MPOC-related publications by our team
The following is a selection of articles about Family-Centred Service and MPOC published by our team members over the years.
The first set of publications relate to the work done to develop MPOC 2.0. Below we have also included a selection of OLDER 'classic' publications related to MPOC-20 as these provide important background work on family-centred service delivery.
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Publications related to MPOC 2.0
King,, G. Pozniak, K. Rosenbaum, P., Duku, E., Chambers, E..M., Kraus de Camargo, O., Martens, R., McCauley, D., Teplicky, R., Wellman-Earl, S. New Directions in Measuring Family-Centred Service: The Updated Measure of Processes of Care (MPOC 2.0). Disability & Rehabilitation.
Researchers and parent partners conducted a two-phase project involving (i) tool development, and (ii) field testing to determine psychometric properties. Sixty-five parents of children with disabilities participated in focus groups to discuss their wants and hopes for service delivery; six parents reviewed the measure for comprehensibility and clarity; and 10 parents and 10 service providers participated in a modified Delphi procedure to establish consensus about item wording. In the field testing phase, 58 parents were involved in the assessment of test-retest reliability, and 273 parents completed construct validity measures. MPOC 2.0 scales were determined through factor analysis. Internal consistency and construct validity hypotheses were examined.
The resulting scales (Supportive and Collaborative Communication, Availability of Care, Family Well-being, and Coordinated Care) had high internal consistencies, good to excellent test–retest reliabilities, and moderate to strong correlations with construct validation measures.
In comparison to the original 30-year-old MPOC-20, the new measure highlights the importance of communication as a relational process involving reciprocal transactions between parents and service providers. It also highlights family well-being, service availability, and coordination of care.
King, G., Pozniak, K., Teplicky, R., Earl, S. 2025. The experiences of parents of children with disabilities receiving healthcare services: Negative emotions and associated situations. Research in developmental disabilities.
This study explored the negative emotions expressed by parents of children with disabilities when describing their experiences with pediatric health care.
Quotes mentioning negative emotional experiences and the situations in which these arose were identified in 13 transcribed focus group conversations involving 65 Canadian parents of children with neurodevelopmental disabilities. Data were analyzed using content analysis.
There were 106 mentions of negative emotional experiences, including stress, frustration, trauma, upset, anger, emotional exhaustion, and fear. Common situations associated with these experiences included being given unwanted responsibilities, waiting for services/appointments, not being listened to, and being treated disrespectfully. Stress and frustration were associated with unwanted responsibilities, not being listened to, and waiting while at scheduled appointments, whereas trauma, upset, anger, and fear were associated primarily with being treated disrespectfully. Negative emotions were considered to arise from parents’ societally based expectations about how they would be treated in health care.
Parents expressed strong negative emotions, indicating a lack of family-centered care in their experiences with pediatric healthcare services. Service providers can reduce the likelihood of negative emotional experiences by gauging the level of involvement desired by parents, listening carefully and sensitively, and acting with respect and understanding
Pozniak, K., King, G., Chambers, E., Teplicky, R., Earl, S. 2024. Family-centered service through the eyes of insiders: Healthcare providers who are parents speak about receiving and providing healthcare in pediatric rehabilitation. Research in Developmental Disabilities.
When healthcare providers (HCPs) become patients, the experience affects their sense of identity, the care they receive, and their clinical practice. In child health, considerably less is known about the experiences of HCP-parents who access the pediatric healthcare system with their own children with disabilities and/or chronic medical conditions.
This study aimed to examine the experiences of HCPs who have children with disabilitiesto identify their experiences with healthcare delivery. A qualitative descriptive study was conducted with HCP-parents, using focus groups and open-ended interviews. Data were analyzed using reflexive thematic analysis.
For HCP-parents, the experience of having a child with a disability affects how they see themselves, their patients, service organizations, and the healthcare system in general. Having medical knowledge and access to networks brings both benefits and unique challenges. HCP-parents also have unique needs that are not currently being addressed. The lived experiences of HCP-parents can contribute to improving patient care. However, the value of this lived experience is unrecognized and underutilized.
The lived experiences of HCP-parents can contribute important insights regarding service delivery, and in particular regarding the application of Family-Centered Service.
King, G., Pozniak, K., Rosenbaum, P., Chambers, E. M., Teplicky, R., Earl, S., & Pinto, M. 2024. Illuminating their reality: the use of metaphor by parents of children with disabilities to express their experiences of health care. Disability and Rehabilitation.
