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Phoenix M, Reitzel M, Martens R, Lebsack J. Reconceptualizing the Family to Improve Inclusion in Childhood Disability Research and Practice. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:710580. [PMID: 36188823 PMCID: PMC9397813 DOI: 10.3389/fresc.2021.710580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/16/2021] [Indexed: 11/26/2022]
Abstract
The World Health Organization's International Classification of Functioning, Disability and Health recognizes that environmental factors impact well-being and life participation for children with disabilities. A primary environment in which children grow and learn is the family. The importance of family has long been recognized in family-centered practice and family-centered research. Although family-centered services and research have been critically explored, the concept of family has received less critical attention in rehabilitation literature. The family construct is due for an updated conceptualization with careful consideration of the implications for childhood disability rehabilitation practice and research. Interrogating the family construct asks questions such as: who is included as a part of the family? Which family structures are prioritized and valued? What is the potential harm when some families are ignored or underrepresented in childhood disability practice and research? What implications could a modern rethinking of the concept of family have on the future of childhood rehabilitation practice and research? This perspective article raises these critical questions from the authors' perspectives as parents of children with disabilities, child focused rehabilitation professionals, and researchers that focus on service delivery in children's rehabilitation and family engagement in research. A critical reflection is presented, focused on how the construct of family affects children's rehabilitation practice and research, integrating concepts of equity, inclusion and human rights. Practical suggestions for children's rehabilitation service providers and researchers are provided to aid in inclusive practices, critical reflection, and advocacy.
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Affiliation(s)
- Michelle Phoenix
- CanChild, McMaster University, Hamilton, ON, Canada
- Faculty of Health Sciences, School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- *Correspondence: Michelle Phoenix
| | - Meaghan Reitzel
- CanChild, McMaster University, Hamilton, ON, Canada
- Faculty of Health Sciences, School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | | | - Jeanine Lebsack
- IWK Strongest Families Research Institute, Halifax, NS, Canada
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Haywood C, Pyatak E, Leland N, Henwood B, Lawlor MC. A Qualitative Study of Caregiving for Adolescents and Young Adults With Spinal Cord Injuries: Lessons From Lived Experiences. Top Spinal Cord Inj Rehabil 2019; 25:281-289. [PMID: 31844380 PMCID: PMC6907026 DOI: 10.1310/sci2504-281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: To examine characteristics of caregiving from the perspectives of adolescents and young adults (AYAs) with spinal cord injuries (SCIs) and their informal caregivers to address outstanding gaps in knowledge relating to definitions of caregiving and its associated practices for this population. Methods: A multiphase qualitative design was applied, using phenomenological and narrative methods to capture data in participants' homes and communities. Participants were recruited from rehabilitation hospitals and community organizations throughout Los Angeles County, California. Inclusion criteria for AYAs included being 15-22 years old, having acquired an SCI within the previous 5 years, and using a wheelchair for mobility. The AYAs nominated persons they identified as primary caregivers to also participate. Data were collected through individual and group interviews as well as activity observations. Results: Data from the 17 participants (9 AYAs and 8 informal, primary caregivers) revealed ways in which the meaning of caregiving varied among dyads. Caregiving practices extended beyond physical assistance to include support for a range of day-to-day activities spanning from practical needs to facilitating developmental trajectories. Although AYAs expressed ideas about preferred caregiver characteristics, care partnerships appeared to be guided more by availability than preference. Conclusion: Phenomenological analysis revealed that the meaning of "caregiving" and its associated practices are highly individualized for AYAs with SCIs. Caregiving is rooted in personal needs related to effects of SCI and developmental goals. Everyday practices are shaped by individual relationships and the beliefs of AYAs and their caregivers. Addressing influences of caregiving on long-term health and function may require attention to developmental processes, caregiver "fit," and ways care is, or can be, distributed throughout broader networks according to personal needs and preferences.
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Affiliation(s)
- Carol Haywood
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elizabeth Pyatak
- University of Southern California, Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, Los Angeles, California
| | - Natalie Leland
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Benjamin Henwood
- University of Southern California, Suzanne Dworak-Peck School of Social Work, Los Angeles, California
| | - Mary C. Lawlor
- University of Southern California, Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, Los Angeles, California
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Sakellariou D. Enacting Varieties of Subjectivity Through Practices of Care: A Story of Living With Motor Neuron Disease. QUALITATIVE HEALTH RESEARCH 2016; 26:1902-1910. [PMID: 25918113 DOI: 10.1177/1049732315584744] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
People living with disability or chronic illness often use practices of care to construct a version of life they are satisfied with. Drawing from a narrative-based study with people living with motor neuron disease (MND), I show how one couple tried to be recognized as active agents in their life, although oscillating between positions of less and more power. Through an examination of the practices of care that the couple enacted, I illustrate how their positioning in relation to practices of care helped them create meaning in their life. In their efforts to create a way of living they were satisfied with, they engaged in negotiations between varieties of subjectivity. Their subjectivity was not static but was constructed as they shared power to carry out everyday self-care activities. The findings also underline the importance for health care practices of exploring the experiential knowledge of people living with MND.
