Working with children, adolescents and young adults with a disability and their families
Family-centred, person-centred
allied health
A guide for practitioners in private practice,
schools and clinical settings
Family-centred, person-centred allied health – FINAL TEXT
1
Published by Disability Services Division
Victorian Government Department of Human Services
50 Lonsdale Street Melbourne Victoria Australia
June 2012
© Copyright State of Victoria, Department of Human Services and Department of Education and
Early Childhood Development, 2012.
This publication is copyright. No part may be reproduced by any process except in accordance with
the provisions of the Copyright Act 1968.
ISBN 978-0-7311-6525-4 (online version)
Authorised and published by the Victorian Government
50 Lonsdale Street, Melbourne
(0210212)
If you would like to receive this publication in another format, please phone 1300 336
731, using the National Relay Service 13 36 77 if required.
This document is available as a word file and a PDF file on the Internet at
www.dhs.vic.gov.au
Family-centred, person-centred allied health – FINAL TEXT
2
Acknowledgements
The Department of Human Services and the Department of Education and Early Childhood Development
wish to acknowledge the contribution of colleagues from around Victoria who provided information and
feedback during the development of the family-centred practice guides suite.
This project aimed to be family centred in its approach; grateful thanks to all the families and people with a
disability who shared their stories and ideas for the project with generosity, courage and candour. Names
and other identifying features have been changed to preserve anonymity.
The project team were: from Red Tree Consulting, consultants, researchers and writers Sarah Marlowe,
Elizabeth Wheeler and Cara Brough; from the Association for Children with a Disability, project manager and
Chief Executive Officer Elizabeth McGarry, project worker Janice Chan and other ACD staff and members;
and researchers and critical readers Carmel Laragy from the RMIT School of Global Studies and her
colleagues Mary Collins and Enza Santangelo.
Suggested citation: Department of Human Services and Department of Education and Early Childhood
Development 2011, Family-centred, person-centred allied health: a guide for practitioners in private practice,
schools and clinical settings, State Government of Victoria, Melbourne.
Family-centred, person-centred allied health – FINAL TEXT
3
Contents
1 Introduction ...................................................................................................................... 6
Who this guide is for .......................................................................................................................................... 6
Principles and context........................................................................................................................................ 6
2 Foundations ..................................................................................................................... 8
Defining family-centred practice ........................................................................................................................ 8
The evidence for family-centred practice ........................................................................................................... 9
Family and person centred ................................................................................................................................ 9
Family-centred practice in our diverse community .......................................................................................... 10
Working with Aboriginal families ...................................................................................................................... 10
Working with culturally and linguistically diverse families ................................................................................ 10
Family-centred organisations .......................................................................................................................... 11
A family-centred service system ...................................................................................................................... 11
Good practice scenario: Crista ........................................................................................... 12
3 Practices that build relationships ................................................................................... 15
Your beliefs, attitudes and values .................................................................................................................... 15
Reflect on your values ..................................................................................................................................... 15
Understand and share power .......................................................................................................................... 16
Interpersonal behaviour ................................................................................................................................... 16
Support people to make informed decisions ................................................................................................... 17
Offer and use interpreters skilfully ................................................................................................................... 17
Keep people in the loop ................................................................................................................................... 17
Good practice scenario: Adam ........................................................................................... 19
4 Practices that support choice ......................................................................................... 22
Decision making and action ............................................................................................................................. 22
Work with people to set outcomes.............................................................................................................. 22
‘Release’ people’s capacity to act .............................................................................................................. 22
Children, young people and decision making............................................................................................. 23
If you are concerned about people’s choices ............................................................................................. 23
Flexible and responsive services ..................................................................................................................... 24
Provide flexible, tailored services ............................................................................................................... 24
Respond to change .................................................................................................................................... 24
Good practice scenario: Tyler ............................................................................................ 25
5 Technical quality ............................................................................................................ 28
Practice informed by everyone’s knowledge ................................................................................................... 28
Improve teamwork and service integration ...................................................................................................... 28
Refer and use secondary consultation ............................................................................................................ 29
Use natural environments ................................................................................................................................ 29
Explain and provide evidence for your approach ....................................................................................... 30
Tailor activities to different environments ................................................................................................... 30
Respond to protective concerns ...................................................................................................................... 30
Self-care and maintaining boundaries ............................................................................................................. 30
Good practice scenario: Georgie ....................................................................................... 31
Family-centred, person-centred allied health – FINAL TEXT
4
6 Monitoring and improving practice ................................................................................. 34
Reflective practice and these guides ............................................................................................................... 34
Monitor and seek feedback ............................................................................................................................. 35
Next steps ........................................................................................................................................................ 35
Endnotes............................................................................................................................ 36
Family-centred, person-centred allied health – FINAL TEXT
5
1 Introduction
It is good when [professionals] ask questions about the child but also openly address the issues a family
might be facing. This is very important because traditionally when someone had a disabled child they keep
things to themselves. They don’t tell friends or others in the community. They feel a lot of guilt. Traditionally,
we believe that a child has a disability because the family did something wrong in a previous life. They are
being punished by God. That’s why we feel shame. When a worker asks about the issues for the family it
can open up your heart. – Lilly, member of a support group for families from a South-East Asian community
Who this guide is for
This is a resource for allied health practitioners working with children and young people with a disability or
developmental delay who wish to explore how working in more family-centred ways can enhance their
practice. The guide aims to orient practitioners less experienced in the approach, and to support their more
experienced colleagues to reflect on and improve this aspect of their practice. Research suggests that even
those dedicated to family-centred practice find it difficult to fully maintain this over time. 1 Other research
reveals that a gap can arise between how family-centred practitioners think of the quality of their work and
the experiences of those they work with.2,3
This is one of seven family-centred practice guides for those working with people with a disability aged 0 to
25 and their families in early childhood intervention (ECI), disability support, planning and education.
Readers interested in deeper exploration should read the foundation guide or, if applicable, the ECI
professionals’ guide. Those with a case management role might benefit from reading Family-centred,
person-centred planning: a practice guide for professionals in intake, planning and case management roles.
Principles and context
The policy context for family-centred practice differs according to professional setting but, broadly,
developments are towards greater emphasis on: evidence-based and reflective practice; inclusion and
participation; choice, self-determination and self-directed support; service integration; and partnership with
families (see Principles, below).
A range of policy documents and resources provide further context for this guide, including: the Victorian
early years learning and development framework, the Early childhood intervention practitioner competencies,
the National disability strategy, the Disability Act 2006 (Vic) and the Commonwealth Family–school
partnerships framework.
Pull out Box - Principles
Children and young people with a disability or developmental delay and their families are best placed to know what mix of
services and supports are likely to meet their needs. Services should be based on the priorities of children and young people
and their families, responding to the particular stage of the child or young person’s development.
A child- and family-centred approach based on a partnership between parents and professionals should maximise the
choices and opportunities available to children and young people with a disability or developmental delay and their
families.
Services provided to children, adolescents and young adults with a disability or developmental delay and their families
should be guided by the following principles:

The best interests of children and young people are paramount.

Services and supports protect and promote human rights, including the rights of the child and young person with a
disability or developmental delay.
 All subsequent references will be to ‘people with a disability’ only for ease of reading.
Family-centred, person-centred allied health – FINAL TEXT
6

Services and supports adopt a child- and family-centred approach that promotes choice and opportunity.

Services and supports are accessible and coordinated to intervene early and adopt a life-cycle approach to the
planning and provision of services.

Services and supports are integrated to meet the holistic needs of children and young people with a disability or
developmental delay and their families.

Services and supports promote social inclusion.

Services and supports are accessible and appropriate for children and young people from diverse cultures and their
families.
Family-centred, person-centred allied health – FINAL TEXT
7
2 Foundations
When you’re dealing with any array of specialists, they all have conflicting ideas. The people I connected
with are those who are prepared to listen [and] say to me, ‘Actually, different people think different things.
I probably like this approach, or I can see merit in this, but there are a variety of opinions on this topic or
options for you to look at.’ It’s empowering. – Kate, mother of Jamie (who has pervasive developmental
disorder) and his younger siblings, Melanie and Callum (who both have Asperger’s syndrome)
Defining family-centred practice
Family-centred practice is a set of values, skills, behaviours and knowledge that recognises the centrality of
families in the lives of children and young people. It is grounded in respect for the uniqueness of every
person and family, and a commitment to partnering with families and communities to support children and
young people with a developmental delay or disability to learn, grow and thrive. It puts family life – and the
strengths, needs and choices of people with a disability and their families – at the centre of service planning,
development, implementation and evaluation.
Family-centred practice is not an end in itself, rather it enables professionals to do what they do more
effectively. It is no less important because of that. Evidence shows that the way supports are provided has
an impact on families, as well as the supports themselves. 4 Supports to families, rather than services, are
central to family-centred practice. The understanding of family-centred practice reflected in this resource is
informed by current literature and interviews with families, people with a disability and professionals. The
concept of ‘family life’ is central, and goes beyond the child or young person and family themselves. It is
them and everything that makes up their world: their relationships, resources and daily lives; their culture,
community and language; their stressors, needs and tensions; their preferences, interests and priorities; their
goals, hopes and aspirations.
When thinking about complex ideas, a model can be a useful tool to breaking down and focusing on key
ideas. These guides use a model drawn from the work of American researchers Carl Dunst and Carol
Trivette,5 which divides family-centred practice into three key elements, and associated aspects (See Figure
1).
Figure 1: The three elements of family-centred practice
Adapted from Dunst and Trivette, 2007
Family-centred, person-centred allied health – FINAL TEXT
8

Practices that build relationships are summarised in the model as the professional’s beliefs, values
and attitudes, and their interpersonal behaviours and skills.

Practices that support choice and participation are those that seek to empower children, young
people and families to make informed decisions and take action, and those that ensure professionals
respond to their unique and changing needs.

