Date Presented 04/13/21
The value of family-centered care is identified in the literature, highlighting the need for therapists to use a variety of approaches. However, there is limited evidence as to how to best provide care with families dealing with complex contexts such as language, cultural, and socioeconomic differences. This session will provide the perspectives of eight OTs who identified strategies to support the primary caregiver and ways in which to build therapeutic alliances.
Primary Author and Speaker: Tamera Keiter Humbert
Additional Authors and Speakers: Patricia A. Henton
Contributing Authors: Shelley Dean
PURPOSE: Current literature related to Family Centered Care (FCC) indicates that diverse approaches are needed and used with traditional family contexts to ensure successful outcomes (1, 2). While there is recognition that complex family contexts impact the care provided and the outcomes of therapy, there is limited evidence as to what approaches actually do support FCC in such circumstances. The purposes of this study were to (1) understand how occupational therapists provide FCC to families with complex contexts, which includes one or more of the following: low socioeconomic status, lack of resources and support, limited English proficiency, cultural differences, divergent healthcare beliefs, limited education, and non-nuclear family structure and (2) investigate therapists' perceptions of meaningful relationships with those families.
DESIGN: A qualitative phenomenological approach was used for this inquiry. Convenience, purposive, and snowball sampling was implemented to recruit participants. Inclusion criteria targeted occupational therapists who (1) had at least one year of experience in pediatrics, (2) provided FCC, (3) were able to identify a current or past client whose family experienced one or more of the following during the therapy process: low SES, lack of resources and support, LEP, cultural differences, healthcare beliefs that differ from the therapist's, limited education, or non-nuclear family structure, (4) identified that they had a meaningful relationship with that family, and (5) able and willing to participate in an in-depth interview.
METHODS: Through semi-structured in-depth interviews, eight occupational therapists working in early Intervention or community-based practice, shared their experiences providing FCC and developing meaningful relationships with families from complex contexts, in particular with the mother as the primary and predominate care giver. Interviews were transcribed and coded using three levels of cyclical coding. Triangulation methods were used to ensure trustworthiness including independent and collective analysis of the data, audit trails, and member checking.
RESULTS: Several themes were identified across all participants' interviews. Two major overarching themes emerged from the coding process: It's Really About The Mom and We're In This Together. It's Really About The Mom describes the mother being central to the therapy process and included subthemes of Getting Through The Day, It's Too Much, and Mom Decides. We're In This Together illustrates the therapist and family forming a collaborative, team-oriented relationship and contains subthemes of It Takes Time, Navigating Therapeutic Conversations, Going Above and Beyond, Include Everybody, and Creating Meaning.
CONCLUSION: Based on the study's findings, despite complex contexts, occupational therapists adjust to the needs of the mom and create meaningful relationships that impacts occupational performance of the child and family. The relationships built with the primary care givers required time, resources, and the use of key therapeutic approaches that supported the role of the care givers. Sensitivity to the significance of roles and the individualized lived experiences of the primary care give is needed.
IMPACT STATEMENT: Understanding complex family contexts and how to build therapeutic alliances with the primary care giver can assist occupational therapy practitioners in providing best practice to families from unique backgrounds.
References
1. Bamm, E. L., & Rosenbaum, R., (2008). Family-centered theory: Origins, development, barriers, and supports to implementation in rehabilitation medicine. Physical Medicine and Rehabilitation, 89(8), 1618-1624. https://doi.org/10.1016/j.apmr.2007.12.034.
2. Fingerhut, P. E., Piro, J., Sutton, A., Campbell, R., Lewis, C., Lawji, D., & Martinez, N. (2013). Family-centered principles implemented in home-based, clinic-based, and school-based pediatric settings. American Journal of Occupational Therapy, 67, 228–235. https://doi.org/10.5014/ajot.2013.006957.