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Burkett K, Morris E, Manning-Courtney P, Anthony J, Shambley-Ebron D. African American families on autism diagnosis and treatment: the influence of culture. J Autism Dev Disord 2016; 45:3244-54. [PMID: 26055985 DOI: 10.1007/s10803-015-2482-x] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cultural factors such as health care access and autism spectrum disorder (ASD) symptom interpretations have been proposed as impacting delayed diagnosis and treatment for African American children with ASD. A qualitative study of urban African American families caring for their child with autism was conducted with 24 family members and 28 ASD professionals. Cultural caring meant families protected their child from harm including potential or actual distrustful encounters, and took action for their child and community to optimize their child's health and address the knowledge deficits of ASD within their community. Families and professionals believed cultural influences delayed families' receiving and seeking appropriate health care for the African American child with ASD affecting timely autism diagnosis and treatment.
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Affiliation(s)
- Karen Burkett
- Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML4002, Cincinnati, OH, 45229, USA.
| | - Edith Morris
- College of Nursing, University of Cincinnati, Cincinnati, OH, USA.,Nursing Research in Patient Services, Center for Professional Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Patricia Manning-Courtney
- Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML4002, Cincinnati, OH, 45229, USA
| | - Jean Anthony
- College of Nursing, University of Cincinnati, Cincinnati, OH, USA
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Solomon O, Angell AM, Yin L, Lawlor MC. "You Can Turn off the Light If You'd Like": Pediatric Health Care Visits for Children with Autism Spectrum Disorder as an Interactional Achievement. Med Anthropol Q 2015; 29:531-55. [PMID: 26332032 PMCID: PMC4715550 DOI: 10.1111/maq.12237] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Substantial scholarship has been generated in medical anthropology and other social science fields on typically developing child-parent-doctor interactions during health care visits. This article contributes an ethnographic, longitudinal, discourse analytic account of a child with autism spectrum disorder (ASD)-parent-doctor interactions that occur during pediatric and neurology visits. The analysis shows that when a child with ASD walks into the doctor's office, the tacit expectations about the visit may have to be renegotiated to facilitate the child's, the parent's, and the doctor's participation in the interaction. A successful visit then becomes a hard-won achievement that requires the interactional and relational work of all three participants. We demonstrate that communicative and sensory limitations imposed by ASD present unique challenges to all the participants and consider how health care disparities may invade the pediatric encounter, making visible the structural and interactional processes that engender them.
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Affiliation(s)
- Olga Solomon
- USC Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California.
| | - Amber M Angell
- USC Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California
| | - Larry Yin
- Keck School of Medicine, Department of Pediatrics, University of Southern California, and Children's Hospital Los Angeles, Division of General Pediatrics, University of Southern California
- USC Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California
| | - Mary C Lawlor
- USC Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California
- Keck School of Medicine, Department of Pediatrics, University of Southern California, Children's Hospital Los Angeles, Division of General Pediatrics, University of Southern California
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Affiliation(s)
- Cheryl Mattingly
- Department of Anthropology, Dornsife College & Division of Occupational Science and Therapy University of Southern California
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Solomon O, Lawlor MC. "And I look down and he is gone": narrating autism, elopement and wandering in Los Angeles. Soc Sci Med 2013; 94:106-14. [PMID: 23890970 PMCID: PMC3788703 DOI: 10.1016/j.socscimed.2013.06.034] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 06/27/2013] [Accepted: 06/27/2013] [Indexed: 10/26/2022]
Abstract
'Wandering' and 'elopement' have been identified as common in autism, affecting half of all diagnosed children ages four to ten, yet families rarely receive advice from practitioners even after the fact. Family perspectives have been missing from the literature as well as from public health and policy debates on how and when to respond to this problem. The problem of 'wandering' and 'elopement' reveals a complex intersection of larger issues encountered by families of children with autism. To consider these issues, this article examines 'wandering' and 'elopement' from the perspectives of African American mothers of children with autism, an underrepresented group in autism research. We consider how the mothers experience these behaviors and the response to these behaviors by professionals, such as service coordinators and law enforcement personnel working within various jurisdictions that become involved with the problem. We analyze the mothers' narratives about 'wandering' and 'elopement' drawn from ethnographic interviews that were collected between October 1, 2009 and August 31, 2012. These interviews were part of a larger project on disparities in autism diagnosis and services that followed a cohort of 25 four to ten-year old children. Drawing on narrative, phenomenological and interpretive traditions, we trace the mothers' developing understandings of 'wandering' and 'elopement' over time, and show how these understandings become elaborated and transformed. This article provides a nuanced, moment-to-moment and longitudinal picture of the mothers' experiences of 'wandering' and 'elopement' that enriches the cross-sectional view of large-scale surveys about the problem and contributes unique insights at the family and community levels. Implications for professional awareness, clinical practice and service provision are also suggested.
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Affiliation(s)
- Olga Solomon
- University of Southern California, Los Angeles, CA 90089, USA.
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