Topics in Early Childhood

Special Education
Volume 28 Number 1
May 2008 42-52
A Review of Processes and Outcomes in © 2008 Hammill Institute on
Disabilities

Family-Centered Services for Children 10.1177/0271121408316699

[Link]
hosted at [Link]
With a Disability
Ian Dempsey
University of Newcastle, Australia
Deb Keen
Griffith University, Australia

The importance of being family centered when providing services to children with a disability and their families has gained
currency in the research and practice literature. A growing body of evidence has validated many of the theoretical links
between the help-giving practices of staff and desirable outcomes for families with a child with a disability. However, it is
clear from the research to date that the relationship between the provision of family-centered services and the achievement
of positive outcomes for children and their parents is complex and is yet to be fully understood. The present article reviews
the research in this area and discusses the links between help-giving practices and child and family outcomes for families
who have a member with a disability. The article summarizes the extant research in an accessible format and identifies areas
for future research.

Keywords: family-centered practice; disability; child and parent outcomes; help-giving practices

T he way in which professionals support children with

disabilities and their families has the potential to
enhance or to impede child and family outcomes.
constant in the child’s life. Second, the family is in the
best position to determine the needs and well-being of
the child. Third, the child is best helped by also helping
Currently, family systems theory underpins many mod- the family, and this help may extend to an understanding
els of service delivery that recognize the interrelatedness of the family’s community and to providing information
of family members and the importance of acknowledg- that the family needs. Finally, family choice and decision
ing the needs of all family members, not just those of the making in the provision of services, showing respect and
family member with a disability (Brown, Nolan, & Davies, affirming families’ strengths, enhancing family control
2001; Carpenter, 1997; Dunst, Trivette, & Johanson, over the services they receive, and partnerships and col-
1994; Fox, Vaughn, Dunlap, & Bucy, 1997; Knox, laborations with families are emphasized (Dunst, 2002;
Parmenter, Atkinson, & Yazbeck, 2000; P. Murray, 2000; Duwa, Wells, & Lalinde, 1993). Family-centered philos-
Turnbull, Blue-Banning, Turbiville, & Park, 1999). ophy has been advocated across a wide range of profes-
Integral to family systems theory is the primacy of the sions from health care (Institute for Family-Centered
parent-professional relationship in which decision mak- Care, 2007; Svavarsdottir, 2006), therapy services
ing and planning around mutually agreed upon goals are (Esdaile & Olson, 2004), early intervention (Australian
shared between parents and professionals who engage Early Intervention Association, 1998), early childhood
in a relationship defined by mutual respect, trust, and education (Keyser, 2007), special education (M. M. Murray
honesty (Keen, 2007). & Mandell, 2006), and general education (Stormshak,
Falling within the family systems milieu, the family- Dishion, Light, & Yasui, 2005). Although the conceptual
centered philosophy has developed from both the help- literature around family centeredness supports this wide-
giving (e.g., Fisher, Nadler, & Depaulo, 1983) and scale adoption, the evidence base is more limited, and
empowerment (e.g., Zimmerman, Israel, Schultz, &
Checkoway, 1992) literatures. There are four crucial Authors’ Note: Please address correspondence to Ian Dempsey,
beliefs that drive the implementation of family-centered University of Newcastle, Callaghan NSW 2308, Australia; e-mail:
services. First, the family and not the professional is the [Link]@[Link].

