Planning with Families for Evaluation and Assessment:

Essential Content of Planning with Families

Page 6 of 13

Influences on a family's decision to talk about their concerns, priorties, and resources

There are many factors that can influence a family’s decision to discuss their concerns, priorities and resources including:

• Cultural mores about family life and raising children. Family members and early intervention providers are each part of a unique cultural and family group that has developed specific perspectives and rules governing interactions and behavior among group members (as well as outsiders). Understanding these cultural variations among families is dependent on the ability of early intervention providers to recognize the cultural influences on their own behavior.
  
  These influences include:
  • age
  • gender
  • sexual preference
  • religion
  • ethnic/racial background
  • socioeconomic status
  • education (informal and formal)
  • geography (urban vs. rural, region of country)
  • communication (verbal and nonverbal, including professional jargon).

How parents organize their family life and raise children is highly influenced by their childhood experiences in their family of origin as well as their cultural background.

Shelley grew up as the only girl in a family with four boys, and learned to stand up for herself. With their first two sons, Shelley and her husband continued her parents' practice of letting the kids work things out for themselves. Their third son was an observant boy who loved to paint and had significant language delays. Shelley was uncomfortable with the speech-language pathologist's recommendations to structure his interactions and elicit speech from him, especially while playing with his brothers. She talked with the SLP about not wanting to over structure his play time at home, and together they identified other settings to encourage his language use.			Shelley's Story

Likewise, the expectations of early interventions providers about family life and parenting are drawn from their own family of origin, personal experiences raising children, and professional training (Barber, Turnbull, Behr & Kerns, 1989).

Fran's father was injured early in her life, and used a wheelchair to get around outside their home. She had many positive memories about her father doing "wheelies" and giving her and her friends rides in his chair. Remembering this, she was surprised by the strong negative reaction her father had to her recommendation that they use an adapted stroller, or rent a child's wheelchair, for their 2 year old daughter during their next vacation. Fran wanted the family to move around without carrying their daughter everywhere, and the father felt that this meant that his daughter probably would not walk.		Fran's Story

It is helpful, when encountering unfamiliar behavior, traditions or suprising reactions, to ask oneself the following questions:

• To whom is this behavior/tradition/reaction unfamiliar?
• What do I see/hear another person do and say?
• What assumptions, if any, am I making about what this person is saying/doing?
• How do these assumptions affect my behavior and interactions with this person?

Having attended a pacifist church his whole life, Sam, an early childhood special educator, was disturbed by one father's interest in letting his young son learn about his hunting gun. Aware that he considered his inappropriate parenting, Sam asked his supervisor to help him understand his reaction, and review his interaction with this father.		Sam's Story

• Perspectives about the nature of developmental delay/disability. A family member's cultural background may influence his/her understanding of a child's behavior and diagnosis, and whether or not a child may need assistance to participate in family and community activities. Most parents develop an "explanatory model," usually unspoken, about a child's personality, behavior, strengths and challenges. Part of this explanation is based on a parent's understanding of a child's identified diagnosis or developmental delay, its severity and impact on daily life, cause for any delay, and what would be helpful (Kleinman, 1988).

Ravi's father believes his son's delayed development is due to his own past misdeeds, and does not think that early intervention can change his son's predetermined path. Ravi's therapist misinterprets his lack of interest in her visit as an indicator of his attachment to his son.		Ravi's Story

Ping marries an American and brings his son, Luo, to the United States for treatment of his autism. She enrolls her son in the local infants and toddler program, and two private programs with very different philosophies because she hopes western medicine will prompt her son's development. She works with Luo whenever he is awake, and doesn't understand his teacher's encouragement to "play" with him.		Ping's Story

• Past experiences obtaining services and interacting with personnel in medical facilities, and agencies such as public health and social services. Previous interactions with professionals such as doctors, nurses, and social workers create expectations for family members about interacting with early intervention providers. Every cultural group has developed mores about giving and receiving professional care for dependent members who are very young, fragile, ill, or at the end of their lives. Each person develops culturally based attitudes about dependency, gaining and losing autonomy, and receiving help from others. It is useful for early intervention providers to ask:

  Are our current early intervention policies, customs and practices helpful?
  If so, to whom are they helpful? Families? Children? Providers? All groups? (Johnston, 1980).

Mybinh's parents are recent immigrants and speak limited English. In their experience, family and friends were born at home, with assistance from the village "midwife." When Mybinh was born prematurely, they consider her stay in the NICU an intrusion on their family life, and don't understand most of the medical procedures recommended by doctors.		Mybinh's Story

Kirsten's mother is a medical librarian, and is comfortable looking up and using medical terms. She reads all the research studies about her daughter's diagnosis, and asks many questions, thinking at least she can educate herself about what to expect. Angela, a new therapist, misinterprets this mother's questions as a sign of mistrust.		Kirsten's Story

• Ability of early intervention providers to build rapport with families from various cultural and socioeconomic groups. Families have suggested that one of the best strategies for developing rapport is to learn to listen like a friend, and provide empathy and support for a family situation (McBride, Brotherson, Joaning, Whiddon and Demmitt, 1993).
  
  In addition to cultural and religious factors, the age/gender match between early intervention providers and family members may influence how comfortable family members feel discussing their priorities, resources and concerns. For example:
  • Some young mothers may not be ready to share personal information with an early intervention service provider who is close in age to their own mother. Other young parents, however, might find this situation very natural.
  • Women in some cultures may not be willing to speak directly to a male early intervention provider unless a male family member is present. Early intervention providers may find themselves talking to fathers who have very little to do with caring for young children.

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