Family-Centered Care Some Practical Issues

Facilitator:

Abraham A. Salinas, MD, MPH

Doctoral Candidate Community and Family Health, College of Public Health, USF

Family-Centered Care Some Practical Issues

Suggested Outline

• Apply family-centered care principles in real life scenarios.

• Identify common challenges faced by patients, families, providers and other decision makers in the implementation of family-centered care.

Principles of Family-Centered Care

• Dignity and Respect

• Recognize family strengths

• Choice

• Communication

• Information sharing

• Educational and emotional support

• Peer-to-peer support

• Flexibility

• Collaboration

• Empowerment

Institute for Family Centered Care, 2005.

“My son has multiple complex problems and out previous hospitalizations have been nightmares; as a matter of fact the past experiences were so difficult that I did not want my child admitted. But with a medically fragile child, this was our only option…”

Source: Kitchen (2005)

A case study…

“…Our recent stay was the best we have experienced in years…The needless frustration and mistakes that the PNP saved for us was truly amazing. She familiarized herself with my son’s medical history and condition and stayed on top of everything that was happening. She reported to physicians and to us on a regular basis. The lack of continuity of care is the most frustrating and scary thing that occurs to parents/caregivers of complex children. I am still in awe of how much the PNP improved our experience.”

Source: Kitchen (2005)

What could happen if family-centered care were to be implemented…

Progression of Family-Centered Care

Family-friendly (1960-80’s)

Family partnership (1990-2000ish)

Family efficacy approach

(The future)

Source: Wayman, 2005; Gance-Cleveland, 2006

Family determines their preferred role and the level of partnership they desire and the healthcare provider supports the family’s information, skills, and social support

Source: IHI Open School for Health Professionals. Available at http://youtu.be/B_SfRXKgpaI

What can happen if family-centered care is not implemented?


Are the following elements appropriate? Environment

Continuity of Care

Family input on the assessment or procedures



What would have been a more adequate approach? Is there a difference between patient-centered and family-centered care?

What is the role of cultural competency on family-centered care? What do we mean by respect and equality?

Try to think of other programs or health services in your community

(non-clinical settings) where a family-centered approach is

needed…

Example from Title V programs…

• Family involvement in Early Steps, the Florida’s Early Intervention System for 0-3 years of age children with developmental delays or at risk of: – Individualized Family Service Plan

– Primary Service Provider Model

– Home-based

– Care-coordination

Individual Family Support Plan (IFSP) • Identify specific concerns, priorities, and resources your family has about your child's

development.

• Building partnerships with the family and professionals who will provide services and supports based on your family's needs, as equal members.

• As the parent, you are the most knowledgeable source of information when it comes to your child's needs and this is why your role in the IFSP is very important. The plan ultimately helps coordinate resources, supports and services to meet you and your child's needs.

• Topics for the Individualized Family Support Plan (IFSP) are:

– How your child is growing and learning

– Immediate needs your child and family has related to your child's development.

– Your family's concerns, priorities and resources.

– Your routines, schedules and environments those are natural to your family's lifestyle.

– Goals and outcomes that your family has for your child and the services that will help your family and your child reach these goals/outcomes.

– Activities that will help your child transition to future services on his or her third birthday.

Why, if family-centered has recognized validity, do we

experience difficulty implementing it?

What can we do to integrate family-centered in public health programs and services, including healthcare?

Patient

Family Healthcare

Professionals

References • Bamm, E. L., & Rosenbaum, P. (2008). Family-centered theory: origins,

development, barriers, and supports to implementation in rehabilitation medicine. Arch Phys Med Rehabil, 89(8), 1618-1624.

• Gance-Cleveland, B. (2006). Family-centered care. Decreasing health disparities. J Spec Pediatr Nurs, 11(1), 72-76.

• IHI Open School for Health Professionals. PFC 101 Dignity and Respect – Family Centered Care. http://app.ihi.org/lms/coursedetailview.aspx?CourseGUID=8eb52137-21d7-4b30-afcd-fd781de6d6d5&CatalogGUID=6cb1c614-884b-43ef-9abd-d90849f183d4

• Institute for Patient- and Family-centered Care. At http://www.ipfcc.org/ • Kitchen, B. E. (2005). Family-centered care: a case study. J Spec Pediatr

Nurs, 10(2), 93-97. • Perrin, J. M., Romm, D., Bloom, S. R., Homer, C. J., Kuhlthau, K. A.,

Cooley, C., et al. (2007). A family-centered, community-based system of services for children and youth with special health care needs. Arch Pediatr Adolesc Med, 161(10), 933-936.

Presenter Disclosures

(1) The content of this presentation is merely the authors’ point of view, and does not necessarily reflect the view of the University of South Florida, Early Steps, or other partner institutions. No financial relationships to disclose.

Abraham A. Salinas-Miranda

Contact Information

Abraham A. Salinas-Miranda, MD, MPH

University of South Florida, Tampa, FL

College of Public Health

Department of Epidemiology and Biostatistics

[email protected]

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Family-Centered Care Some Practical Issues