Technical quality is about having the information, knowledge and expertise needed to deliver highquality supports and services, and apply it for the benefit of children and families.
The following chapters outline each element in turn, giving tips and ideas for practice. In between, their
implications are explored through good practice scenarios drawn from the experiences of children, families
and professionals. Practice points alongside are colour-coded to the elements for easy reference.
The evidence for family-centred practice
In recent years increasingly strong evidence has begun to emerge about the efficacy of family-centred
practice in a range of settings. A 2007 synthesis of 47 studies, primarily in early childhood intervention
settings, reported links between family-centred practice and greater family satisfaction with the helpfulness of
services, as well as improvements in parental self-efficacy, levels of social support available to the family,
child behaviour/wellbeing, and family functioning.6
Australian reviews of the family-centred practice literature have concluded that the theoretical evidence for
the approach is strong,7 and that family-centred practice produces ‘positive parent and family benefits
beyond those produced by structural intervention factors (such as the form and frequency of services
provided) and non-intervention factors (such as employment, housing and health care)’. 8 In 2010 a further
synthesis of 52 studies concluded that: family-centred approaches had both direct and indirect effects on
parent, family and child behaviour and functioning; indirect effects were the strongest; and these occurred
through parental self-efficacy beliefs. That is, parental self-efficacy and wellbeing influenced parent–child
interactions, which in turn had a positive effect on child development. 9
In a school context, evidence also suggests that greater partnership between school staff and families has
benefits for: learning outcomes; student engagement and retention; smoother transitions; increased
confidence; social skills; emotional resilience; communication skills; classroom behaviour and general
wellbeing; and reducing the effects of disadvantage among children from low socioeconomic backgrounds.10
Family and person centred
Approaches within allied health have changed over time from a largely medical model to a more personcentred and sometimes family-centred approach. Traditionally, clinic-based ‘interventions’ focused on the
child or young person, with goals set by professionals and informed by medical needs and expected
developmental pathways.11 In the past two decades this began to change as services and supports moved
more into community settings and practitioners recognised the benefits of family involvement in carrying out
therapeutic activities, setting goals and shaping supports. Practitioners are also recognising the benefits of
drawing on the family’s knowledge to better understand the child or young person’s environment and
context.12,13
Working with families is important, but the focus on the child, adolescent or young adult with a disability
remains equally so. This is because supporting their potential, wellbeing, inclusion and participation is the
ultimate goal. It is also because almost all young people, as they mature, want more say in their daily lives
and futures. When they reach adulthood, most will have the legal right to make their own decisions. Indeed,
all young people, as they mature, need support to develop the skills and confidence needed to make
decisions for themselves, or to contribute to decision making according to their capacity. Practitioners need
to consider how to support a child or young person to have input into decisions that affect them.
In some ways, family-centred practice and person-centred practice are two sides of a coin, requiring similar
skills and behaviours. Yet they can come into tension if the views of young people and families conflict, as
can happen in any family.
Family-centred, person-centred allied health – FINAL TEXT
9
Family-centred practice in our diverse community
Victorians are very diverse. We come from more than 200 nations and 120 faiths, speak more than 200
languages and dialects, and include more than 30,000 Aboriginal people, representing more than 30 distinct
communities. Almost a quarter of us were born overseas, 74 per cent from non-English-speaking countries;
one in five of us speak a language other than English at home.14
Culturally responsive practice is when professionals and organisations respond respectfully and skilfully to
the needs of diverse communities, addressing discrimination and ensuring that culture informs all aspects of
service provision: from intake, assessment and planning to implementation, monitoring and evaluation.
Culturally responsive practice and family-centred practice are deeply linked, because culture profoundly
shapes both human development and family structures, whatever a family’s cultural background.
Understanding and responding skilfully to this is key to: ‘looking at the whole child and not just the presenting
problem, looking at the whole extended family and not just the parents, and looking at the whole community
and not just the family … culture is a key mediator between people and their social environments’. 15
The principles and basic approaches to cultural responsiveness with Aboriginal and culturally and
linguistically diverse (CALD) families are similar, but the practices and key issues are very different, in part
due to cultural differences, but also because of Aboriginal communities’ particular experiences of
colonisation, institutional racism and exclusion.
Working with Aboriginal families
Partnership with Aboriginal families and communities, and Aboriginal community-controlled organisations
(ACCOs) is critical to increasing engagement and building capacity. Partnership can include formal
agreements and protocols, networking, secondary consultation and referrals, co-case management and
project work. The Victorian Aboriginal Child Care Agency’s (VACCA’s) Aboriginal cultural competence
framework16 offers helpful strategies for building productive and respectful partnerships.
Family-centred practice with Aboriginal families requires professionals to have some understanding of a
family’s kinship network, and often to engage at community level, recognising the culturally specific role of
extended families, Elders, grandparents and other relatives with responsibilities for culture and care.
Professionals also need to understand the importance of cultural safety to children and young people’s
wellbeing.17 Supporting cultural safety might include ensuring children (for example, those at special school
or living in care) have ongoing opportunities for connection with culture and community and other children
from their background. Cultural safety is also something that concerns families when receiving services or
considering approaching a service for assistance. 18 It asks that professionals show cultural respect (for
example, when addressing Elders), and strive to learn, reflect and share power.
When services and professionals are culturally sensitive, responsive, reflective and respectful, this creates
space for Aboriginal families – including prospective clients – to feel culturally safe, to ‘be themselves’. 19 This
makes it more likely that they will be open with you as a service provider, giving you a fuller picture of their
needs, and making it more likely that your work will achieve its intended outcomes:
Workers need to have an understanding of kinship, and of cultural safety. But even if they don’t
understand the family’s kinship and history, an understanding of cultural safety will allow them to actually
work with people, and learn as they go. – Jody Saxton-Barney, Victorian Aboriginal Disability Network
Working with culturally and linguistically diverse families
Partnership is also fundamental to culturally responsive practice with CALD families20 – first with families,
and with staff in specialist services (including migrant resource centres and others with cross-cultural
expertise and networks) for service provision, secondary consultation, training, referral and co-case
management.
Professionals need to learn about aspects of a family’s culture that might influence the design and delivery of
services and supports. These might include the family’s: cultural beliefs and practices in relation to disability;
Family-centred, person-centred allied health – FINAL TEXT
10
family make-up and who is responsible for caring for people with a disability; understandings of human
development, raising children and the knowledge and skills appropriate to children of differing ages; attitudes
to gender and separation of the sexes; practices around interpersonal communication, touch and personal
space; beliefs about which matters are private and which can be discussed openly; and management of
everyday family life, including meals, transport, leisure and cultural observances and celebrations.
Remember that all cultures (including the dominant one) are complex and evolving, and every individual and
family have their own relationship to cultural norms. Be wary of the subtle power of stereotypes; many
cultural beliefs and practices are complex and sometimes not well understood by professionals. Secondary
consultation can be invaluable, but the most relevant source of information about a family’s culture will
always be the family members themselves.
As with Aboriginal families, culturally responsive practice with CALD families requires organisational capacity
and commitment – the tools, policies, systems and training – to support good practice. This includes
assessment tools that ask about families’ language, cultural and religious needs. Professional development
is also important, for example, in working with language services, and around specific issues relevant to
working with disability in the organisation’s catchment.
Family-centred organisations
Every practitioner’s work is influenced by many factors, not least: the support, supervision and professional
development available to them; their workplace role, structure and conditions; and their organisation’s
policies and procedures. These impact greatly on how successfully any one practitioner can implement
family-centred practices. Australian family-centred practice researcher Tim Moore and others 21 point to
commonalities in positive, effective relationships between managers and staff, and those between
professionals and families, suggesting that one influences the other. 22 Organisations should therefore
support staff to work in family-centred ways and create a culture of mutual respect and collaboration for staff
and service users. This is discussed further in the organisational guide in this suite.
A family-centred service system
Relationships between organisations are also critical. Most families use multiple services and experience the
support they receive as a ‘service system’. Poor integration in that system can create real difficulties for
them. Many aspects of service integration of course require structural change. But as a practitioner you can
help children, young people and families by improving communication and coordination with other the
services they use, especially during times of transition between services and sectors.
Family-centred, person-centred allied health – FINAL TEXT
11
Good practice scenario: Crista
The people in this story
Crista: child with a disability
Tim and Monica: Crista’s father and mother
Jordan and Brooke: Crista’s siblings
Madeleine: student support services officer – speech therapist
Chloe: classroom integration aide
Teresa: private occupational therapist
‘It was such a relief to get the diagnosis,’ Tim tells her. ‘It was the aide, Chloe, who raised it. We spent Prep
and Grade 1 problem solving and hearing how disruptive Crista was, and worrying we’d made a mistake
going mainstream. But it turned out that none of us really understood Crista’s actual needs.’
Madeleine encourages Tim to tell her more about how his daughter’s sensory issues and intellectual
disability impact on her daily life and experiences at school. Tim describes how their family life revolves
around reducing Crista’s anxiety and tantrums. ‘It’s hard on the others,’ Tim says. ‘They get that she has
extra needs, mostly. At least her brother does. Brooke’s four, so she can be pretty demanding herself!’
‘We are committed to making mainstream work,’ Tim says. ‘But it needs to be a good experience for Crista.
It’s been hard. She finds it difficult to concentrate, especially when people are talking. She can have pretty
big meltdowns, and tells other kids to shut up, which hasn’t helped her make friends! I’m not sure if she
notices. She likes being on her own, but we really want to help her connect with other kids.’
Madeleine asks what other services the family is using, and Tim names only the aide and paediatrician. ‘I
can work with Crista on her social skills, and to help her cope and communicate better in class,’ Madeleine
says. ‘But I think she would benefit from seeing an occupational therapist. Did the paediatrician mention
that?’
Tim says she might have, but he and Monica were so overwhelmed during the appointment that he can’t
remember. ‘Did she give you any information about sensory processing disorder?’ Madeleine asks. Tim
says the pamphlet she gave them raised more questions than it answered. They had gone online but found
themselves overwhelmed again, and unsure which websites to trust.
‘I can send you some links,’ Madeleine offers. ‘And email you some good articles.’ She tells Tim she can
recommend some private occupational therapists (OTs) but that she’ll also see if the community health
centre might take a referral. She finishes by asking Tim whether he’d like Crista to be present at their
meeting, and he agrees.
When the appointment begins, Madeleine concentrates on connecting with Crista. She clings to her dad,
but Madeleine draws her out gently and playfully, keeping her voice low. She sees Tim smile at Crista’s
enthusiastic participation in a card game with Madeleine and her father. Then she explains to Crista how
they can work together, using words and concepts she and her father can both understand.
Towards the end, so she can speak to Tim, Madeleine gives Crista a puzzle to do. She explains that the
community health centre can no longer take referrals for school-aged children and checks that Tim is happy
with a referral to a private therapist. She gives him the contacts for Teresa, an OT who she’s worked with
before.
‘She’s very family centred,’ Madeleine says. ‘She’ll work with all of you, and help you find ways to work with
Crista at home on her sensory issues and anxiety. If you agree, she and I can stay in touch to make sure
our approaches are working well together. She might also be able to come along to the student support
group [SSG] meetings, so we can both work well with the school.’
Madeleine then gives Tim an information sheet about sensory activities to do at home. ‘You might need to
wait for an appointment to see Teresa, so here are some initial ideas. Some of these activities Teresa will
Family-centred, person-centred allied health – FINAL TEXT
12
need to talk you through, but some are straightforward. They can help Crista stay calm and focused, or help
you intervene before she gets too worked up.’ Madeleine explains that she will see Crista for five sessions,
focusing largely on assessment. She will then meet with Tim and Monica to discuss her assessment and a
treatment plan, and then again after a further five sessions for a review. She finishes by giving Tim her
contact details.
Following the first five sessions, Madeleine runs through her assessment with Tim and Monica. In accord
with the family’s priorities, the plan focuses on Crista’s work in class and her social skills. Madeleine
outlines what she could do with Crista and how this might be supported at home through play and family
time, checking often that she’s being clear and that Tim and Monica are happy with her approach.
Madeleine describes how she role-plays social interactions with Crista and encourages Tim and Monica to
do the same. She gives them copies of the ‘social stories’ that she is using with Crista to help her learn
about social cues and responses, and suggests some sibling groups that Jordan and Brooke might be
interested in. Madeleine also meets with Crista’s teacher and aide. They discuss strategies for the
classroom that might help her concentrate better, including ways that the aide, Chloe, can support Crista
more effectively.
When the family first see Teresa, three months later, she also starts by playing with Crista. Tim notices that
his daughter is already quicker to engage. They play games and talk then Teresa gives Crista an activity so
she can talk to her parents. Tim and Monica have many questions. Madeleine’s web links started an
exploration that led to an online community of parents with children with sensory issues. Tim and Monica
have been trying activities suggested in materials from Madeleine and by parents online.
‘We’re off to a flying start!’ Teresa says. ‘Crista is clearly benefiting from what you’re doing. Can you tell me
what you’ve learned online? And ask your questions. That will give me an idea of what you know, so I can
help build on that. Then we’ll talk about where Crista is at, and what support might be helpful from me.’
As they talk, it becomes clear to Teresa that the family is very positive about what they’re doing at home, so
she just suggests a few minor adjustments. She also asks about how things are for Jordan and Brooke.
‘Jordan has been to a siblings group twice now,’ Monica says. ‘I think it’s been great for him to find out he’s
not alone!’ Then they discuss the family’s priorities. Tim and Monica are keen for Teresa to work with
Madeleine around school, which is still quite a struggle. When Teresa mentions assessment, Tim suggests
that she look at Madeleine’s assessment, and invites her to call Madeleine to talk about how they can work
together, and with the school.
Teresa asks if Madeleine has been to Crista’s SSG meetings. ‘She’s coming next time,’ Monica says. ‘It’s
tricky. She has such limited hours. Chloe, the aide, has been fantastic too, but Crista shares her with two
others. And the teacher wants to do the right thing, but I think she’s still struggling not to see Crista as a
problem because of her behaviour.’
Over the next few weeks Teresa and Madeleine communicate by phone and email. Teresa does her
assessment, and in consultation with Tim and Monica she and Madeleine share information and develop a
joint treatment plan. It includes a number of suggestions about physical changes to the classroom to help
Crista concentrate better.
Tim asks if Teresa will also come to the next SSG meeting, and she agrees. ‘Let’s give the school some
information about what we’re doing,’ she suggests. ‘How about sending them the treatment plan as a draft,
so we’re all prepared for a really good discussion?’
Chloe, Crista’s aide, is also invited to the meeting. She had come to one meeting the previous year, when
Crista was really struggling. This time, as she watches Monica and Tim talking about their daughter to the
teacher and assistant principal, it strikes Chloe what great advocates they’ve become for her. They seem
so much more confident that between everyone present – ‘Crista’s support team’, as Monica and Tim call
them – they can make this work.
Family-centred, person-centred allied health – FINAL TEXT
13
Practice Tips:
Create space for people to tell their whole story if they want
Draw on family knowledge to understand the child and family’s needs and context
Talk to family members about their wishes for the child
Check what services the family is receiving; offer your opinion respectfully about options
Check what information the family has, what they want and in what form
Be aware of financial pressures and what referrals might be appropriate
Communicate directly with the child to build a relationship with them and the family
Use your sector knowledge and networks to refer appropriately
Give information about other services
Offer to communicate with other services and work with them; suggest ways to increase service integration
Invite families to participate in therapeutic activities
Explain your approach to families, involving them in planning, report on progress
Make yourself contactable if families have questions
Formulate services and supports in line with family priorities for their child, invite them to participate in
therapeutic activities
Work as a team with the family, teachers and other professionals working with the child
Build supports into the child’s environment
Communicate directly with the child to build a relationship with them and the family
Encourage family reflection on their successes; check what people know already
Ask about impacts on siblings; refer to meet other family members’ needs
Respond to family priorities; share information, with permission
Draw on the family’s knowledge to understand the child’s context
Work well as a team to support the child and family; consult with the family
Communicate with other members of the ‘team’, including school staff
Empower and encourage family members to act as advocates for the child
Family-centred, person-centred allied health – FINAL TEXT
14
3 Practices that build relationships
We as parents are inspired when there is care shown to the siblings and other family members. There needs
to be respect and understanding shown to all because therapists are not only working with the child with a
disability but also the family. We seek out those therapists and services that do provide support to us all. –
Cass, mother of Abel (who has autism), Jack (who has a learning delay) and their sister, Julie
When the doctor told me he’d never be independent, he’d never be able to do things for himself, it was an
incredibly negative thing to say. I kept looking at my son who was smiling at me, who seemed to be making
milestones, who was responding to what I was saying. All of a sudden this doctor gave me the prognosis of
‘He’ll never do anything, he will not learn’. I kept looking at this gorgeous boy and thinking Who is right here?
– Alison, mother of Mark (who has a mild intellectual and physical disability and who recently travelled
overseas and now has a part-time job he is passionate about)
Research demonstrates that open, trusting and collaborative relationships are key to supporting children,
young people and families to adapt to the changes and challenges that disability brings to their lives. 23,24 Of
course relationships are two-way, shaped as much by the experiences, behaviours and values of children
and families as by those of practitioners. People’s prior experiences of services are critical; if these have
been less than positive or not family centred, it can take time to build trust, optimism and a sense of
partnership.
Your beliefs, attitudes and values
We each bring our own beliefs, values and attitudes to every interaction we have – with family, friends,
colleagues and those we work with. We rarely state them aloud, but they shape everything we do. Familycentred practice asks practitioners to demonstrate certain values, including that people can adapt to the
challenges in their lives. This isn’t always easy. Resources are limited; different systems offer different
supports, and often have different eligibility criteria, access points and requirements. Some families are
struggling with very complex issues, so you need to strive not to judge. Families value highly those
professionals they don’t feel judged by.
Yet everyone makes judgements sometimes – it’s part of being human. What matters is what you do next:
how aware you are, how you challenge yourself, and how this affects your interactions. It can be helpful to:

