodside et al., 2001).	7-point scale ranging from 1 (not at all) to 7 (to a very great extent)
Canadian Occupational Performance Measure (COPM; 1, 2)	Law et al. (2019) ^b Canada	Semistructured interview-based rating scale	Family and client needs: Prioritize self-care, productivity, and leisure goals and change	Internal reliability and test–retest reliability	Validated against functional, psychological, and social functioning measures. Concurrent, criterion, convergent, divergent, construct, and content validity consistently support that it measures occupational performance (Carswell et al., 2004).	Responses are documented and then ranked on a 10-point scale ranging from 1 (not at all) to 10 (very high) according to importance, performance, and satisfaction with performance
Family L.I.F.E. (Looking into Family Experiences) (1, 2)	Honaker et al. (2012)^b United States	Semistructured interview and time diary	Family needs: family priorities and perceived change in routines, rituals, and occupations	Test–retest r = .92	Face, content, and construct validity and convergent validity were established (Honaker et al., 2012).	Open-ended questions
Parents’ Satisfaction During Intervention Questionnaire (PAPI–II), Satisfaction Post–Intervention Questionnaire (PAPI–III; 1, 2)	Waldman-Levi et al. (2017) ^b Israel	Parents complete questionnaires preintervention, during intervention, and postintervention	Family needs: parents’ expectations and satisfaction with occupational therapy intervention for their children; includes measures of the child’s function and parental involvement	αs = .48–.80	Moderate correlations found between the PAPI–II and PAPI–III and child outcomes in treatment and with COPM (Waldman-Levi et al., 2017).	Rated on a 5-point scale ranging from 1 (very little) to 5 (very much).
Parent Empowerment and Efficacy Measure (2)	Freiberg et al. (2014) Australia	20-item parent questionnaire	Family needs: parent empowerment and perceptions of being a good parent and use of networks.	α = .92, test–retest reliability = .84	The measure has high convergent and concurrent validity (Freiberg et al., 2014).	Responses are made on a 10-point scale ranging from 1 (This sounds nothing like me) to 10 (This sounds exactly like me).
Parenting Daily Hassles Scale (2)	Crnic & Booth (1991) United States	20-item parent questionnaire	Frequency and intensity of events of challenging child behavior or parenting tasks	αs = .81–.90 (Crnic & Booth, 1991)	NA	Each item is rated on a 4-point scale ranging from 1 (rarely) to 4 (constantly), and intensity is rated on a 5-point scale ranging from 1 (no hassle) to 5 (big hassle).
Life Participation for Parents (LPP; 2)	Fingerhut (2013) ^b United States	23-item parent questionnaire	Family needs: satisfaction with the effectiveness and efficiency of the parents’ own participation in activities and occupations	α = .90, r = .89	The LPP correlated moderately with the Parenting Stress Index–Short Form (Abidin, 1990; r = .54)	Items are rated on a 5-point scale ranging from 1 (strongly agree) to 5 (strongly disagree), with an option for comments.

Note. FCC = family-centered care; ICC = intraclass correlation; NA = not applicable.

Components of FCC (according to Kokorelais et al., 2019) addressed are as follows: 1 = collaboration; 2 = family contexts; 3 = dedicated policies and procedures; 4 = education and information.

All or some of the measure’s developers are occupational therapists.

References

Abidin

R. R.

(1990). Parenting Stress Index–Short Form. Pediatric Psychology Press.

American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy , 74(Suppl. 2), 7412410010. https://doi.org/10.5014/ajot.2020.74S2001

Bandura

(1986). Social foundations of thought and action: A social cognitive theory. Prentice-Hall, Inc.

Carswell

McColl

M. A.

Baptiste

Law

Polatajko

, & Pollock

(2004). The Canadian Occupational Performance Measure: A research and clinical literature review. Canadian Journal of Occupational Therapy , 71 , 210–222. https://doi.org/10.1177/000841740407100406

Coker

(2010). Effects of an experiential learning program on the clinical reasoning and critical thinking skills of occupational therapy students. Journal of Allied Health , 39 , 280–286.

Crnic

K. A.

, & Booth

C. L.

(1991). Mothers’ and fathers’ perceptions of daily hassles of parenting across early childhood. Journal of Marriage and Family , 53 , 1042–1050. https://doi.org/10.2307/353007

Duncan

E. A.

, & Murray

(2012). The barriers and facilitators to routine outcome measurement by allied health professionals in practice: A systematic review. BMC Health Services Research , 12 , 96. https://doi.org/10.1186/1472-6963-12-96

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

Freiberg

Homel

, & Branch

(2014). The Parent Empowerment and Efficacy Measure (PEEM): A tool for strengthening the accountability and effectiveness of family support services. Australian Social Work , 67 , 405–418. https://doi.org/10.1080/0312407X.2014.902980

10.

