Family-centered and Family-focused approaches are often portrayed as similar or equal to each other, though there are inherent differences between the two, especially in relation to how the family is perceived.
Engaging families is both science and an art. Engaging families is also multi-disciplinary, and a vital component in juvenile justice, education, child welfare, behavioral health, medical and social services. Organizational frameworks of practice can be either family-focused or family-centered. These frameworks can be at the center, the core, of every aspect of services provided and the manner in which servives are planned and delivered. It is a theoretical orientation which determines the regard for families, the level of input from families, and the goals differ with each approach.
Family-Focused Care, program design, engagement approach places families at the center of services, but the goals are externally imposed, almost dictated to families as subordinate to the expert professionals. This methodology informs parents that ‘this is what we need you to do’ as opposed to ‘tell us what you need us to help you do’.Though families are the focus of care, they are not placed at the center of care. It remains an ‘us vs. them’ paradigm, and not a ‘we’ model.
A Family-Centered Care[FCC]approach:
- sees the patient and family as the experts on themselves. Patients and families are active participants in all aspects of services and involved in the decision-making about care.
- feels patients, families and professionals bring different strengths and resources to the working relationship.
- feels that families have important information to share with professionals.
- has the helping relationship set up as a partnership based on trust, respect, honesty and open communication. Everyone works collaboratively in addressing needs and concerns.
Two interconnected models of care that exemplify a family-centered approach in children’s mental health – systems of care and wraparound – have been evolving in the United States. Systems of care was developed in the 1980s to address the needs of children with serious mental and emotional disorders In a systems-of-care approach, agencies work together and collaboratively with families to ensure that children and their families have access to the services and supports that they need to succeed. It is described as a community-based, child-centered, family-focused, culturally appropriate service approach in which care is tailored to the needs and preferences of individual children and families.
Within the context of their families, the children are placed at the center of the clinical process, and their families are acknowledged as full partners at all levels of system planning. Families are included at every level of the process, and services are collaborative, integrated and provided in the least restrictive settings possible.
A core component of the systems of care model is its use of wraparound. Wraparound is an “integrated assessment and planning process” that literally wraps services around the children by using the strengths, needs and goals of individual children and their families along with services in the families’ natural support system in developing the treatment plans.
In the United States, wraparound has become the national standard for service planning for children and youth with complex mental health needs and their families, and systems of care is the national standard for service delivery. They all indicate a shift from a crisis-oriented, professionally directed, acute-care approach focusing on unique episodes to a model that stresses continuing care, an ecological approach and long-term supports.
Children do not live in isolation; they are cared for and nurtured in their families and communities. A paradigm shift is required in which families are viewed as a key part of the solution rather than as part of the problem. Professionals working in children’s mental health services should actively invite youth and families to be involved at all levels. Service providers must be supported in acquiring the skills needed to practice FCC. Working collaboratively, with children and families recognized as part of the interdisciplinary team, viewing children in the context of their families and communities, and being able to identify and build on child and family strengths with a focus on instilling hope and optimism require new knowledge and skills.
Due to the stigma associated with mental health issues, families have not been as strong in advocating for change in mental health as they have been in other areas of child health, but this is beginning to change, and in the case of education, the shift to parent partnerships, parent leadership and decision-making at school, is following the other disciplines. Families are now being placed at the center of education policy, learning progress, practices, services and are identified as meaningful and valued allies sharing similar goals for children-academic success. Let the family advocacy movement continue!