42
 Dempsey, Keen / Family-Centered Services 43

further research focused on the processes and outcomes family-centered practice, and to policy makers by clari-
of family-centered practice is needed. Processes relate to fying the robustness of the conceptual basis of family-
the kinds of supports and resources, experiences, and centered practice.
opportunities offered, whereas outcomes refer to capacity-
building effects that may include parent well-being and
family quality of life (Dunst, 2005).
Method
The family-centered field can best be described as
A literature search on family-centered practice and
being in an adolescent phase of development. The disci-
families of a child with a disability was conducted to
pline has had an important influence on service philoso-
identify empirical studies that examined the relationship
phy and orientation (particularly for young children with
between process and outcome variables. The PsycINFO
a disability), and it has provided research support for several
and ERIC databases were used in this search to identify
of the crucial hypotheses that underpin family-centered
studies conducted since 1987. Dissertations and concep-
practice. For example, the research has consistently shown
tual papers were excluded, as well as studies with a
that a family-centered help-giving style is closely associ-
family-centered nomenclature but lacking in conceptual
ated with enhanced parent control appraisals (Dempsey &
or practical evidence that the reported study made use of
Dunst, 2004; Dunst, Trivette, Boyd, & Brookfield, 1994;
family-centered principles. Several studies using family-
Northouse, 1997). However, for the field to reach its full
centered as a key word did not make use of family-
potential, there needs to be an ongoing testing of family-
centered principles (i.e., the studies provided no evidence
centered practice and the important outcomes believed to
that support staff followed the defining principles of the
derive from that practice.
family-centered approach described earlier in this article).
This article reviews the family-centered empirical liter-
A set of 35 studies that met these criteria were included in
ature as it relates to families of a child with a disability,
the review, and these studies are listed in Table 1, along
and the review is guided by several imperatives. First, there
with the variables they examined, which have been cate-
is a need to promote evidence-based practice in family-
gorized as either independent, moderating, or dependent
centered services to enhance the integrity of the profes-
variables. This approach was favored over categorizing the
sion. Second, there is a need to provide family-centered
variables as service delivery processes or outcomes due to
practitioners with information that will be immediately
the variability found across the studies in the way these
useful and replicable in their workplaces, and a synthesis
variables were treated and the moderating role of some
of the research in this area will assist in achieving this
variables. Several studies reported on a single variable
aim. Finally, there is a need for the testing of a coherent
only, and as this variable has been used as an independent
model to explain how the work of family-centered prac-
variable in other research, it is classified as such here.
titioners affects families and their children. Without the
empirical confirmation of conceptual models, a discipline
cannot advance beyond its theoretical base.
A potentially useful approach to take in achieving a
Results
thorough testing of the assumptions underlying the
family-centered philosophy is to develop a framework to Service Delivery Processes
facilitate that testing process. Implicit in this approach The manner in which services are provided by profes-
should be recognition of the relationship between con- sionals to families is crucial to the family-centered
ceptualization, operationalization, and measurement in approach, and the research literature has typically consid-
understanding the process and outcome variables associ- ered service delivery as an independent variable, reflect-
ated with family-centered services (Babbie, 2007; Hall, ing its role as a process in the achievement of desirable
1996). At a basic level, this means examining the rela- outcomes for children and families. An important consid-
tionship between what is done and what results from eration in an examination of family-centered practice is to
that action. For example, the encouragement by staff of establish objective procedures to determine the extent to
parents for gains in their child’s development (a process) which services are family centered. Three approaches are
may logically lead to an enhancement of parents’ posi- evident in the literature. First, some instruments have
tive beliefs in their parenting skills (an outcome). Such been developed to permit staff to complete self-evaluations
an analysis can be most helpful to practitioners who are of their service (e.g., P. J. McWilliam & Winton, 1990;
striving to improve the outcomes that derive from their Murphy, Lee, Turnbull, & Turnbull, 1995). Second, there
interventions, to researchers with an interest in determin- is one report of independent raters’ assessments of video-
ing the relationship between key variables that underpin taped exchanges between staff and parents (Goetz,
44 Topics in Early Childhood Special Education

Table 1
Independent, Moderating and Dependent Variables, and Instruments,
Reported in Family-Centered Research Studies
Study Independent variables Moderating variables Dependent variables Instruments

