Family-centred service: moving ideas into practice

Original Article

copy 2005 Blackwell Publishing Ltd

633

Blackwell Science LtdOxford UKCCHDChild Care Health and Development0305-1862Blackwell Publishing Ltd 2005

0 2005

31

6633642

Original Article

Fam-

ily-centred serviceM Law

et al

CorrespondenceMary Law

CanChild

Centre for Childhood Disability Research McMaster University Institute for Applied Health Sciences 1400 Main Street West Room 403 Hamilton Ontario L8S 1C7 CanadaE-mail lawmmcmasterca

Original Article

Family-centred service moving ideas into practice

M Law R Teplicky S King G Kingdagger M Kertoy T MoningDagger P Rosenbaum and J Burke-GaffneyDagger

CanChild

Centre for Childhood Disability Research McMaster University HamiltondaggerThames Valley Childrenrsquos Centre London andDaggerHamilton Family Network Hamilton ON Canada

Accepted for publication 15 July 2005

Abstract

Background

With parents more involved in their childrsquos day-to-day care concepts of family-centred

service (FCS) are increasingly adopted in childrenrsquos health and rehabilitation service organizations

Methods

In this paper we report the results of a study to develop and evaluate educational materials

for parents service providers and health sciences students about FCS The materials focus on the

nature and philosophy of FCS and the practical skills and systemic changes required for its

implementation

Results

Thirty-six participants (12 families 12 service providers and 12 rehabilitation science

students) were randomly assigned to receive one of the six FCS educational packages each

containing three FCS educational sheets Participantsrsquo ratings of the format and content and the

impact of the FCS Sheets were very high with overall means above 50 on a 7-point scale Using a

mixed model analysis we found significant differences in participantsrsquo ratings of familiarity with the

materials (students were less familiar than service providers) After statistical adjustment for

familiarity there were no significant differences between the groups or the packages on ratings of

format and content or impact

Conclusions

There were no significant differences in the way in which the participant groups rated

the impact of the FCS Sheets and the specific packages did not have an effect on the participantsrsquo

ratings The FCS educational materials even those less familiar to participants were rated highly on

format and content and impact Results indicate that the material was perceived to be important to

each group and was formatted and written in a way that was easy to understand This finding

counters current recommendations in the knowledge transfer literature that suggest different

versions should be written for different target groups

Keywords

childhood disability family-centred service health service research knowledge transfer

Introduction

Children with chronic disabilities receive ongoing

services from health professionals over a period of

many years In the past decade because of legisla-

tive and societal changes the nature of the relation-

ship between parents families and service

providers has changed Parents want more influ-

ence in determining the nature of the services that

are best for their child As well parents are increas-

ingly involved in co-ordinating services and imple-

menting home programmes particularly because

634

M Law

et al


Child Care Health amp Development

31

6 633ndash642

of resource limitations within healthcare systems

In light of these changes family-centred service

(FCS) has become increasingly adopted in hospi-

tals and community-based service organizations

across North America

FCS is a method and philosophy of service deliv-

ery that emphasizes a partnership between parents

and service providers (Hostler 1994) In this

approach each family is given the opportunity to

decide how involved they want to be in the services

and decision making for their child (Brown

et al

1997 Rosenbaum

et al

1998) The strengths

resources and needs of all family members are con-

sidered (Allen amp Petr 1998 Rosenbaum

et al

1998) There is evidence to indicate that FCS leads

to improved outcomes for children and families

(King

et al

1999 2004) and that parents are more

satisfied with services that are perceived to be fam-

ily-centred (King

et al

1999 Law

et al

2003)

The philosophy of FCS has been described in

many articles (Bailey

et al

1992 Edelman

et al

1992a Rosenbaum

et al

1998) Similarly several

studies have identified barriers that limit the

implementation of FCS Examples of such barriers

include limited time human resources and finan-

cial resources (King

et al

2000 Litchfield amp

MacDougall 2002) lack of skills needed to put FCS

into practice (King

et al

2000 Iverson

et al

2003)

and lack of support from the organization for using

FCS (King

et al

2000) Other authors indicate that

many service providers find it difficult to be family-

centred because they were trained in models such

as the medical model in which the service provider

is seen as the expert (Lawlor amp Mattingly 1998

Bruce

et al

2002)

The barriers listed in the previous paragraph

suggest a need for practical materials about the key

ideas of FCS and strategies to enable its implemen-

tation particularly for service providers and deci-

sion makers within healthcare organizations and

health science students Although the literature on

barriers to implementing FCS does not identify

issues specific to parents the nature of their role in

this approach implies that they would also benefit

from knowledge about and strategies for contrib-

uting to the family-centredness of services

One way to provide practical information about

FCS is through written educational materials

While there are some educational materials about

FCS available (eg Edelman

et al

1992b c) there

are no specifically designed packages of materials

that address the broad range of issues and partic-

ularly the skills required by parents service pro-

viders students and decision makers to implement

FCS As well there have been no reported evalua-

tions of the utility of educational materials in

improving peoplersquos understanding or practice of

FCS

In other areas of health care evaluation of the

impact of written materials on service providersrsquo

practice has yielded inconsistent results In a syn-

thesis of systematic reviews Grimshaw and col-

leagues (2001) reported that printed education

materials were generally not effective in facilitating

change in service provider behaviour but indicated

that they appear to raise awareness of new infor-

mation This finding is congruent with Diffusion

of Innovations Theory a theory of behaviour

change that proposes that mass-media strategies

(eg distribution of printed educational material)

are more effective in facilitating changes in aware-

ness and knowledge than changes in behaviour

(Rogers 1995) In addition this theory suggests the

importance of increased knowledge by hypothesiz-

ing that this change is a necessary precursor to

changes in behaviour The view that changes in

practice are preceded by changes in other areas is

also supported by the Theory of Planned Behav-

iour which specifies that changes in beliefs atti-

tudes and intentions to perform the behaviour

occur prior to behaviour change (Ajzen 1991)

