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Overview and Theoretical Foundation of Family-Centered Care

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Family-centered care is a service delivery philosophy and approach that respects the rights, roles, and abilities of family members. Services are provided through a collaboration with the family and child to support their outcomes and promote their well-being and quality of life.

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Physical therapists have identified the need for professional and post-professional training to foster competency in collaborating with families (Cochrane & Farley, 1990; Iversen, Shimmel, Ciacera, & Prabhakar, 2003; Sparling & Sekerak, 1992). While professionals value family-centered care, there can be challenges when implementing this philosophy (Bruce et al., 2002).

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The purpose of this chapter is to provide an introduction to issues related to family-centered care to support physical therapists in their interactions and interventions with the children and families they serve.

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Family-centered care is not restricted to the pediatric specialty area; it is a life-span approach. The World Health Organization's model on functioning, disability, and health supports a family-centered approach (2001). Cherry (1991) identified that in pediatric physical therapy, “there is a greater need for a holistic approach that encompasses the total child, the family, and the natural settings where children live, learn, and play” (p. 70). This need especially continues during the transition into adulthood (Gall, Kingsnorth, & Healy, 2006; Rubin & Quinn-Curran, 1983).

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In addition, family-centered care is not restricted to one practice setting. Family-centered care is a standard of practice for both hospital and community-based services. Family-centered care provides an opportunity for a preventive and supportive approach to wellness across the life span and along the entire continuum of care.

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The foundation for family-centered practice is based on the synthesis of many theoretical frameworks. The fundamental premise of family-centered care is that a person does not exist in isolation but functions within a family as well as within larger and more complex social systems. Social systems, including the family unit, influence the function of that person, and that person subsequently influences the function of the systems to which he or she belongs. This proposition is central to systems theory. The family systems theory views individual and family functioning as an interactional dynamic process (Becvar & Becvar, 1988). Interventions for the family can indirectly influence the child's development and function.

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In pediatric physical therapy, the needs of children can best be met by involving their families. The transactional model of development emphasizes the reciprocal relationship between the child and caregiving environment and stresses the importance of an appropriate match between the child and the environment. A supportive environment may minimize the effects of biological risks (Sameroff & Chandler, 1975; Sameroff & MacKenzie, 2003). The child's characteristics and the environment together influence functional outcomes.

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The ecological model of human development discusses the role that larger social systems ...

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