EMPIRICAL STUDIES
Parent perspectives of therapy services for their children with
physical disabilities
Snaefridur Thora Egilson PhD, OT (Professor)
University of Akureyri, School of Health Sciences, Akureyri, Iceland
Scand J Caring Sci; 2011; 25; 277–284
Parent perspectives of therapy services for their chil-
dren with physical disabilities
Background: Children who have physical disabilities typi-
cally attend occupational and physical therapy services on
a regular basis. The importance of being family centred
when providing services to children with a disability has
been highlighted in recent years. Thus, it was considered
important to gather the opinions of parents towards the
services their child receives.
Aim: To explore the perspectives of parents of children
with physical disabilities to occupational and physical
therapy services provided to their child.
Method: Open interviews were conducted with 17 parents
(14 mothers and three fathers) of children aged 7–13,
selected through a purposeful sample. Data analysis was
based on an inductive approach.
Results: Nine categories emerged and were organized under
three main headings: The role of the therapist, service
location and arrangements, and characteristics of good
service. Although several positive remarks were made,
many parents in this study were poorly informed of
intervention goals and what took place during therapy
Introduction
All over the Western world, there is a call for compre-
hensive therapy services for children with physical
disabilities, emphasizing family-based practice and inter-
disciplinary coordination (1–6). Family-based practice
operates on the main principle that parents know their
children best and that the best way to promote the func-
tioning of a child with disability is to foster their family and
immediate environment. Keeping in mind that families are
unique, the services should take into consideration their
Correspondence to:
Snaefridur Thora Egilson, University of Akureyri, School of Health
Sciences, Solborg við Nordurslod, 600 Akureyri, Iceland.
E-mail: sne@unak.is
Ó 2010 The Author
Scandinavian Journal of Caring Sciences Ó 2010 Nordic College of Caring Science
doi: 10.1111/j.1471-6712.2010.00823.
sessions. Most parents wished for mutual respect, joint
decision-making in planning intervention, and collabora-
tion with the therapy services. The aspiration for active but
manageable roles that did not demand a burdensome
amount of the parents’ time and energy was evinced. The
parents became increasingly critical of the services, as their
children grew older. They placed emphasis on services
being offered in their local community, and that more
specialized service should be centralized, especially for the
children with the most complex needs.
Conclusions: The results reflect the importance of the needs
and wants of the parents and children being respected.
Thus, parents should play an active role in defining pri-
orities and strategies for implementation. The results also
indicate that therapists need to put more thought into the
conditions and environment of the child instead of focus-
ing solely on underlying issues connected to their impair-
ments.
Keywords: physical impairment, family-based practice,
intervention, collaboration, therapy services.
Submitted 23 September 2009, Accepted 19 June 2010
individual culture and values. Professionals are asked to
review the needs of each family, work closely with them,
and make use of their strengths. Emphasis is placed on the
practical involvement of the family in identifying therapy
goals, organizing intervention methods, and evaluating
results (4–7).
New research highlights the importance of family-based
approaches. Parents’ satisfaction with services seems to be
directly related to how family-based they are, while good
flow of information, respect, and the support of profes-
sionals are also highly regarded by parents (2, 6–11).
Flexibility and compatibility in the services offered are
important, especially at turning points in the child’s and
family’s lives when transitions between service providers
are made. This relates to the start of school at all grade
levels and changes in roles as the child moves towards
adolescence and adulthood (1, 12). Interdisciplinary
coordination is often counted as the main precondition for
277
278 S.T. Egilson
the families of children with complex needs receiving
adequate services (10, 13).
In spite of this discourse, changing traditional working
habits can be challenging. It has been pointed out that
therapists are more likely to take into account the needs
and goals of children and their families if they are similar to
their own. Some therapists find it difficult to work so
closely with parents and to deal with their emotions and
thus are inclined to use traditional methods where the
division of power is clear (5, 14). Therapists typically work
in a clinic culture where the professional is viewed as a
specialist and emphasis is placed on assessment and treat-
ment at the therapy setting (15). In addition, therapists
may find it hard to work with parents who have different
backgrounds, values, and views than they do especially if
the needs of the child and the family do not coincide in
their opinion (7, 16, 17). All of these factors can hinder the
realistic practice of family-based services.