However in a more recent systematic review of

the dissemination and implementation of clinical

practice guidelines Grimshaw and colleagues

(2004) report that the majority of strategies that

have been investigated including educational

materials have modest to moderate impact on the

way in which service providers deliver services

Freemantle and colleagues (2003) and Grimshaw

and colleagues (2004) indicate that the current lit-

erature in this area is limited both in quantity and

in quality and they conclude that further research

is needed to better understand the impact of

printed educational material and other activities

designed to facilitate changes in healthcare

practice

Family-centred service

635



31

6 633ndash642

This paper reports the results from an evaluative

study with two major purposes The first objective

of this study was to develop educational materials

for parents service providers and health sciences

students about FCS The focus of these materials is

on the nature and philosophy of FCS and the prac-

tical skills and systemic changes required for its

implementation The educational materials were

named lsquoFCS Sheetsrsquo to reflect their focus on pro-

viding lsquo

Facts Concepts and Strategiesrsquo

about FCS

The second objective was to evaluate the format

and content of the FCS Sheets and the perceived

effect of these educational materials on knowledge

and beliefs about FCS and on intentions to imple-

ment changes in practice

This study builds on the findings from a pilot

study in which six educational materials were

developed by the research team and evaluated by

service providers and parents The findings from

the pilot study informed the research teamrsquos deci-

sion making regarding the development of the

research versions of the materials that were used in

this study

Methods

Development of the FCS Sheets

The participants in the pilot study and members of

the research team recommended additional topics

to the six developed for the pilot study The

research team discussed the list of potential topics

and determined that 12 of the newly recommended

topics were relevant to the practice of FCS were

distinct from one another and warranted develop-

ment of an FCS Sheet As such a total of 18 FCS

Sheets were included in this study Of the 18 topics

six focused on general concepts and information

about FCS (eg What is family-centred service)

and 12 addressed more specific issues related to the

provision of services (eg Setting goals together)

The list of all FCS Sheet topics is included in

Appendix 1

In the pilot study short (one to two pages) and

long (five to six pages) versions of the FCS Sheets

were tested There was no clear recommendation

for length as some of the participants preferred the

short versions and others preferred the long ver-

sions However using this information the

research team decided to develop materials that

were three to four pages in length which was

judged to be adequate space for inclusion of back-

ground information about the topic as well as

strategies for putting the ideas into practice

The research team also developed an outline for

the FCS Sheets to ensure that similar information

was being included in each of the drafts The sec-

tions for the FCS Sheets included an introductory

lsquohookrsquo or clinical story relevance of the topic to

FCS factual and conceptual information practical

strategies for putting the concepts into practice

and references The FCS Sheets were written to

ensure that the materials were applicable to both

parents and service providers and when appropri-

ate decision makers within organizations

The decision to develop one FCS Sheet for mul-

tiple audiences rather than separate materials for

various group was based on the findings from the

pilot study in which the participants particularly

the parents indicated that they preferred to see the

strategies that were recommended for each of the

groups (ie parents service providers and decision

makers) The authors focused on using plain easy-

to-understand language so that the materials

would be appropriate for a range of audiences

One or two research team members were

assigned as the primary author(s) for each FCS

Sheet based on the individualsrsquo expertise and

interest in the topic The entire team reviewed the

draft FCS Sheets and the primary authors made

revisions based on team feedback This process

continued until the team was satisfied with the

content of the FCS Sheets The FCS Sheets were

then edited by an occupational therapist who was

familiar with FCS and the topics covered in the

FCS Sheets but was external to the research team

The research co-ordinator made revisions to the

drafts based on the editorrsquos recommendations and

final approval was received from the primary

authors

The 18 FCS Sheets were grouped in threes mak-

ing a total of six different research packages Each

package contained one FCS Sheet that addressed a

general concept of FCS and two FCS Sheets that

were about more specific topics regarding FCS The

topics were grouped in such a way to make certain

636

M Law

et al



31

6 633ndash642

that the same primary author did not write all of

the FCS Sheets in one package (see Appendix 1)