DeChillo, Koren, & Parent-professional Parent demographic Parent satisfaction Research developed measures
Schultze (1994) collaboration characteristics of collaboration and
Staff training satisfaction
Dempsey (1995) Family-centered practices Enabling Practices Scale
Dempsey & Family-centered practices Age of child Family empowerment Enabling Practices Scale
Dunst (2004) Locus of Control Parent educational training Locus of Control
Comfort and autonomy and employment status Family Empowerment Scale
Dempsey, Foreman, Family-centered practices Age of child Family empowerment Enabling Practices Scale
Sharma, Locus of Control Parent educational training Locus of Control
Khanna, & Frequency of contact and employment status Family Empowerment Scale
Arora (2001) Parent involvement with
advocacy organizations
Dunst (1997) Family-centered practices Parent participation Helpgiving Practices Scale
Dunst (1999) Family-centered practices Parenting supports Child development Helpgiving Practices Scale
Family socioeconomic
status
Location of service
Child diagnosis
Number of services provided
Frequency of child contact
Hours of parent contact
Dunst, Boyd, Family-centered practices Parent participation Helpgiving Practices Scale
Trivette, &
Hamby (2002)
Dunst & Dempsey Family-centered practices Parenting competence, Selected items from Enabling
(2007) personal control, Practices Scale
self-efficacy Everyday Parenting Experiences
Scale
Dunst, Trivette, Characteristics of support Personal control Professional Helpers
Boyd, & Characteristics Scale
Brookfield (1994) Personal Control Appraisal
Scale
Dunst, Trivette, Family-centered practices Case study interviews of
Gordon, & help-giving styles
Starnes (1993)
Dunst, Trivette, & Family-centered practices Personal control Helpgiving Practices Scale
Hamby (1996) Resources, supports, services Personal Control Appraisal Scale
Dunst, Trivette & Family-centered practices Parent empowerment Professional Helpers
LaPointe (1994) Characteristics Scale
Parent Empowerment Survey
Goetz, Gavin, & Family-centered practices Family Provider Interaction
Lane (2000) Analysis
Granat, Lagander, & Family-centered practices Measurement of Processes
Börjesson (2002) of Care
Heller, Miller, & Parent demographics and Self-efficacy Satisfaction with Family Support Index
Hsieh (1999) socioeconomic status services Researcher designed
Service usage Caregiver burden instruments for caregiver
Community integration burden and self-efficacy
Community Integration Scale
Judge (1996) Family-centered practices Staff experience and Personal control Helpgiving Practices Scale
Frequency of contact training Control over early Frequency of contact
intervention services Personal Control Appraisal
Scale
Early Intervention Control Scale

(continued)
 Dempsey, Keen / Family-Centered Services 45

Table 1 (continued)
Study Independent variables Moderating variables Dependent variables Instruments

Judge (1997) Family-centered practices Personal control, Helpgiving Practices Scale

Frequency of contact parent empowerment, Frequency of contact
control over early Personal Control Appraisal
intervention services Scale
Early Intervention Control Scale
King, Kertoy, Parent beliefs and attitudes Parent demographic Self-efficacy Measure of Beliefs about
King, Law, to family-centered characteristics Participation in Family-
Rosenbaum, & practices Parent membership of Centered Service
Hurley (2003) Family-centered practices support groups Measure of Processes of Care
Presence of child behavior
problems
Staff experience and
training
King, King, Family-centered practices Parent demographic Parent satisfaction Measure of Processes of Care
Rosenbaum, & Family functioning characteristics Parent emotional Family Assessment Device
Goffin (1999) Adequacy of social support Level of child disability well-being Social Support Questionnaire
Impact on components of Parent stress Impact on Family Scale
family life Survey Diagnostic Instrument
Child behavior problems Coping Health Inventory for
Parent coping behaviours Parents
Client Satisfaction Questionnaire
Symptom Checklist-90-Revised
Centre for Epidemiological
Studies Depression Scale
King, G.A, Family-centered practices Measure of Processes of Care
Rosenbaum, P.L.,
& King, S.M.
(1997)
Law, M., Hanna, S., Service culture Parent satisfaction Service culture
King, G., Parent beliefs and attitudes Measure of Beliefs about
Hurley, P., to family-centered Participation in Family-
King, S., practices centered Service
Kertoy, M., & Family-centered practices Measure of Processes of Care
Rosenbaum, P. Number of services received Number of received services
(2003) Complexity of child’s Complexity of child’s problems
problems Client Satisfaction Questionnaire
Mahoney & Family-centered practices Child development Family-Focused Intervention
Bella (1998) Mother-child Scale
interaction Bayley Scales on Infant
Maternal stress Development
Family functioning Receptive and Expressive
Emergent Language Scale
Vineland Adaptive Behavior
Scale
Maternal Behavior Rating
Scale
Questionnaire on Resources
and Stress
Family Environment Scale
McBride, Family-centered practices Semistructured interviews
Brotherson,
Joanning,
Whiddon, &
Demmitt (1993)
McWilliam, Snyder, Family-centered practices Family Orientation of
Harbin, Porter, Staff characteristics Community and Agency
& Munn (2000) Service type Services
Family Report/Brass Tacks