Occupational and physical therapy services to Icelandic
children with physical disabilities have traditionally been
provided by special institutions or agencies. Recently, there
has been a trend to establish the expertise needed on a
community level and more holistic services focusing on the
child in his or her context are emerging. The national
habilitation centre serves the whole population, which is
only slightly over 300 000. Most children with physical
disabilities are discharged at the age of six, but children
with myelomeningocele and neuromuscular disorders
continue to receive follow-up services through specialty
clinics (18).
Although more focus is being placed on the nature and
content of therapy services for children with disabilities in
many countries (5, 15, 19–21), little has been written
about this situation in the Nordic countries. In the wake of
changing professional views, it is important to review the
situation by gathering the opinions of parents on the ser-
vices they receive. This information may help therapists to
tailor their services to the needs and wants of families and
to assist educators in preparing their students for working
with parents. The aim of this study was to obtain an
understanding of the opinions of Icelandic parents of
children with physical disabilities towards the services of
occupational and physical therapists.
Material and methods
The study was conducted within a qualitative framework
(22, 23). It was approved by the Icelandic Bioethical
Committee (03-116).
Participants
Seventeen parents of children with physical disabilities
participated in the study, 14 mothers and three fathers all
between 40 and 60 years old. Eleven interviews were
Scandinavian Journal of Caring Sciences Ó 2010 Nordic College of Caring Science
conducted with the mother only and three with both
parents present. In ten cases, the children lived with both
parents, while four children lived only with their mothers.
Eight families resided in or near the capital, and six families
resided in other parts of Iceland, either in towns or in rural
areas. The parents were selected through a purposeful
sample designed to reflect typical variations regarding their
children’s type and severity of impairment, and differences
in their environment. Nine parents had a child with
cerebral palsy (CP); six parents had a child with neuro-
muscular or musculoskeletal disorders; and two parents
had a child with myelomeningocele. Seven of these chil-
dren had mild learning disabilities. All the children, nine
boys and five girls, ranging in age from 7 to 13 years were
in a regular class in their local school.
The children and their families had been in close contact
with occupational and physical therapists from a young
age. At the time of the study, 13 children had connections
to occupational therapy on some level and all attended
physical therapy services on a regular basis.
Data collection and analysis
Research data were based on open interviews with the
parents conducted by the author. Prior to the interviews,
guidelines were developed with the key issues that were to
be discussed. The parents were asked about the services
their child used and about the connection and communi-
cation of the therapists with home and school, what kind
of services they wanted and where they should take place.
The interviews averaged 60 min; they took place in the
family’s homes and at convenient times for them. In
addition, the parents were contacted by phone 1–2 years
after the initial interview to gauge how their situations had
developed. With prior parent’s permission, all interviews
were recorded and transcribed.
Data analysis was guided by the work process recom-
mended by Bogdan and Biklen (22) for a descriptive
analysis. Open coding was used initially to separate data
into categories and to see processes connected to the topic
under study. The open codes were then compared and
contrasted to detect similarities and differences across
cases. For reflexive analyses, the coded transcripts were
re-read to recall the initial reactions during and after the
interviews. Categories were then synthesized and larger
segments of the data connected through focused coding.
Comparing the data to these categories helped refining
them and acknowledging their intensity and impact. When
reduncancy was consistently seen in the coding of the
data, the developed categories were considered saturated.
To strengthen credibility and confirm that the interpre-
tations reflected the parent’s actual perspectives, a member
check was conducted by providing summaries of the
findings to parents and asking for feedback. The minor
comments made were all included in the final analysis. To
Ó 2010 The Author

further enhance trustworthiness, an audit trail was com-
piled, describing the reasoning steps taken when moving
from the transcribed text towards final interpretations
(24). Additionally, the analysis was shared with a profes-
sional research team for discussion and review. The
interviews were taped and analysed in Icelandic. To cor-
rectly convey the tone and meaning of the direct quota-
tions, assistance was sought from a professional translator.
