Service Practice Evaluation of the Early Intervention Programs for Infants and Young Children in Singapore

Adaptation of the Measure of Processes of Care for the Evaluation of Family-Centeredness of Services in India

OBJECTIVE

This study aims to (1) adapt the Measure of Processes of Care (MPOC-20) for use in India and (2) evaluate family-centered services for children with disabilities and their caregivers in an urban Indian context.

METHODS

In this cross-sectional observational study, we translated the MPOC-20 into Hindi. Caregivers of children diagnosed with developmental disabilities who read and/or understood Hindi and had received services for ≥6 months were recruited. The psychometric properties of the Hindi MPOC-20 were assessed using factor analysis followed by reliability analyses. The Hindi MPOC-20 was used to assess caregiver perceptions about the family-centeredness of services delivered between October 2016 and February 2017 at Ummeed Child Development Center.

RESULTS

Of the 170 eligible children, 141 (83%) comprised the study sample. Most were boys (66%) with a median age of 67 months. Factor analyses yielded a 4-factor scale with items loading differently from the original measure. The resulting Hindi MPOC-20 had acceptable to good internal consistency (Cronbach's alpha of scales: 0.71-0.86). On the Hindi MPOC-20, Respectful and Coordinated Care, Enabling Partnership, and Providing Specific Information were identified as strengths and Providing General Information as a relative limitation of the service by caregivers across different income and education groups.

CONCLUSION

The Hindi MPOC-20 shows acceptable psychometric properties for use with caregivers of children with disabilities in India. The availability of Hindi MPOC-20 paves the way for the assessment of the family-centeredness of services in India and provides a roadmap for adaptations in other low- and middle-income countries.

Family-centred care in early intervention: A systematic review of the processes and outcomes of family-centred care and impacting factors

Family-centred care (FCC) has been established as a best practice model for child disability services internationally. However, further empirical support is required to explore the operationalization and efficacy of FCC, in the absence of a universal practice model. This review aimed to identify the key processes and outcomes of FCC in early intervention (EI) settings and the factors that impact FCC. A systemic review was conducted exploring the processes and outcomes of FCC delivered to children predominantly aged 0-6 years with disabilities/suspected disabilities and families as part of EI or early services. The search procedure was informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Moher et al., 2009). Narrative analysis of data was guided by Braun and Clarke (2006, 2014). Data were presented as per the standards for reporting qualitative research (SRQR; O'Brien et al., 2014). Forty-two studies were included. The majority (90.5%) outlined the processes of FCC, with 59.5% of studies detailing outcomes. Processes were largely reported as qualitative data and/or subscales of the Measure of Processes of Care (MPOC; King et al., 1995), which were subsequently collated. Findings indicated eight key operational processes and corresponding outcomes. Variables that hinder or facilitate FCC included family/professional characteristics, family/service resources, and parent attitudes, engagement and agency. FCC was largely conceptualized as the application of services to children and their families. Critical perspectives on FCC are discussed. It is hoped this research will contribute to the development of a framework of FCC in EI to inform services provided to young children with complex needs and their families and future research.

Correlates of adaptive skills in children with autism spectrum disorder

LAY ABSTRACT

Despite improving services and care for individuals with autism spectrum disorder, functional outcomes such as daily living skills tend to be suboptimal for many. This study wanted to identify modifiable early intervention factors that are associated with better outcomes and possible high-risk groups of children who are at risk of poorer outcomes. Participants included 193 children aged between 5 and 12 years of age whose parents provided information on their family background and early intervention characteristics. These children also had their adaptive behaviour skills examined by formal testing. Results indicated that shorter wait time for early intervention was associated with better adaptive behaviour scores. Children from families with financial difficulties and lower paternal education were also at risk of poorer adaptive skills. Designing services for children with autism such that wait times to enter early intervention services are minimised following initial diagnosis can improve their eventual functional outcomes. Changes in healthcare policy to allow expedited entry or targeted intervention to children from low socio-economic status families can also enhance their eventual adaptive skill gains.

Parental perceptions of paediatric rehabilitation services using the Malay Measure of Processes of Care

BACKGROUND

Neurodevelopmental disabilities are amongst the main conditions encountered in our paediatric rehabilitation centre. To identify the necessary actions to achieve family-centred care in the tertiary healthcare division, we explored the perceptions of parents on the paediatric rehabilitation services received by their children with neurodevelopmental disabilities.

