Working with children, adolescents and young adults with a disability and their families
Family-centred, person-centred
planning
A guide for professionals in intake, planning and case
management roles
Family-centred, person-centred planning – FINAL TEXT
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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 978-0-7311-6524-7 (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
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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 planning: a guide for professionals in intake, planning
and case management roles, State Government of Victoria, Melbourne.
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Contents
1 Introduction ...................................................................................................................... 6
Who this guide is for .......................................................................................................................................... 6
Principles and context........................................................................................................................................ 7
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 ................................................................................ 11
Family-centred organisations .......................................................................................................................... 11
A family-centred service system ...................................................................................................................... 11
Good practice scenario: Eleanor ........................................................................................ 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, stay in touch ............................................................................................................. 18
Good practice scenario: Raha ........................................................................................... 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 .............................................................................................................. 23
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: Paul ............................................................................................. 25
5 Technical quality ............................................................................................................ 28
Draw on everyone’s knowledge ....................................................................................................................... 28
Use creative planning tools ............................................................................................................................. 28
Improve teamwork and service integration ...................................................................................................... 29
Refer and use secondary consultation ............................................................................................................ 29
Self-care and maintaining boundaries ............................................................................................................. 30
Good practice scenario: Jimmy .......................................................................................... 31
6 Monitoring and improving practice ................................................................................. 34
Reflective practice and these guides ............................................................................................................... 34
Monitor and seek feedback ............................................................................................................................. 35
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Next steps ........................................................................................................................................................ 35
Endnotes............................................................................................................................ 36
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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
A lot of my friends, their marriages have broken down. So sometimes other things take priority. [Workers
need to remember that] it’s a life. It’s not just managing a child with additional needs … it’s about being quick
to listen, and slow to give advice until you really know the family and understand. – Kate, mother of Jamie
(who has pervasive developmental disorder), Melanie and Callum (who both have Asperger’s syndrome)
Who this guide is for
This is a resource for disability service professionals in planning-related roles who wish to explore how
working in more family-centred ways can enhance their practice. These roles vary but include intake,
assessment, case management and facilitation, and some aspects of social work. The guide aims to help
orient newer professionals to the approach and to support their more experienced colleagues to reflect on
and improve their practice.
Research suggests that even professionals dedicated to family-centred practice find it difficult to fully
maintain it over time. Other research reveals that a gap can arise between how family-centred professionals
think of the quality of their work, and the experiences of those they work with. 1,2.
This is one of seven guides for those working with people with a disability or developmental delay 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 or organisational guides.
Pull out text 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.
The Victorian Government’s vision is based on the following service 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.

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.
 All subsequent references will be to ‘people with a disability’ for ease of reading.
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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 above).
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2 Foundations
We’ve had many case managers over the years, some great, some I hardly know. The one we’ve got at the
moment is amazing. She is giving us a lot of challenges, making us think about what’s possible, putting us in
touch with people who will help develop Mark into a capable man, comfortable going into the community and
living his life. – Alison, mother of Mark (who has a mild intellectual and physical disability)
One case manager was particularly good. She didn’t get us more [funding] than the others, but she would
identify what would work for us, then see if she could get it. If she couldn’t, well so be it. They don’t have
endless amounts of money. What you can have and what you need are probably very different things. Most
families understand that. But [some case managers] would come in and almost ‘contain’ what you could say
you needed. – Amy, mother of Emily (who has complex medical needs), her older brother, Anthony, and
younger sister, Lisa (who has a learning delay)
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. 3 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 stresses, 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 for breaking down and focusing on central
ideas. These guides use a model drawn from the work of American researchers Carl Dunst and Carol
Trivette,4 which divides family-centred practice into three key elements, and associated aspects (see Figure
1).
Figure 1: The three elements of family-centred practice
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Adapted from Dunst and Trivette, 2007