Participant recruitment

Parents and service providers were recruited from

a childrenrsquos rehabilitation centre in Ontario

Canada Health science students were recruited

from McMaster Universityrsquos occupational therapy

and physiotherapy programmes and from the Uni-

versity of Western Ontariorsquos School of Communi-

cation Sciences and Disorders Twelve participants

were recruited for each group (ie parents service

providers and health science students) for a total

of 36 participants This sample size was selected

because it was determined that 90 power to find

a moderate effect size of 05 standard deviation

between the mean scores of the intervention

groups would be achieved if each research sum-

mary was evaluated by six participants Therefore

the sample size equalled the number of research

packages (6) multiplied by the number of partici-

pants assigned to each package (6) divided by the

number of participant groups (3) resulting in 12

participants per group The study was reviewed

and approved by the Research Ethics Board at

McMaster University

Data collection and analyses

Once verbal consent was obtained participants

were randomly assigned one of the six research

packages to ensure that all topics were reviewed by

an adequate and equal number of participants

Each research package contained information

about the study a written consent form a demo-

graphic questionnaire three FCS Sheets and three

evaluation forms

Participants were asked to read the FCS Sheets

and complete an evaluation form for each sheet

The evaluation form was developed and used in

a previous research study conducted by three of

the authors (see Teplicky

et al

2005) The form

included 12 questions that were rated on a 7-

point scale (see Table 1) For data analysis pur-

poses the evaluation questions were grouped

into three categories The first category included

only one item ndash the participantrsquos familiarity with

the topic ndash because it was judged that this ques-

tion addressed a different issue than the other

questions The other two categories were identi-

fied based on examination of the internal

consistency of various item groupings The stan-

dardized item coefficient alpha scores for the

selected groupings were 080 for lsquoformat and con-

Table 1

Evaluation form questions and scales

Categories and

questionsstatementsDescriptors on the 7-point rating scale

FamiliarityHow familiar were you with the topic before reading this FCS Sheet 1

=

Not at all4

=

Somewhat familiar7

=

Very familiar

Format and contentI liked the layout of the information 1

=

Strongly disagreeI found the font (print) size easy to read 4

=

Neither agree nor disagreeI found the style of print ease to read 7

=

Strongly agreeThis FCS Sheet is clearly written and easy to readThe information is presented in an unbiased wayI enjoyed reading this FCS Sheet

ImpactThis FCS Sheet increased my understanding of the topic 1

=

Strongly disagreeThis FCS Sheet has influenced what I think about the topic 4

=

Neither agree nor disagreeThis FCS Sheet will influence the things that I do when I am working with others 7

=

Strongly agreeI will share this FCS Sheet with othersOverall this FCS Sheet will be useful for me

FCS family-centred service


637



31

6 633ndash642

tentrsquo (six items) and 090 for lsquoimpactrsquo (five

items) Although the questions in the lsquoformat and

contentrsquo category appear to address two different

concepts the items were grouped together

because their standardized item coefficient alpha

scores were higher when grouped and the

research team judged that this grouping would

still allow for meaningful interpretation of the

findings The scores for these groupings were

determined by calculating the average rating of

the related items

The data were entered into the Statistical Pack-

age for the Social Sciences version 110 Descrip-

tive statistics were run to explore the demographic

variables and the scores related to familiarity for-

mat and content and impact of the FCS Sheets

Correlations between the demographic variables

and the familiarity format and content and

impact scores were calculated In addition mixed

model analyses were conducted to explore poten-

tial differences in the way the participant groups

rated their familiarity with the topics and the for-

mat and content and impact of each FCS Sheet

The level for detecting statistical significance was

set at

P

lt

005

Results

The participants

Twelve parents 12 childrenrsquos rehabilitation service

providers and 12 health science students evaluated

the FCS Sheets Tables 2ndash4 provide demographic

information about all of the participants Parent

respondents were all female (11 mothers one

adoptive mother) spoke English at home and the

majority lived in two-parent households There

was a range of education levels amongst the parent

respondents The respondentrsquos child with a disabil-

ity ranged in age from infant to adolescent and had

a variety of primary health andor developmental

problems Service providers came from the therapy

disciplines of speech occupational and physiother-

apy Providers had a broad range of years of expe-

rience both in practice and with children with

special needs Health sciences students also were

from the three therapy professions and 11 of the

12 students were in the first year of their educa-

tional programmes Seven of the 12 students had

previous experience in working with children with

special needs

Table 2

Demographic characteristics of the parents and their children (

n

=

12)

Category Response optionsNumber ofresponses

Percentage ofrespondents

Childrsquos age at time of the study Birth to 4 years 11 months 2 16750ndash9 years 11 months 5 417100ndash14 years 11 months 4 333150ndash20 years 1 83

Childrsquos primary health or development concern Autism or PDD 1 83Cerebral palsy 1 83Communication disorder 1 83Developmental delay 5 417Other 4 333

Number of services the child receives 1ndash5 4 3336ndash10 6 5011ndash15 2 167

More than one child in the family with special needs Yes 6 50No 6 50

Educational level of respondent Completed high school 3 25College or technical training 4 333University education 3 25University ndash graduate degree 2 167

PDD pervasive developmental disorder

638

M Law

et al



31

6 633ndash642

The FCS Sheets

Each participant evaluated three FCS Sheets

Figure 1 displays mean ratings of familiarity for-

mat and content and impact across all FCS Sheets

by each participant group

Familiarity

A mixed model analysis found significant differ-

ences between the participant groups (

F

=

419

df

=

2

P

=

003) regarding familiarity with the

topics

Post hoc comparisons found that across all

Table 3

Demographic characteristics of the service providers (

n

=

12)



Primary area of work Communicative disorders assistant 4 333Occupational therapy 2 167Physiotherapy 2 167Speech-language pathology 4 333

Experience with children and youthwith special needs

Less than 5 years 3 255 years to less than 10 years 4 33310 years to less than 15 years 2 16715 years to less than 20 years 2 16720 years or more 1 83