Results
The results are presented as nine categories under the
three main headings (Table 1): The role of the therapist,
service location and arrangements, and characteristics of
good service. In general, the first two headings identify the
present situation, while the third looks to the future.
The role of the therapist
The interviewees highlighted a few main points in their
descriptions of the therapists, represented by the following
three categories: Monitoring the use of assistive devices,
providing information and advice, and improving physical
function or promoting participation?
Monitoring the use of assistive devices. The parents considered
assistive devices as very important, both to enable their
child to participate in various settings, to improve his or
her function, and to prevent future problems. In the par-
ent’s opinion, the therapists played key roles in advising on
devices, supplying them, and in following up on their use.
The mother of a 13 -year-old boy said:
As far as assistive devices are concerned the employees
have...been so on top of things that I’ve just said, yes,
thanks. And they’ve pushed things forward, but
always in very good contact with me.
Others found inadequacies in devices being adjusted reg-
ularly and their usage reviewed, like this mother of an
8 -year-old boy:
Last year and up until this year he had a physical
therapist who was a decent therapist for his body
needs. But when it came to equipment and all that,
she didn’t do anything, in my opinion. And I was kind
of bothered by this...of having to always point out and
to even get lukewarm responses back. Because these
Table 1 Major categories identified
The role of the therapist Service location and arrangements
Monitoring the use of assistive devices Therapy within the local community
Providing practical information and advice Service coordination at a national level
Improving physical function or promoting participation?
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Scandinavian Journal of Caring Sciences Ó 2010 Nordic College of Caring Science
Parent perspectives of therapy services 279
people must of course have the education, they have
the pamphlets, they have the experience.
While many parents were content with the situation at
home, they felt that the therapists needed to better con-
sider the school environment. In several instances, there
was limited follow-up, or the parents followed up on their
own and passed information between the therapists and
the school.
The parent’s accounts often reflected how much was at
stake and how their communication and patience were put
to the test, as evident in the description of the mother of an
8 -year-old child who had great difficulty getting around.
A tricycle was ordered that we’d waited for for a very
long time. Way too big, as if she hadn’t had in mind
who she was ordering it for. And I remember, we were
so disappointed and the trike was returned right away.
And then another process was set in motion and you
just feel like there’s so much inconsideration. And it
was just horrible. And with all the patience we’d
shown, keeping our cool, always being polite, always
positive but decisive. And it can be so hard because
you have to have good communication with these
people. Because as soon as you have that disabled
child you he’s yours and you share him with a million
people. And it’s not a good thing if you end up on the
sidelines. It’s not worth it. But it can be really hard.
In general, the parents felt that the issue of assistive devices
was well addressed during the children’s early years, but
much less after the children began attending elementary
school.
Providing practical information and advice. The interviewees
described how their therapists offered useful information,
instructions, and recommendations that eased daily life for
the family. Reflecting on the preschool years, the parents
reported getting information about the child’s disability,
learning about handling and positioning, and obtaining
instructions about their child’s therapeutic programme.
When the child entered school, the parents were usually
less involved and consequently did not receive as many
guidelines.
Information on the selection, organization, and layout of
the homes was also in focus. The situations varied, from
remodelling of houses to the choice of shower rails and
faucet handles. The father of a 13 -year-old boy said:
Characteristics of good service
The family in the forefront
Help towards self-sufficiency
Professional behaviour
Coordinating and preparing for the future
280 S.T. Egilson
Before we bought here we asked whether it was safe
for us to move like this up onto the second floor. We
didn’t dare make the decision by ourselves without
getting advice and recommendations on it.
The parents wanted clear information that could be easily
accessed. Instead, many reported that it was often like an
obstacle course. The parents often shared information be-
tween them that they felt the professionals should have
made available.