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 applying 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 and wellbeing, and family functioning.5
Australian reviews of the family-centred practice literature have concluded that the theoretical evidence for
the approach is strong,6 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)’. 7 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. 8
Family and person centred
Approaches to practice in disability services have changed over time, moving from a largely medical model
to a person-centred, and now more family-centred approach. Traditionally most supports were clinic based
and focused on the child or young person, with goals set by professionals. 9 In the past two decades this
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began to change as services moved into community settings and professionals recognised the benefits of
family involvement in setting goals, shaping services and carrying out activities. The benefits of drawing on
the knowledge of the child, young person and family to better understand their needs, environment and
context are also recognised.10,11
Working with families is crucial, but the focus on the child, adolescent or young adult with a disability remains
equally important. 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 life and
future. When they reach adulthood, most will have the legal right to make their own decisions. All young
people need support to develop the skills and confidence needed to do so, or to contribute to decision
making according to their capacity. Professionals need to consider how to support a child or young person’s
input into decisions that affect them.
In some ways family and person-centred practice are complementary, 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 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.12 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 vital 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.13
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
framework14 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.15 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.16 It asks that professionals show cultural respect (for
example, when addressing Elders), and strive to learn, reflect and share power.
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When services and professionals are culturally sensitive, responsive, reflective and respectful, this creates
space for Aboriginal families – including prospective clients – to feel culturally safe and to ‘be themselves’.17
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 families;18 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 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, and 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 19 point to
commonalities in positive, effective relationships between managers and staff, and those between
professionals and families, suggesting that one influences the other.20 Organisations should therefore
support staff to work in family-centred ways and create a culture of mutual respect and collaboration for both
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. People in planning and case management roles have a crucial role in improving communication and
coordination between diverse services (see page 16).
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Good practice scenario: Eleanor
The people in this story
Eleanor: person with a disability
Carl: Eleanor’s father
Diane: Eleanor’s neighbour
Annette: case manager
Darren: social worker
Graeme: facilitator
Carl is frantic to talk to someone about Eleanor, who is at home. His neighbour Diane will be able stay until
more support is available, he says, but she has young children so Eleanor will need more support soon. A
nurse brings the social worker, Darren, who first rings Diane, then after-hours respite response.
Given the urgency, Darren is put straight through to a case manager, Annette. After hearing the situation,
Annette asks Darren if Carl is happy with the support Eleanor will receive from her neighbour. She asks
Darren to let Carl know she will first visit Eleanor, then Carl himself, as soon as possible. She then asks
Darren for Diane’s phone number.
Annette calls Diane. After Annette tells Diane what is happening, she asks to speak to Eleanor. She is very
upset about her dad, and anxious about who will look after her if he is in hospital for long. Annette listens,
reassuring Eleanor that Carl is getting good care, and that she will arrange for meals on wheels and
personal assistance for Eleanor through the local council. She then rings the council to make these
arrangements. She calls Eleanor back to let her know that a support worker called Nadia will be there in the
morning to help before Diane leaves, and that Annette herself will visit Eleanor after that.
Nadia comes at eight the next morning to help Eleanor shower and dress. Annette arrives at 9.30 and goes
first to Diane’s house. Over a cup of tea it becomes clear that Diane and her partner, Kim, are close to
Eleanor and Carl, but their capacity is limited by having a newborn and a two-year-old. They go across to
Eleanor’s house and find her tired and still worried about her dad, but less anxious. Nadia was nice, she
says, and did everything just like her dad or Diane would. She wants to see Carl, so Annette rings to check
how he is, then takes her into the hospital.
Annette gets a coffee while the two have time alone, then they all talk in the ward. Annette listens while Carl
and Eleanor discuss his hospital experiences, and how she managed without him. She sees how proud
Carl is of his daughter’s ability to cope, and how interdependent they are. Carl is likely to be in hospital for
at least a week, so Annette asks if they’re ready to talk about what supports Eleanor will need. Carl wants
to get everything arranged, but he suddenly feels breathless. The nurse tells him to rest, and Annette says
she’ll make some short-term arrangements and return the next day.
The next day Carl is improved but worried about Eleanor. What if he can’t care for her anymore? Will she
have to live in a home? Annette reassures them both that she will work to get support for Eleanor that will
enable her to stay at home and take the pressure off Carl. She explains what disability support and respite
services do, and that she’ll help Eleanor and Carl work out what they want and need, find some possible
options and help them apply for funding if required.
Knowing Carl wants to get things organised quickly, Annette focuses on finding short-term care options.
Long-term support will require more work, and Annette begins explaining the process for accessing funding
to them both.
Annette takes Eleanor in twice more during Carl’s 10-day stay. She offers to wait outside, but they insist
she join them. As they talk, she finds out more about their life together. Since Eleanor finished school and
Carl retired, they’ve started enjoying their neighbourhood. They have lunch at the bowls club or a cafe
every day, and know the shopkeepers well. Both love books and movies, and often go to the library and
cinema. It seems Carl has had endless energy for pushing Eleanor’s chair, and they both love chatting with
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everyone they meet.
At the hospital they discuss options for ongoing personal assistance, a hoist and respite. ‘We need to look
after your health too, Carl,’ Annette says. Eleanor nods and squeezes her dad’s hand. Annette outlines
several options for respite and in-home support, including a paraplegic-specific service, which Carl and
Eleanor choose. She also offers contacts for an ABI self-help group.
‘It’s also important you stay connected to your local community,’ she says. ‘You know so many people. Who
do you think might like to visit, and maybe even help out?’ Eleanor names Diane and Kim, and another
neighbour. Carl names some family friends and a favourite librarian. Annette encourages them to ask for
support, saying, ‘You might be surprised at who says yes’.
The doctor comes in and is pleased to meet Annette. ‘The reason we’re discharging you is because
Eleanor has supports in place,’ she tells Carl. ‘And we need to make sure you have the care you need, so
she doesn’t end up looking after you! The nurse will explain our in-home nursing service, and the social
worker will discuss other referrals.’
When she visits the family two months later, Annette finds that Carl’s health has deteriorated. He has begun
receiving a high level of services, and Eleanor’s level of support is clearly inadequate. Annette talks to the
family about increasing support, and together they fill in a Disability Support Register application over
several visits.
It takes eight months for the package to come through. In the meantime, Annette organises more home
help through a program for older people, and helps Eleanor organise a meeting of neighbours and friends
willing to help out more. There they make a roster for helping with shopping and other tasks, so that
Eleanor can use her other supports for personal assistance.
When the new package comes through, Graeme, a facilitator from another service, invites Annette to help
develop Eleanor’s plan. When they meet with Carl and Eleanor, both are focused on managing the current
situation. Graeme encourages them to ‘step back’, and think about Eleanor’s future. He asks: ‘What do you
love doing? What dreams or ambitions do you have?’ Eleanor finds it hard to say but eventually begins
talking about her enjoyment of computers and playing keyboards, and her desire to write and perform her
own music one day.
Then he gently asks about Eleanor and Carl’s hopes and fears. They slowly open up about their fears about
Carl’s health, and what Eleanor’s choices might be if he dies or is hospitalised for long. They talk about
possibilities for ongoing support now, what would be needed in a crisis, and what options Eleanor might
want longer term. Then they talk about what supports they have around them in terms of family, friends and
other networks.
Graeme convenes a larger meeting, including Rob, Diane and Kim, and four other friends who have been
helping out. Graeme encourages Eleanor and Carl to share their thoughts since last time, and writes the
issues on a whiteboard: Eleanor’s dreams, daily life, keeping Eleanor healthy, keeping Carl healthy, support
if Carl goes to hospital, long-term planning for Eleanor. He asks everyone to think about what has been
working for Eleanor and Carl – in terms of their strengths and current supports – and what hasn’t.
Together they determine a range of supports, funded and otherwise, that Eleanor and Carl will need in the
coming year. Graeme and Annette research and canvass options with Eleanor and Carl. At the final
meeting they decide on the plan, and each make ‘commitments’ to the actions they will take. Given the
state of Carl’s health they then set six-monthly reviews. Eleanor and Carl ask Annette to manage their
supports, which now include personal assistance, equipment, physiotherapy, occupational therapy, respite
and support for Eleanor at TAFE.
Practice Tips:
Make sure family members are happy with arrangements
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Talk directly to the person with a disability about their family member’s situation
Report back and let the person know what is happening
Draw on the family and close friends’ knowledge to understand needs
Respect family privacy, listen and learn from observation
Check if people are ready to receive information; reassure family members
Respond to concerns, offer information, explain your role and approach
Be sensitive to people’s sense of urgency; help families with paperwork
Listen and ask questions to get a holistic understanding of the family and the context
Offer options in response to needs expressed; offer other appropriate ideas
Encourage the young person and family to maintain and draw on informal supports
People are often carers for older or unwell parents; put supports in place
Encourage people to manage their services within their capacity
Respond to changing circumstances; help with paperwork
If funded resources are inadequate or there is a wait for services, find other ways to meet the need, including
informal supports
Use creative person-centred and family-centred tools to draw out needs and desires
Encourage people to set outcomes informed by long-term goals and needs
Sensitively support people to face fears, plan for crises and long-term needs
Draw on the expertise of the young person, family, partner, friends and other services
Reflect on problems, build on strengths, set review dates based on context
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3 Practices that build relationships
I don’t always stick to the assessment tool. A lot more comes out of that hour with a family than the ‘tick a
box’. Active listening and really hearing are important, as opposed to asking questions. You need to do that
but can often leave it to last. – Intake and assessment worker
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
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. 21,22 Of
course relationships are two-way, shaped as much by the experiences, behaviours and values of children
and families as by those of professionals. 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:
Validating the parents’ past journey is very important – the grief and the chaos that they’ve had to deal
with. I’ve had clients say to me, ‘You’re case manager number eight’. I’d open at a blank page of my
notebook to say, ‘This is our new beginning. This is where we start together’. But first I would give them
time with the book closed to tell me what case managers one to seven did wrong. – Case manager
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 professionals 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 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 17)

challenge negative ‘stories’ about families that can arise in a sometimes deficit-focused system

understand and value people’s knowledge and experience, however expressed

practise 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 25). 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.
Family-centred, person-centred planning – FINAL TEXT
15
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. Professionals
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’. By doing so, you
can ensure that you don’t impose your values on the families you work with. Be aware of 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.23 Professionals 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. 24
The dynamics between professionals and the people they work with are, of course, shaped by broader
power structures and family stressors. These include lack of access to education, financial resources and
support networks.25 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 communities also continue to experience high levels of discrimination, including from
service providers.26 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.27

Sharing your observation of what you are learning about the child or young person and family
(particularly their strengths and capacity to meet their own needs) helps build self-efficacy (see page 24).