Number of service providers who workwith children in specified age groups

Birth to 4 years 11 months 12 1005 years to 9 years 11 months 7 58310 years to 14 years 11 months 4 33315 years to 20 years 3 25

Participants selected all applicable responses

Table 4

Demographic characteristics of the health science students (

n

=

12)



Primary area of work Occupational therapy 4 333Physiotherapy 4 333Speech-language pathology 4 333

Studentrsquos year of study First year 11 917Second year 1 83

Experience with children with special needs None 5 417Less than 2 years 2 1672 years to less than 4 years 4 3334 years to less than 6 years 1 83

Sibling with special needs Yes 0 0No 12 100

Figure 1

Mean ratings ndash all topics included

Respondent group

StudentService providerParent

Mea

n

70

60

50

40

30

20

10

00

Familiarity with topic

Format and content

Impact


639



31

6 633ndash642

topics students rated themselves as significantly

less familiar with the FCS topics than service pro-

viders (

t

=

-

280

P

=

001) There were no signifi-

cant differences between students and parents

(

t

=

-

201

P

=

006) or between parents and service

providers (

t

=

-

080

P

=

044) There were no sig-

nificant main effects of package (

F

=

191 df

=

5

P

=

013) that is the familiarity ratings were not

significantly different for different topic packages

These values are the result of the mixed model

analysis with the non-significant interaction

between group and package removed

Format and content

Participantsrsquo ratings of the format and content of

the FCS Sheets were very high with an overall

mean of 581 on the 7-point scale The parentsrsquo

mean score was 565 (SD

=

103) the service pro-

vidersrsquo mean score was 591 (SD

=

070) and the

studentsrsquo mean score was 587 (SD

=

061) Because

of the significant differences between participant

groups on topic familiarity familiarity was entered

as a covariate in the mixed model analysis of format

and content When the non-significant interac-

tions were removed from the analysis the main

effect of familiarity was found to be not significant

(

F

=

080 df

=

1

P

=

038) and this variable was

also removed There were no significant differences

between the groups (

F

=

070 df

=

2

P

=

052) or

the packages (

F

=

202 df

=

5

P

=

013) on ratings

of format and content However there was a sig-

nificant interaction between group and package

(

F

=

264 df

=

10

P

=

004) indicating that the

format and content ratings for packages differed

depending on participant group

Impact

Similar to the analysis of the ratings for format and

content familiarity was added as a covariate for

analysis of the impact ratings This mixed model

analysis found no significant main effects of pack-

age (

F

=

040 df

=

5

P

=

085) or participant

group (

F

=

147 df

=

2

P

=

025) after the non-

significant main effect of familiarity and the non-

significant interactions between group package

and familiarity were removed Thus there were no

significant differences in the way in which the par-

ticipant groups rated the impact of the FCS Sheets

and the specific packages did not have an impact

on the participantsrsquo ratings

Correlations

The relationships between familiarity format and

content and impact scores with the demographic

variables such as levels of work experience parent

education family income and level of service use

were also examined For parent respondents sig-

nificant correlations were found between familiar-

ity with the topics and number of services their

child received (

r

=

068

P lt 005) format and con-

tent and respondentrsquos level of education (r = -058

P lt 005) and impact and respondentrsquos level of

education (r = -065 P lt 005) Parent respondents

with university education provided lower ratings

for format and content (mean of 521 as compared

with 597) and impact (mean of 440 as compared

with 571) than parent respondents without uni-

versity education These differences were not

examined statistically because of the small number

of parents in each grouping There were no signif-

icant correlations between their childrsquos age and

measures of familiarity format and content or

impact There were no significant correlations for

service providers or students between familiarity

format and content or impact and number of years

of experience working with children with special

needs

Discussion

Findings from this study indicate that the FCS edu-

cational materials even those less familiar to par-

ticipants were rated highly on format and content

and impact Analyses found that there were no sig-

nificant differences between participant groups for

ratings of format and content and impact These

results indicate that the material was perceived to

be important to each group and was formatted

and written in a way that was easy to understand

This finding counters current recommendations in

the knowledge transfer literature that suggest dif-

ferent versions should be written for different

target groups (eg Lavis et al 2003) However it

640 M Law et al

copy 2005 Blackwell Publishing Ltd Child Care Health amp Development 31 6 633ndash642

supports previous research by members of this

research team that found one version written for a

number of audiences can be effective particularly

when the audiences are dealing with issues at the

same level (eg meeting the rehabilitation needs of

a child vs developing a policy) (Teplicky et al

2005) This finding suggests that writing educa-

tional materials in a clear and understandable

manner may obviate the need for the development

of different materials for each audience (Westbrook

amp Boethel 1995)

The analyses also found a significant interaction

between respondent group and package on format

and content While the reasons for this finding are

not clear some topics such as wait lists evidence-

supporting FCS setting goals may have been per-

ceived to be more relevant to service providers than

the other groups of participants

The inclusion of an assessment of familiarity

with the topics was important since the impact of

familiarity on openness to new ideas is unclear

Our results indicate that the use of educational

materials can increase perceived knowledge

whether or not the recipient is familiar with the

topic In contrast to parents and students service

providers rated themselves as highly familiar with

many of the FCS topics yet still perceived the mate-

rials to have impact The relative influence of famil-

iarity is being examined in more detail in another

study being conducted by our research team on

the impact of these educational materials on

behaviour

While we recognize that high ratings of per-

ceived impact may not lead to direct changes in

behaviours towards FCS there are ways in which

the FCS Sheets can be useful That is research and

theories of knowledge transfer (Rogers 1995

Grimshaw et al 2001) suggest that written materi-

als appear to increase awareness and knowledge

and interactiveinterpersonal approaches have bet-

ter potential for facilitating changes in practice

When interpersonal approaches (such as problem-

based learning interactive workshops or educa-

tional outreach visits) are utilized there is often a

need for materials to support the new knowledge

that is being communicated The FCS Sheets could

be used in conjunction with such interpersonal

approaches to provide an accessible resource or

starting point for learning more about FCS

(Teplicky 2005)

