Integrating a Family-Centered Approach into Social Work Practice with Families of Children and Adolescents with Disabilities

Abstract

This article identifies a family-centered practice construct for working with children and adolescents with disabilities and their families. The experiences of these families have shifted considerably over the past 30 years. A legislative and historical context provides the basis for an understanding of present policies and practices that influence current approaches to service delivery. Though family-centered practice is emphasized in various practice settings, there is still a need to integrate this philosophy into social work practice with children and adolescents with disabilities and their families. In order to enhance the ability of the social worker to integrate this construct into practice, a framework for exploring the experiences of children, adolescents and families is provided. This framework provides an overview of factors related to the individual child, the family and siblings for the social worker to consider when working with these families. The social worker's role as collaborator, advocate, team member and family resource is highlighted.     

A RATIONALE FOR FAMILY THERAPY SPECIALIZATION IN EARLY INTERVENTION

Over the past two decades, professionals providing intervention to families with children with disabilities have witnessed a philosophical shift from individually oriented care to family-centered care. Although the relevance of family therapy to these families has been formally acknowledged through the Individuals with Disabilities Education Act (IDEA), the integration of the fields of family therapy and developmental disabilities has not yet occurred to any signigicant degree. Awareness of critical issues associated with developmental disabilities and the potential impact on the family system is vital to the process of family-centered intervention. In this paper we address the need for family specialists to become knowledgeable about early intervention considerations relevant to young children with disabilities and their families.     

Family support in practice: voices from the field

This paper revisits core family support messages for social work practice in working with children and families, linking to findings from high-profile child protection cases in the UK and the Republic of Ireland. Drawing on a comparative study where these identified practice messages were explored through the lens of testimony of family support workers in the UK and Ireland, these core messages are examined. Operating with hard-to-engage children and parents, we hear how families and family support worker colleagues now view the core functions of child and family work across both jurisdictions (Ireland and England). The authors argue that by naming a more detailed set of practices that are deemed as most useful by families, based on the benefits and challenges of intensive family support work, key messages arise that have major resonance for social work and multiagency practice into the future. A basic message from this study is that valuable lessons on engagement and intervention with families can be drawn for professionals by examining the practice elements of this group of paraprofessionals in the child and family arena. This paper adds to debates on the role of support and intervention in social work and family support work.     

Understanding the experiences and needs of South Asian families caring for a child with learning disabilities in the United Kingdom: an experiential–contextual framework

The prevalence of learning disabilities amongst South Asian communities in the United Kingdom is thought to be almost three times higher than in any other community. Despite this, service utilisation amongst this group remains low and working cross-culturally can pose unique challenges for service providers. The experiences of South Asian families caring for a child with learning disabilities within the United Kingdom are multifaceted. This article proposes an experiential–contextual framework for exploring these experiences. The framework incorporates minority experiences as well as medical and social models of disability. The experiential–contextual framework has been applied to understanding important aspects of South Asians experiences, including: the interpretations and understanding of learning disabilities; interactions with healthcare systems; minority group pressures; and the influence of acculturation and diversity within ethnic groups.     

Achieving Competent Family Practice with Same-Sex Parents

Abstract

Due to the increasing recognition of same-sex marriage in different jurisdictions and growing numbers of parents raising children in the context of a same-sex relationship, it is becoming ever more important for family therapists to attain clinical competence in working with families headed by same-sex parents. This paper takes as its premise that good intentions and general acceptance of diversity are not sufficient in working with this population of families. Rather, clinical competence rests on experience working with lesbian and gay clients and knowledge of the impact of heterosexism on parenting in the context of same-sex relationships. Equally critical to competent family therapy practice is a theoretical framework that pulls together complementary concepts from different bodies of theory to analyze family structures and functions in the social context of heterosexism. To this end, this paper reviews family systems theory, structural social work, ecological systems theory and queer theory with an eye to culling complementary constructs relevant to working with same-sex parents. Specific aspects of family functioning such as maintenance of boundaries around and within families and role differentiation between parents are then explored using this theoretical framework. Finally, implications for the clinician working with families led by same-sex parents are reviewed.     

Rural social work The perceptions and experiences of five remote practitioners

Abstract

Living and working as a remote, rural social worker is a challenging experience. This qualitative study explores the experiences of five longer-term social workers in rural Western Australia. It provides a glimpse of their world including initial experiences, factors which support long-term rural practice, the demands and skills needed, the difficulties working in a bureaucracy and the positive aspects of rural practice. Tentative conclusions indicate that rural practice is distinct, due to the demands of living and working in the same community. Moreover, skills must be applied in the context of few secondary referral points or after hours services, and huge distances. The difficulty of maintaining professional identity and feelings of personal isolation are significant, but are compensated for by families who are settled and reluctant to leave, These findings can be used to inform social work education and improve retention of workers and quality of rural practice.     