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 referring 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. 28

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. Gathering relevant information and observation will help you determine the most
relevant questions to ask.
Family-centred, person-centred planning – FINAL TEXT
16

Making space for the whole ‘story’ enables people to feel heard and builds a more complete picture of
their needs. Sometimes, of course, people won’t want to tell their story yet again. Services can help by
sharing information, with permission.

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 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 professionals are insincere in
expressing caring or empathy.29 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 professionals 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, ensure you have the information and offer it to them in an
appropriate form. Any suggestions should arise from a deep understanding of and reflection on the family’s
needs, priorities and concerns. Such suggestions 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.
The following can be helpful:

Check what information the family and young person think they might want, and when. Information
overload is common. If people don’t have a lot of information, it might be helpful to describe the kinds of
things you could tell them, and ask which would be helpful.

Ask about what they already know. You can then avoid patronising them. Address 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 families 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 families 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 include:

current accessible information about disabilities and developmental delays, supports and services,
including research

assistance in weighing up the risks and benefits of different options

leaving written information with people to reflect on after your meeting

assistance in making sense of conflicting information

information about what might be ahead for them, and what choices they might want then

how to link with other families for support and information sharing.
Collect 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 would prefer to use an interpreter. This enables you to
communicate better, and is critical 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 (possibly exposing your agency to legal risk). It also ensures family and friends are able to
participate fully in the discussion.
Family-centred, person-centred planning – FINAL TEXT
17
Keep people in the loop, stay in touch
Communication and follow-through are key issues for families and young people. Issues you might need to
discuss regularly with families include:

how changes in circumstances (such as the child’s age, development stage or medical needs, or family
income or employment status) might affect the services available to them

relevant changes in your role or availability (including leave), organisation, sector, policies or funding, or
in the services you are coordinating on their behalf

