Expectations of parents on low incomes and therapists who work with parents on low incomes of the first therapy session

Abstract

Family-centred practice involves allowing families' needs to direct therapy. Parents and therapists often come from different socio-economic positions, yet little is known about how this impacts family-centred practice. This study aimed to explore expectations of care among parents on low incomes and among occupational therapists who work with these families. Ten parents who were holders of a low-income Health Care Card and had a child on a waiting list for publicly funded occupational therapy services, and nine paediatric occupational therapists were asked about perceptions of therapy using semi-structured, in-depth interviews. Interview transcripts were analysed using a qualitative descriptive approach. While therapists recognised families' expectations that therapy would 'fix' their child, some of the concerns of parents such as how their child's behaviour reflected on their parenting skills went largely unrecognised. In addition, no therapists recognised parents' primary concerns about their child's physical health, their desires for a structured approach to therapy or the somewhat fatalistic approach some parents were taking to therapy. Some therapists recognised the complexities they encountered in engaging with parents from low socio-economic positions and tried to adapt their practice with some taking less of a family-centred approach and focussing on the needs of either the parent or the child while others continued to practice with a focus on the family as a whole. These findings have implications for therapists seeking to work within a framework of family-centred practice with clients from low socio-economic positions.