The study results also indicate a significant

inverse relationship between ratings of format and

content and impact with parentrsquos education level

It is hypothesized that parents who have a higher

level of education may have higher expectations of

educational materials and as a result may rate the

materials lower However there were relatively

small numbers of parents at each education level

so this finding could have been related to charac-

teristics of these individuals

A limitation of this study is that the sample size

although large enough to achieve sufficient statis-

tical power was relatively small In addition the

sample included parents and service providers

from only one childrenrsquos rehabilitation centre in

Ontario As well we did not involve decision mak-

ers in the evaluation so cannot comment on the

potential utility of the FCS Sheets for this group

Our findings however do indicate that it is

possible (and even desirable) to develop similar

educational materials for families students and

practitioners Each of these groups of participants

reported that the materials had an impact on their

knowledge and thinking as well as their intentions

to change their behaviours We believe that these

findings are very promising given the relative cost-

effectiveness of distributing written material

particularly through the use of electronic commu-

nication (eg the FCS Sheets can be downloaded

free of charge from the CanChild web site ndash http

wwwfhsmcmastercacanchild) Further research is

being conducted by our research team to examine

whether the FCS Sheets can be used to facilitate

actual changes in behaviour that will foster a more

family-centred approach to service delivery in chil-

drenrsquos rehabilitation centres Findings from this

research which is being conducted in three coun-

tries will help us to better understand the utility of

written materials that focus on providing informa-

tion and practical strategies for putting ideas into

practice

Acknowledgements

We wish to thank all study participants for sharing

their time and knowledge with us during the study

Family-centred service 641


We also wish to acknowledge Dr Stephen Walter for

statistical consultation Sarah Miles for editorial

work and Pat Abernathy for assistance with for-

matting the FCS Sheets This study was funded by

the Bloorview Childrenrsquos Hospital Foundation

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Ajzen I (1991) The theory of planned behaviour Orga-

nizational Behaviour and Human Decision Processes

50 179ndash211

Allen R I amp Petr C (1998) Rethinking family-centered

practice American Journal of Orthopsychiatry 68 4ndash

15

Bailey D B McWilliam P J amp Winton P J (1992)

Building family-centered practices in early interven-

tion a team-based model for change Infants and

Young Children 5 73ndash82

Brown S M Humphry R amp Taylor E (1997) A model

of the nature of family-therapist relationships impli-

cations for education American Journal of Occupa-

tional Therapy 51 597ndash603

Bruce B Letourneau N Ritchie J Laroque S

Dennis C amp Elliott M (2002) A multisite study of

health professionalsrsquo perceptions and practices of

family-centred care Journal of Family Nursing 8

408ndash429

Edelman L Elsayed S S amp McGonigel M (1992a)

Overview of Family-Centered Service Coordination

Pathfinder Resources St Paul MN USA

Edelman L Greenland B amp Mills B L (1992b) Build-

ing ParentProfessional Collaboration Facilitatorrsquos

Guide Kennedy Kreiger Institute St Paul MN USA

Edelman L Greenland B amp Mills B L (1992c) Family-

Centered Communication Skills Facilitatorrsquos Guide

Kennedy Kreiger Institute St Paul MN USA

Freemantle N Harvey E L Wolf F Grimshaw J M

Grilli R amp Bero L A (2003) Printed educational

materials effects on professional practice and health

care outcomes (Cochrane review) The Cochrane

Library 1 Available at httpgateway1ovidcom

ovidwebcgi (retrieved 14 April 2003)

Grimshaw J M Shirran L Tomas R Mowatt G

Fraser C Bero L Grilli R Harvey E Oxman A

amp OrsquoBrien M (2001) Changing provider behaviour

an overview of systematic reviews of interventions

Medical Care 39 (S2) IIndash2ndashII-45

Grimshaw J M Thomas R E MacLennan G Fraser

C Ramsay C R Vale L Whitty P Eccles M P

Matowe L Shirran L Wensing M Dijkstra R amp

Donaldson C (2004) Effectiveness and efficiency of

guideline dissemination and implementation strate-

gies Health Technology Assessment 8 1ndash102

Hostler S L (1994) Family-Centered Care An Approach

to Implementation University of Virginia Charlottes-

ville VA Canada

Iverson M Poulin Shimmel J Ciacera S amp Prabhakar

M (2003) Creating a family-centered approach to

early intervention service perceptions of parents

and professionals Pediatric Physical Therapy 15

23ndash31

King S Kertoy M King G Rosenbaum P Hurley P

amp Law M (2000) Children with Disabilities in Ontario

A Profile of Childrenrsquos Services Part 2 Perceptions About

Family-Centred Service Delivery for Children with

Disabilities McMaster University CanChild Centre

for Childhood Disability Research Hamilton ON

Canada

King G King S Rosenbaum P amp Goffin R (1999)

