Greater Family Empowerment Benefits Children With Disabilities

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    The good news? A study has shown that physical therapists (PTs) tend to build capacity in the families of children with disabilities, and do so with more success than other professions analyzed.

    The bad news? With a score of 68 out of 100, it's nothing to write home about—at least according to Carl J. Dunst, PhD, whose June 13 NEXT presentation challenged his audience to reconsider how they approach early interventions.

    Dunst is a developmental psychologist and cofounder of the Oreleana Hawks Puckett Institute, a North Carolina organization focused on evidence-based practice to enhance child and family functioning. Dunst centered most of his remarks on interventions called for in the federal Individuals With Disabilities in Education Act (IDEA) part C, whose guidelines were characterized by Dunst as stressing family capacity-building, yet barely mentioning family involvement.

    As defined by Dunst and his institute, "family capacity-building refers to the methods and procedures used by early childhood practitioners to create or provide parenting opportunities and experiences to strengthen existing, and promote the development of, new parenting abilities in a manner that enhances and strengthens parenting self-efficacy beliefs." Dunst explained that a "self-efficacy belief" is a belief that the activities being engaged in by the parent are making a positive difference.

    In some ways, the importance of family capacity-building can be boiled down to simple math. Dunst said that absent parental involvement, early intervention provided by professionals twice a week for 50 weeks amounts to less than 3%-4% of a 2-year-old’s waking hours. Thus, getting parents to understand and feel they can employ an intervention can make all the difference in a child's development.

    And while the idea of family capacity-building is great, execution has been lacking, according to Dunst. "Many of the approaches [to family capacity-building] are sort of made-up assumptions instead of research-based assumptions," he said.

    Dunst and his colleagues engaged in extensive research to solve that problem, and have developed evidence-based guidelines on what kinds of approaches are most likely to help families. But for these approaches to work, he explained, intervention professionals need to change the way they think about what they do.

    To create meaningful opportunities for families to build capacity, Dunst told attendees, professionals need to move from "treatment" to "promotion," from "expertise" to "empowerment," from a "deficit-based" approach to a "strengths-based" one, from "services-based" to "resource-based," and from "professionally centered" to "family-centered."

    The shift demands that providers be acutely aware of individual family needs, as well as their own ability to communicate and evaluate. Dunst said that this approach requires equal parts relational and participatory skills, so that providers are not just listening to parents but are acting on what they hear to come up with intervention strategies that the family will take on and use consistently.

    "The extent to which any intervention can be incorporated into things families do routinely … the more likely it is that the child will actually benefit from the intervention," Dunst said, and went on to explain how even the interventions with the best fit for a family need to be carefully presented, demonstrated, and then evaluated by the provider. “It's crucial that the provider give feedback to the family member's performance of the intervention and check in with the family member after a period of time to listen to their feedback.”

    And although he said that the details of the data and models are important, Dunst stressed 3 simple "take-home" messages to attendees that should be remembered after all those details have faded: "this matters a great deal. It's research-based. And it will require a paradigm shift," he said.

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