new potential sources of support, and financial information such as the hours of service remaining in a
given funding period.
Another common complaint of families is when professionals become less communicative, such as if there is
a delay in funding becoming available, or if funding applications have been unsuccessful. It is especially
important to maintain communication during these times, and work in partnership with families to find other
ways to meet expressed needs.
Family-centred, person-centred planning – FINAL TEXT
18
Good practice scenario: Raha
The people in this story
Raha: person with a disability
Asima: Raha’s mother
Fatimah: Raha’s older sister
Mahmoud and Zainab: Raha’s brother and sister-in-law
Samarah: community development worker
Prue: intake and assessment worker
Alice: case manager
Hanan: disability support worker
The family receives support from an ethnic community organisation, especially from Samarah, a part-time
community development worker. Samarah recognises Asima’s increasing levels of fatigue and, with
Asima’s permission, makes contact with Department of Human Services Intake and Response.
Prue, a new intake and assessment worker, notes that the family is Lebanese and speaks Arabic at home.
She books a telephone interpreter for the next day, checking that they will be interpreting in Lebanese
Arabic.
Prue has accompanied some colleagues on their assessments since starting, but this will be her first visit
on her own, and she is nervous. She reads the forms many times and asks two colleagues what she should
keep in mind. ‘Take your time,’ says one. ‘Don’t rush into filling out the forms. Sometimes people need to
just talk for a while.’
Prue’s other colleague comments: ‘I’ve worked with a few Lebanese families. I’ve found it really difficult to
get them to accept support.’ The first colleague replies wryly, ‘Maybe you haven’t been offering them the
right kinds of choices?’ He turns to Prue. ‘The main thing is to not make assumptions. You need to learn
about people’s culture, but what it means to them, not what the stereotypes say. Everyone’s different.’
When Prue rings, the phone is answered by Raha’s much older sister, Fatimah. She speaks fluent English,
so Prue asks the telephone interpreter to stand by while they work out who will take the call. ‘I need to visit
the family, so we can talk about what supports your family might want for your sister,’ Prue says. ‘Would
you like to be there when I come?’ Fatimah says yes, and offers to interpret. Prue thanks her, but says her
agency requires her to bring a professional interpreter. ‘That way, you can concentrate on supporting your
mum, and telling me about Raha,’ Prue explains.
Fatimah passes the phone to her mother. Prue introduces herself through the interpreter, and explains the
reason for her call and visit. ‘Fatimah has told me she would like to be there,’ says Prue. ‘I wondered if you
would also like Samarah to be there?’ Asima agrees, so they settle on a couple of possible times, and Prue
says she will contact Samarah to confirm her availability. ‘Is it okay if I talk with Samarah about what she
has done for your family so far?’ Prue asks Asima, and Asima consents.
At the first visit, Asima shows Prue around the house and introduces Prue to Raha. Prue recognises the
level of care Asima has provided for so long with limited support. She has her forms in her bag, but bearing
in mind her colleague’s advice, she doesn’t get them out yet. She expresses admiration for the level of care
Asima provides for her daughter, and for their beautiful, welcoming home.
At first Prue finds talking through the interpreter awkward but is careful to ensure she is speaking directly to
Asima and Raha, rather than about them to the interpreter. Fatimah and Samarah arrive soon after. Prue is
careful to address everyone equally, including Raha. She begins by briefly explaining her role and the
services her agency offers. ‘I’m not here to tell you what to do,’ she says. ‘Just to learn about how things
are going for you, find out what support or services you need, and whether services that our agency or
others offer might be helpful for you.’ She has brought some service brochures in Arabic and English and
Family-centred, person-centred planning – FINAL TEXT
19
asks which language they would like the information in. Fatimah asks for the information in both languages.
Asima has warmed to Prue but not to the idea of services, especially when Prue explains about respite.
‘Looking after children is a family’s responsibility,’ she says firmly. Fatimah speaks up. ‘Mum, don’t you
think it might be helpful to have somewhere Raha can be cared for? What if you’re sick again, and I can’t be
here, or Mahmoud or Zainab?’ She tells Prue that Asima had to go into hospital a couple of years ago,
when she herself was overseas. Mahmoud had had to stay with his sister for a week, just after his wife
Zainab gave birth to their youngest child. ‘That wasn’t good for Zainab or the children,’ she reminds her
mother. ‘And they never get to see you because you’re always taking care of Raha.’
Reluctantly, Asima agrees that it would be good if they could find a respite service she felt comfortable with,
for emergencies. Prue asks if she would be willing to have someone look after Raha at home, sometimes,
so that she could attend to other activities. Samarah suggests Hanan, a young woman the family know well,
who recently finished her disability certificate. Asima agrees and Prue suggests a good local agency that
Hanan could apply to. They discuss Raha’s needs and medical issues further, and Prue offers to send them
information in Arabic and English about activities and therapies that could be helpful.
Prue explains that she will not be visiting them again but that a case manager will support them from now
on, if they are willing. She explains the case manager’s role, and rings her agency to see if someone has
been allocated. ‘Would the family prefer a woman?’ asks her team leader, and Prue relays the question. ‘Of
course,’ Asima and Fatimah say together, and Prue confirms this. After the call she tells them her colleague
Alice will be their case manager. ‘She’s very nice,’ Prue says. ‘And very experienced.’
For the next eight months, things go well. Asima and Raha are very pleased with how carefully Hanan
learns from Asima about exactly how to care for Raha. Raha tells Alice, through an interpreter, how much
she likes Hanan and how much fun they have, and Fatimah tells her that it’s been great for Raha to have
another young woman around.
A month later, Fatimah calls. Her grandmother is very sick and Asima must travel to Lebanon immediately.
Alice has taken Asima and Raha to see three residential respite houses in the past few months, and now
organises for Raha to stay with one the family has chosen. Raha settles in well, but during the three weeks
that Asima is away, she develops pneumonia, and is transferred from respite to hospital.
When Asima returns Raha is well again, but her mother is guilt-stricken and furious. ‘I should never have
agreed!’ she cries. ‘We will never send her away again!’ Alice listens, affirming Asima’s feelings quietly. She
asks if the family wants to talk to the respite service, and explains that they can make a complaint if they
want. Asima sighs and says no, Raha has had pneumonia before. She doesn’t really blame them, but it is
hard to think of her daughter getting sick in a strange place, among people she doesn’t know.
‘Well, let’s think of another solution,’ says Alice. ‘Because there will be times you need to be away again,
because of another family member’s health, or your own.’ She checks things are still going well with Hanan,
and suggests that Hanan’s agency might be able to provide other workers that Asima and Hanan could
train up to be just as good at caring for Raha.
This works well for the family. When Asima is admitted to hospital again five months later, Raha has several
carers she knows and likes who provide additional assistance until Asima is fully recovered.
Practice Tips:
Consider the impact of caring on family members and its sustainability
Strengthen your skills in working with interpreters; ensure correct language
Draw on colleagues’ experience
Make time for people to ‘tell their story’
Learn about cultural difference but do not make assumptions about a family
Always offer an interpreter; never use family members or friends to interpret
Family-centred, person-centred planning – FINAL TEXT
20
Speak directly to the main carer, not through others who speak more English
Work well with other service providers supporting the family
Seek permission to discuss family issues with other service providers
Take time to establish a respectful rapport with family members
Always include the person with a disability in any discussion about them
Offer information in appropriate languages; explain your service/role
Learn from and consider the needs of all family members
Encourage the family to consider different supports for different needs
Draw on community networks to provide appropriate supports
Provide appropriate information about supports to inform family choice
Explain who is who in your service
Be sensitive to issues regarding gender
Get feedback from children, young people and families about services
Give people choices about supports; respond to crisis situations
Express empathy and support
Offer ideas for resolution or action
Address the family’s concerns, tailor responses, make sure the family is in control
Family-centred, person-centred planning – FINAL TEXT
21
4 Practices that support choice
A parent knows their child a lot better than any professional. But sometimes the young person hasn’t had a
chance to express their needs and wants. ‘What are your goals? What do you want to do with your life?’ How
often do parents ask that? These are questions that young people might have a chance to explore when they
access an Individual Support Package, but the answers might not always be what the parent wants to hear.
– George Taleporos, Youth Disability Advocacy Service Coordinator and person with a disability
Case management has really assisted our family through some difficult times. In our chaotic life they always
seemed so organised. They have always been in tune with what was happening in our family, especially
during times when we needed extra help, like when Samuel’s brothers were born. They spoke to us
beforehand, and we discussed what additional help we might need. It was reassuring to have a plan in place
and know that they weren’t going to say, ‘There’s no more funding left’. – 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 and mental illness, family violence and discrimination, including that based on gender,
ability, race, religion, sexual orientation, family structure and circumstances.
Decision making and action
Family-centred practice means that choices – as far as possible – are in the hands of those most affected by
them. Yet those choices will always be limited by resources. What does being family centred mean in this
context? Some families recount experiences where they felt their ability even to express needs was
‘constrained’ by professionals focused on what was likely to be funded.
If someone expresses a need that at first seems to go outside guidelines or resources, ‘no’ should never be
your first or final answer. This is an opportunity to explore what the request means to the person or family;
what difficulty it might help resolve; and what benefit it might have for the person with a disability. These
explorations might well reveal that the request does fit the criteria, or that there are other resources – funded
or otherwise – that could meet the need.
Exploring a range of options for how the person’s needs can be met, including through creative use of
informal and universal supports, and using available resources in different ways, can often address a
person’s need.
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, then discuss desired outcomes,
bearing in mind your power to shape people’s expectations, and the need not to build unrealistic
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 to everybody and are therefore 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.
Family-centred, person-centred planning – FINAL TEXT
22
‘Release’ people’s capacity to act
What if a family wants you to make the decisions and just ‘fix it’? Everyone has different desires and
capacities 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 they need a break or different support.
Respite might help, but some families don’t want other people caring for their child. Some might be eligible
for more financial assistance or help with other responsibilities. It might also be helpful to think about who
you are trying to engage, and if it would be helpful to ask if there are other family members or people in their
informal network who could become more involved. Creative planning processes (see page 31) can help
families identify who this might be.
British health researcher Jennie Popay says professionals assume that people don’t engage because they
lack skills and capacity.30 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 professionals, they will be reluctant to engage again.
She suggests that rather than ‘building’ people’s capacity to engage, professionals 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.31 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 expectations, because they are not optimistic 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, you
can 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. Professionals
must respect young people’s choices and not be drawn into family conflict. It is also critical to respect young
people’s privacy, even before age 18. Yet 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 31). 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 (see page 18) to have a sufficiently informed opinion

you are simply feeling challenged by values different from your own (see page 16)

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 their choice to be well informed

their thinking might change with additional support, such as a second opinion or counselling.
Family-centred, person-centred planning – FINAL TEXT
23
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).
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. This means tailoring your own ways of working and exploring options
and seeking out services that better meet the shifting needs of the person with a disability and their family.
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 settings

make yourself available by phone or email should the young person need that

offer referrals to help meet the needs of all family members, including siblings and parents, and
caregivers who themselves have a disability

help families deal with the range of challenges having a child with a disability can bring through
appropriate supported referral (for example, in relation to grief, frustration with the lack of understanding
or support, social isolation and disruption to family routines)

provide support and referrals for families and young people to deal with stressors like isolation, poverty,
homelessness, family violence, mental ill-health and chronic illness (note that in 2006, for example, 36
per cent of Aboriginal parents caring for a child with a disability aged under 12 themselves had a chronic
disease32)

ensure supports are culturally informed (see page 9), including communication, assessment, planning,
outcomes setting, design, implementation and review

reduce the demands on families by ensuring they always see the same one or two professionals

make notes so families don’t have to repeat information

fill out forms with families, transfer previously collected information into new forms and share information
with other services (with 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 professionals 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