Family-centered caregiving and well-being of

parents of children with disabilities linking process

with outcome Journal of Pediatric Psychology 24

41ndash53

King S Teplicky R King G amp Rosenbaum P (2004)

Family-centered service for children with cerebral

palsy and their families a review of the literature Sem-

inars in Pediatric Neurology 11 78ndash86

Lavis J N Robertson D Woodside J M McLeod

C B amp Abelson J and the Knowledge Transfer Study

Group (2003) How can research organizations more

effectively transfer research knowledge to decision

makers Milbank Quarterly 81 221ndash248

Law M Hanna S King G Hurley P King S

Kertoy M amp Rosenbaum P (2003) Factors affecting

family-centred service delivery for children with dis-

abilities Child Care Health and Development 29

357ndash366

Lawlor M amp Mattingly C (1998) The complexities

embedded in family-centered care American Journal

of Occupational Therapy 52 259ndash267

Litchfield R amp MacDougall C (2002) Professional

issues for physiotherapists in family-centred and com-

munity-based settings Australian Journal of Physio-

therapy 48 105ndash112

Rogers E M (1995) Diffusion of Innovations 4th edn

The Free Press New York NY USA

Rosenbaum P King S Law M King G amp Evans J

(1998) Family-centred service a conceptual frame-

work and research review Physical and Occupational

Therapy in Pediatrics 18 1ndash20

Teplicky R (2005) Facilitating Family-centred Service in

a Childrenrsquos Rehabilitation Centre Impact of a Prob-

lem-based Learning Intervention Unpublished

masterrsquos Thesis McMaster University Hamilton

ON Canada

Teplicky R Law M Stewart D Rosenbaum P

DeMatteo C amp Rumney P (2005) Effectiveness of

642 M Law et al


rehabilitation for children and youth with brain

injury evaluating and disseminating the evidence

Archives of Physical Medicine and Rehabilitation 86

924ndash931

Westbrook J D amp Boethel M (1995) General Charac-

teristics of Effective Dissemination and Utilization

National Center for the Dissemination of Disability

Research Austin TX USA

Appendix 1 FCS Sheet topics and the packages in which they were grouped

General topics

Specific topics

FCS Sheet no Title Package no

1 What is family-centred service (FCS) 62 Myths about family-centred service 33 How does family-centred service make a difference 24 Becoming more family-centred 45 Ten things you can do to be family-centred 1

18 Are we really family-centred Checklists for families service providers and organizations 5


6 Identifying and building on parent and family strengths and resources 17 Parent-to-parent support 38 Effective communication in family-centred service 49 Using respectful behaviours and language 6

10 Working together from providing information to working in partnership 211 Negotiating dealing effectively with differences 412 Making decisions together how to decide what is best 513 Setting goals together 614 Advocacy how to get the best for your child 315 Getting the most from appointments and meetings 516 Fostering family-centred service in the school 117 Family-centred strategies for wait lists 2

634

M Law

et al



31

6 633ndash642

of resource limitations within healthcare systems

In light of these changes family-centred service

(FCS) has become increasingly adopted in hospi-

tals and community-based service organizations

across North America

FCS is a method and philosophy of service deliv-

ery that emphasizes a partnership between parents

and service providers (Hostler 1994) In this

approach each family is given the opportunity to

decide how involved they want to be in the services

and decision making for their child (Brown

et al

1997 Rosenbaum

et al

1998) The strengths

resources and needs of all family members are con-

sidered (Allen amp Petr 1998 Rosenbaum

et al

1998) There is evidence to indicate that FCS leads

to improved outcomes for children and families

(King

et al

1999 2004) and that parents are more

satisfied with services that are perceived to be fam-

ily-centred (King

et al

1999 Law

et al

2003)

The philosophy of FCS has been described in

many articles (Bailey

et al

1992 Edelman

et al

1992a Rosenbaum

et al

1998) Similarly several

studies have identified barriers that limit the

implementation of FCS Examples of such barriers

include limited time human resources and finan-

cial resources (King

et al

2000 Litchfield amp

MacDougall 2002) lack of skills needed to put FCS

into practice (King

et al

2000 Iverson

et al

2003)

and lack of support from the organization for using

FCS (King

et al

2000) Other authors indicate that

many service providers find it difficult to be family-

centred because they were trained in models such

as the medical model in which the service provider

is seen as the expert (Lawlor amp Mattingly 1998

Bruce

et al

2002)

The barriers listed in the previous paragraph

suggest a need for practical materials about the key

ideas of FCS and strategies to enable its implemen-

tation particularly for service providers and deci-

sion makers within healthcare organizations and

health science students Although the literature on

barriers to implementing FCS does not identify

issues specific to parents the nature of their role in

this approach implies that they would also benefit

from knowledge about and strategies for contrib-

uting to the family-centredness of services

One way to provide practical information about

FCS is through written educational materials

While there are some educational materials about

FCS available (eg Edelman

et al

1992b c) there

are no specifically designed packages of materials

that address the broad range of issues and partic-

ularly the skills required by parents service pro-

viders students and decision makers to implement

FCS As well there have been no reported evalua-

tions of the utility of educational materials in

improving peoplersquos understanding or practice of

FCS

In other areas of health care evaluation of the

impact of written materials on service providersrsquo

practice has yielded inconsistent results In a syn-

thesis of systematic reviews Grimshaw and col-

leagues (2001) reported that printed education

materials were generally not effective in facilitating

change in service provider behaviour but indicated

that they appear to raise awareness of new infor-

mation This finding is congruent with Diffusion

of Innovations Theory a theory of behaviour

change that proposes that mass-media strategies

(eg distribution of printed educational material)