It was consistently noted that responsibility was not well
enough defined, and it was often random who saw to or
took initiative in situations. Most wished for much better
coordination and communication flow between service
providers. One mother said:
Very rare for professionals to, for example, show up at
schools to look over the conditions there, usually not
even then unless the parents request it.
According to many, it became the parent’s responsibility to
ensure that things went well.
Improving physical function or promoting participation? The
parents described physical therapists focusing on mobility,
promoting stamina and endurance, and reducing the risk
of contractures and deformities. A few parents followed up
on the exercises at home as this mother of a 13 -year-old
boy:
Tumi’s just switched physical therapists and the one
who took over is just great. He showed initiative in
increasing the number of visits from two times a week
to three. He brought a new exercise program that has
been so easy for us parents to follow in regards
stretching and that kind of thing.
Although the parents considered the therapy as important,
some doubtful voices were also heard regarding the worth
of the therapy sessions, especially from the parents of older
children. The mother of an 11 -year-old boy said:
But you don’t know the real benefit of these physical
therapies...He goes on summer vacation of course,
maybe for two months or even more. And I don’t
stretch him out, we stopped taking on the physical
therapist role during vacations a long time ago. And
what I find strange and actually a little disturbing is
that I don’t see any difference in him during spring
and autumn, I don’t see that he’s deteriorated at all.
Limited communication about the therapy goals or what
happened during therapy sessions was reported by many.
Or, as one mother said:
As far as I know there aren’t even any meetings with
the parents about the goals of the therapy, about what
the parents would like to get out of them. They don’t
even know what’s going on in therapy.
The occupational therapy interventions traditionally
focused on fine-motor activities and improving the chil-
dren’s performance in self-care tasks, such as bathing,
personal care awareness, and moving about in the
Scandinavian Journal of Caring Sciences Ó 2010 Nordic College of Caring Science
community. Alternatively, parents felt that not enough
emphasis was placed on these tasks or the transfer from the
therapy setting to the child’s daily environment. The father
of a 13 -year-old boy claimed his son had learned various
practicalities during occupational therapy sessions, such as
dressing himself and using different tools. However, he
was concerned about the transference of these learnings:
He doesn’t bring the skills home to apply to all the
things he does here at home and at school. Far from it.
Of course he keeps on doing things the way he feels is
easiest, though it’s not right and though there may be
much better methods for him.
All the parents were concerned with their child’s social
participation but reportedly this was not the centre of
attention in therapy.
Service arrangements
Two categories emerged on service arrangements. These
constitute therapy within the local community and service
coordination at a national level.
Therapy within the local community. All the children had
access to physical therapy although some had to travel as
much as 20 km each way to reach the service. Access to
occupational therapists was less and seldom available in
local communities outside of the capital area.
The interviewees wanted services in their local com-
munity. It was made clear that trips to the therapists took
up much time, put pressure on the family life, and reduced
the amount of time the children had to engage with their
peers. The parents of the children living in rural areas
sought therapy in the capital area, some up to 2 weeks
each summer. Most voiced the difficulties that accompa-
nied the travelling and the discussions often focused on
whether it was worth the effort. A description of the sit-
uation is revealed in the words of a 12- year-old boy’s
mother: ‘‘The child goes to therapy at a center at some
random place in town that has nothing to do with the
child’s reality.’’ Later in the interview, she said:
The therapy should just clearly be a part of everyday
life as much as possible. It should be in the home, it
should be in the preschools, it should be in the
schools. Where the child is.
Some thought it best for therapy to be a part of local health
clinic services, while others mentioned that above all there
should be therapy centres near their neighbourhoods. All
the parents wanted to see therapists in contact with
schools to consider access issues, the use of assistive
devices, and to provide advice on practical situations.
The parent’s emphasis was not only focused on the
location of services, but on its content and follow-up in the
child’s daily environments. Or as one mother put it: ‘‘Two
hours in physical therapy are a total waste if the child sits
the rest of the week in a broken-down chair.’’
