THE CULTURAL WORLD OF PROFESSIONAL PRACTICE WITH FAMILIES OF CHILDREN WITH A DISABILITY: A NEW UNDERSTANDING OF FAMILY-CENTRED PRACTICE

Abstract

Human service professionals provide a range of services to support the health and development of children with a disability and to assist their families. Over the past two decades, family-centred approaches have become widely acclaimed as a means of providing quality services. To date, research has focused predominately on identifying or measuring discrete elements of professionals’ practice with families, such as parent–professional partnerships, family-centred practice and family empowerment, often neglecting to consider the broader practice context. What is missing is an empirical and contextually grounded understanding of how professionals interpret and enact the multiple concepts informing practice. This study addresses this gap by exploring how professionals think, feel and act when working with families and by examining more broadly, the multi-dimensional and contextual concept of ‘professional practice’. In this study, professional practice with families is conceptualised as a cultural activity. The study sought to identify and describe the culture of professional practice with families and how this culture is instantiated in daily work practice. The theoretical framework underpinning this study comes from Jerome Bruner’s cultural psychology, and specifically his writings on situated action, culture and narrative. Accordingly, narrative was considered a means to identify, describe and understand the daily work practices of professionals ‘situated’ in their cultural setting and their own intentions when working with families. One hundred and sixty three stories about professional practice were collected in focus groups and individual interviews with human service professionals in New South Wales, Australia. These narratives were analysed deductively to identify the culture of professional practice. This culture comprised of ten components reflecting professionals’ understanding of the culturally acceptable ways of working with families. The cultural components reflected principles underlying family-centred practices as well as traditional medically framed and emerging business-like principles associated with managerialism and economic rationalism. Narrative analysis was employed to inductively develop four cultural core narratives grounded V in participants’ stories: Making it work, having to fight, hopeless struggle and making the best of it. Professionals potentially have all of these narratives available to them to explain their actions in each practice situation. The results of this study provide a description and analysis of the cultural world of professional practice with families. For family-centred approaches to become a reality, these findings emphasise the critical importance of education, policy and staff development for professionals working with families that addresses the broader practice context. Suggestions are made regarding further exploration of the crosscultural validity and the application and implications of these narratives for professionals and families. By exposing the culture of professional practice and the four cultural narratives, this study challenges professionals, managers, academics and policymakers alike to critically examine the practice culture and their contribution to creating and sustaining it