(continued)
46 Topics in Early Childhood Special Education

Table 1 (continued)
Study Independent variables Moderating variables Dependent variables Instruments

O’Neil, Palisano, & Family-centered practices Parenting stress Measure of Processes of Care
Westcott (2001) Child development Measures of Process of Care
for Service Providers
Parenting Stress Index
Bayley-II Motor Scale
Petr & Allen (1997) Family-centered practices Family-Centered Behavior
Scale
Reich, Bickman, & Family-centered practices Knowledge of services Parent Professional
Helflinger (2004) Attitudes to helping, Self-efficacy Collaboration Scale
treatment acceptability Personal assertiveness Helping Orientation Scale
and seeking support Treatment Acceptability Rating
Form
Attitudes Toward Seeking
Professional Help Scale
Mental Health Services
Knowledge Questionnaire
Vanderbilt Mental Health
Services Efficacy
Questionnaire
Rathus Assertiveness Scale
Romer & Family-centered practices Parent satisfaction Researcher developed
Umbreit (1998) questionnaire on nature of
service provided and
satisfaction
Thompson, Lobb, Family-centered practices Family empowerment Family Implementation Scale
Elling, Herman, Extent of family networks Coping and adaptation Family-Centeredness Scale
Jurkiewicz, & to stress Family Social Support Scale
Hulleza (1997) Questionnaire on Resources
and Stress
Family Empowerment Scale
Trivette, Dunst, Family-centered practices Personal control Helpgiving Practices Scale
Boyd, & Frequency of contact Frequency of contact
Hamby (1995) Personal Control Appraisal
Scale
Trivette, Dunst, & Family-centered practices Parent income Personal control Helpgiving Practices Scale
Hamby (1996a) Control over early Personal Control Appraisal
intervention services Scale
Early Intervention Control Scale
Trivette, Dunst, & Family-centered practices Staff training Personal control Helpgiving Practices Scale
Hamby (1996b) Personal Control Appraisal
Scale
Trivette, Dunst, Family-centered practices Parent empowerment Helpgiving Practices Scale
Hamby, & Parent Empowerment Survey
LaPointe (1996)
VanRiper (1999) Family-centered practices Parent well-being Family Provider Relationships
Parent depression Instrument
Family functioning Parental Psychological
Well-being
Center for Epidemiological
Studies Depression Scale
General Scale of Family
Assessment Measure
Van Schie, Siebes, Family-centered practices Parent satisfaction Measure of Processes of Care
Ketelaar, & Parenting stress Client Satisfaction
Vermeer (2004) Questionnaire
Research developed stress
index
 Dempsey, Keen / Family-Centered Services 47

