Parent/Professional Collaboration:
The Current Reality and Challenges for the Future

by Joyce Robin Borden and Glenda Z. Fine

Introduction

Historically, the relationship between many parents¹ of children and adolescents who have emotional or behavioral disorders and mental health professionals has been problematic. Families have identified this as a significant barrier that affects every aspect of their child's mental health treatment and service delivery. Since 1984, Parents Involved Network (PIN), a statewide, parent-run support, advocacy, information and referral source, and technical assistance center for families, has views this issue as critical to improving service delivery. From the outset, PIN has vigorously advocated for institutionalizing the concept of parent/professional collaboration² at both the case and policy development/program planning levels.

Family partnership is one of the six core principles, which provide the framework for Pennsylvania's Children's Mental Health System. Family partnership is defined (1995): "Family-focused services recognize that the family is the primary support system for a child. The family participates as a full partner in all stages of the decision-making and treatment planning process, including implementation, monitoring and evaluation." Presently, there is a broad consensus that parent/professional collaboration is crucial to providing good services to children and adolescents with emotional and behavioral disorders. In principle, many individuals support the value of families as equal partners both in treatment planning and decision-making for their child, and in policy development.program planning. Yet, the reality often differs. This paper will discuss the history of parent/professional collaboration in Pennsylvania, the current reality and challenges for the future.

History

The relationship between PIN and Pennsylvania CASSP (child and Adolescent Service System Program) started eleven years ago when the Pennsylvania Office of Mental Health, Bureau of Children's Services received a federal CASSP grant. Because PIN was involved with CASSP from the beginning, its impact on the development of CASSP values and principles was significant. Even more important was the early vision of the Pennsylvania CASSP pioneers, namely Connie Dellmuth, Lenora Stern and Pat Serra of her Children's Bureau who understood the importance of parent/professional partnership. Because they believed that families of children and adolescents with emotional or behavioral disorders know their children best, should be partners with mental health professionals in their child's treatment planning process and participate as partners in state and regional policy/program development, these values were incorporated in the CASSP core principles.

How has this early vision of families as partners been realized over the years? On one level, families have been active members of the Pennsylvania CASSP Advisory Committee, the Pennsylvania CASSP Minority Initiatives Sub-Committee, and the Pennsylvania Mental Health Planning Council as well as workgroups to develop policy and programs. They have participated in the development of regulations pertaining to family-based mental health services, intensive case management and residential treatment facilities. At first, most partnership activities were located at the state level. Over time, however, with advocacy efforts from parents, other advocates, professionals and representatives of the Pennsylvania Office of Mental Health's Bureau of Children's Services, these activities began to take place at the county and regional levels.

Although the degree of family involvement may vary from county to county, many families are active participants at their local county and regional levels. They are members of local CASSP Advisory Committees and Mental Health/Mental Retardation Advisory Boards; they participate in regional activities. In some regions of the state families participate in licensing visits to family-based mental health programs and residential treatment facilities. Furthermore, families have worked with training institutions across the state in training activities and presented at numerous conferences to promote parent/professional collaboration. The level and degree of participation continues to expand.

On another level, how have these collaborative efforts translated into meaningful involvement on the individual case level when families seek equal partnership in their children's treatment planning process? Rostain (1990) writes:

Effective collaboration between parents and mental health professionals requires mutual respect, clear communication and sustained involvement. Unfortunately, parents and professionals often encounter one another in oppositional relationships under stress circumstances. In order to overcome these barriers to collaboration, both parties need to appreciate and understand where the other is coming from. (pp.1,2)

Collins and Collins (1990) point out:

Numerous parents and professionals who advocate for parents have argued that one important barrier to enhance parent/professional collaboration is professional attitudes and perceptions of parents. What parents describe as the parent-blaming attitudes of professionals may be better understood as a reflection of the cultural tendency to blame mothers. The traditional orientation of mental health professionals is toward pathology and the weaknesses or inadequacies of parents, usually mothers. The authors' professional experience points to the self-fulfilling nature of these perceptions when parents are not seen as trustworthy or knowledgeable. (p.1)

Over the past twelve years, almost all mothers who called PIN expressed the belief at some point during the call that they are viewed by professionals as the cause of their child's problems. Smith (1990), a clinical social worker, writes:

Mothers have rarely fared well in psychological literature. Freud tended to dismiss them in a few quick strokes. After Freud, analytical theorists and developmental psychologists came to recognize that mothers were important to their children's psychological development. Unfortunately, that importance has mostly been observed in the negative. Either the mother does not attach well enough, or she does not let go significantly to promote her child's optimal development. Thanks in large measure to psychology and psychoanalysis, this century has witnessed an exhaustive cataloging of the varieties of maternal failure. (p. 34)

Although partnership is one of the six core CASSP principles which undergirds all policies emanating from the Pennsylvania Children's Bureau, many families experience something else. Fine writes (1992):

When parents seek professional help, they seek to join their own expertise with that of the professionals. Parents are responsible for their children 24 hours a day and know their needs and habits well. Often, however, they feel as if their expertise and rights are being denied and they are being blamed or patronized. (p. 130)

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¹Throughout this paper, parents and families will be used interchangeably.

²Throughout this paper, collaboration and partnership will be used interchangeably.