how often 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

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 planning – FINAL TEXT
24
Good practice scenario: Paul
The people in this story
Paul: person with a disability/illness
Denise: Paul’s partner
Bonnie: Paul and Denise’s daughter
Doris and Ken: Paul’s mother and her partner
Cath: Paul’s aunt
Katie and Pete: Paul’s sister and her boyfriend
Roland and Johnny: Paul’s cousin and his boyfriend
Daryl: case manager at a mainstream service
Maree: family support worker at an Aboriginal community-controlled health organisation
‘Maybe start by talking with a worker at the health service to get advice on approaching the family, and an
idea of how partnership could look in practice. Just remember that you can’t tell them any identifying details
about the family unless you have the family’s permission.’
Daryl rings Maree, a family support worker at the ACCHO. They discuss the partnership agreement, and
Daryl asks how Maree thinks it could work. ‘It depends what the family wants,’ she says. ‘Aboriginal families
should always be offered the choice of an Aboriginal or mainstream service, or both. When I work with
families, my role involves family support and service coordination.’ Daryl tells Maree about his own role.
‘There are some cross-overs,’ says Maree. ‘But you’ve got more expertise around funding. A partnership
between the two of us could be good, if the family wants it.
‘I can also give you advice around working in culturally respectful ways. Even if the family ends up working
just with your agency, it’s often useful for us to be involved until they feel more comfortable with you,’ Maree
continues. ‘Many Aboriginal people have had negative experiences with mainstream services, and it can
take time to build trust. You could offer to the family that I have a yarn with them to explain your service.
And if the family wants me to stay involved, I could do the assessment with you, maybe do joint visits while
they get to know you. It’s all up to them.’ Daryl asks if Maree has initial advice for when he rings the family.
‘Take your time,’ she says. ‘Be clear who you are and what organisation you’re from and what you can offer
to the family.’
When he rings Paul, Daryl carefully explains his organisation and role but feels that Paul is a bit confused.
However, he is more responsive when Daryl asks if he would like Maree to ring, and gives permission for
Daryl to pass on information to Maree. When Daryl rings Maree back, she asks him to explain how he
would work with Paul and the family. Daryl explains that priorities would be set with Paul and the family, and
supports tailored to what they wanted. This might be about finding ways to draw on informal and general
supports, as well as disability-specific supports. He explains though that the first step is to apply for a
funding package. He also mentions some of the types of supports people with MND often access, and how
they are funded.
When Maree rings back, she says Paul has agreed that she and Daryl can visit together. Maree then tells
Daryl about Aboriginal family and kinship networks. ‘For Aboriginal people, family isn’t just mum and dad
and the kids,’ she says. ‘Various people might be involved in caring for Paul and supporting the family.
People have different responsibilities to each other, depending on where they sit in the kinship network.’
When Daryl and Maree arrive Denise ushers them into the courtyard, where Paul is wrapped in a doona
with Bonnie on his lap. Daryl and Maree introduce themselves, then Paul introduces his mum, Doris, and
her partner, Ken, his aunt, Cath, his sister, Katie, and her boyfriend, Pete, his cousin, Roland, and his
boyfriend, Johnny.
Maree chats with the family for a while and then says, ‘Alright, as I said on the phone the other day we are
going to discuss getting some support for Paul and Denise. Daryl is going to tell you what kind of support
Family-centred, person-centred planning – FINAL TEXT
25
his service can offer and then we’ll talk about what you might want.’
Paul’s mother asks Daryl how he came to be doing this work, and Daryl explains a little about his family
background (including his brother with a disability), his training and role. Daryl notes that everyone defers to
Paul’s mother, who they call Aunty Doris. When he replies to her questions he calls her Mrs Greenwood,
but after a while asks how she would like to be addressed. She smiles and says, ‘Mrs Greenwood is fine
until we get to know each other better.’
They talk about various supports that Maree and Daryl’s services could give Paul and the family, and what
they might want. Denise and Aunty Doris talk most, and reiterate often how important it is for Paul to have
family around him, including Aunty Cath, Katie and Pete, who are down from Queensland. After a while
Daryl asks, ‘Is there anything that would make it easier for people to stay?’ Aunty Cath laughs. ‘It’d be nice
if the roof didn’t leak!’ Daryl laughs too, saying that he doesn’t think that the funding guidelines cover leaky
roofs. He asks Paul and Denise if they have reported the leaky roof to the Office of Housing. She says
things have been so stressful she can’t remember if she mentioned it or not the last time she contacted
them. Daryl says he has a spare half an hour now and is happy to make some calls on the family’s behalf
about the roof if it would help ease the burden.
Several days later Daryl rings Paul to check if the roof has been fixed. Paul sounds terrible. ‘I’m so tired,’ he
says. ‘I can’t sleep, I can’t get comfortable.’ Daryl suggests physio, or using pillows to get more comfortable.
Paul agrees, and Daryl contacts a physiotherapist, Robert, to arrange a joint visit. He spends some time
talking to Robert about what he has learned about supporting Paul and the family appropriately.
During the appointment, Robert shows Paul and Denise how to arrange pillows for Paul’s comfort, and how
to massage Paul to ease stiffness and pain. He makes some references to equipment that Paul might need
as the disease progresses, and leaves some information about this. Daryl stays on after Robert leaves and
checks in with them about how the appointment was for them. ‘The massage was good,’ Paul says. ‘But all
that stuff about equipment, I don’t know about that.’
Denise says, ‘But if you need it, sweetheart, if it helps – we have to do everything we can.’ Paul shakes his
head. ‘I don’t want it. I just need my family around me.’ Aunty Cath pats Paul’s shoulder, but Denise looks
upset. As she shows Daryl out, she says, ‘You’ve got to tell him to get the help he needs, he’s so stubborn’.
Daryl talks to Paul about it next time and brings the family some reading about options for maintaining
Paul’s independence as the disease progresses. Paul shakes his head. ‘I don’t want all that. I don’t mind a
wheelchair, but all that other stuff ...’ Maree spends quite a few visits with the whole family, and with Denise
on her own, helping her to accept – if not agree with – Paul’s choices.
Eleven months later Paul’s movement is very restricted and he has agreed to a disability support worker.
He wants to go home to Queensland before he’s too sick to travel. ‘I want to see my country. I want to see
them old fellas,’ he says. Aunty Doris is still staying, and she, Aunty Cath, Denise and Bonnie will come.
Paul’s package will provide him with a hoist, wheelchair and attendant care during the trip but not the plane
fares or other transport needed. However, Daryl does some research and finds a community service
organisation that can help.
When the family returns two months later, the disease is progressing quickly. Bonnie is still up north with
her grandmother and cousins, but Aunty Cath, Katie and Pete have come down for as long as they’re
needed. Daryl and Maree visit weekly, Daryl bringing lunch to share with whoever is there. Paul continues
to receive attendant care, as well as support to attend a NAIDOC week gathering and some gigs by his
favourite bands.
‘I don’t want to go to hospital,’ Paul says one day. ‘When the time comes, I want to be here.’ Denise starts
crying but holds his hand and nods. Daryl and Maree come again a few days later and gently talk to Paul,
Denise and Aunty Cath about Paul and the family’s preferences for his palliative care. Maree organises an
in-home palliative care service through the Aboriginal health service, and Daryl finds some funding from a
local charity to help the family pay for flights for Bonnie, Aunty Doris and Ken to return in the next week.
Three weeks later Maree rings. Paul died in the night, she says. She is at the house, and the family would
Family-centred, person-centred planning – FINAL TEXT
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like Daryl to come over. Daryl asks Maree if there is any cultural information he needs to know about
mourning before he visits and she explains a little about Sorry Business. When Daryl arrives, he expresses
his sorrow to the family, and sits with them and Maree over several cups of tea.
There are a lot of silences but also lots of sharing of memories. Daryl is glad to have spent so much time
with the family, and contributes a couple of stories. He offers to contact all of the service providers – his
colleagues, Paul’s doctors, the attendant care service, the equipment hirers, Centrelink and so on – to
inform them of Paul’s passing. Denise, Aunty Doris and Aunty Cath thank him.
Daryl spends the next couple of days making phone calls and sending letters, notifying every service and
relevant department of Paul’s death. He obtains some funding to contribute to the cost of transporting
Paul’s body to Queensland for burial, and sends up a large floral arrangement, a personal card and another
signed by all his colleagues. He visits Denise and Bonnie once more when they return, and Maree tells him
that she will continue to support the family.
Practice Tips:
Find out if your service has partnership agreements with Aboriginal services
Seek secondary consultation from Aboriginal workers and agencies
Always offer Aboriginal families the choice of an Aboriginal service first
Seek advice from Aboriginal workers; be aware of historical context
Explain your role and service clearly; tune into
non-verbal signals
Work well with other professionals; understand each other’s roles
Learn from experts; build your knowledge about family and kinship structures
Take a lead from Aboriginal workers and families; learn from observation
Make a personal connection; show respect in appropriate ways to Elders
Listen to what people tell you about their priorities; respond accordingly
Advocate on the person and family’s behalf when appropriate
Offer information about support options; seek feedback about services
Share information with other service providers about working with the family
Offer information to ensure people are able to make informed decisions
Check in with people about their experience of supports
Accept that people have a right to their own choices; support family members
Consider ways to support people’s cultural and emotional needs
Find different ways to support people coming together, such as food
Offer information and choices; plan for what is coming up for people
Find ways to support and reduce the burden on grieving families such as by dealing with paperwork for them
Find appropriate ways to express condolences for family members’ loss
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5 Technical quality
Many agencies we work with work only with the client, and don’t see the importance of working with the
whole family. Trying to educate them is a real challenge, whether that is through a forum, or partnership and
liaison, or case conferencing. Involving everyone and discussing the issues, delegating roles and
responsibilities. Time spent is the key, but we don’t always have the capacity or resources. – Case manager
Planning needs to be family centred, where the person involved, their goals, aspirations and dreams are
looked at. Then those plans need to be put into context with other family members’ needs and wants. Where
possible, planning should involve not only the child and family members, but others who are closely involved
with the child, whether it’s a therapist, carer or friend. The outcomes in the long term will be much better. –
Cass, mother of Abel (who has autism), Jack (who has a learning delay) and their sister, Julie
All professionals accumulate specialist knowledge – through their training, work, reading, networking and
professional development. For those in planning roles and casework roles this includes knowledge of all
relevant services, funding, processes, procedures and the policy environment. Other knowledge they need
includes how to:

identify signs and risks of mental ill-health, suicide, drug and alcohol abuse, sexual abuse and family
violence, and how to refer in response to these and other needs, such as for diagnosis, counselling,
family therapy, parenting programs or carer’s support, or for income, housing or legal support

respond to concerns about a child or young person’s safety (whether or not they are mandated), which
can lead to a report to Child Protection or referral to Child FIRST

work with interpreters, including Auslan and spoken languages, in person and on the telephone

understand the impact of privacy laws, including the sharing of information across services.
Draw on everyone’s knowledge
Professionals need to maintain the currency of their technical knowledge. Whether they are intake workers,
case managers or facilitators, it is essential that they have access to a good-quality, up-to-date database of
resources and service providers.
It is equally critical to draw on the deep knowledge that families have of themselves and each other,
including how things are done in the family, how family members communicate and work around each
other’s needs. Research shows that most parents and caregivers also have a good understanding of their
child’s development,33 and are often their own greatest resource. It can also be helpful to draw on the
knowledge of people in the family’s support networks, including extended family, friends and other services.
Use creative planning tools
British person-centred planning expert Helen Sanderson encourages planners to work creatively with young
people and families. She advises not to be constrained in your thinking by the available resources or old
pathways that might lead, for example, to a young adult going into a day service or community residential
unit without having explored other possibilities that individualised funding and drawing on informal and
community supports make possible.34
She outlines many creative planning tools that can be drawn on for formal planning activities, such as the
development or review of a support plan, or to address an emerging need or resolve an issue. These include
tools that focus on:

the strengths, abilities and personalities of the child or young person with a disability and their family –
useful in transitions between services and in reducing the frequent focus on deficits and problems
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
the person and family’s relationship circles, which can help identify what supports are available and how
they can be strengthened, and the balance of paid support, family and friends in a person’s life

what makes a day good or bad for a child or young person and their family, and what might help ensure
there are more good days

identifying which strategies are working, and which aren’t, so as to build on the positives

the child or young person themselves, using information in formats they relate to – stories with images,
audio, songs, movies or newspaper/magazine clippings

the gifts, skills and interests of the person with a disability, including what they are good at and can
contribute to, what they want to do more of, what makes them happy, and who they like to be around

the person and family’s hopes and dreams, which can tell others a lot about them and bring those
involved in planning together around a common purpose

the person and family’s fears, which can tell others which people, places or experiences should be
avoided

how to provide good support for all the things the person and family want to do, from daily life to
participating in education, work, community and recreational activities

how people spend their week, including daily and weekly routines for the child or young person, their
parents or caregivers and siblings, and when support might be needed

communication, for example, how the person with a disability uses words, gestures, posture, facial
expression and sound to communicate

personal and family histories (including milestones, achievements and negative experiences), which can
help build on positive experiences, avoid negative ones and identify people or activities from the past
that the person or family might want to reconnect with.35
Improve teamwork and service integration
Many families have more than one worker, whether from the same or different agencies. Many have
experienced reduced service quality, service gaps or contradictory information arising from a lack of
communication and coordination between workers and services.
People in planning and case management roles play a critical part in looking at ‘the big picture’ for children,
young people and families, and bringing them together with a range of service providers for planning
purposes. It can be challenging to support people coming from sometimes very different perspectives and
disciplines to work as a team, but whatever can be done to improve communication and coordination
between services will benefit the people and families they are working with.
Teamwork requires skills and good processes. It also helps if professionals see themselves as part of a
service system. This is how families experience them and how they are most effective. Better teamwork and
service integration can help to ensure:

everyone understands each other’s roles, skills, areas of expertise and practice approaches

everyone knows the family’s preferences

records are clear, respectful, and able to be read and understood by everyone within the organisation
(and beyond, if shared with permission)