Gavin, & Lane, 2000) and one case study approach to Several studies have made an important contribution
understanding the interaction between parents and pro- to understanding the components of help-giving practices
fessionals (Dunst, Trivette, Gordon, & Starnes, 1993). and how those components are differentially associated
Finally, a much wider range of parent reports of service with service outcomes. For example, the EPS comprises
received have been developed. three factors measuring the level of comfort, participation,
Many studies have reported significant differences and autonomy by parents in their relationship with pro-
between parent and staff ratings of the family-centered fessionals (Dempsey, 1995). Dempsey and Dunst (2004)
nature of early intervention services (Dempsey & found that the comfort and autonomy factors from the
Carruthers, 1997; Filer & Mahoney, 1996; McBride, EPS accounted for the majority of (and for approximately
Brotherson, Joanning, Whiddon, & Demmitt, 1993; R. A. equal amounts of) increases in empowerment in families
McWilliam, Snyder, Harbin, Porter, & Munn, 2000). in the United States and Australia. Using the HPS, Dunst
These findings suggest that so long as family centered- (1997) and Dunst et al. (2002) demonstrated that although
ness is defined in relation to the specific needs of parents, parents’ perceptions of how comfortable they felt in their
then professionals’ views of the extent to which they are relationship with staff remained stable across services
meeting those needs may be unreliable. Because the vast with different levels of family centeredness, higher levels
majority of measures of family-centered practice rely on of parent participation were always found in family-
parent scales, they—and not professional evaluations— centered services.
are discussed here. Similar findings in parents’ perceptions of help-giving
In addition, the research reports considerable variation in across services were found by King, Rosenbaum, and
parents’ perceptions of family-centered practice across ser- King (1997), Judge (1996), and Granat et al. (2002).
vices (Dunst, Boyd, Trivette, & Hamby, 2002; Mahoney & More recently, King and her colleagues (2003) found
Bella, 1998; Petr & Allen, 1997; Trivette, Dunst, & Hamby, that although both parents and staff strongly believed in
1996b; VanRiper, 1999). Consequently, a family-centered the principles of family-centered practice, staff members
mission statement does not guarantee that parents will per- were less likely than parents to note the difficulties of
ceive the service to be family centered. This finding lends implementing the approach. In addition, parents’ percep-
support to the use of parent report instruments despite their tion of the family-centered support they received was
subjective nature and to use multiple data sources to better significantly associated with satisfaction with the service,
understand parental perceptions of help-giving practices reduced stress, and higher emotional well-being (King,
(Rodger, Keen, Braithwaite, & Cook, 2007). King, Rosenbaum, & Goffin, 1999).
Using the Enabling Practices Scale (EPS; Dempsey, Several studies have shown a low correlation between
1995), Dempsey and Dunst (2004) and Dempsey, the frequency of contact between parents and help givers
Foreman, Sharma, Khanna, and Arora (2001) found sig- and measures of parental control. Also, studies have shown
nificant positive correlations between parents’ perceptions no association between the frequency of contact and
of family-centered practice and their reported level of help-giving practices (Dempsey et al., 2001; Trivette,
empowerment after the variance related to a range of other Dunst, Boyd, & Hamby, 1995). Taken together, these
variables had been accounted for. These studies included results are consistent with Dunst, Trivette, and Hamby’s
groups of families with a young child with a disability (2007) meta-analysis of family-centered help-giving
receiving support services in Australia, the United States, practices research that found that help-giving practices
and India. In a further study, seven internally consistent are related to a variety of child and family outcomes con-
items from the EPS that measure partnerships between sistent with the assumptions of family-centered practice
parents and professionals accounted for a substantial described earlier in this article.
amount of variance in both parents’ perception of their
ability to obtain supports and resources and the degree to
which parents perceived they had choice in how staff Parent and Child Outcomes
worked with them (Dunst & Dempsey, 2007). Researchers in the area of family-centered planning
Dunst, Trivette, and Hamby (1996) used the Helpgiving have been interested in determining what outcomes are
Practices Scale (HPS) to show that family-centered achieved for children and their parents who participate in
service provision was significantly related to the extent services that ascribe to a family-centered approach. To
to which parents perceived they were able to obtain needed this end, dependent variables identified in the selected
resources, supports, and services from the target service. studies include parenting stress, competence and locus of
The HPS has been used extensively in family-centered control, and aspects of child development and behavior.
research (see Table 1). Some child and parent characteristics may, however, be
48 Topics in Early Childhood Special Education

