Family-centred service, functional goal setting and co-ordination of a child's move between programmes are important concepts of rehabilitation services for children with cerebral palsy identified in the literature. We examined whether these three concepts could be objectively identified in programmes providing services to children with cerebral palsy in Alberta, Canada.
Programme managers (n= 37) and occupational and physical therapists (n= 54) representing 59 programmes participated in individual 1-h semi-structured interviews. Thirty-nine parents participated in eleven focus groups or two individual interviews. Evidence of family-centred values in mission statements and advisory boards was evaluated. Therapists were asked to identify three concepts of family-centred service and to complete the Measures of Process of Care for Service Providers. Therapists also identified therapy goals for children based on clinical case scenarios. The goals were coded using the components of the International Classification of Functioning Disability and Health. Programme managers and therapists discussed the processes in their programmes for goal setting and for preparing children and their families for their transition to other programmes. Parents reflected on their experiences with their child's rehabilitation related to family-centredness, goal setting and co-ordination between programmes.
All respondents expressed commitment to the three concepts, but objective indicators of family-centred processes were lacking in many programmes. In most programmes, the processes to implement the three concepts were informal rather than standardized. Both families and therapists reported limited access to general information regarding community supports.
Lack of formal processes for delivery of family-centred service, goal-setting and co-ordination between children's programmes may result in inequitable opportunities for families to participate in their children's rehabilitation despite attending the same programme. Standardized programme processes and policies may provide a starting point to ensure that all families have equitable opportunities to participate in their child's rehabilitation programme.
Fathers of 103 Canadian infants (ages 2 to 12 months) were observed interacting with their child using the Nursing Child Assessment Teaching Scale (NCATS). Compared with the NCATS reference data for 387 mothers of similar-aged infants with similar marital status and ethnic background, there was no significant difference on the overall total score. However, fathers had significantly lower scores than mothers on the total parent score. Infants interacting with the fathers had significantly higher total child scores than those interacting with the mothers. Although mothers and fathers were equally sensitive to their infant's cues, fathers were less contingent in interaction with their infants. Implications for practitioners are discussed.
Mothers and fathers of 54 term infants and 49 preterm infants were observed individually interacting with their infant in the home during a structured task (Nursing Child Assessment Teaching Scale) when the child was 3 and 12 months old. Parents of preterm infants had lower interaction scores than parents of term infants. Differences between the groups were not explained by differences in the behavior of the infant, in levels of stress (measured by the Parenting Stress Index), in marital support (measured by the Dyadic Adjustment Scale), or in level of involvement with their child. Fathers of both term and preterm infants had lower interaction scores than mothers. Parents' interaction scores decreased over time, while the responsiveness and clarity of cues of the infants increased over time. The results are discussed in relationship to other research on prematurity stereotyping and the vulnerable child syndrome.
Fathers and mothers of 49 healthy preterm and 54 full-term infants were observed interacting with their child at 3 and 12 months using the Nursing Child Assessment Teaching Scale. Each parent completed the Parenting Stress Index at both times. At 18 months adjusted age, the children were assessed using the Bayley Scales of Infant Development, Sequenced Inventory of Communication Development-Revised, and MacArthur Communicative Development Inventory. Preterm children scored significantly lower on the Bayley Mental scale and on the number of words produced. Early parent-child interactions contributed to the child's development. Mother's interactions with the child, child gender, and family socioeconomic status predicted 17% of the variance in the Bayley Mental score. Mother's and father's interactions with the child, child gender, and the child's behavior with his or her mother predicted 22% of the variance in receptive communication skills.
Fathers of 49 Canadian children (ages 13 to 24 months) were observed interacting with their child at home using the Nursing Child Assessment Teaching Scale (NCATS). Consensus ratings from two observers were used in the analysis. Compared with the NCATS reference data for 164 mothers of similar ethnicity and marital status with similar-aged children, mothers were more responsive than fathers in the interactions. Mothers had significantly higher scores on the overall Total NCATS score, on the Total Parent score, and on the Parent Contingency score than the fathers. In contrast, children were more responsive to fathers than mothers. Children interacting with their fathers had significantly higher Total Child scores and higher Child Contingency scores than those interacting with their mothers. Maternal and paternal age and education were not correlated to scores on the NCATS. Implications for practitioners are discussed and the results are compared to a study of mothers and fathers interacting with children ages 2 to 12 months old in which the observations were measured by the NCATS. Results suggest that NCATS cutoff scores used to identify mothers in need of intervention should be used with caution for father--toddler interactions.