Ó 2010 The Author

Service coordination at a national level. The parents of chil-
dren with the most extensive impairments stressed the
importance of the national habilitation centre. Some of
these families lived outside of the capital area where pro-
fessional knowledge was limited. This description is typical
of these interviewee’s responses:
I see a strong central facility like we have in Reykjavik
that services the whole country and then smaller
facilities in rural areas that could take on and see to
the situation a little more.
The importance of service coordination at a national level
to ensure continuity and to fight instability because of staff
turnover was highlighted. The parents of the children with
myelomeningocele and neuromuscular disorders were in
general content with the speciality clinics for children up
to 16 years old. The same was not available for children
with CP, and their parents were vocal about the lack of
follow-up after the age of six. On this subject, many
praised the preschool years in retrospect and claimed the
difficulties increased after the children entered elementary
school.
Characteristics of good service
In relation to good service, four categories emerged: The
family in the forefront, help towards self-sufficiency, pro-
fessional behaviour, and coordinating and preparing for
the future.
The family in the forefront. A distinct desire for the therapists
to take into more consideration the needs of the family was
reported. But opinions varied and the follow-up data
showed that what was currently happening in the child’s
and family’s life had much impact on their experience and
their desire for service arrangements. Some parents
wanted to take part in everything relating to their child,
while others wanted therapists to take responsibility for
specific issues. Most wanted an active part in decision-
making while not bearing the main responsibility for
services, either by being team coordinators for their own
agendas or by being information bearers between services.
They felt it important that they receive information to
reflect on to then make their own informed, independent
decisions. A shortage of clear communication channels and
definitions of roles and responsibilities complicated matters
as one mother noted: ‘‘You don’t always know when
you’re infringing on the professionals and when you
should show initiative.’’
Some differences between the parents of younger and
older children emerged in the analysis as the parents
became increasingly critical of the service provided as their
children grew older. Additionally, the parents of the older
children often offered ideas of how therapists and profes-
sionals should work together. The mother of a 12 -year-old
boy had this to say:
Ó 2010 The Author
Scandinavian Journal of Caring Sciences Ó 2010 Nordic College of Caring Science
Parent perspectives of therapy services 281
I take it upon myself at the beginning of each year to
make sure that they sit down with the family, with the
child and his family, and that we go over his needs.
That there is a clear goal that is being worked toward.
And to make that possible we need therapists who are
well involved in what is happening with people on a
daily basis. That they realize what the needs are. And
included in these goals are adjustments to his chair at
school, access at school, access at home, the shower
situation, the toilet situation, his bed, his food, how
the kitchen is organized. And so on. It touches
everything.
One mother described her first few years of experience
with therapy services and how she ultimately took matters
into her own hands and decided to trust her own judge-
ment:
I felt like there were all these commands, that you
should always do this and that for the child...So
then I just stopped it, you know. I found out myself
what was best for her and for me. I was always
unhappy with this walker that she had before she
started walking, thought she always looked like a
slouch in it and completely ridiculous to see her in
it. So I went to a toy store and found a doll carriage.
And she stood perfectly with the carriage and
walked...You just have to find things out a little
yourself.
In general, parents wanted more information and initiative
from therapists but ultimately wanted the autonomy to
choose, reject, and decide for themselves.
Help towards self-sufficiency. When their child was young,
most parents considered it important to get clear guide-
lines, preferrably that the therapist was a step ahead of the
family. Alternatively, as their child grew older, the parents
wanted more flexibility and mutual planning. The parents
of the oldest children placed emphasis on the importance
of therapists supporting the actions of the children and
their families, and that the strengths of each family would
be used to their advantage. The mother of a 13 -year-old
boy said:
It is very important that parents get the help they
need, and there are different considerations that have
to be taken into account, as everyone is different.
Those who work with the parents, first, have to learn
to listen. Second, take into account the strength of
each individual, both the child and the parent. And if
they see that you could do things differently, then
help you with it. And it is very important to ask the
parents (what they want).
Another mother said:
The parents need to be taught along with the children,
because it’s through the parents that everything flows
to the child, this ‘problem solving.’ It can’t just be a
professional who has all the answers.
