Family-centered services inside and outside the preschool

Status, attitudes and experiences of professionals in a complex work environment

Abstract

Despite the avowed aims of Icelandic welfare policies and legislation to provide services in a family-centred and inclusive manner, parents of young disabled children commonly express their experiences of services as characterized by fragmentation, inflexibility, and long waiting lists. The study presented in this article is conducted within the field of disability studies and combines several intersecting theoretical approaches. The first is a socio-relational and human rights understanding of disability which is at the core of the UN Convention on the Rights of Persons with Disabilities (CRPD). Other central theoretical foundations are family-centred theories, which emphasize a holistic view of child and family, together with collaboration between all entities on goals and implementation of services. Finally, the study is informed by the third generation of cultural-historical activity theory (CHAT) and relational practices. The aim of the study is, firstly, to explore the much-discussed discrepancies between the service goals of the welfare and education systems and the actual services as seen from the standpoint of service providers in a theoretical and historical light. Secondly, the aim is to suggest a new way of thinking and acting in service provision for the purpose of developing a much-needed service reform. A qualitative case study methodology was applied. The research consists of three case studies, located in three different municipalities in Iceland. In accordance with the case study approach, a variety of methods were employed to gain a comprehensive view of each case. The data gathering involved three focus group interviews with 13 professionals, providing therapies and assistance outside the preschool, and semi-structured interviews with 11 specialists from diverse disciplines who worked within or in relation to preschools. Moreover, participant observations were conducted in each municipality together with extensive document reviews and participant observations. The data were analysed and interpreted using theoretical guidance from family-centred services, socio-relational and rights-based views on disability, and cultural-historical activity theory with emphasis on relational practices. The findings reveal a high level of convergence between the three cases with variations mainly based on experiences of individual participants, rather than geographical location or type and size of municipality. Several organisational and professional barriers, such as inconsistent administrative policies, lack of expert resources, strict time limits, productivity requirements and different professional views and traditions were identified among the service providers. Furthermore, lack of awareness of the basic principles of family-centred services and the rights-based provisions of the CRPD was revealed. Considering the findings, recommendations for service development are made on the grounds of cultural-historical activity theory (CHAT) and Edwards’ relational concepts of the “gardening tools”. These relational concepts are about professionals working together purposefully towards shared goals that reflect motives based on the resources that each specialism can contribute. Thus, aiming at the creation of common knowledge, in this case, that of gardening tools, is not only beneficial for individual children but also for the parents, the school, and welfare provision in general. It is, therefore, claimed that the relational turn in professional practice offers the opportunity for a much-needed service reform. Developing practices based on these concepts adds something new to individual professional knowledge and performance which is of great value when moving from one-to-one centrebased services to a relational service arrangement in line with existing rights-based inclusive policy ideals.