Moving from Principles to Practice: Recommended Policy Changes to Promote Family‐Centered Care

Abstract

This paper emphasizes the value of family-centered care. Discussion highlights family-centered philosophies (e.g., Systems of Care [SOCs]) and practice models (i.e., wraparound) and identifies discrepancies between conceptualizations and actual practice. Data from multiple sources detail issues in fidelity to family-centered values and needs and risks experienced by siblings of children with severe emotional disturbance and their caregivers. This discussion provides a springboard for policy recommendations to strengthen family support programming and enhance family-centered care, from modifying funding streams such that systems extend their reach beyond children with full-blown, diagnosable problems (those meeting standards of “medical necessity), to supporting prevention and early intervention initiatives that address families as targets for intervention. Recommendations include ensuring that communities with SOC funding address the needs of families; broadening Medic-aid rules and definitions; expanding the range of reimbursable activities and services; and increasing funding for evaluating family-centered care models and family support programming.

A Mental Health Needs Assessment of Urban American Indian Youth and Families

“…Children/families who already demonstrate emotional or behavioral difficulties could have additional clinical services added to their wrap-around plan. This shift would be consistent with what has been proposed by Kilmer et al (2010) in order to address the disconnect between principles and practice and bring SOCs more in line with their family-centered philosophy. In addition, this approach would decrease stigma by promoting the notion that all children and families need supports and services for healthy development and by embedding most services in systems that were mainstream and familiar to families.…”

“…However, it has been consistently demonstrated that there is a substantial gap between SOC philosophy and values and actual practice and that this gap may at least partially explain the mixed outcomes in SOC research (Kilmer et al 2010). In particular, it has been noted that the familycentered care philosophy of SOC is not supported by current policy (Kilmer et al 2010); SOC implementation does not always take into account the ecological perspective, especially as related to the incorporation of prevention and informal supports for families (Cook and Kilmer 2010a, b); that most current behavioral health systems and policies do not support the implementation of a comprehensive wrap-around model (Bruns et al 2010); and that SOCs are not always developed and implemented using an authentic community-based participatory process (Pullman 2009). …”

Perceptions of Family Environment and Wraparound Processes: Associations with Age and Implications for Serving Transitioning Youth in Systems of Care

“…Study findings underscore the importance of policies that encourage and enable SOCs to focus on the needs of the entire family , and suggest that CFT facilitators should anticipate that implementation of wraparound with transitioning youth will bring challenges and be more difficult in certain ways. More specifically, greater efforts may need to be made to: (1) provide adequate support for caregivers and reduce their strain, which, if unchecked, could decrease motivation of caregivers to participate in teams, (2) assess the needs of the whole family and attend to and work to improve the quality of family life, so that the capacity for the family to serve as a resource for youth is enhanced (see e.g., Kilmer et al 2010); (3) enhance youth relationships with other team members, and possibly, incorporate additional team members from outside the family, attending specifically to youth suggestions of potential new members. With regard to the latter, it may be particularly important to evaluate whether support network members from more recently established adult relationships (e.g., peers, romantic partners, co-workers) are included in the team.…”

Guest editorial: Advancing a family-centered practice agenda in child welfare

“…It is expected that the cultural and personal preferences of the child and family are incorporated into decision making. These principles were recently reaffirmed in a review by Epley et al (2010) and applicability extends beyond child welfare to other practice settings including early intervention (Dunst, Boyd, Trivette, & Hamby, 2002), practice with children facing serious mental health distress (Kilmer, Cook, & Munsell, 2010) and health care (Smith, Swallow, & Coyne, 2015;Wong, 2014).…”

“…Despite the emphasis on adopting family-centered principles in child welfare, research suggests families receiving services do not consistently describe their experiences in ways that are theoretically coherent with these five principles (Lietz, 2011), and similar problems were also discussed regarding implementation of family-centered practice when working with children facing severe emotional disturbance (Kilmer et al, 2010) or disabilities (Wright, Hiebert-Murphy, & Trute, 2010). In studies by Smith and Donovan (2003) and Michalopoulos, Ahn, Shaw, and O'Connor (2012), child protective workers concur that the strengths-based, family-centered practice principles are not consistently translated to practice citing several individual and organizational factors as barriers to implementation.…”