become more aware of your assumptions and values

reflect on situations that make you uncomfortable and seek support to deal with them better

engage in regular reflective practice with your supervisor and team (see page 15)

challenge negative ‘stories’ about families that can arise in a sometimes deficit-focused system

understand and value people’s knowledge and experience, however expressed

practice engaging with people on their own terms.
Professionals need to accept and work with people as they are and for who they are. This can be
challenging sometimes, and does not, of course, mean that you should not take action if a child or young
person’s safety is at risk (see page 24), nor does it mean that you cannot respectfully challenge families if
you have strong concerns about the impact of their choices.
Reflect on your values
Our deepest values are shaped by a blend of our ethnicity, race, history, socioeconomic status, ability,
location, language, beliefs, values, education, lifestyle, politics, family make-up, gender, sexual orientation
and spirituality.
Mostly, our values are invisible to us. We grew up with them and they shape our daily lives. Often we take
them for granted. Sometimes we also take for granted that our values and our ways of doing things, are
‘normal’. But every person and family has their own history, values and ways of doing things. Practitioners
Family-centred, person-centred allied health – FINAL TEXT
15
need to be sensitive to this in their work with every family, of course, but especially those from minority
communities, including Aboriginal, CALD and same-sex parented families.
Family-centred practice asks you to reflect on your values and how they differ from others’. Beware the
subtle power of stereotypes, and remember that all cultures (including the dominant one) are complex, and
change over time; all cultures have strengths and problems, and everyone has their own relationship to
cultural norms.
Understand and share power
Family-centred practice requires a shift from the ‘power over’ relationships that often characterised
traditional, medical-model approaches, to ‘power with’ relationships of collaboration, information and
resource sharing.25 Practitioners should also work towards ‘power through’ relationships, where young
people, families and organisations come together to create new resources or approaches that increase
everyone’s skills, capacities and resources, and benefit the wider community. 26
The dynamics between practitioners and the people they work with are, of course, shaped by broader power
structures and family stressors, including lack of access to education, financial resources and support
networks.27 Prior experiences can also have a profound effect. Most Aboriginal families include at least one
member of the Stolen Generations, for example. Service systems in many migrant families’ countries of
origin might be very different from those in Victoria.
Aboriginal and CALD families also continue to experience high levels of discrimination, including from
service providers.28 Although this is more often subtle than blatant, it can result in children, young people
and families feeling uncomfortable and alienated.
Interpersonal behaviour
Interpersonal qualities like warmth and empathy are fundamental, but other interpersonal skills are also
important:

Skilled listening builds trust and helps you gather information to plan effective supports together. It
is also important to hear what isn’t being said.29

Sharing your observation of what you are learning about the child or young person and family
(particularly their strengths and growing capacity to meet their own needs) helps build self-efficacy (see
page 6).

Sensitive communication in relation to the child or young person’s development gives families both
accurate information and a sense of hope. The first messages that families receive from services are
powerful, and can shape their journey for years.

Acknowledging the needs of parents, caregivers and siblings (and referrals to help meet those needs)
demonstrates understanding of the family.

Engaging directly with children demonstrates respect for their right to have a say and helps build a
relationship with them and their family. People do not need to be verbal to communicate. It is about
getting to know them, and how they express needs and preferences. Resources are available to help
communicate with people with a disability.30

Asking the right questions, open-ended or specific, helps to elicit meaningful information. ‘What would
you like to work on?’ can be daunting, especially early on. You can get people talking in different ways:
Ask about an area of family life (‘How are you all sleeping?’ or ‘Are any routines changing?’), or
respectfully observe their behaviour or mood. Some people find it easier to start with what hasn’t been
working for them.

Making space for the whole ‘story’ enables people to feel heard and builds a more complex picture of
their needs. Sometimes people won’t want to tell their story yet again. Services can help by sharing
information, with permission.
Family-centred, person-centred allied health – FINAL TEXT
16

Tuning in to non-verbal signals can enhance communication. Remember that body language is not
universal, but has diverse cultural meanings. Discuss with colleagues or reflect on non-verbal cues to be
sensitive to when working with different communities, and ask the family if you are unsure.
Above all, authenticity is critical. Research has found that families know when practitioners are insincere in
expressing caring or empathy.31 They appreciate warmth and interest, but only when it is genuine.
Support people to make informed decisions
Informed decision making requires families to consider their own needs and preferences, and the relevant
information. For the latter they often rely on you. Some practitioners see family-centred practice as simply
‘doing what families want’, and are unsure if they can offer input. If it is clear that a family is unaware of
information or ideas that might assist them, ask if they would like to hear about it. Any suggestions should
arise from a deep understanding of and reflection on the family’s needs, priorities and concerns. They should
be conveyed as options and delivered in a way that empowers the family to make their own decisions freely
and in their own time.
It can be helpful to:

Check what information the family and young person want, and when. Information overload is common.
If people don’t have much information at all, it might help to first describe the kinds of things you could
tell them, and ask what they want to know more about.

Ask what the family and young person already know. You can then avoid patronising them. Address any
misconceptions; engage with their beliefs; and use language they can relate to.

Check if you are being clear and if they want more information.

Ask how they prefer to receive information. Some people like verbal explanations; others prefer
diagrams, role-plays, discussion or problem solving.