METHOD

A cross-sectional study involving 200 parents of children with neurodevelopmental disabilities aged 1-18 years was carried out. The Malay version of the Measure of Process of Care (MPOC-20) questionnaire was used to measure the perceptions of parents on the services. Descriptive statistical analysis was done to describe the mean score of each MPOC-20 scale. Univariate and bivariate analyses were used to examine the associations between the characteristics of parents and children as well as the sociodemographic and environmental factors with the MPOC-20 scales.

RESULTS

The mean score of the MPOC-20 scales ranged from 4.50 to 5.65 (SD 0.93-1.51). Amongst the MPOC-20 scales, parents ranked enabling, having good partnership and being comprehensive (EP) the highest, whereas the provision of specific information (PS) received the lowest score. Amongst all the MPOC-20 scales, significant differences were shown in parent's employment, between children's age groups and between ethnic groups.

CONCLUSIONS

The Malay MPOC-20 is a validated tool that can be used in evaluation of services among the Malay-speaking community, and therefore, it is recommended for our clinical use to improve family-centred practice in paediatric rehabilitation.

Validity, internal consistency reliability and one-year stability of the Slovene translation of the Measure of Processes of Care (20-item version)

BACKGROUND

The Measure of Processes of Care (MPOC) was developed as a self-administered questionnaire for parents to report on behaviours of healthcare providers. The original (MPOC-56) and the 20-item version (MPOC-20) have established reliability and validity, but the instrument must be rechecked whenever translated and applied in a different social and cultural setting. The aim of our study was to evaluate validity, internal consistency reliability and 1-year stability of the Slovene translation of MPOC-20.

METHODS

Parents of children who were admitted as inpatients or outpatients of several hospitals and health centres were invited to participate. MPOC-20, the Client Satisfaction Questionnaire (CSQ-8) and a separate question on stress and worries were sent by mail. Descriptive item analysis was performed. Cronbach's alpha coefficient and corrected item-total correlations were used to assess internal consistency for each of the five MPOC-20 subscales. To evaluate validity, we correlated the MPOC-20 subscale scores with CSQ-8 scores and a stress alleviation rating. Assessment with MPOC-20 was performed again 1 year later and we used paired-samples tests to compare mean scores of both assessments.

RESULTS

Parents of 235 children participated in the study (80% mothers). They reported high general satisfaction as 15 out of the 20 MPOC-20 mean item scores were above 5 (out of 7) and none was below 4. The mean MPOC-20 mean subscale scores were 5.83 (SD 1.10) for Coordinated and Comprehensive Care for Child and Family, 5.62 (SD 1.12) for Respectful and Supportive Care, 5.45 (SD 1.23) for Enabling and Partnership, 5.33 (SD 1.61) for Providing Specific Information about the Child and 4.59 (SD 1.65) for Providing General Information. The ranking order of the mean rating of the MPOC-20 subscales was similar to previous studies. The parents reported that they felt their stress and worries had been notably or slightly reduced through the process of care in the last year in more than two-thirds of the cases. All the MPOC-20 subscales (as well as the CSQ-8 scale) showed high internal consistency: the corrected item-total correlations were far above the lower limit for item's acceptance of 0.3. After 1 year (66 returned questionnaires) none of the mean subscale scores changed statistically significantly (P-values 0.159-0.910).

CONCLUSION

The Slovene translation of the MPOC-20 can be considered as a valid and reliable instrument that shows good stability over a period of 1 year, and as such it can be adopted in clinical practice.

Measure of processes of care: a review of 20 years of research

AIM

This article reviews literature on findings from the Measure of Processes of Care (MPOC) to assess family-centred services.

METHOD

Systematic searches for papers citing MPOC in both PubMed and Web of Science identified 107 articles. Fifty-five met the criterion for inclusion in this review in that they reported MPOC data.

RESULTS

Over the past 20 years MPOC has been used in settings additional to the children's treatment centres for which it was designed; used in 11 countries and translated into 14 languages; and used to measure change in respondents' perceptions over time. MPOC findings have also informed our understanding of the provision of family-centred services. Overall, parents report that service providers do a good job of providing respectful, comprehensive services in partnership with families, but that there remain limitations in the provision of general information, an area for improvement. Finally, MPOC has been shown to correlate with various other measures related to the provision of family-centred services.

INTERPRETATION

The MPOC 'family' of measures can be used to assess both families' and service providers' experiences and perceptions of the family-centredness of services received/provided. Opportunities abound for further research enquiries.