are more effective in facilitating changes in aware-

ness and knowledge than changes in behaviour

(Rogers 1995) In addition this theory suggests the

importance of increased knowledge by hypothesiz-

ing that this change is a necessary precursor to

changes in behaviour The view that changes in

practice are preceded by changes in other areas is

also supported by the Theory of Planned Behav-

iour which specifies that changes in beliefs atti-

tudes and intentions to perform the behaviour

occur prior to behaviour change (Ajzen 1991)

However in a more recent systematic review of

the dissemination and implementation of clinical

practice guidelines Grimshaw and colleagues

(2004) report that the majority of strategies that

have been investigated including educational

materials have modest to moderate impact on the

way in which service providers deliver services

Freemantle and colleagues (2003) and Grimshaw

and colleagues (2004) indicate that the current lit-

erature in this area is limited both in quantity and

in quality and they conclude that further research

is needed to better understand the impact of

printed educational material and other activities

designed to facilitate changes in healthcare

practice


635



31

6 633ndash642










viding lsquo


about FCS













this study

Methods
















Appendix 1















































authors







636

M Law

et al



31

6 633ndash642

























McMaster University









evaluation forms






et al

2005) The form













Table 1


Categories and



=

Not at all4

=

Somewhat familiar7

=

Very familiar


=


=


=



=


=


=




637



31

6 633ndash642











the related items














set at

P

lt

005

Results

The participants





















special needs

Table 2


n

=

12)









638

M Law

et al



31

6 633ndash642

The FCS Sheets





Familiarity



F

=

419

df

=

2

P

=


topics


Table 3


n

=

12)









Table 4


n

=

12)







Figure 1


Respondent group


Mea

n

70

60

50

40

30

20

10

00


Format and content

Impact


639



31

6 633ndash642



viders (

t

=

-

280

P

=



(

t

=

-

201

P

=


providers (

t

=

-

080

P

=



F

=

191 df

=

5

P

=






Format and content





=



=

070) and the


=

061) Because







(

F

=

080 df

=

1

P

=




F

=

070 df

=

2

P

=

052) or

the packages (

F

=

202 df

=

5

P

=

013) on ratings



(

F

=

264 df

=

10

P

=




Impact





age (

F

=

040 df

=

5

P

=

085) or participant

group (

F

=

147 df

=

2

P

=

025) after the non-








Correlations








child received (

r

=

068


















needs

Discussion














640 M Law et al












amp Boethel 1995)





















behaviour


















(Teplicky 2005)









































practice

Acknowledgements










References



50 179ndash211



15













408ndash429





























ville VA Canada





23ndash31







Canada





41ndash53














357ndash366


















ON Canada



642 M Law et al





924ndash931






General topics

Specific topics








635



31

6 633ndash642










viding lsquo


about FCS













this study

Methods
















Appendix 1















































authors







636

M Law

et al



31

6 633ndash642

























McMaster University









evaluation forms






et al

2005) The form













Table 1


Categories and



=

Not at all4

=

Somewhat familiar7

=

Very familiar


=


=


=



=


=


=




637



31

6 633ndash642











the related items














set at

P

lt

005

Results

The participants





















special needs

Table 2


n

=

12)









638

M Law

et al



31

6 633ndash642

The FCS Sheets





Familiarity



F

=

419

df

=

2

P

=


topics


Table 3


n

=

12)









Table 4


n

=

12)







Figure 1


Respondent group


Mea

n

70

60

50

40

30

20

10

00


Format and content

Impact


639



31

6 633ndash642



viders (

t

=

-

280

P

=



(

t

=

-

201

P

=


providers (

t

=

-

080

P

=



F

=

191 df

=

5

P

=






Format and content





=



=

070) and the


=

061) Because







(

F

=

080 df

=

1

P

=




F

=

070 df

=

2

P

=

052) or

the packages (

F

=

202 df

=

5

P

=

013) on ratings



(

F

=

264 df

=

10

P

=




Impact





age (

F

=

040 df

=

5

P

=

085) or participant

group (

F

=

147 df

=

2

P

=

025) after the non-








Correlations








child received (

r

=

068


















needs

Discussion














640 M Law et al












amp Boethel 1995)





















behaviour


















(Teplicky 2005)









































practice

Acknowledgements










References



50 179ndash211



15













408ndash429





























ville VA Canada





23ndash31







Canada





41ndash53














357ndash366


















ON Canada



642 M Law et al





924ndash931






General topics

Specific topics







636

M Law

et al



31

6 633ndash642

























McMaster University









evaluation forms






et al

2005) The form













Table 1


Categories and



=

Not at all4

=

Somewhat familiar7

=

Very familiar


=


=


=



=


=


=




637



31

6 633ndash642











the related items














set at

P

lt

005

Results

The participants





















special needs

Table 2


n

=

12)









638

M Law

et al



31

6 633ndash642

The FCS Sheets





Familiarity



F

=

419

df

=

2

P

=


topics


Table 3


n

=

12)









Table 4


n

=

12)