Use plain language, avoid unnecessary jargon, and help people to decode the terms and acronyms they
need to know to navigate the system.
Information and support that young people and families might find useful to aid decision making includes:

current information about disabilities and developmental delays, supports and services, including
research

assistance weighing up the risks and benefits of different options

assistance making sense of conflicting information

your learning from other families (respecting confidentiality), including what might be ahead for them,
and what choices they might want then

how to link with other families for support and information sharing.
It is worth collecting good-quality, plain language information resources on important or common topics for
families. You might find these online, or develop them with input from families and young people. A plain
language explanation of your organisation and role, and how they fit into the service system, would also
benefit many.
Offer and use interpreters skilfully
Always ask people with limited English if they prefer to use an interpreter. This enables you to communicate
better and is crucial to accurately understanding families’ context, needs and choices. Always use
professional interpreters (NAATI levels 2–3), never family or friends. This ensures accurate interpreting, that
family members are not put under undue pressure, and that confidentiality and impartiality are not breached.
These all contribute to service quality and help protect your organisation from legal risk.
Keep people in the loop
Family-centred, person-centred allied health – FINAL TEXT
17
Communication and follow-through are key issues for families and young people. Issues you might need to
discuss regularly with families include:

how developmental or other changes in the child or family’s circumstances might affect supports

relevant changes in your role or availability (including leave), organisation, sector, policies or funding

potential sources of support, and information such as the hours of service remaining in a given period.
Family-centred, person-centred allied health – FINAL TEXT
18
Good practice scenario: Adam
The people in this story
Adam: 12-year-old with a disability
Sara and Josiah: Adam’s mother and father
Mary, Miriam and John: Adam’s siblings
Delia: physiotherapist at Adam’s school
Marnie: social worker at Adam’s school
Ben: child psychologist
Adam (12) loves reading and swimming. He lives with his mother, Sara, father, Josiah, and siblings, Mary (21),
Miriam (17) and John (15). Adam has Becker muscular dystrophy. In the past nine months he has had to use
his wheelchair more and more, but he has no heart problems and so far no difficulties breathing.
The family has accessed few services apart from those offered by the hospital. However, Adam recently started
at a specialist school for students with physical disabilities and will now be seeing Delia, a physiotherapist
employed by the school.
Delia notes from Adam’s file that the family is South Sudanese and requires an interpreter. Her usual
practice is to invite parents to attend their child’s first appointment. Having once mistakenly assumed that
Arabic was the appropriate language for Sudanese families, she rings first to check which language the
family are most comfortable speaking.
Adam’s older sister, Mary, answers the phone in English. Delia explains who she is and why she is ringing.
Mary says, ‘Mum prefers to speak Dinka, but Adam can interpret for her, or I can’. Delia thanks her, but says
that school policy requires her to provide a professional interpreter for Sara, and checks whether the family
would prefer a female interpreter. Mary says yes, they would. ‘You’re most welcome to come,’ Delia tells Mary.
‘But it would be great if you could be there to talk about your brother, rather than having to worry about
interpreting.’ Delia asks when Sara will be available and says she’ll call back using the telephone interpreter.
When Delia calls again, it takes a while to clear up Sara’s confusion about who Delia is. Delia knows from
Adam’s file that he has had some physio at the hospital, so explains that her service is similar but offered
through the school at no cost. ‘Would you like to come along to Adam’s first appointment?’ she asks. ‘I can
tell you more about how physiotherapy works, and we can discuss what support you might like from me.’
Delia organises an interpreter to be present when Sara, Mary and Adam come in. Delia hasn’t had a lot of
experience with face-to-face interpreters, but she soon gets used to addressing Sara and the others directly
and waiting for the interpreter to translate, rather than speaking to the interpreter about the family in the third
person. Adam and Mary both speak a mixture of Dinka and English, which keeps the interpreter very busy
ensuring that everyone present understands everything that is said.
Delia has found some plain language resources about Adam’s condition and the benefits of physiotherapy.
She offers them to the family to read later but also offers to go through them now, with the interpreter
present. Sara agrees, so Delia goes through the materials, checking often that she is being clear. She
makes sure to ask, ‘Am I explaining this clearly enough?’, rather than, ‘Do you understand?’ – thus making it
clear that it is her responsibility to ensure she is communicating clearly. As she does so, Sara begins to
engage more actively in the conversation. It emerges that the hospital has never explained some key
information about Adam’s condition in a way the family could understand. They spend a long time discussing
this, and the basics of physiotherapy.
At first Adam seems disengaged, but Delia observes that he is listening carefully. She takes a lead from
Sara, addressing most of her questions to her, but also asks Adam a number of questions directly. He
answers briefly. This conversation takes so much of the appointment that Delia doesn’t get time to talk about
Family-centred, person-centred allied health – FINAL TEXT
19
the family’s goals for therapy, so she invites them to come again.
Next time Sara and Adam come without Mary. Sara is more comfortable than at the first appointment, and
tells Delia a lot about Adam’s health and other pressures on the family. Despite efforts by Delia and his
mother, Adam is even less communicative. Sara wonders how he’s coping with his health problems and
other issues in his family.
Sara tells Delia about her husband Josiah’s back pain that often keeps him off work. He has only had
unskilled jobs in the seven years they’ve been in Melbourne because his accountancy diploma isn’t
recognised in Australia. It sounds to Delia as if Josiah might also have depression. And although Sara holds
the family together, she is often distressed and anxious herself.
Delia asks if the hospital suggested any stretching or other exercises to do at home, but Sara only
remembers a suggestion about swimming. Adam says he likes swimming and often goes with his brothers.
Delia asks about it, encourages him to swim whenever he can, and explains the school swimming program,
which includes hydrotherapy. Delia usually uses her time with parents to talk to them about a range of
strategies they can implement at home to support their child’s therapy and how this can fit into the family’s
usual routines. This will be important to do with Adam, especially as his condition seems to be progressing
quickly. However, Delia decides it can wait until more supports are in place for the family.
Delia asks whether the family is using any support services. The answer is no, apart from some initial
settlement services and the hospital, although Sara says the family’s pastor often visits and spends time with
Josiah. Delia suggests the family might benefit from seeing the school social worker, and that there might be
other services that could help. Sara sounds keen. She gives permission for Delia to talk with Marnie, the
social worker, about what’s happening with the family.
When Delia speaks to Marnie, she agrees to see the family but also suggests that a child psychologist might
help Adam deal with the emotional impacts of his condition. She names one with expertise in disability who
Adam could see free on the family’s healthcare card. She also suggests that Josiah might benefit from going
to a specialist counselling service that works with refugees who have experienced trauma, and that the
family might benefit from case management, especially if Adam’s condition continues to worsen quickly.
When Delia conveys all this to Sara, she is happy to hear there might be additional help available, especially
for Adam, who has started refusing to attend school. Sara has never heard of case management, and they
spend a long time talking about what support a case manager could offer the family.
With Sara’s permission Delia refers Adam to Ben, the child psychologist. At Sara’s request she makes the
initial call, then an intake worker calls Sara using an interpreter to set up a face-to-face appointment. Delia
also calls the specialist counselling service, which contacts the family. When Delia rings Sara again three
weeks later, she tells her that Josiah has now seen a specialist counsellor twice and is very positive about it.
Ben, the child psychologist, hasn’t had a lot of experience working with African families. When Delia calls he
is very grateful for whatever information she can pass on about the family and asks if she has any other
advice. ‘A lot of people have been through very difficult experiences with the civil war, and with coming to
Australia,’ Delia says. ‘I don’t know what this family has been through, or how it has affected Adam, but it
might be worth getting some general background information about this community’s refugee experiences.’
Delia suggests that Ben contact the local migrant resource centre, which produces information resources
about local migrant communities, and also has a worker whose job includes supporting service providers to
work with African families. She also tells him about the specialist counselling service Josiah is seeing. She
suggests he contact them for secondary consultation about how the family’s experiences in Sudan and of
migration might be affecting Adam.
Practice Tips:
Strengthen your skills in working with interpreters; ensure correct language
Family-centred, person-centred allied health – FINAL TEXT
20
Always use professional interpreters, never friends or family members
Don’t assume that people understand the system; explain your role clearly
Access training in working well with interpreters if possible
Find and offer plain language resources; offer translations if possible
Check what the family knows and wants to know; explain basic information if needed
Check often that you are explaining things clearly enough to be understood
Tune in to non-verbal signals; engage the child or young person directly
Make space for people to tell their story; understand the child’s context;
Use natural environments, offer family members a role in therapy if desired
Affirm the young person’s strengths, tailor supports to their interests
Adapt your usual practice to the specific needs and capacity of the family and child
Meet the needs of family members, refer and draw on colleagues’ knowledge
Make supported referrals rather than just giving out a number, be aware of families’ financial constraints
Check with the family if they are happy for you to refer, respond to changing needs
Explain how the service system works, give information to support informed choice
Share information with services you refer to, with the family’s permission
Build your knowledge about the community’s context; seek support
Use secondary consultation to understand the child’s context
Family-centred, person-centred allied health – FINAL TEXT
21
4 Practices that support choice
We were a large, growing family. As therapists came on board with us, they wouldn’t say, ‘Your next
appointment will be …’ and look in their diary. They would say, ‘What are you doing? When and where can
we see you that best suits you?’ They were looking at what was happening for us and our family. When the
kids were little we’d have to be in five places at once. So they’d fit in therapy with us. Or they’d use their
knowledge and resources to find equipment for us to trial – which is really time consuming – and sometimes
they’d even deliver it to the doorstep. – Paula, mother of Samuel (who has a physical and intellectual
disability) and several other children
Participatory practices arise from a commitment to self-determination: the notion that people are entitled to
make decisions for themselves and live the life they choose. This principle underpins self-directed support,
increasingly the basis for all Victorian disability services and supports.
Everyone has the right to self-determination, but family-centred practice also requires that professionals
recognise and address the factors that affect people’s power to make choices in their lives. These include
homelessness, unemployment, educational disadvantage, poverty, isolation, lack of access to essential
services, chronic/mental illness, family violence and discrimination, including that based on gender, ability,
race, religion, sexual orientation, family structure and circumstances.
Decision making and action
Many choices are made during a family’s engagement with a service. What supports are needed? How often
will the young person or family see a practitioner? What will therapeutic activities be and where will they take
place? How might family members and others (such as teachers) be involved? Family-centred practice asks
that as much as possible these decisions be made by those most affected by them.
Work with people to set outcomes
Children, families and young people need to define the outcomes they wish to achieve. Yet many find this
hard if they don’t know what’s possible. You could outline your approach and then discuss desired
outcomes, bearing in mind your power to shape people’s expectations. People might express a desired
outcome in terms of an ability or function. Or they might talk about the child or young person being able to
take part in an activity important to the whole family. This can then be translated into activities that make
sense for everybody, which means they are more likely to be supported outside your session.
Some people might hesitate to name certain issues or hopes because they fear they are trivial or unrealistic
or because they doubt that their needs will be met. Supporting people to plan approaches that help achieve
short-term, realistic goals will support progress towards outcomes that might at first seem unattainable.
‘Release’ people’s capacity to act
What if a family wants you to make the decisions, do the therapy and just ‘fix it’? Everyone has a different
capacity to act at different times. Most parents and caregivers also juggle paid work, the needs of siblings
and other issues. Many find their capacity to take an active role increases as they journey through the
system and adapt to the changes brought about by their child’s disability. If you are struggling to actively
engage people, consider whether:

the supports or activities in question have been designed collaboratively around families’ goals and
priorities, daily life and long-term capacity

you are offering sufficient support for the parent or caregiver to take an active role, for example, offer
them the chance to practice doing a task with their child while you are present, to build confidence, give
reassurance and adjust technique
Family-centred, person-centred allied health – FINAL TEXT
22

you need to coordinate with other professionals involved with the family, to effectively tailor all supports
so the family’s needs are at the centre of an integrated support plan

the rationale for the family’s participation has been clearly communicated

their inability to engage is due to unavoidable circumstances, or whether more or different support would
help them engage, such as respite, more financial assistance or help with other responsibilities or
referrals to meet other needs (including their own, those of their child with a disability or other siblings)

you are trying to engage the person or family appropriately, and whether it would be helpful to invite (with
their permission) other family members or people in their informal network to be part of the process.
British health researcher Jennie Popay says practitioners assume people don’t engage because they lack
skills and capacity.32 Most will act on issues that matter to them, she says, if they believe it is likely to be
effective. But if experience has taught them that their views will be ignored or that ultimate control of
resources lies with practitioners, they will be reluctant to engage again.
She suggests that rather than ‘building’ people’s capacity to engage, practitioners should ‘release’ people’s
inbuilt capacity by addressing issues that lead to reluctance, ensuring decisions are in their hands and that
their views do meaningfully inform planning and other processes.33 In the end, a family’s level of engagement
is up to them. Of course, some go beyond advocacy for themselves to advocate for others and for broader
change.
Children, young people and decision making
Some families are keen for their child to have input into decisions, some less so. This might be because of
family or cultural values because they are not optimistic that their child can gain the relevant skills, or
because their child’s views differ from their own.
If appropriate, you can support children and young people’s input into decision making by communicating
with them directly. If they are verbal or use communication devices, ask about their preferences. If not,
ascertain their preferences by getting to know them – their personality, strengths, likes, dislikes and unique
ways of communicating. You can also suggest they be present and (where possible) included in discussions.
Sometimes young people’s choices conflict with the views of their family of origin. Once they reach 18, most
young people (unless under a guardianship order) are entitled to make their own decisions. Practitioners
must respect young people’s choices and not be drawn into family conflict. It is also important to respect
young people’s privacy, even before age 18. However, most young people will benefit from an ongoing
relationship with their family. You might find ways to support people to resolve conflict, such as by offering
them information or referring them to a mediator or youth advocate.
If you are concerned about people’s choices
Some situations require you to act because a child or young person’s safety is at risk (whether or not you are
mandated – see page 32). More often, you might work with someone whose choices you have strong
concerns about. It might help to consider (with your supervisor) whether:

you have gathered enough information from them to have a sufficiently informed opinion

you are simply feeling challenged by values different from your own

your suggested course of action is informed by family-directed outcomes and responsive to the family’s
needs

you provided enough appropriate, accessible information for the family’s choice to be well informed

their thinking might change with additional support, such as a second opinion or counselling.
Importantly, you must consider the level of risk and possible harm their decision might pose, and your role
and responsibility to the child or young person and family. Speak with your supervisor, with social workers or
others in your team, and with Child FIRST (you don’t need to make a referral).
Family-centred, person-centred allied health – FINAL TEXT
23
Flexible and responsive services
Flexibility means being willing and able to tailor your practice to people’s needs and wishes. Responsiveness
means being alert to when these shift. Both depend on your role and capacity; some practitioners are fairly
autonomous, while others are restricted by their job descriptions or the pressures of time or resources. The
reality for most is somewhere in between.
Provide flexible, tailored services
Providing flexible, tailored services might mean being able to:

fit in with family schedules, including work or school

provide support for transport, or deliver supports in the home, school or other accessible setting

make yourself contactable by phone or email should the young person or family have questions

offer referrals to help meet the needs of all family members, including siblings, parents and caregivers
who themselves have a disability

help families deal with the challenges having a child with a disability can bring, including grief,
exhaustion and frustration with the lack of understanding or support, financial stress, social isolation and
disruption to family routines (for example, through appropriate supported referral)

provide support and referrals for families and young people to deal with other stressors like isolation,
poverty, homelessness, family violence, mental ill-health and chronic illness (in 2006, for example, 36
per cent of Aboriginal parents caring for a child with a disability aged under 12 themselves had a chronic
illness34)

ensure supports are culturally informed (see page 10), including communication, assessment, outcome
setting, design, implementation and review

reduce the demands on families, for example: by ensuring they always see the same one or two
practitioners; making notes so they don’t have to repeat information; filling out forms with families; or
transferring previously collected information into new forms

sharing information or working collaboratively with families’ other services (with their permission).
Respond to change
Discuss with families and young people how changes in their needs or circumstances might affect their
supports. Transition points between sectors, organisations, funding or practitioners can be times of particular
need. People often struggle to find their feet when practices and funding models differ from those they have
encountered before.
In considering your own responsiveness to change, it might be helpful to think about:

how your service stays in touch with developmental and environmental changes for children, young
people and families

when reviews occur, who initiates them, what you ask, and how you involve the child or young person

how children, young people and families can tell you when their needs change at other times

how you communicate with people when they enter your service, including if they need to adjust to more
family-centred ways of working