more appropriately identified as moderating variables, family-centered support and parent stress have a positive
but there is a need for further research to clarify the and a negative relationship with parent empowerment,
nature of these relationships. respectively.
Dunst, Trivette, and Johanson (1994), Dunst, Trivette,
Parent Stress and Well-Being and Hamby (1996), Trivette et al. (1995), Trivette et al.
(1996b), and Judge (1996) found that the extent to which
The association between parent stress and family-
families reported they were able to obtain needed
centered support has been examined by several studies.
resources and services was significantly related to help-
Mahoney and Bella (1998) found no significant relation-
giving practices. Finally, Dunst, Trivette, and LaPointe
ship between the nature of the service that parents said
(1994), Trivette, Dunst, Hamby, and LaPointe (1996),
they received and perceived stress. In contrast, O’Neil,
and Judge (1997) found a strong and significant rela-
Palisano, and Westcott (2001) and van Schie, Siebes,
tionship between parent empowerment and help-giving
Ketelaar, and Vermeer (2004) found that help-giving
practices.
practices explained a moderate amount of variance in
parent stress. A recent study by Keen, Rodger, Couzens,
Parenting Competence
and Muspratt (2008) found that child-related parenting
stress improved for families who received a family- Although it is a strong feature of family-centered phi-
centered intervention but no similar gains were found losophy (Dunst, Trivette, & Deal, 1988), there is limited
for parents in a matched control group. evidence of a significant association between the use of
There is conflicting evidence whether stress may be help-giving practices and the development of parenting
best considered as an outcome and not an intervening vari- competence. Heller, Miller, and Hsieh (1999) found
able in the family-centered model. King and her col- increased care-giving self-efficacy for parents with an
leagues (1999) found that help-giving practices, although adult child with intellectual disability versus a control
having a small but significant and direct relationship with group following a family-centered intervention. In addi-
stress, demonstrated a stronger association with stress via tion, a family-centered intervention for families of a child
parents’ satisfaction with services. Although satisfaction with autism led to improvements in parenting competence
with services was not measured by Thompson et al. in an experimental group but not for a control group of
(1997), parent stress played an important moderating role parents (Keen et al., 2008).
in the relationship between family-centered practice and
empowerment. Finally, VanRiper (1999) reported a small Child Development
but significant association between parents’ psychological
well-being and help-giving practices. The relationship between family-centered practice
and child development has also received little attention
Measures of Control in the family-centered research. Mahoney and Bella
(1998) found no significant relationship between these
The family-centered literature has also used a variety variables. However, in a study of more than 500 parents,
of measures to assess parents’ perceived empowerment Dunst (1999) showed that the only significant predictor
and control over their life circumstances. The Family of child progress in a multivariable model was the extent
Empowerment Scale measures a family’s perception and nature of parenting supports provided by early inter-
of their empowerment across two dimensions: level vention workers.
(e.g., interactions with individuals, service staff, and
community organizations) and expression (e.g., a belief Child Behavior Problems
in the ability to bring about change, participation in and Level of Disability
advocacy activities) of empowerment (Koren, DeChillo,
& Friesen, 1992). The Family Empowerment Scale has As might be expected, child behavior problems have
been shown to be closely associated with the family been shown to be significantly associated with a number
centeredness of services in several studies. For example, of measures of parental emotional well-being (King
Dempsey et al. (2001) and Dempsey and Dunst (2004) et al., 1999). However, this study did not clarify whether
found that help-giving practices accounted for the largest parental depression may contribute to behavior prob-
amount of variance in empowerment and that no other lems. The severity of the child’s disability does not
variable used in the studies was significantly associated appear to be significantly associated with the provision
with empowerment for four of five samples of parents. of help giving or to parent empowerment (Dunst, 1999).
Furthermore, Thompson et al. (1997) demonstrated that A small but significant correlation between child age
 Dempsey, Keen / Family-Centered Services 49