everyone stays in the loop (email can be useful)

there are processes to resolve any problems.
Refer and use secondary consultation
Supported referral is a key aspect of practice for those in intake and planning roles. When you make a
referral it might be helpful to discuss:

which services might meet the person’s needs, including the type of service, location and hours
Family-centred, person-centred planning – FINAL TEXT
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
whether the other agency is family centred and how the family might engage with it

expectations about the service and whether it would like you to liaise or coordinate

whether it might be helpful to share information with the other agency (after seeking permission).
Professionals working in intake, assessment, case management and facilitator roles come from a variety of
educational and professional backgrounds, including early childhood (for those in early intervention intake),
social work, counselling and allied health. It’s important to make referrals when an individual or family’s
needs go outside the boundaries of your job role, even if you have the skills and experience to meet those
needs.
You might also need to refer people for new or different disability supports, or for information on diagnosis or
medical treatment, including a second opinion.
Secondary consultation is also very useful, both for building your own knowledge and capacity and deciding
when and where to refer:
Secondary consultation is such an underestimated support. I regularly tap into information from other
agencies and workers. For example, I rang the Islamic Society to speak to a woman about whether it
would be appropriate to attend a client’s funeral, what to wear and what to expect. I contacted MND
Victoria to discuss stages of [motor neurone] disease, how death might be for another client and what to
expect. I contacted Child Protection to discuss concerns and gather service information. – Case manager
Establish ongoing relationships within services you refer to regularly, or whom you might contact for
secondary consultation, or engage in partnership, perhaps including co-case management, collaborative
planning or project work. This might include Child FIRST services, multicultural and Aboriginal organisations,
or those with expertise in gay, lesbian, bisexual, transgender and intersex (GLBTI) issues.
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 clients. It includes: clinical supervision; debriefing after difficult/critical incidents;
peer support; breaks and holidays; and professional development. Of course, staff will only take care of
themselves if supported to do so, as discussed in the organisation guide.
One aspect of self-care is appropriate ‘boundaries’ with clients. This can be confusing, given that care and
empathy are key to building trusting, open and collaborative relationships. Some professionals work in
people’s homes and engage with intimate facets of families’ daily lives. 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 clients.
Boundaries might 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 planning – FINAL TEXT
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Good practice scenario: Jimmy
The people in this story
Jimmy: child with a developmental delay
Narelle: Jimmy’s mother
Frederick: Jimmy’s father
Harry: Jimmy’s maternal grandfather
Marta: DEECD intake worker
Pia: facilitator
‘It’s been difficult. My husband says there’s nothing wrong with Jimmy, he’s not happy.’ Narelle stops
suddenly and Marta hears a man’s voice. ‘Yes I am. We need to find out, for Jimmy,’ Narelle says. The man
speaks again. ‘Yes, yes, okay,’ Narelle says, and asks Marta, ‘Can you come next Monday at two? My
husband wants to be here.’ Marta will need to reschedule a meeting but agrees. She starts to explain what
the visit is for, but Narelle hangs up.
Marta describes the interaction to her team leader, Hannah, saying, ‘Something doesn’t feel right, the mum
sounds almost frightened’. Hannah asks, ‘Of her husband?’ Marta is unsure. There are tensions about
Jimmy, but it’s hard to know if it goes deeper. Hannah gives Marta some information about family violence,
including what to look for, and suggests she accompany Marta on the first visit for Marta’s safety.
When they arrive, Narelle is crouched next to Jimmy, who is screaming in the hallway. ‘Come into the
kitchen ‘til she’s got him under control,’ Frederick says. Marta can hear Narelle pleading, offering Jimmy a
story. Frederick talks about the footy until Narelle comes in cradling her son, his face buried in her neck.
When Marta asks what the MCH nurse had said, Frederick says, ‘She reckoned he might be autistic! I said
to Narelle there’s no way. The little bugger is just stubborn.’ ‘But Frederick, we should find out for sure,’
Narelle turns to Marta: ‘What do you think?’ There’s a pause. Hannah and Marta watch Jimmy slide off his
mother’s lap and lean against the humming dishwasher. He finds a toy car and drives it repeatedly against
the wall, singing wordlessly.
‘I’m not a paediatrician,’ Marta says. ‘You would certainly need to get a proper assessment and diagnosis to
know for sure, but since you ask, then yes, I think it’s possible that Jimmy might have autism spectrum
disorder.’ Narelle nods, but Frederick looks appalled. ‘My son is not like that,’ he almost shouts at her.
Marta looks at Frederick, reminding herself not to be judgemental. The ‘A’ word is hard for any parent at
first. Narelle watches her son, still crashing his car into the wall. After a while Hannah catches Frederick’s
eye. ‘I understand,’ she says. ‘It’s a shock, but it’s not all bad news.’ He looks sceptical, but sits down with
his arms crossed. ‘There are two good arguments for getting a diagnosis,’ Hannah says. ‘One is that with
that condition, early intervention makes a huge difference – the earlier the better. Many kids can catch up
with their peers in lots of areas. Also, if that is what Jimmy has, it makes a difference to the level of support
available to him.’
Both parents watch their son lining up toy cars. ‘So if it is that,’ says Narelle, ‘we can get more help’. ‘But
look at him,’ Frederick says. ‘He’s fine. He just needs a bit more discipline when he’s trying it on.’ Narelle
looks apologetically at Marta and Hannah. ‘It’s up to you, of course,’ Marta says. ‘Do you want to know
more about the condition?’ Frederick frowns, but Narelle says, ‘Yes, please. Then we can decide.’
Marta outlines characteristics of children on the spectrum. Narelle nods, and even Frederick listens. There
would be a wait for specialist services, Marta says, but they can do a lot while they are waiting. She gives
Narelle a list of private therapists Jimmy could see in the meantime, and an information sheet on activities
to support social and speech development. She then asks about contact with other children. Narelle says
she has found it hard to get out and about, but Marta encourages her to get back in touch with her mothers’
group. Scowling, Frederick agrees to fill in the forms.
Family-centred, person-centred planning – FINAL TEXT
31
When they finish, Frederick grunts goodbye and slams the front door. A moment later they hear his car roar
off. As Narelle shows Marta and Hannah out, she says, ‘He gets so angry. He blames me, and he’s
probably right.’ Both Hannah and Marta stop, and look gently at Narelle, waiting. ‘Do you think children can
get like that – you know – if ... if they get a knock when they’re still in the womb?’ asks Narelle. ‘No,’ says
Hannah. ‘We don’t yet fully understand what leads to autism, but if Jimmy has it, that’s very unlikely to be
the cause.’
Marta asks, ‘Are you worried Frederick might be angry because of what we have said about Jimmy’s
condition?’ Narelle nods tearily. ‘Does Frederick hurt you or Jimmy often?’ Hannah asks. Narelle says that
Frederick pushes and hits her sometimes, but never Jimmy. ‘It’s important to know that children are
affected just as much by witnessing violence as being hurt themselves,’ Marta says. ‘Narelle, you and
Jimmy need to be safe. You must ring the police if he hurts you, or if you’re scared. Just dial 000. There are
services that can help you work out what to do so you can both be safe.’
They talk for a while. Narelle asks if they will ring a family violence service for her, and Marta agrees. When
she calls Narelle later that day, Marta explains that a family violence worker can meet Narelle and Jimmy at
the community health service to talk about her options. Narelle bursts into relieved tears, and thanks Marta.
***
Jimmy’s life changes a lot in the next three years. He moves to Melbourne with Narelle and only sees his
dad occasionally, usually with his grandad at a play centre. Narelle doesn’t regret her decision. She finds
her parents a great support but struggles with depression, finding life with Jimmy – now diagnosed with