how you support children, young people and families to leave your service or the sector.
Family-centred, person-centred allied health – FINAL TEXT
24
Good practice scenario: Tyler
The people in this story
Tyler: teenager with a disability
Jade: Tyler’s older sister
Russell: Tyler’s father
Ann: Tyler’s paternal grandmother
Lisa and Dean: Tyler’s aunt and uncle
June: Tyler’s teacher and Year 7 coordinator
Faye: Koorie education worker
Narelle: SSSO speech therapist
Tyler (13) has just finished first term at high school, where his sister, Jade (15), is in Year 9. The family
moved to the area at the end of last year. They live with their paternal grandmother, Ann, Aunty Lisa and
Uncle Dean. Their father, Russell, works interstate and comes home every couple of months. Their mother
left when the children were young.
June is Tyler’s teacher and Year 7 coordinator. She and Tyler’s other teachers find Tyler a likeable but
disruptive student, and he’s recently been in two fights.
The problems tend to happen in class, not the playground, where Jade and other Aboriginal students look
out for him. June has had a lot of experience teaching children with autism spectrum disorder, and
wonders if this might be affecting Tyler, although no one has advised the school that he has the condition.
She phones the regional Koorie education worker, Faye, to discuss a way forward.
Faye met Tyler’s grandmother Ann in the first week of school and suggested she ring her. ‘Sometimes
families prefer to discuss things with an Aboriginal worker first,’ Faye says. ‘I’ll ask how things are going
and what services are involved.’
When Faye rings, Ann says she’s heard that Tyler has been in a bit of trouble but hadn’t realised that
Faye could help. Faye asks if Tyler has seen anyone about help with his speech other issues. Ann says
that a doctor mentioned autism when Tyler was little, but then the kids’ mother left and Russell and the
kids moved to Melbourne, so it was never followed up. Faye tells Ann that support is available for Tyler
and the family. They arrange for Faye to visit the family, and for a meeting at the school.
Ann’s first meeting at the school is with June, Faye, the assistant principal (responsible for all students
with additional needs) and the student welfare coordinator. They ask Ann for her thoughts on what’s
happening for Tyler at school, and what supports she might want for him. ‘We’ve never thought anything
was wrong,’ she says. ‘Ty has his good days and bad days, like any kid. But if he needs help at school, he
should get it.’
They discuss the screening tests for autism, and Ann agrees to a referral to a paediatrician at the local
Aboriginal Community Controlled Health Organisation and an educational psychologist. She wants Faye
to come along to appointments.
Tyler is diagnosed with autism spectrum disorder and a mild intellectual disability. He is referred to
Narelle, a speech therapist and student support services officer. Narelle hasn’t worked with many
Aboriginal students. She sees from the referral that Faye is still involved with the family and rings her for
advice.
Faye explains that she is supporting the family and has referred them to various services, including a
counsellor at the Aboriginal health service and Autism Victoria. ‘I can support the family as long as they
want me involved, and can come along to student support group [SSG] meetings when they get going,’
Family-centred, person-centred allied health – FINAL TEXT
25
she says.
Narelle usually attends one or two SSG meetings for the students she works with. She mentions her lack
of experience working with Aboriginal students, and asks if it would be helpful if she could come to more
of Tyler’s SSG meetings. ‘Yes, if the family agrees,’ Faye says. ‘There are lots of services involved with
this family, and it’s important we’re all talking to each other and working together.’
Narelle says she usually invites the family to a child’s first appointment. Faye suggests that, if the family
agrees, she could also come. ‘It’s all about relationships,’ Faye says. ‘I’m sure that’s true for everyone you
work with, but it’s especially so for Aboriginal people. A lot of families have had bad experiences with
mainstream services. Me being there can help you build a relationship with the family.’ Narelle thanks
Faye and asks for advice for when she rings Ann. ‘Take your time,’ Faye says. ‘Tell her you’ve spoken
with me, and be clear who you are, what you do, and what organisation you’re from.’
Narelle explains her role carefully to Ann when she rings but feels Ann is wary. However, Ann is more
responsive when Narelle mentions Faye, and is keen for Faye to attend Tyler’s first speech therapy
appointment.
Faye tells Narelle about kinship networks. ‘For many Aboriginal people, family isn’t just mum and dad and
the kids,’ she says. ‘Ann looks after Tyler and Jade when their dad is away. There’s their aunty they live
with, and their uncle and other relatives. People have different responsibilities in caring for kids, and
passing on culture.’ Faye will see Ann before the appointment and talk to her about what to expect.
Faye does the introductions when Ann and Tyler arrive for Tyler’s appointment. Ann asks Narelle if she
has children herself, and they chat for a while. Narelle notes how deferential Faye is with Ann and makes
sure she is too. After some time Faye says, ‘We mentioned that Narelle can help Tyler with his speech.
Shall we talk about that now?’
Ann asks Narelle what she thinks Tyler needs. ‘I would need to talk to Tyler and the family a lot more to
find that out. It’s also important what you think he needs.’ Ann thinks about this. ‘To us, Ty is just Ty. He’s
different from his sister, but all kids are different. So it’s hard to say. But if seeing you can help him with
his schoolwork, and with his autism, then good.’
‘We’re finding out more about what helps with autism all the time,’ Narelle says. ‘Shall I tell you some of
what I know?’ Ann agrees. As Narelle talks, Ann responds by describing what they do when Tyler gets
‘stressed out’. ‘Everything you’re doing is just what I’d recommend,’ Narelle says. ‘I do have one
suggestion. Lots of kids find it helpful to have somewhere quiet to go when there’s a lot going on. Would
that work for him?’
Ann looks thoughtful. ‘There’s always a lot going on around our place! Sometimes he takes himself
outside, but I wouldn’t want to send him away, or for him to feel left out.’ Narelle says, ‘Maybe there’s a
way of reducing stimulation without doing that.’ She turns to Tyler. ‘Tyler, do you like listening to music?’
Tyler nods, and names a couple of his favourite bands. ‘That’s great,’ Narelle says. ‘Do you ever use
headphones?’ Tyler says his Aunty Lisa has some for her mp3 player and Ann says she’s sure Lisa would
be happy to lend the mp3 player to Tyler when he needs it.
At the end of the appointment Narelle says she can see Tyler fortnightly at school and invites the family
and Faye to come along for as long as they like. They work out a regular appointment time that suits
everyone.
Over the next two months Narelle plays games with Tyler and chats to him, Ann and Faye. Over time she
explores the family’s goals for Tyler’s therapy. One thing Ann wants Narelle to work on is Tyler’s ability to
sit still, listen and concentrate. ‘It’ll help at school, but I also want him to do it more at home. Stories are an
important part of our culture,’ she says. ‘If Tyler is zapping around he’s going to miss out on knowing his
culture, and who he is.’ As Narelle works with the family, she is often astonished at how culturally different
they are than she would ever have expected, and how much that needs to inform her work with Tyler. She
often feels out of her depth but is enjoying learning. Narelle’s team is also learning, as she shares her
experiences in reflective practice.
Family-centred, person-centred allied health – FINAL TEXT
26
Narelle also attends Tyler’s SSG meetings, along with Ann, Faye, Tyler’s teacher June, the assistant
principal, the student welfare coordinator, the aide and the Aboriginal counsellor. The discussions are
lengthy but lead to positive changes in the classroom environment, and ways that Tyler’s teachers and
aide work with him. Faye is pleased that her own input is valued but even more that the focus is on what
the family want for Tyler.
Practice Tips:
Learn from observation of the young person’s environment; reflect on protective factors
Seek secondary consultation and partnership with Aboriginal workers
Be aware of Aboriginal families’ prior experiences with services; work with Aboriginal workers
Find out what families know about their child’s needs and condition; explain what supports are available
Explain the service system and processes to families, support their participation; consider partnering with
Aboriginal services
Offer information about disability, diagnosis and the role of different professionals to support informed choice
Read the file to see what services families are linked to; read all the available information
Seek advice from Aboriginal workers; be aware of historical context
Take a lead from Aboriginal workers; offer families the choice of services
Partner with Aboriginal professionals where available to build a relationship with the family and increase your
own capacity
Explain your role, tune in to non-verbal signals
Learn about Aboriginal kinship and other aspects of cultural practice
Learn from observation of appropriate communication, show respect to Elders
Affirm the family’s knowledge of their child
Ask what families want, offer information so they can make informed choices
Draw out family knowledge to understand the child’s environment
Affirm the family’s strengths, offer information respectfully for them to consider
Get feedback on suggested strategies, tailor strategies to family’s culture and context
Encourage the family to offer possible solutions; affirm their input
Have an open-door approach with families
Build trust and connection slowly over time
Use tools and methodologies that draw out cultural factors and knowledge of the family and child
Follow family priorities; ensure your practice is culturally informed
Work well as a team; work with the young person in their natural environment
Family-centred, person-centred allied health – FINAL TEXT
27
5 Technical quality
Therapists often say that it’s really what you do at home that matters, so there is usually ‘homework’ to do
with your child between sessions. The therapists are not necessarily aware of everything else that you are
dealing with at home – other therapies, medications, bed wetting, other appointments, respite services,
support applications, let alone the needs of the rest of the family. And if you’re seeing them privately, then
the speech therapist doesn’t know what the physio has said – the only person who knows it all is the parent.
It is usually the mother who has to process it all somehow. Sometimes you can do it well, and sometimes
you just have a nervous breakdown. – Anita, mother of Michael (who has Down syndrome) and his two
younger siblings, Ryan and Claire
I like my current physios because there’s two of them. If one goes on holidays, the other works with me. The
one who works with me most, she’s a really kind, genuine person. She does things that benefit my function,
like stretch my legs, or we’ll do sitting balance or bike reading. I’ve got a three-wheeler with a carer’s seat on
it, and she’d take me out riding, and we started doing hills. If I wanted to challenge myself she accepts that,
but she’d also mention things I could do to improve myself. – Anthea, advocate and young person with a
disability
Children, young people and families rely on practitioners to have the technical expertise required to deliver
high-quality services. You acquire your expertise through pre-service training, experience, supervision,
networking, secondary consultation, reading and ongoing professional development. Family-centred practice
means applying that expertise to benefit the child or young person and family.
The disciplines of allied health staff include physiotherapy, speech pathology, occupational therapy, social
work and psychology. Their discipline-specific skills and knowledge are too numerous and varied to discuss
here. Current thinking about these can be accessed through professional journals, continuing education and
training. Many allied health staff also hold leadership positions. Their approach to management and
supervision can influence their staff’s capacity to work in family-centred ways,35 as discussed in the
organisational guide.
Allied health practitioners also require knowledge of: various conditions; colleagues’ different modalities
(especially if part of a multidisciplinary team); the processes and procedures of their own and related
services; funding and the policy environment; and the impact of privacy laws, including on sharing
information between family members and services.
Below is a discussion of other general skills and knowledge relevant to family-centred practice for allied
health practitioners working with children and young people outside ECI. Refer to the Early childhood
intervention service professionals guide for a discussion of competencies specific to that sector.
Practice informed by everyone’s knowledge
Practitioners need to maintain the currency of their technical knowledge and have access to a good-quality
database of resources and service providers. It is equally important to draw on the deep knowledge that
every family has of themselves, including how things are done within the family and how family members
communicate and work around each other’s needs. Research shows that most parents and caregivers have
a good understanding of their child’s development. 36 Jennie Popay and others describe how health service
providers can improve service quality by drawing on the ‘lay knowledge’ of service users. 37
A wide range of discipline-specific tools and methodologies enable practitioners to draw that knowledge out
and build a rich understanding of the child or young person’s needs and context. This is important
information for assessment, planning, implementation and review of supports and services.
Improve teamwork and service integration
Family-centred, person-centred allied health – FINAL TEXT
28
Many families have more than one worker, whether from the same or different agencies. Many have
experiences of reduced service quality, service gaps or contradictory information, arising from a lack of
communication and coordination between professionals and services. It helps if practitioners see themselves
as part of a service system. This is how families experience them and how they are most effective.
Improving service integration requires skills and good processes. Children, young people, families and
practitioners all benefit when:

everyone involved in supporting the child or young person and their family understands each other’s
roles, skills, areas of expertise and practice approaches

everyone knows and is focused on the needs and priorities of the child or young person and family

everyone (including the young person and family) is kept up to date

there are processes to resolve any problems.
It can be challenging to work with services coming from a very different perspective or different discipline,
including those that are less person centred or family centred, but whatever support you can offer to improve
communication and coordination with other services will be beneficial.
Refer and use secondary consultation
Practitioners might need to refer people for new or different disability supports, or for information on
diagnosis or medical treatment, including a second opinion. Practitioners also need to know how to identify
signs and risks of mental ill-health, suicide, drug/alcohol abuse, sexual abuse and family violence, and how
to refer in response to these and other needs. Other needs include counselling, family therapy, parenting
programs and carers support, and income, housing and legal support.
If you cannot meet a particular need, offer options without making people feel ‘fobbed off’. It can help to:

be specific about the need you cannot meet and why

discuss what services might meet the family’s needs, including the service type, location and hours