Families with Children with Disabilities - Inequalities and the Social Model

This article suggests that families with children with disabilities experience a range of inequalities that families with children without disabilities do not suffer. It draws on a recent qualitative study to illustrate the way in which it is not just disabled people, but in the case of disabled children, whole families that suffer from unequal opportunities and outcomes. We draw on the social model of disability to show that the lives of these families are often characterised by financial hardship, stress and anxiety as a result of social barriers, prejudices and poorly conceived service provision. The social model of disability is usually drawn upon to illustrate the way in which social organisation disables people with impairments. In this instance, we illustrate the way in which social organisation disables not just the family member who has an impairment but the whole family unit. By applying this model of disability, new ways of creating practices and policies for these families can be developed which incorporate their views into the heart of the policy-making process.     

Creating space to think and feel in child protection social work; a psychodynamic intervention

Professionals working with families in difficulty require a structured space to consider their work. As organisations and the systems within and across them become more sophisticated it seems that less attention is being paid to the emotional and psychological aspects of working with families than to the paperwork and processes that surround the work. Systems psychodynamic theory and the methodical reflective practices it underpins offers a suitable framework in which to consider practicing and researching in this emotionally complex field. This paper describes one aspect of a small doctoral study designed to provide a sustained reflective space (Work Discussion Group) to Irish child protection social workers in order to closely explore the reality of their practice experience. This paper explores one worker’s experience of bringing a written account of her work with a family to the WDG. Findings suggest that her work was undertaken in a climate concerned with efficiency, certainty and the reduction of risk. This climate evoked anxiety and reduced opportunities for reflective and considered practice. The work discussion group provided containment for this worker’s anxiety and allowed her to make sense of this anxiety and its accompanying defences and to move closer to working with this family.     

The Postadoption Needs of Adoptive Parents of Children With Disabilities

Adoptions of children with disabilities are considered special needs, due to the higher level of support needed pre- and postadoption by families and children for adoptions to succeed. Despite this fact, very few studies examine the specific postadoption experiences of families with children with disabilities. Using secondary analysis of a national survey of adoptive parents, as well as interviews and a focus group with adoptive parents in one state, this study examines families’ with adopted children with disabilities challenges and unmet needs after adoption, as well as the postadoption needs and experiences of adoptive families with children with developmental and intellectual disabilities and adoptive families of children with emotional, behavioral, and mental health disabilities. Findings indicate that families with children with disabilities do report higher rates of challenges and barriers to service access, and that this is particularly true in families with adopted children with emotional, behavioral, and mental health disabilities. Implications for research and practice are discussed.     

Interpersonal justice: the importance of relationships for child and family social workers

There is still much to learn about what it means to be a child and family social worker. Child and family social workers have a job that often entails making difficult decisions regarding vulnerable children and families in collaboration with other professionals, under stressful conditions in an increasing cost-restrictive climate with diminishing resources. The organisational justice framework has primarily been used to ascertain employee’s perceptions of fairness and can be used to explain a variety of organisational behaviours. Here, it was used qualitatively as a framework to structure the research aims of exploring the lived experience of child and family social workers. The results suggest that the relationships’ social workers have with their peers and managers are significant components to how they manage emotions involved with practice.     

Bespoke program design for school-aged therapy disability service delivery

This article uses the evaluation of a school-aged therapy service for children with disabilities in Western Australia to investigate models of service delivery. The current literature on family-centered practice, multidisciplinary and transdisciplinary approaches, and 4 models of service are reviewed. The models include the life needs model, the relational goal-orientated model of optimal service delivery to children and families, the quality of life model, and the collaborative model of service delivery. Analysis of the data is presented together with a bespoke model of service delivery for children with disabilities, arguing that local contexts benefit from custom-made service design.     

Health Care innovation and children in poverty: lived experiences of caregivers of children with disabilities in a medicaid-serving ACO

This paper reports the results of a qualitative study of caregivers of children with disabilities enrolled in a Medicaid-serving accountable care organization (ACO). The state of Ohio mandated ACO enrollment for Medicaid-eligible children with disabilities in 34 of 88 counties effective July 2013. Research participants were queried in focus groups and individual interviews about their children’s care experiences and care coordination after enrollment. Most told researchers that they themselves are their children’s care coordinators, and many indicated that resource scarcity is a more pressing problem than fragmented care. Data analysis identified a theme of scarcity and four categories of insufficiency that made caregiver efforts on behalf of their children more difficult: a lack of health services under managed care, resource constraints on other agencies and programs for which families were eligible, a lack of financial support, and a lack of family support. A conceptual framework places ACO care coordination among more upstream factors and identifies ways in which ACOs serving Medicaid populations may wish to address the social determinants of the well-being of children with disabilities. Implications for future research are discussed.     

An exploratory study of the relationships between adolescents with impaired mobility and their parents in Greek families

This study questions commonly held Greek social policy assumptions that families are the best and only providers of support to children and adolescents with impaired mobility. This is because the experiences of family life by Greek adolescents with such impairments can be characterized by a cycle of over-protection, dependency and social isolation. We also identify theories of disability that might help to explain the life experiences of the adolescents in our study. Because there is limited research that has examined such ideas in the Greek context we propose an initial and modest hypothesis informed by these theories to explain this cycle of impaired functional, psychological and social development experienced by these adolescents in Greek society.     