(but not child disability) and help-giving practices was practices and higher levels of empowerment than families
reported by Judge (1997). not involved with advocacy services (Dempsey et al., 2001).
Staff characteristics have not been well examined. Two
Moderating Variables studies have reported differences in parents’ perceptions
of collaboration with staff and parent control across staff
Family-centered theory acknowledges the importance professional disciplines (DeChillo et al., 1994; Trivette
of a range of variables in moderating the impact of et al., 1996b). R. A. McWillliam and colleagues (2000)
family-centered practice on desirable child and parent found that although type of agency (e.g., early intervention
outcomes. These moderating variables have been variously program, health department) was the strongest predictor
presented as both dependent and independent variables of perceived family centeredness, setting (e.g., home,
in the selected studies, and they have included character- clinic) and staff experience were also predictors.
istics of the study participants, parents’ satisfaction with
support, and parent control attributions. Satisfaction With Support
Characteristics of Children, Many studies show a significant correlation between
Families, and Staff help-giving practices and parent satisfaction with the ser-
vice they receive (DeChillo et al., 1994; Dempsey &
The research findings are generally consistent in
Dunst, 2004; Dempsey et al., 2001; McBride et al., 1993;
showing little relationship between a variety of demo-
VanRiper, 1999; van Schie et al., 2004). In addition, Law
graphic characteristics of parents, children, and staff, and
and colleagues (2003) demonstrated that the strongest
process and outcome variables in family-centered ser-
predictors of parent satisfaction were the extent of a
vices. For example, Dempsey and Dunst (2004) and
family-centered culture within the relevant organization
Dempsey et al. (2001) found no significant correlation
and parents’ perceptions of the extent to which service
between parents’ educational training, employment sta-
practices were family centered. Parents display a higher
tus, the age of their child, and parents’ sense of control.
degree of satisfaction when family-centered service is
DeChillo, Koren, and Schultze (1994), using a wider
provided and lower satisfaction when it is not provided
range of demographic variables, found no significant dif-
(Romer & Umbreit, 1998).
ferences in reported levels of collaboration with staff
across demographic categories. Parent educational qual- Parent Control Attributions
ifications, parent age, parent membership of support
groups, and the presence of child behavior problems Judge (1996) reported strong associations between
accounted for very little of the variance in parent beliefs both personal control and control over the nature of early
about family-centered practices in a study by King and intervention services and help-giving practices.
her colleagues (2003). The same study found that receiv- Frequency of contact between parents and professionals
ing training in family-centered practice and professional was also closely associated with these control measures
experience explained a small but significant amount of in this study.
the variance in staff beliefs about family-centered prac- Locus of control had a moderate but nonsignificant
tice. These results are also consistent with research find- relationship with parent empowerment in a study by
ings by Judge (1996). Dempsey and Dunst (2004). Dempsey et al. (2001) found
Parent demographic variables (education, employment, a significant relationship between locus of control and
and income) had a significant inverse relationship with empowerment in one of two groups of parents. In one of
child behavior problems in a study of more than 170 these groups (parents who were members of an advocacy
parents of young children with a disability (King et al., organization), those with more internalized locus of con-
1999). In this study, although the level of the child’s dis- trol tended to report higher levels of empowerment. In
ability was an important predictor of the financial and per- both of these studies, help-giving practices had a small
sonal impact of care, it did not make important and nonsignificant relationship with locus of control.
contributions to parent stress, well-being, and satisfaction The extent of collaboration between parents and pro-
with the service provided to the family. Trivette, Dunst, and fessionals was strongly related to parents’ perceived self-
Hamby (1996a) found that higher income families were efficacy in a study of more than 200 parents of children
less likely to report help-giving practices as empowering as receiving mental health services (Reich, Bickman, &
lower income families. Finally, families involved with an Heflinger, 2004). Furthermore, this relationship was
advocacy organization for the inclusion of school students demonstrated by parents at baseline, at 3 months and at
with a disability reported lower levels of help-giving 12 months after a parent training program.
50 Topics in Early Childhood Special Education