find and provide any information you have promised (lack of follow-through by busy workers is a
common complaint from families).
Discuss the other agency’s approach (including whether they are family centred), the family’s expectations,
and how they might engage with the service. If possible, ask the family if they would like you to liaise or
coordinate. If it seems helpful to share information with the other agency, seek the family’s permission.
Establish ongoing relationships within services you refer to regularly and those you might contact for
secondary consultation. Engage in partnerships, perhaps including co-case management, collaborative
planning or project work. Partnership might include Child FIRST services, multicultural and Aboriginal
organisations and organisations with expertise in gay, lesbian, bisexual, transgender and intersex (GLBTI)
issues.
Use natural environments
Many practitioners routinely integrate supports into children and young people’s environments. Where they
once focused on teaching special exercises ‘to do at home’, perhaps including special equipment,
practitioners are now likely to embed activities into everyday care, play and household activities.
This might include, for example: ways of carrying children that help to strengthen posture and limbs; word
and clapping games that support speech and social skills; climbing activities in the backyard or local park
that help with balance and gross motor skills; and toys or household tasks that help with fine motor skills. If
you start with activities the child, young person or family already does and the goals they desire (see page
23), they are more likely to do the activity regularly, making the goal more achievable.
Some activities will always be most effectively performed by practitioners, perhaps because of the skills
required or because children and young people often respond differently to someone who isn’t their parent.
Family-centred, person-centred allied health – FINAL TEXT
29
Yet practitioners are usually with a child or young person for only an hour a week or fortnight. Families are
children and young people’s first and best teachers, and are best placed to implement activities in the
context, with the frequency needed for them to be effective. However, it is critical that the expectations
placed on families are realistic, and tailored to their needs, capacity and environment.
Explain and provide evidence for your approach
Some families welcome the opportunity to participate in these ways, perhaps because it means fewer
appointments, or because it adds another dimension to their role, or because they see the benefits for their
child. Others feel overburdened or concerned that their parental role or lack of expertise will make the
support less effective. When you introduce the idea of natural learning, explain its rationale and explore what
it might mean to parents and caregivers’ relationship with the child, especially if they have to do procedures
that cause discomfort. Discuss how you might teach any skills needed and how you will check they are doing
things correctly.
Some families might feel that a natural learning approach results more from services being unavailable than
from the potential benefits for their child: respectfully offer them research about its effectiveness; tailor
supports to their needs, capacities and preferences; and ensure they have the financial and other supports
they are entitled to. In the end, of course, their participation is up to them.
Tailor activities to different environments
Often the most appropriate natural learning environment is the home, but it can include kindergarten, school,
sports clubs and facilities, libraries and community centres. This raises a question about the flexibility of your
role: Could it include building the capacity of others who provide services to the child, young person and
family? The answer depends on many things, including your organisation’s policies, time and resources, and
the willingness and capacity of staff in that setting.
Respond to protective concerns
Responding to concerns about a child or young person’s safety and stability is a key responsibility of
practitioners (mandated or otherwise). It can lead to a report to Child Protection or referral to Child FIRST –
see the Children, Youth and Families website for guidance. 38 VACCA says practitioners should also consider
whether an Aboriginal child or young person is ‘culturally safe’, that is, do they have an ongoing connection
to culture and community.39 This requires partnership with Aboriginal services, and VACCA offers strategies
for this.40 Children or young people from CALD backgrounds have similar needs for an ongoing connection
to culture and community – partnership with multicultural and ethno-specific services can support this.
Self-care and maintaining boundaries
Self-care is important for your occupational health and safety (including your mental health) and your
capacity to work well with people. Self-care includes: accessing clinical supervision; debriefing after
difficult/critical incidents; peer support; breaks and holidays; and professional development. Your supervisors
and co-workers play an important role in supporting you to look after yourself at work.
One aspect of self-care is maintaining appropriate personal and professional boundaries. This issue can be
confusing, given that care and empathy are fundamental to building trusting, open and collaborative
relationships. Some practitioners work in people’s homes and engage with intimate facets of daily life. A
caring professional can be an emotional lifeline in tough times, but they are not a friend or part of the family.
Appropriate boundaries are best set by organisations, and should be clearly communicated to staff and
service users.
Boundaries vary between organisations and communities. The reality for many rural and cultural
communities is that people often know or know of each other. In Aboriginal organisations people are likely to
be connected through diverse lines of kinship, and different boundaries might apply. Whatever boundaries
suit your organisation and context, if they appear to be shifting in an inappropriate direction in a particular
relationship this needs to be thoughtfully addressed in supervision.
Family-centred, person-centred allied health – FINAL TEXT
30
Good practice scenario: Georgie
The people in this story
Georgie: person with a disability
Kyle: Georgie’s boyfriend
Beth, Ron and Jackie: Georgie’s mum, dad and sister
Norman: Georgie’s uncle
Laura: occupational therapist at the rehab hospital
Frank: social worker at the hospital
Miles: physiotherapist at the hospital
Terri: case manager
Georgie’s mother, Beth, father, Ron, and sister, Jackie (19) are often with Georgie, and Laura gets to know
them well. One day when they aren’t there, Georgie asks Laura’s advice. ‘You said we’d need to look at
where I was living soon, to make modifications,’ Georgie says, and Laura nods. ‘But I don’t know where I
want to live. Mum wants me at home, but I moved out when I was 17 – I already feel like a baby, not being
able to do things for myself.’
‘Shall I get you some information about your options?’ Laura says. ‘There’s supported accommodation, or if
you have your own place there’s funding to make modifications. You’ll need to decide soon because
modifications take time, and you need wherever you’re living to be ready for you before you can go home.’
As Laura works on Georgie’s hands, Georgie talks about her dilemma, and not wanting to hurt her parents’
and sister’s feelings. Jackie and Georgie have always been very close, even after Georgie left home, and
Jackie is keen for Georgie to be back where she can help her. ‘And I’d love that too,’ Georgie says. ‘Oh, I
wish I didn’t have to decide now – it’s hard enough ...’ She breaks off with a sob and looks down at her
immobile body.
Laura finds information for Georgie about accommodation options and, with Georgie’s permission, talks to
the hospital social worker, Frank. He visits Georgie and starts the process of getting long-term services and
supports. With her permission he rings the Department of Human Services, and an intake worker contacts
Georgie to make an appointment.
Meanwhile the housing issue has become very difficult. Georgie’s dad, Ron, supports her independence, but
Beth and Jackie accuse him of not wanting Laura at home. One day the family has a heated argument in
front of Laura, and Beth asks for her opinion. ‘It’s not for me to say,’ Laura replies. The family are looking at
her expectantly. ‘Only you can decide. But I can suggest people who could help you work through it.’ Beth
nods slowly. Georgie thanks Laura and the tension eases.
Afterwards, Laura reflects on what she heard. Beth is worried about Georgie’s safety and doubts Georgie will
be able to develop the skills to take care of herself. Jackie seems most worried that her sister will end up
living in ‘some awful place’ far away.
Laura thinks she can help ease some of Beth’s concerns but not Jackie’s. Georgie doesn’t own a place, so
her choices might be limited. When Laura next sees Georgie, she offers to speak to Beth, and Georgie
agrees. ‘I’m not going to talk her into anything,’ Laura says. ‘You’re an adult, so legally it’s your decision. But
you need to resolve this as a family. I just thought it might help if your mum understands what independent
living could look like for you, and what support is available.’
When she rings Beth, Laura spends a long time just listening. Beth’s grief for her daughter is very raw. She is
furious at Georgie for not ‘just coming home’, and at her husband for supporting Georgie’s position. Laura
acknowledges her feelings but carefully avoids taking sides. When Beth finishes her outpouring, Laura
explains why she has rung. Beth is not enthusiastic but agrees to listen.
Before she begins Laura says, ‘You’re such a close family. A lot of people in Georgie’s position don’t have
Family-centred, person-centred allied health – FINAL TEXT
31
anything like that kind of support. And you’ll always stay connected, no matter where she’s living.’ Laura
hears Beth exhale, like she’s been holding her breath. Laura pauses, then continues. ‘Her recovery is going
well. Whether she’s living with you or independently, she’ll be able to do more and more for herself, including
meeting many of her own basic needs, and perhaps even driving a modified car. Wherever she’s living,
getting back that independence and freedom will be so important.’
Laura explains more about the skills Georgie could develop over time, especially if she’s living in the right
kind of space, with the right equipment and supports. She gives examples of other patients with C7 injuries
like Georgie’s, trying to create a picture for Beth of how her daughter’s life could be. ‘Independent doesn’t
mean unsupported,’ she says. ‘Whether she’s at home with you or not, there’s a range of services that can
help her achieve greater independence, whether she decides to go back to uni, or whatever.’
Beth asks some questions, then says, ‘You know, Jackie had been planning to move out before this
happened. Ron and I had all kinds of plans for when we had the place to ourselves. So there would be up
sides for us too.’ Laura offers Beth contacts for a family counsellor to talk it through, but Beth says, ‘No, I
think we’ll get there. Thank you, Laura.’
Next time Laura visits, case management support has been organised for Georgie as a result of the meeting
with the intake worker. The case manager, Terri, has rung, and Georgie is excited. ‘I want you to come to my
planning meeting. Can you? My folks will be there. For the first time I feel like I might get a real life again.’
Georgie says that Terri wants to talk to Laura, and gives Laura permission to share information with Terri.
When Terri rings Laura she says, ‘It sounds like you’ve been a great support to Georgie and the family. Can
you come to the planning session? And will you be able to keep working with Georgie out of rehab?’ Laura
says she and the physiotherapist, Miles, can work with Georgie until she has long-term supports in place.
The first meeting is spent on the housing issue because so much else depends on it. Laura observes that the
family seem much more able to see each other’s point of view. Terri encourages them to think about a range
of options. ‘What would be the ideal?’ she says. ‘ What do you all think?’ As each of the family answers, an
idea emerges. The family home is on a corner block, and the mortgage is mostly paid. What about a flat with
its own entry? Everyone throws in ideas, and Ron suggests that his brother, a builder, could build Georgie
something really great.
Ron and Beth get financial advice, and it seems the flat idea is viable. While Georgie is still in rehab, Laura
helps her with researching options for the flat, and brings her various pieces of equipment to try. Laura shows
Georgie websites with equipment for daily living and mobility, exercises for increasing her mobility and
strength, and ideas for building accessible homes. Georgie enjoys the research and becomes involved in an
online community of people with spinal injuries. Slowly her strength, and arm and hand function increase and
she becomes more self-sufficient.
During this time Georgie and Kyle get back together, and decide he will also move into the flat. At Georgie’s
request Laura comes to a couple of meetings with her, Kyle, Ron and Ron’s brother, Norman, the builder.
Georgie and Norman have come up with some great ideas for the flat and want her input. Laura finds it
exciting to think about a purpose-built dwelling rather than retrofitting an existing one.
When Georgie is allocated an individual support package she asks Laura along to another planning session.
Terri is there, and the whole family, including Kyle. They talk about Georgie’s future, and her plans to now
study architecture. As the group discuss what support she will need to reach this goal, Laura sees how much
faith Beth and Ron have in their daughter’s determination to do whatever she sets her mind to.
Practice Tips:
If they wish, help young people and families see what might be ahead for them
Offer information so young people and families can make informed decisions
Make time for people to tell their story if they wish; be comfortable with people’s strong emotions
Family-centred, person-centred allied health – FINAL TEXT
32
Seek permission to refer on to other services, as appropriate
Don’t get drawn into family conflict; offer resources for the family to resolve issues
Suspend your own judgement of family members; empathise
Address the family’s concerns; offer information so people can make informed choices
Listen actively; affirm feelings without getting drawn into conflict
Affirm a young adult’s right to decide but also the importance of family
Affirm a family’s strengths and ongoing support role
Tune into non-verbal signals
Offer families information; help them see
what might be ahead
Offer referral to specialist services to help families resolve issues
Participate in planning, if possible and desired by the young person/family
Assist children and families with transitions; refer for ongoing support
Support young people/families to find solutions; encourage creative thinking
Consult with the young person and family in implementing your technical knowledge
Inform and empower people to make decisions
for themselves
Offer your professional expertise as required by the young person and family
Tailor supports, drawing on existing networks to reach the young person’s goals
Family-centred, person-centred allied health – FINAL TEXT
33
6 Monitoring and improving practice
Years ago a speech therapist told us to book into [a non-government special school]. At that stage it’s years
in advance, you have no idea whether that’s an appropriate school, or a good fit for your child or anything.
But she said that unless we had her name down we’d be unlikely to have a chance of getting her in. And she
was right – bless her for just telling us that. It was quite confronting at that stage to think maybe Louise
wouldn’t be going to mainstream secondary school. She could have just ignored the issue, and not
confronted me with that. But she did, and she did the right thing. And because of that experience I’ve often
asked professionals questions about the future. – Jan, mother of Louise (who has an intellectual disability)
and her brother, Matthew
When a young person demonstrates that clearly they have certain preferences, honour those as much as
possible. Otherwise when they get older, and their parents are no longer around, they’re just not equipped to
make decisions for themselves. – George Taleporos, Coordinator of the Youth Disability Advocacy Service
and a person with a disability
Research has shown that many organisations and practitioners begin with a willingness to be family centred
but that such practices tend to wane over time, a phenomenon known as ‘professional drift’.41 A number of
studies have also identified gaps between how family centred early childhood practitioners think they are and
families’ experiences.42,43 Therefore both reflective practice and seeking regular feedback from families and
children are critical to successful implementation of family-centred approaches.
Reflective practice and these guides
There is strong evidence that ‘professionals who regularly reflect on what they do, why they do it and how
this new knowledge can be used to improve their practice, achieve the best outcomes for children and
families’.44 This guide has suggested the need for reflective practice in various contexts, and its usefulness is
widely accepted in human services. Yet research reveals a lack of clarity about what such practice
involves.45
Early work in reflective practice introduced the concepts of ‘reflection in action’ (thinking on your feet, which
could also be linked with Australian researcher Tim Moore’s concept of ‘mindful practice’ 46 in family-centred
contexts) and ‘reflection on action’ (thinking after the event). It has been described as ‘repeated cycles of
examining practice, adjusting practice and reflecting on it, before you try again’, 47 and identified as requiring
a focus on goals and a commitment to monitoring, evidence-based practice, open-mindedness,
inclusiveness and dialogue.48 Reflective practice has also been linked to action research49 and the need for
critical reflection, where professionals question their assumptions and how their values inform practice.
The guides in this suite are designed to support a range of work to strengthen practice by professionals
alone, with colleagues, in supervision and in teams. A 2005 joint Canadian–British study found that written
family-centred practice materials (like these guides) contribute most effectively to practice change by
providing support for knowledge communicated through interactive and interpersonal strategies such as
problem-based learning, interactive workshops and educational outreach visits (for students). 50
Professionals and services should therefore consider using the guides (including the good practice scenarios
herein, and the deeper conceptual discussions, practice examples and family stories in the foundation guide)
to support professional development, reflective practice, team discussion and practice-based learning.
There are also many other resources available to support reflective practice. Australian early childhood
researcher Glenda McNaughton 51 suggests six questions that practitioners can use to create positive
change:

How have I come to do things this way?

