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

What does collaboration mean to families? Borden states (1991):

Partnership — parent-child-professional — means developing a model based on individual and family strengths. It also means respect for the child within the context of his or her family and a respect for the family taking into account the differences which exist within a family and the differences in cultures, values and life styles among families. Partnership also means establishing a relationship based on equality and tolerance. It means respect and planning together. It means respecting family choices and avoiding labeling a value or choice as pathological just because it is outside the value system of the professional.

For families collaboration means being equal decision-makers in all aspects of their child's treatment planning process.

While there is consensus that collaboration is desirable, there is often a difference in concept and how it it operationalized. In our experiences both in assisting individual families and participating in licensing/site visits, it appears that for many professionals collaboration means involvement in treatment — mandatory family therapy — and learning how to parent or being present at a meeting to receive information. In many instances both families and professionals use the same words such as "partnership," "decision-maker" or "equality" but these words have different meanings for both. Each comes together with differing expectations. Many families are frustrated that partnership means only being the recipient of services. This is the level of partnership where families feel the dissonance between the expressed value and overt behavior.

Furthermore, DeChillo et. al. (1994) write:

For some professionals there is a dilemma inherent in the concept of collaboration. In traditional helping relationships professionals exercise a good deal of power that can take many forms, including knowledge, expertise and access to resources. However, true recognition of reciprocity and mutuality in helping relationships carries profound and to some unsettling implications for traditional notions of professionalism. (pp. 574-575)

Because parents and professionals have different roles — parents seeking help, professionals as helpers — unintended outcomes may occur. Without each understanding the dynamics of differing expectations and roles, without an open dialogue about these issues, and without mutual respect for the expertise that each brings to the relationship, there will continue to be significant barriers to an effective and productive relationship. Additionally, Corp and Kosinski (1990) write:

Professionals must reexamine the theories they were taught on family structures and dynamics, and reassess how interviewing techniques, information presentation, and treatment methods may actually distance them from parents and create barriers. (p. 245)

Developing collaborative relationships with mutual respect requires a commitment from both parent and professional. It requires an attention to things which may seem like small details such as language, for example, the use of jargon or acronyms and styles of interaction which might include how people are referred to and addressed. A checklist developed in 1987 by Portland Research and Training Center for Family Support and Children's Mental Health, Portland, Oregon provides a list of questions for parents and professionals to ask themselves. The answers to these questions provide both with the necessary tools for developing a collaborative relationship. Although this checklist was developed nine years ago, the questions are still critically important and relevant today (see Appendix A and Appendix B).

Developing collaborative relationships has also required a paradigm shift in the children's mental health system from the more traditional ways of delivering services to children and their families. Some new directions include strengths-based approached rather than a deficit model approach, a growing awareness of the team and primary decision-maker. Furthermore, families have become more knowledgeable about their rights to participate in all aspects of decision-making for their children and are asserting these rights. Hodas (1995) writes:

Families and professionals exchange information. Since families know their child best, professionals listen and learn and parents offer valuable perspectives of the child. Professionals can ask about the child's interest, strengths and individual needs. Families are asked to articulate their goals for the child (p. 7)

It appears there is also an increasing interest in understanding and changing the dynamics of parent/professional collaboration. We base this on increased requests for parent/professional collaboration trainings and for PIN materials; an increasing number of parents who state they are feeling more positive about their encounters with professionals; and the hiring of parents and advocates by county MH/MR programs in approximately ten counties in Pennsylvania.

Overcoming the barriers to effective collaboration is a process that has been evolving slowly over the past ten years. While there are many hopeful signs and reports of improved collaborative efforts, there is still much to be done.

Challenges

In the new landscape of managed care how will parent/professional partnerships fare? Behavioral health managed care companies have potential to create services components that are consistent with CASSP principles. The challenges families face are to continue their vigilance and advocacy efforts to ensure that they do not lose what they have gained. Specifically, they must continue their advocacy to ensure that:

1. Families are involved in the treatment planning and decision-making processes, and evaluation of services for their children;

2. Children and their families receive culturally competent services;

3. Families are meaningfully involved in the program planning, policy development and evaluation of services at state and local levels;

4. Interagency collaboration continues;

5. Families are involved in the development of the appeals and grievance procedures;

6. Families are involved in developing and presenting training to providers;

7. Families participate on managed care governance structures including the management board and advisory, credentialing and quality assurance committees;

8. Families are involved in the development of monitoring standards and participate on state and local monitoring committees;

9. Families are involved in the development of outcome measures; and

10. Families of children have an equal voice in any planning, monitoring or evaluation processes at the state and local level.

While managed care offers the promise of delivering coordinated services, there is still the potential for managed care entities to dominate the collaborative processes that have emerged over the past 10 years. Families are particularly concerned that at the individual case level fiscal issues will far outweigh the individual needs of children and their families. Families and other advocates must present a unified voice to ensure that their particular issues are not lost in the emerging new system and that their needs are incorporated into the practices and policies of managed care as it is implemented in the Commonwealth. In the long-run this will be fiscally sound policy.

Conclusion

The path to developing collaborative relationships both at the individual and systems levels has been filled with challenges for both parents and professionals. And while collaborative relationships exist now to some degree, particularly in the arena of policy planning and program development, partnerships at the individual case level still remain elusive for many. The seeds of collaboration have been sown. Our vision for the next 10 years is that parent/ professional collaboration will be uniformly institutionalized across the state and be incorporated as a primary tenet of behavioral health managed care entities.

Glenda Z. Fine is director and Joyce Robin Borden is assistant director of Parents Involved Network of Pennsylvania, Philadelphia, PA. Both Glenda and Joyce serve on the statewide CASSP Advisory Committee and both have served on the state Mental Health Planning Council.

Dated:November 1996

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