autism and an intellectual disability – quite stressful. Attention from Jimmy’s grandparents, kindergarten and
ECI supports have improved Jimmy’s speech and social skills. An ECI professional supports his transition
into school, then refers the family to a case manager for ongoing support.
The school obtains funding for Jimmy and things go fairly well until he is 12, when his grandma dies.
Narelle’s grief turns into major depression, and Jimmy’s anxiety and behavioural issues escalate. Narelle
goes into hospital, and Jimmy’s grandad, Harry, struggles to look after him. Harry has no contact details for
Frederick, who last visited five years ago.
The case manager, Trish, organises short-term foster care for Jimmy and fills in a Disability Support
Register application with Harry, emphasising the risk of Jimmy needing long-term care. It takes some
months for the application to come through. Narelle rings Trish quite often, asking when it will come. Trish
finds this a little stressful because she has no answers for Narelle, but she is patient with her,
understanding the difficult situation she is in. She has encouraged Harry to have contact with Jimmy while
he is with the foster carers, and Harry has been taking Jimmy to see his mum.
Narelle comes out of hospital before Jimmy’s package comes through and is at the first planning meeting at
Harry’s house. Jimmy is still with the foster carers, but at the facilitator’s suggestion Harry has brought him
along. Trish is there, as is Jimmy’s student welfare coordinator.
Pia is the facilitator. As everyone settles for the meeting she watches Jimmy sitting between his mum and
grandad. Narelle looks tired but happy, and squeezes her son’s hands as he plays with her fingers. ‘From
my perspective, this meeting is about Jimmy,’ says Pia, nodding to him. ‘But it’s also about keeping this
family together, and supported. What do you think?’ Tears spring into Narelle’s eyes, and she nods, and
Jimmy holds Narelle and Harry’s hands. Pia writes ‘Jimmy’s needs’, ‘Staying together’ and ‘Family support’
on three pieces of butcher paper, and sticks them on the wall. ‘So let’s think together – what could all that
look like?’ she asks the group.
Over three meetings Harry, Narelle and Jimmy decide to live together – somewhere that suits all of them.
Trish helps Narelle to get a pension and carer’s payment, and find a therapist. Harry wants to meet some
other caregivers of kids with autism, so she finds him a group. With Jimmy’s enthusiastic approval Pia gets
funding for a computer for his schoolwork, while Trish arranges fortnightly respite with the same foster
carers.
Narelle suggests that the carers come to one of the meetings. They are pleased but defer to Narelle when
Family-centred, person-centred planning – FINAL TEXT
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Pia invites them to speak, which Narelle appreciates. The final plan for Jimmy includes a psychologist and
speech therapist to support him and strengthen his social skills in preparation for high school.
Practice Tips:
Be flexible; meet families’ requirements, especially if they are under pressure
Draw on experience to understand family issues
Protect worker safety as an occupational health and safety issue
Build a picture of the child’s environment through observation
Offer information about services, including their rationale and benefits
Learn about the child, drawing on your expertise and observing their environment
Be aware of your judgement of family members; empathise
Offer information and explain your actions; put the child’s best interests first
Offer information to enable the family to make an informed decision
Offer options for support; draw on existing and universal services
Be aware of the impact of family violence on children; respond accordingly
Learn how to identify and respond appropriately to family violence
Make supported referrals to appropriate services when needed
Assist children and families with transitions; refer for ongoing support
Respond to crises; seek resources for changes in family circumstances
Stay in communication with the family while waiting for funding; put supports in place as available
Consider ways to include the child or young person in planning activities
Build a picture of the child and family dynamics through observation
Focus on the child or young person and family; draw on everyone’s expertise
Meet family members’ needs as well as the child or young person’s
Empower the young person to have input; include foster carers if appropriate
Family-centred, person-centred planning – FINAL TEXT
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6 Monitoring and improving practice
My son ... sometimes runs away from home [and] hits me. Sometimes he touches people. He wanted to go
to the city on his own. I didn’t want him to go. The case manager was very good. He found a worker that
teaches my son that when he goes out he should take food and drink, be back on time and he shouldn’t
touch anyone. The case manager also warned his other workers that he runs away. – Participant in a
support group for families from one South-East Asian community
When I started I fought like blazes to get everything possible for every family. I still advocate for families,
often. But there are only so many resources for the region, so part of our job is to say no sometimes. I’ve
never heard a not-good reason for someone wanting more resources than their package size. You’ve got to
acknowledge the concern, or the difficult situation people are in. You give a wide context on why, and
suggest, ‘Let’s try other things’, say making an application to the Lions Club or Rotary Club. You do as much
as you can to find options, to get the job done. – Facilitator
Research has shown that many organisations and professionals begin with a willingness to be family
centred, but that such practices tend to wane over time, a phenomenon known as ‘professional drift’. 36 A
number of studies have also identified gaps between how family centred early childhood professionals think
they are, and families’ experiences. 37,38 Both reflective practice and seeking regular feedback from families
and children are therefore 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’.39 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.40
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’ 41 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’, 42 and identified as requiring
a focus on goals and a commitment to monitoring, evidence-based practice, open-mindedness,
inclusiveness and dialogue.43 Reflective practice has also been linked to action research44 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 reflective 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). 45 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 46 suggests six questions that professionals can use to create positive
change:

How have I come to do things this way?

How have I come to understand things this way?

Who benefits from how I do and understand this?

Who is silenced in how I do and understand this?
Family-centred, person-centred planning – FINAL TEXT
34

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
Professionals 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. Professionals 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 checklist47 is a tool for use primarily in
supervision, focusing on the 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 families48 that professionals might use to develop a
set of questions to ask 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 or focus groups, and
analysis of findings, using findings to inform practice change and dissemination of results to service users.
Next steps
Many Victorian professionals 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 professionals who support them.
The organisational guide will be of interest to 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 planning – FINAL TEXT
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Endnotes
1 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.
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26 VicHealth et al. 2009.
27 Department of Human Services 2008, Every child every chance: best interests case practice model summary guide,
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28 For example, see resources listed at
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29 McWilliam, RA, Tocci, L and Harbin, GL 1998, ‘Family-centred services: service providers’ discourse and behaviour’,
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36 Trivette (unpublished) cited by Dunst and Moore 2010.
37 McWilliam et al. 2000.
38 McWilliam et al. 2000.
39 Department of Education and Early Childhood Development (DEECD) 2010, citing MacNaughton, G 2005, Sylva, K et
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