Gafni-Lachter

, & Ben-Sasson

(2022). Promoting family-centered care: A provider-training effectiveness study. American Journal of Occupational Therapy , 76, 7603205120. https://doi.org/10.5014/ajot.2022.044891

11.

Honaker

Rosello

S. S.

, & Candler

(2012). Test–retest reliability of Family L.I.F.E. (Looking Into Family Experiences): An occupation-based assessment. American Journal of Occupational Therapy , 66 , 617–620. https://doi.org/10.5014/ajot.2012.004002

12.

Ketelaar

Russell

D. J.

, & Gorter

J. W.

(2008). The challenge of moving evidence-based measures into clinical practice: Lessons in knowledge translation. Physical and Occupational Therapy in Pediatrics , 28 , 191–206. https://doi.org/10.1080/01942630802192610

13.

King

(2009). A framework of personal and environmental learning‐based strategies to foster therapist expertise. Learning in Health and Social Care , 8 , 185–199. https://doi.org/10.1111/j.1473-6861. 2008.00210.x

14.

King

, & Chiarello

(2014). Family-centered care for children with cerebral palsy: Conceptual and practical considerations to advance care and practice. Journal of Child Neurology , 29 , 1046–1054. https://doi.org/10.1177/0883073814533009

15.

King

, & Rosenbaum

(2004). Evaluating health service delivery to children with chronic conditions and their families: Development of a refined Measure of Processes of Care (MPOC−20). Children’s Health Care , 33 , 35–57. https://doi.org/10.1207/s15326888chc3301_3

16.

Knecht-Sabres

L. J.

(2013). Experiential learning in occupational therapy: Can it enhance readiness for clinical practice? Journal of Experiential Education , 36 , 22–36. https://doi.org/10.1177/1053825913481584

17.

Kokorelias

K. M.

Gignac

M. A. M.

Naglie

, & Cameron

J. I.

(2019). Towards a universal model of family centered care: A scoping review. BMC Health Services Research , 19 , 564. https://doi.org/10.1186/s12913-019-4394-5

18.

Kolb

D. A.

Boyatzis

R. E.

, & Mainemelis

(2014). Experiential Learning Theory: Previous research and new directions. In Sternberg

R. J.

& Zhang

(Eds.), Perspectives on thinking, learning, and cognitive styles (pp. 227–248). Routledge. https://doi.org/10.4324/9781410605986-9

19.

Law

Baptiste

Carswell

McColl

Polatajko

& Pollock

(2019). Canadian Occupational Performance Measure (5th ed., rev.). COPM, Inc.

20.

Nickel

W. K.

Weinberger

S. E.

Guze

P. A.

Carney

Ende

Hoy

, . . . Sweet

D. E.

; Patient Partnership in Healthcare Committee, American College of Physicians. (2018). Principles for patient and family partnership in care: An American College of Physicians position paper. Annals of Internal Medicine , 169 , 796–799. https://doi.org/10.7326/M18-0018

21.

Park

J. S.

Moore

J. E.

Sayal

Holmes

B. J.

Scarrow

Graham

I. D.

, . . . Straus

S. E.

(2018). Evaluation of the “Foundations in Knowledge Translation” training initiative: Preparing end users to practice KT. Implementation Science , 13 , 63. https://doi.org/10.1186/s13012-018-0755-4

22.

Romli

M. H.

Wan Yunus

, & Mackenzie

(2019). Overview of reviews of standardised occupation-based instruments for use in occupational therapy practice. Australian Occupational Therapy Journal , 66 , 428–445. https://doi.org/10.1111/1440-1630.12572

23.

Schenker

Parush

Rosenbaum

Rigbi

, & Yochman

(2016). Is a family-centred initiative a family-centred service? A case of a conductive education setting for children with cerebral palsy. Child: Care, Health and Development , 42 , 909–917. https://doi.org/10.1111/cch.12354

24.

Unsworth

, & Baker

(2016). A systematic review of professional reasoning literature in occupational therapy. British Journal of Occupational Therapy , 79 , 5–16. https://doi.org/10.1177/0308022615599994

25.

Waldman-Levi

Hirsch

Gutwillig

, & Parush

(2017). Psychometric properties of the Parents as Partners in Intervention (PAPI) Questionnaires. American Journal of Occupational Therapy , 71 , 7102220020. https://doi.org/10.5014/ajot.2017.020289

26.

Woodside

Rosenbaum

King

, & King

(2001). Family-centered service: Developing and validating a self-assessment tool for pediatric service providers. Children’s Health Care , 30 , 237–252. https://doi.org/10.1207/S15326888CHC3003_5