Figure 1 use of help-giving practices is closely related to parent

A Model of Processes, Outcomes, and satisfaction with the professional support they receive.
Mediating Variables in Family-Centered Practice Although the evidence is not as strong, several studies
with Families With a Child with a Disability support an association between help-giving practices and
both a number of parent control appraisals and parent stress
Service delivery processes and well-being. There is very little research support to con-
Help-giving practices
Frequency of support Parent/child demographics firm the assumed links between help-giving practices and
both child development and parenting competence. Bailey
et al. (2006) note that there has been a lack of agreement
and a consequent lack of consistency in the conceptualiza-
Parent control attributions
tion of family outcomes in research on families for young
(e.g., locus of control, children with a disability. Their identification of five family
self-efficacy)
outcomes, developing from stakeholder research, is an
example of a socially valid process that may assist in the
development of future research frameworks.
That there are some important variations in the level of
Parent and child outcomes
Parent satisfaction Child development confidence we have about several assumptions inherent to
Parent satisfaction with child’s development
with support
Parent stress the family-centered philosophy is not surprising, given the
Parenting capabilities
Parent empowerment relatively limited research literature in this area. However,
because the philosophy has been widely adopted as best
practice in a variety of disciplines, it is crucial that important
gaps in the research backing for family-centered support are
Discussion and Future Research Needs addressed. First, it is crucial that the field undertakes further
longitudinal studies to permit some confident assertions
A review of the family-centered literature reveals a rel- about the causal relationship between relevant variables that
atively small research base on which to understand the the current family-centered research, which is dominated by
relationships that exist between service delivery processes cross-sectional studies, does not allow. For example, at the
and child and parent outcomes. The model presented in moment, it is not possible to provide consistent evidence that
Figure 1 reflects our current knowledge of these rela- a range of child and family outcomes improve over time as
tionships based on the research literature. Briefly, family- a consequence of help-giving practices. A second crucial
centered help giving is directly related to locus of control, need is for future research to determine the extent to which
self-efficacy, and satisfaction with the support parents help-giving practices are related to both parenting capabili-
receive, and indirectly related to a number of parent and ties and child outcomes such as child development and
child outcomes. Furthermore, the model shows that parent reduction of child behavior problems. In this regard, both
appraisals are directly related to parent and child out- experimental research and research that incorporates a wider
comes and that the former mediate the impact of help giv- range of relevant variables will assist.
ing on parent and child outcomes. In conclusion, the family-centered philosophy continues
Several of the relationships shown in Figure 1 are to hold much promise in the generation of desirable out-
strongly supported by the family-centered research litera- comes for children with a disability and their families. The
ture. There is consistent support of a strong relationship existing limited research base has done much to confirm sev-
between help-giving practices and parents’ reported eral of the important features of this philosophy. However,
empowerment and control over important aspects of their for the family-centered philosophy to achieve its full poten-
lives. This relationship holds true for families from many tial and to ensure that it becomes more than just an interest-
cultural backgrounds and for families with a wide variety ing feature of family-professional partnership theory, future
of demographic characteristics. Furthermore, the literature family-centered research needs to systematically target a
has also consistently demonstrated that help giving by ser- number of important areas in need of clarification.
vice providers that incorporates a participatory component
is most strongly associated with a range of desirable
family outcomes. That is, for outcomes to be optimized,
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O’Neil, E., Palisano, R. J., & Westcott, S. L. (2001). Relationship of Ian Dempsey is a senior lecturer at the University of Newcastle in
therapists’ attitudes, children’s motor ability, and parenting stress Australia. He researches and publishes in the areas of support for
to mothers’ perceptions of therapists’ behaviours during early families of a child with a disability, Australian special education leg-
intervention. Physical Therapy, 81, 1412–1424. islation and policy, and employment services for adults with intellec-
Petr, C. G., & Allen, R. I. (1997). Family-centered professional tual disability.
behavior: Frequency and importance to parents. Journal of
Emotional and Behavioral Disorders, 5, 196–204. Deb Keen is an associate professor at Griffith University in Australia.
Reich, S., Bickman, L., & Helflinger, C. A. (2004). Covariates of self- Her research interests lie in interventions, education, and program
efficacy: Caregiver characteristics related to mental health services evaluations that build capacity in families and communities and
self-efficacy. Journal of Emotional and Behavioral Disorders, 12, enhance developmental and learning opportunities and outcomes for
99–109. individuals with a disability, particularly autism.