282 S.T. Egilson
Some requested closer support and instruction from ther-
apists. As one father noted: ‘‘We aren’t perfect and we a lot
of times don’t see the forest for the trees. We’re just nor-
mal.’’ Rather than expansive therapy plans, the parents
wanted useful pointers to make daily routine easier and to
increase the capabilities and comforts of the child and the
family. As has been noted, some wished for clear guidance,
while others wanted to control the journey, especially the
parents of older children.
Professional behaviour. The parents’ descriptions of the
professionals they had met were often very personal and
used to define how service should and should not be.
Individual characteristics meant much more than profes-
sional title or degree. The most emphasis was placed on the
initiative, insight, interest, reliability, and communication
skills of the therapists, and that they reacted quickly and
well to people’s requests. The parents wanted strong and
capable professionals who kept them on track. As one
mother of a 12 -year-old boy stated:
I want people who ask questions. I don’t want people
who agree with everything I say, because those aren’t
people who are thinking. And that means they’re not
using the resources, you know?
In addition, the parents felt that concern and aspirations
for the child and family were necessary qualities for ther-
apists. They needed the knowledge, vigour, and skills to get
involved, bring in ideas, and following them through. The
great majority wished for enthusiastic and responsible
professionals to support the family, help them take on
daily life, and set standards for the increased function and
participation of their children.
Coordinating and preparing for the future. All the parents
expressed a desire for more coordination of services.
Consultation to schools and other institutions were high-
est on their list. The parents felt it important for service to
be visible and that it was clear who had what rights, who
had what responsbilities, when and how. The need for a
single point of contact, a person who had an overview of
the child’s situation and who guided the family through
the jungle of the system came up repeatedly. One mother
said:
There needs to be one person with a whole view over
all the developmental elements, motor development,
cognitive development and social development. They
need to connect the home, school and other places
where the child seeks services, help people to priori-
tize and push things along. This is necessary to guar-
antee a holistic approach, that people are headed for
the same goal.
Finally, the informants felt it important that ways were
found to anticipate and prepare for problems that lay in the
future and to offer support to help their children to
develop and utilize their strengths to the fullest.
Scandinavian Journal of Caring Sciences Ó 2010 Nordic College of Caring Science
Discussion
The purpose of this study was to explore how parents of
Icelandic children with physical disabilities view the ther-
apy services that their children had received. Although
several positive remarks were made about the services,
many parents in this study were poorly informed of
intervention goals and what took place during therapy
sessions. This lack of communication about principle focus
points and expectations is rather surprising given the
current emphasis on family-centred services in the litera-
ture (4–8). Therapists need to think carefully about how to
increase their collaboration with the family. They also
have to find a way to express what they do so that their
service is more visible. The results of this study indicate
that therapists need to place emphasis on family choice
and decisions, cooperation with parents and teachers, and
the transference of learnings in therapy sessions to the
home and school.
Specific issues raised by the parents involved supplying
assistive devices in school and monitoring their use.
Promoting accessibility and efficient use of assistive
devices should be a priority in service to children with
physical disabilities in order to enable them to access and
participate in important activities and settings. The needs
of the child within a particular setting should be matched
with the available technology to enhance or enable active
involvement, interaction with others, and independence
(25).
Interestingly, the therapy services seemed to be mutable
and dependent on what individual took on the service
each time – highlighting the importance of professional
competencies and help-giving practices, consistently found
in research (6, 9, 26). The lack of coordinated practices
meant that the ability, interest, and perspective of the
therapists were imperative. To guarantee best practice, the
role and responsibilities of the therapist has to be well
defined, while simultaneously allowing for flexibility to
accommodate different families. Therapists need to con-
sider the content and arrangement of their service and to
ensure that their interventions are informed by a sound
theoretical base and crafted to meet the changing needs
and priorities of the child and the family (27–29).
The parents in this study placed emphasis on services
being offered in their local community and that they
would not have to seek it out in many locations. After this
study was conducted, more therapists work within the
community, such as in schools, which may facilitate
increased collaboration and the transference of learnings
over into the daily environments of the child. Neverthe-
less, given the population and geography of Iceland, some
families will continue to travel for necessary services. It
should be noted that the parents felt that more specialized
service should be centralized at a national level, especially
for the children with the most complex needs.
