Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
The purpose of this study was to evaluate gaps between parent and provider perceptions of the family-centeredness of services and the contribution of the service setting (outpatient versus schools) to these gaps. Findings indicated significant gaps between parents and providers, and between practice settings, in all assessed domains. These gaps suggest areas of opportunity for OTs to enhance their practice in order to foster more effective partnerships with parents.
Primary Author and Speaker: Liat Gafni-Lachter
Additional Authors and Speakers: Ayelet Ben-Sasson, Shaimaa Alsaaed
PURPOSE: Although Evidence consistently demonstrates the benefits of Family-Centered Care (FCC) to deliver improved outcomes for children, families, healthcare providers, it is not always implemented effectively (Nickel, Weinberger & Guze, 2018). Previous studies demonstrated that both parents and healthcare providers desire a partnership, but differ in the way they perceive and evaluate the extent to which the care is family-centered (Almasri, An & Palisano, 2017; Bellin et al 2011). The purpose of this study was to explore the types and extent of gaps between parent and provider ratings of the FCC provided, as well as the contribution of the service setting to these gaps.
DESIGN: 66 parent-provider dyads were recruited for this quasi-experimental study; 33 dyads included families of children receiving care in the school system and 33 in out-patient clinics. Parents' mean age was 35.7 (SD = 7.24), with 24.2% holding an academic diploma. Most parents (87%) were mothers. Children's ages ranged between 1-15 years. Most children (92.4%) were treated once weekly while the others twice. Children's diagnoses varied and included developmental delay, Down's syndrome, cerebral palsy, autism, and hearing impairments. Provider mean age was 33.15 (SD = 6.5), 70% female, 100% held an academic diploma, with a mean of 8.61 years of experience (SD = 5.9, range: 1-21) working in pediatric care.
METHOD: Two versions of The Measures of Processes of Care (parent form and service provider form) were used to assess parent and provider perspectives of the family-centeredness of the services provided to the child and family. Specific domains assessed included enabling and partnerships, respectful and supportive care, providing specific information and providing general information. Data were analyzed using multivariate analysis of variance (MANOVA) with the service setting as covariate to identify differences, and Pearson's R to identify correlations between the perspectives.
RESULTS: MANOVA demonstrated significant differences (Wilks' Lambda = .86, F(4,60) = 34.49, p < .001, ηp
2 = .70 ) between parent and provider perspectives across all domains. Parents rating the family-centeredness of care was significantly higher than providers in all domains except for providing specific information in which providers rated themselves higher than did the parents. Providing general information was consistently the lowest rated domain. Pearson's R showed no significant associations between how parents and providers rated the care. Ratings were significantly higher in clinics compared to schools (Wilks' Lambda = .79, F(4,60) = 4.02, p = .006, ηp
2 = . 21). However, the differences between parent and provider perspectives were not a factor of the service setting.
CONCLUSION: Significant differences across all assessed domains suggest that even when parents perceive the care to be family-centered, gaps between parent and provider are prevalent. Such gaps may limit the partnership and the effectiveness of interventions. The main setting gaps were found in the way providers communicate specific and general information to parents. This can be addressed by enhancing awareness and providing training on effective information exchange to empower parents to become active partners in the care of their child. Practical strategies to enhance effective information exchange will be presented.
IMPACT STATEMENT: Identifying the gaps between parents and providers, and between different service settings illuminates how we can improve as providers to enhance partnerships for better health outcomes for children with disabilities and their families.
References
Nickel, W. K., Weinberger, S. E., & Guze, P. A. (2018). Principles for patient and family partnership in care: an American College of Physicians position paper. Annals of internal medicine, 169(11), 796-799. https://doi.org/10.7326/M18-0018
Almasri, N. A., An, M., & Palisano, R. J. (2018). Parents' perception of receiving family-centered care for their children with physical disabilities: a meta-analysis. Physical & occupational therapy in pediatrics, 38(4), 427-443. https://doi.org/10.1080/01942638.2017.1337664
Bellin, M. H., Osteen, P., Heffernan, C., Levy, J. M., & Snyder-Vogel, M. E. (2011). Parent and health care professional perspectives on family-centered care for children with special health care needs: Are we on the same page?. Health & Social Work, 36(4), 281-290. https://doi.org/10.1093/hsw/36.4.281