Dating and Sexuality among Minority Adolescents with Disabilities: An Application of Sociocultural Theory

Adolescents with disabilities, American Indians, Hispanics, and African Americans are more likely to experience victimization and pregnancy as teens. This study explored ethnic and racial minority youth with disabilities’ dating and sexual experiences from the perspectives of social workers using Vygotsky’s sociocultural theory. Thirteen in-depth interviews were conducted with master’s degree–holding high school social work practitioners. Social workers described family beliefs and practices, socioeconomic status, special education, historical influences, and resiliency as aspects of adolescents’ lives that impacted their dating and sexuality. Social workers’ dialogue concerning family beliefs and attitudes toward abusive relationships were interpreted as internally oriented signs used by adolescents with disabilities to navigate their dating and sexuality. Socioeconomic status, family practices, and special education were interpreted as externally oriented meditational tools. Social workers reported that many adolescents experienced a history of violence, but that some adolescents adapted their cultural heritage by creating new values for themselves and engaged in healthier dating and sexual behaviors than their peers. Finally, although social workers were a source of support to adolescents with disabilities, they were also at times a portal for ethnocentric discourse.     

Applications of a Capability approach to disability and the International Classification of Functioning, Disability and Health (ICF) in social work practice

As disability rates increase more social workers will require greater preparation to practice effectively with individuals with disabilities. The Capability approach and the International Classification of Functioning, Disability and Health provide helpful tools for social worker training. The capability approach emphasizes the need to assess what individuals are able to do in their real-life environments (capabilities) rather than capacity or functional status. The ICF provides helpful disability-related terminology and an actual classification to assist social workers to develop appropriate interventions that facilitate capability development among individuals with disabilities. Using the capability framework with the ICF will contribute to improved understanding of disability among social work students and practitioners.     

Social Workers’ Roles in Supporting the Sexual and Relational Health of Children with Disabilities

The purpose of this study was to understand social workers’ roles in meeting the sexual and relational health needs of children (aged 3–11) with disabilities. We conducted semi-structured interviews with 12 social workers from a range of practice settings. A phenomenological lens privileged the perspectives of social workers in their definitions of disability and sought to convey the meaning they assigned to their experiences of working with children in practice concerning matters related to sexual and relational health. Social workers enacted a broad definition of disability and often came to work with youth in contexts labeled as sexually problematic. In the provision of sexual health services, social workers embodied commonly adhered to roles including as practitioners, enablers, advocates, brokers, and managers. Services are needed that promote positive sexuality and relational health among children with disabilities. It is important that social workers be proactive advocates for the full inclusion of people with disabilities as equal sexual citizens.     

Outcomes of family centered meetings for families referred to Child Protective Services

In order to address the number of children entering the foster care system each year and to promote the family's participation in the decision-making process, family-centered meetings have been widely adopted throughout the United States as well as in other countries. Since 1989, Family Group Conferencing, Family Group Decision Making, and Family Team Meetings have all been introduced into public child welfare systems. This paper will refer to all three approaches as family-centered meetings. However, little empirical research has been done to test the impact of these meetings on families referred to Child Protective Services (CPS). This paper examines literature on the impact of family-centered meetings with families referred to CPS on child and family functioning outcomes. The results suggest that more research is needed to examine fidelity models and specific types of interventions being implemented. However, all of these three appear to increase kinship care placements. More research is needed, specifically regarding the contexts where family-centered interventions could be appropriate. Implications for practice are also discussed, with special consideration of integrating family-centered interventions with other interventions to promote both family participation and child safety.     

An approach to learning about social work with people with disabilities

The author shares some practice experience and personal reflection on her introduction to working with people with disabilities. Recognizing that the construct of "disability" is in the eye of the beholder, she shares an outline for one approach to an introductory course in working with people with physical, cognitive and developmental, and psychiatric disabilities. Common themes in practice and service delivery are discussed, as well as the unique role social workers can play in interagency collaboration.     

Everything you never wanted to know about special education . . . and were afraid to ask (I.D.E.A.)

Social workers who work with families and children are often unaware of the legal protections afforded to educational experiences for children, particularly to children with disabilities. Yet, all social workers, regardless of their practice setting, should be aware of the important educational rights to which children with disabilities and their families are entitled, as codified in the original legislation, P.L. 94-142, and its subsequent revisions. This legislation is currently entitled the "Individuals with Disabilities Education Act," or the "I.D.E.A." Provisions included in the I.D.E.A. are covered with which all states that receive federal educational funding are mandated to comply. Reviewed are the 13 "disabling conditions" that allow for students to qualify to receive special educational services, as long as one of the conditions is adversely impacting their educational success. It concludes with recommendations for social work advocacy regarding this legislation.     

A study of home-based services for families of adolescents

Adolescents and their families present some of the most difficult challenges for family-centered, home-based service providers. A study of 51 families of adolescents, who received services from one rural home-based program was conducted in order to describe the characteristics distinguishing families in which placement was averted from families in which placement was not. Content analysis of case records indicated group differences on severity and type of adolescent behavior, family functioning, and families' follow-up with discharge recommendations. Gender differences in placement rates were also noted. Implications for the provision of family-centered, home-based services to families of adolescents were discussed.