Ó 2010 The Author
 Parent perspectives of therapy services 283

Although the respondents had much in common, anal-

ysis showed variations in their desire for services. Some
parents wanted to take a very active role, while others
chose foremost to consider selected issues. These results
underscore that services need to be tailored to individual
situations, with the values and culture of each family as a
guide. This is consistent with literature, emphasizing that
families have options with respect to their level of
involvement at different times (4, 8).
Noteworthy are the different views expressed by the
parents of the younger and older children, and the fact that
parents became increasingly critical of the services, as their
child grew older. The parents of the younger children
focused mainly on the present and wanted clear messages
and guidance from the therapists. The parents of the older
children asked for mutual planning and decision-making
with the therapists and more consideration for the future
of their child. Quite probably the therapists had the chil-
dren’s future in mind but had not communicated their
goals clearly enough to the parents. It is important for
intervention issues to focus on the child being able to live a
functional and fulfilling adult life. For this to happen,
thought needs to be given to the conditions and environ-
ments of the child and to thoroughly prepare for a positive
transition into adulthood (12).
The parents in this study frequently carried information
between therapists and schools. They felt the role of
‘middleman’ difficult and reportedly it lead at times to
conflict between families and schools. Thus, therapists
should take more responsibility for coordinating informa-
tion and service than they do now. Parents’ need for
functional yet manageable responsibilities that do not take
up too much time is consistent with results from another
study (30). The results of this study reflect the importance
of the needs and wants of the parents and children being
respected. Thus, parents should play an active role in
defining priorities and strategies for implementation. The
parents know their children’s strengths best and the ulti-
mate responsibility for their child is theirs.
Finally, it is necessary to prepare for the future by delin-
eating strategies and methods that support the child’s par-
ticipation in as many situations as possible. It is essential that
increased participation outcomes for children with disabili-
ties and their families are the centre of therapists’ efforts and
attention. Traditional child-focused service delivery
approaches need to be replaced by ways of looking at what
children and families really want and need (2, 31, 32).
Conclusion
Compared to many other nations, the Nordic countries
have a long tradition of community focus to health service
provision, concentrating on the individual within his or her
environment. Thus, it is even more interesting that the shift
in parent–therapist partnership reported in the literature
(5, 7, 16) is not better adopted in Iceland. It should be noted
that many studies have focused mainly on the services
provided to the families of preschool children, and there
may be less family involvement as the child gets older.
The study has implications beyond Iceland as it points to
the importance of studying actual practices from the user’s
point of view, that is, whether new attitudes and knowl-
edge are translated into practice. The message to educators
is to prepare their students with the necessary skills to
work in partnership with families of children with dis-
abilities – defining and developing helpful strategies and
focusing on professional qualities and behaviour. How-
ever, some of the hindrances in adopting family-centred
services may be structural in nature and thus require a
broader approach than merely new knowledge, and
improvements in attitudes or behaviour. Rather, they
speak to the fundamental structure of the way services are
organized and carried out. Therefore, each society should
consider convenient infrastructures from their own per-
spective as situations can be varied.
Presently, there is an ongoing discussion about designing
and implementing family-centred services in Iceland. In
2007, the Icelandic Ministry of Social Affairs introduced a
policy statement, focusing on service cooperation to meet
the needs and wants of families of children with disabilities
(33). Quantitative studies, using the Measure of Processes
of Care (34, 35) and Measure of Processes of Care for
Service Providers (36) to evaluate the implementation of
therapy services, are in process and will enable an objec-
tive examination of how family-centred the services are.
Although this study was limited to a relatively small
number of parents, it has provided important insights into
the perspectives of Icelandic parents of children with
physical disabilities. Additional research in this area may
monitor and reflect changes in the services provided by
Icelandic occupational and physical therapists, as regarded
by parents.

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