How have I come to understand things this way?
Family-centred, person-centred allied health – FINAL TEXT
34

Who benefits from how I do and understand this?

Who is silenced in how I do and understand this?

How many other ways are there to do and understand this?

Which of those ways might lead to more equitable and fair ways of doing and understanding things?
Monitor and seek feedback
Practitioners should seek feedback during the course of their work from children, young people and families,
and ensure they have the opportunity to give regular anonymous feedback on the service.
In more than two decades of research into family-centred practice, many tools have been created to
measure the family centredness of various aspects of services and supports. Practitioners and agencies
might look at how these could be used to inform existing service user feedback tools or adapted to their
organisation and context.
For example, Dunst and Wilson’s Family-centred practices checklist52 is a tool for use primarily in
supervision, focusing on implementation of relational and participatory practices. Services might want to give
thought to expanding the tool to cover relevant technical skills and knowledge, in line with staff key
performance indicators.
Carl Dunst has also produced sample tools for use with families 53 that practitioners might use to develop a
set of questions to ask of children, young people and services during review periods or at other times.
Organisations might also adapt them as a tool (or set of tools) for seeking regular anonymous feedback from
children, young people and families.
The organisational guide includes further discussion of issues related to seeking feedback from children,
young people and families, including the design of tools, implementation of surveys and focus groups,
analysis of findings, using findings to inform practice change, and disseminating results to service users.
Next steps
Many Victorian practitioners are skilled in family practice. It can be hard to find the time to reflect and learn
from each other and from the families you work with, but the evidence shows it is well worthwhile.
For those wanting to read further, the foundation guide in this suite explores many ideas more deeply, and
provides many more stories from families, young people and the diverse practitioners who support them. The
organisational guide will be of interest for those wanting to explore how organisations can better support
family-centred practice and bring families into every aspect of their processes and practices.
Family-centred, person-centred allied health – FINAL TEXT
35
Endnotes
1 Trivette, C (unpublished) cited by Dunst, C and Moore, T 2010, Family centred practice presentations, ECIA (Victoria)
Seminar, 13 August 2010, referenced in Moore, T, Family centred practice – presentation handout, viewed
November 2011, <www.eciavic.org.au/events/professionaldevelopment.html>.
2 King, GA, Law, M, King, SM and Rosenbaum, PL 1998, ‘Parents’ and service providers’ perceptions of the familycentredness of children’s rehabilitation services’, Physical and Occupational Therapy in Pediatrics, vol. 18, no. 1, pp.
1–20.
3 McWilliam, RA, Snyder, P, Harbin, GL, Porter, P and Munn, D 2000, ‘Professionals’ and families’ perceptions of familycentred practices in infant-toddler services’, Early Education and Development, vol. 11, no. 4, pp. 519–538.
4 Summers, JA, Marquis, J, Mannan, H, Turnbull, AP, Fleming, K, Poston, DJ, Wang, M and Kupzyk, K 2007,
‘Relationship of perceived adequacy of services, family–professional partnerships, and family quality of life in early
childhood service programmes’, International Journal of Disability, Development and Education, vol. 54, no. 3, pp.
319–338.
5 Dunst, CJ, Trivette, CM and Hamby, DW 1995, ‘Measuring the help-giving practices of human services program
practitioners’, Human Relations, vol. 49, no. 6, pp. 815–835.
6 Dunst, CJ, Trivette, CM, and Hamby, DW 2007, ‘Meta-analysis of family-centered help-giving practices research’,
Mental Retardation and Developmental Disabilities, vol. 13, pp. 370–380.
7 Dempsey, I, Keen, D, Pennell, D, O'Reilly, J and Neilands, J 2009, ‘Parent stress, parenting competence and familycentered support to young children with an intellectual or developmental disability’, Research in developmental
disabilities, vol. 30, no. 3, pp. 558–566.
8 Moore, T and Larkin, H 2005, ‘More than my child’s disability…’ a comprehensive literature review about family-centred
practice and family experiences of early childhood intervention services, Scope Victoria Ltd, Melbourne.
9 Trivette, C, Dunst, CJ and Hamby, DW 2010, ‘Influences of family-systems intervention practices on parent-child
interactions and child development’, Topics in Early Childhood Special Education, vol. 30, no. 1, pp. 3–19.
10Yap, K and Enoki, D 1995; Epstein, J 2005; Leadbeater, C and Wong, A 2010; Izzo, CV, Weissberg, RP, Kasprow,
WJ and Fendrich, M 1999; and Henderson, A and Mapp, K 2002), all cited in DEECD, The importance of family
partnerships – evidence, viewed July 2011,
<www.education.vic.gov.au/about/directions/familiesaspartners/importance/evidence.htm>.
11 Viscardis, L 1998, ‘The family-centred approach to providing services’, Physical & Occupational Therapy in Pediatrics,
vol. 18, no. 1, pp. 41–53.
12 Bastion, E 2002, ‘Creating a community vision for the care and education of young children’, in Children first: making
the vital years count – Country Children's Services Association of NSW Conference 2002, Katoomba, NSW.
13 Litchfield, R and MacDougall, C 2002, ‘Professional issues for physiotherapists in family-centred and communitybased settings’, Australian Journal of Physiotherapy, vol. 48, pp. 105–112.
14 Victorian Health Promotion Foundation (VicHealth), Onemda VicHealth Koori Health Unit (The University of
Melbourne), McCaughey Centre: VicHealth Centre for the Promotion of Mental Health and Community Wellbeing
(The University of Melbourne) and the Victorian Equal Opportunity and Human Rights Commission2009, Building on
our strengths: a framework to reduce race-based discrimination and support cultural diversity in Victoria: summary
report, VicHealth.
15 Victorian Aboriginal Child Care Agency (VACCA) 2008, Aboriginal cultural competence framework, Department of
Human Services, Melbourne.
16 VACCA 2008.
17 VACCA 2008.
18 VACCA 2008.
19 VACCA 2008.
20 See both National Medical and Health Research Council (NMHRC) 2005, Cultural competency in health: a guide for
policy, partnerships and participation, viewed November 2011, <www.nhmrc.gov.au/_files_nhmrc/publications> and
Department of Human Services, 2004, Culturally and linguistically diverse strategy, State Government of Victoria,
Melbourne.
21 Dinnebeil, L and Rule, S 1994, ‘Variables that influence collaboration between parents and service coordinators’,
Journal of Early Intervention, vol. 18, pp. 349–361; Hedges and Gibbs 2005.
22 Moore, T 2006, Parallel processes: common features of effective parenting, human services, management and
government, ECIA (Victoria) Annual Conference, viewed November 2011, <www.eciavic.org.au>
23 Dunst, CJ, Boyd, K, Trivette, CM and Hamby, DW 2002, ‘Family-oriented program models and professional helping
practices’, Family Relations, vol. 51, no. 3, pp. 221–229.
24 Moore and Larkin 2005.
25 Turnbull, AP and Turnbull, HR 2000, Families, professionals and exceptionality: collaborating for empowerment, 4th
edn, Merrill/Prentice Hall, Upper Saddle River, New Jersey.
26 Turnbull and Turnbull 2000.
Family-centred, person-centred allied health – FINAL TEXT
36
27 Guralnick, MJ 2006, ‘Family influences on early development: integrating the science of normative development, risk
and disability, and intervention’, in K McCartney and D Phillips (Eds), Handbook of early childhood development,
Blackwell, Oxford, pp. 44–61.
28 VicHealth et al. 2009.
29 Department of Human Services 2008, Every child every chance: best interests case practice model summary guide,
State Government of Victoria, Melbourne.
30 For example, see resources listed at
<www.scopevic.org.au/index.php/site/whatweoffer/communicationresourcecentre>, viewed November 2011.
31 McWilliam, RA, Tocci, L and Harbin, GL 1998, ‘Family-centred services: service providers’ discourse and behaviour’,
Topics in Early Childhood Special Education, vol. 18, no. 4, p. 206.
32 Popay, J 2006, Where’s the evidence? The contribution of lay knowledge to reducing health inequalities, Glasgow
Centre for Population Health Seminar, viewed November 2011,
<www.gcph.co.uk/assets/0000/0353/Jennie_Popay_Summary.pdf>
33 Popay 2006.
34 Australian Bureau of Statistics 2006,2004–05 National Aboriginal and Torres Strait Islander health survey, ABS,
Canberra.
35 Moore 2006.
36 Harris, SR 1994, ‘Parents’ and caregivers’ perceptions of their children’s development’, Developmental Medicine and
Child Neurology, vol. 36, no. 10, pp. 918–923.
37 Popay 2006.
38 For guidance about making a report to Child Protection or referral to Child FIRST see <www.dhs.vic.gov.au/forindividuals/child,-youth-and-family-services/child-protection>, viewed November 2011.
39 VACCA 2008.
40 VACCA 2008.
41 Trivette (unpublished), cited by Dunst and Moore 2010.
42 McWilliam et al. 2000.
43 McWilliam et al. 2000.
44 Department of Education and Early Childhood Development (DEECD) 2010, citing MacNaughton, G 2005, Sylva, K et
al. 2003, Raban B et al. 2007 in Victorian early years learning and development framework evidence paper – practice
principle 8: Reflective practice, viewed November 2011, <www.vcaa.vic.edu.au/earlyyears/evidence.html>.
45 Khinsella 2009; Ghaye and Ghaye 1998, cited in DEECD 2010.
46 Moore, T 2007, The nature and role of relationships in early childhood intervention services, Second Conference of
the International Society on Early Intervention, 14–16 June 2007, Zagreb, Croatia, viewed November 2011,
<netsvic.org.au/emplibrary/ccch/TM_ISEIConf07_Nature_role_rships.pdf>.
47 Gruska, McLeod and Reynolds 2005, cited in DEECD 2010.
48 PollardA 2002, cited in DEECD 2010.
49 McMahon, T 1999, ‘Is reflective practice synonymous with action research?’, Educational Action Research, vol. 7, no.
1, pp. 163–169.
50 Law, M, Teplicky, R, King, S, King, G, Kertoy, M, Moning, T, Rosenbaum, P and Burke-Gaffney, J 2005, ‘Familycentred service: moving ideas into practice’, Child: Care, Health & Development, vol. 31, no. 6, pp. 633–642.
51 McNaughton 2005, cited in DEECD 2010.
52 Wilson, LL and Dunst, CJ 2005, Checklist for assessing adherence to family-centered practices, CASEtools:
instruments and procedures for implementing early childhood and family support practices, vol. 1, Center for the
Advanced Study of Excellence in Early Childhood and Family Support Practices, Family, Infant and Preschool
Program, J. Iverson Riddle Developmental Center, Morganton, North Carolina, viewed November 2011,
<http://w.fippcase.org/casetools/casetools_vol1_no1.pdf>.
53 Dunst, C 2010, Family-centred practice presentation handout, ECIA Seminar, 13 August 2010, viewed November
2011, <www.eciavic.org.au/events/professionaldevelopment.html>.
Family-centred, person-centred allied health – FINAL TEXT
37