Figure 1


Respondent group


Mea

n

70

60

50

40

30

20

10

00


Format and content

Impact


639



31

6 633ndash642



viders (

t

=

-

280

P

=



(

t

=

-

201

P

=


providers (

t

=

-

080

P

=



F

=

191 df

=

5

P

=






Format and content





=



=

070) and the


=

061) Because







(

F

=

080 df

=

1

P

=




F

=

070 df

=

2

P

=

052) or

the packages (

F

=

202 df

=

5

P

=

013) on ratings



(

F

=

264 df

=

10

P

=




Impact





age (

F

=

040 df

=

5

P

=

085) or participant

group (

F

=

147 df

=

2

P

=

025) after the non-








Correlations








child received (

r

=

068


















needs

Discussion














640 M Law et al












amp Boethel 1995)





















behaviour


















(Teplicky 2005)









































practice

Acknowledgements










References



50 179ndash211



15













408ndash429





























ville VA Canada





23ndash31







Canada





41ndash53














357ndash366


















ON Canada



642 M Law et al





924ndash931






General topics

Specific topics








637



31

6 633ndash642











the related items














set at

P

lt

005

Results

The participants





















special needs

Table 2


n

=

12)









638

M Law

et al



31

6 633ndash642

The FCS Sheets





Familiarity



F

=

419

df

=

2

P

=


topics


Table 3


n

=

12)









Table 4


n

=

12)







Figure 1


Respondent group


Mea

n

70

60

50

40

30

20

10

00


Format and content

Impact


639



31

6 633ndash642



viders (

t

=

-

280

P

=



(

t

=

-

201

P

=


providers (

t

=

-

080

P

=



F

=

191 df

=

5

P

=






Format and content





=



=

070) and the


=

061) Because







(

F

=

080 df

=

1

P

=




F

=

070 df

=

2

P

=

052) or

the packages (

F

=

202 df

=

5

P

=

013) on ratings



(

F

=

264 df

=

10

P

=




Impact





age (

F

=

040 df

=

5

P

=

085) or participant

group (

F

=

147 df

=

2

P

=

025) after the non-








Correlations








child received (

r

=

068


















needs

Discussion














640 M Law et al












amp Boethel 1995)





















behaviour


















(Teplicky 2005)









































practice

Acknowledgements










References



50 179ndash211



15













408ndash429





























ville VA Canada





23ndash31







Canada





41ndash53














357ndash366


















ON Canada



642 M Law et al





924ndash931






General topics

Specific topics







638

M Law

et al



31

6 633ndash642

The FCS Sheets





Familiarity



F

=

419

df

=

2

P

=


topics


Table 3


n

=

12)









Table 4


n

=

12)







Figure 1


Respondent group


Mea

n

70

60

50

40

30

20

10

00


Format and content

Impact


639



31

6 633ndash642



viders (

t

=

-

280

P

=



(

t

=

-

201

P

=


providers (

t

=

-

080

P

=



F

=

191 df

=

5

P

=






Format and content





=



=

070) and the


=

061) Because







(

F

=

080 df

=

1

P

=




F

=

070 df

=

2

P

=

052) or

the packages (

F

=

202 df

=

5

P

=

013) on ratings



(

F

=

264 df

=

10

P

=




Impact





age (

F

=

040 df

=

5

P

=

085) or participant

group (

F

=

147 df

=

2

P

=

025) after the non-








Correlations








child received (

r

=

068


















needs

Discussion














640 M Law et al












amp Boethel 1995)





















behaviour


















(Teplicky 2005)









































practice

Acknowledgements










References



50 179ndash211



15













408ndash429





























ville VA Canada





23ndash31







Canada





41ndash53














357ndash366


















ON Canada



642 M Law et al





924ndash931






General topics

Specific topics








639



31

6 633ndash642



viders (

t

=

-

280

P

=



(

t

=

-

201

P

=


providers (

t

=

-

080

P

=



F

=

191 df

=

5

P

=






Format and content





=



=

070) and the


=

061) Because







(

F

=

080 df

=

1

P

=




F

=

070 df

=

2

P

=

052) or

the packages (

F

=

202 df

=

5

P

=

013) on ratings



(

F

=

264 df

=

10

P

=




Impact





age (

F

=

040 df

=

5

P

=

085) or participant

group (

F

=

147 df

=

2

P

=

025) after the non-








Correlations








child received (

r

=

068


















needs

Discussion














640 M Law et al












amp Boethel 1995)





















behaviour


















(Teplicky 2005)









































practice

Acknowledgements










References



50 179ndash211



15













408ndash429





























ville VA Canada





23ndash31







Canada





41ndash53














357ndash366


















ON Canada



642 M Law et al





924ndash931






General topics

Specific topics







640 M Law et al












amp Boethel 1995)





















behaviour


















(Teplicky 2005)









































practice

Acknowledgements










References



50 179ndash211



15













408ndash429





























ville VA Canada





23ndash31







Canada





41ndash53














357ndash366


















ON Canada



642 M Law et al





924ndash931






General topics

Specific topics














References



50 179ndash211



15













408ndash429





























ville VA Canada





23ndash31







Canada





41ndash53














357ndash366


















ON Canada



642 M Law et al





924ndash931






General topics

Specific topics







642 M Law et al





924ndash931






General topics

Specific topics







Documents

Family-centred service: moving ideas into practice