This study set out to explore the nature and meaning of metaphors used by parents of children with disabilities when describing their healthcare experiences. A systematic procedure was used to identify and analyze metaphors spontaneously mentioned by parents in 13 focus groups held with 65 Canadian parents of children with disabilities. Attention was paid to identifying deep (i.e., meaningful) metaphors rather than common expressions.
A total of 214 deep metaphors were identified and categorized into four target-source groupings. Parents used journey metaphors to describe experiences of uncertainty, conflict and harm metaphors to describe confrontational, harmful, and demeaning experiences of care, games and puzzles to describe the unknowns of care and attempts to resolve these unknowns, and metaphors concerning environmental barriers (i.e., walls and doors) to express feelings of exclusion and difficulties accessing care.
Parents’ metaphors expressed experiences of uncertainty, powerlessness, and attempts to exert agency in healthcare interactions. The metaphorical groupings provide new insights into how and why lack of family-centeredness in service delivery is bewildering, distressing, and disempowering to parents. Implications for service providers include paying attention to what metaphor use reveals about parents’ experiences, and discussing parents’ metaphors with them to create joint understanding, providing a fertile ground for collaboration.
Pozniak, K., King, G., Rosenbaum, P., Chambers, E., Martens, R., Earl, S., Kraus de Camargo, O., McCauley, D., Teplicky, R. 2023. What do parents want from healthcare services? Reports of parents’ experiences with pediatric service delivery for their children with disabilities. Disability & Rehabilitation.
Family-centred service (FCS) is an established approach for delivering services in children’s rehabilitation and healthcare. This article describes that parents continue to report mixed experiences with healthcare services for their children, as well as their ideas about what they need and want from these services. These findings will inform the development of an up-to-date measure of Family-Centred Service called Measure of Processes of Care (MPOC 2.0).
A qualitative descriptive study was conducted with parents, using focus groups and open-ended interviews. Data were analyzed using inductive content analysis.
Parents want care that is individualized, co-ordinated, easily accessible, and takes into account the entire family dynamic. They want service providers (SPs) to be informed and invested in their child’s care, and to provide parents with practical assistance. They also want to be treated with respect, caring and empathy, and to work together with SPs on the care plan. Novel components of care not identified in the original FCS guiding principles include: responsiveness to needs and mental health; effective communication (vs information giving); practical support (in addition to emotional and informational support); and availability and scheduling.
Publications related to original MPOC
Cunningham, B., and Rosenbaum, P. (2014) Measure of Processes of Care: a review of 20 years of research. Developmental Medicine & Child Neurology.
This article reviews literature on findings from the Measure of Processes of Care (MPOC) to assess family‐centred services. 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.
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.
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.
King, G., King, S., Rosenbaum, P., Goffin, R. (1999) Family-centered caregiving and well-being of parents of children with disabilities: linking process with outcome. Journal of Pediatric Psychology.
This study examined the strength of the relationship between parents’ perceptions of family-centered, professionally provided caregiving and their emotional well-being (feelings of distress and depression). This was done in the context of other factors that might affect well-being (child behavior problems, coping strategies of parents, protective factors in the social environment, child factors related to disability, and family factors).
We asked 164 parents of children with nonprogressive neurodevelopmental disorders (primarily cerebral palsy, spina bifida, or hydrocephalus) to complete a series of instruments measuring the constructs of interest.
Results: Structural equation modeling showed that more family-centered caregiving was a significant predictor of parents’ well-being. The most important predictors of well-being were child behavior problems and protective factors in the social environment.
Services are most beneficial when they are delivered in a family-centered manner and address parent-identified issues such as the availability of social support, family functioning, and child behavior problems.
Rosenbaum, P., King, S., Law, M., King, K., Evans, J. (1998) Family-centred service: A conceptual framework and research review. Physical & Occupational Therapy in Pediatrics.
Family-centred service (FCS) is a popular phrase widely used to encompass a set of ideas about service delivery to children and their families. Despite the increasing adoption of the concepts of FCS, however, many clinicians may remain uncertain about exactly what FCS means. This review article has four purposes. The first section presents a brief review of the history and ideas behind FCS. Second, the authors present a new framework of FCS, blending the elements of this approach into a set of ideas that have immediate clinical applicability. The third focus of this paper is to review the research evidence that supports FCS and to point to areas where further research is needed. Finally we consider the implications for service providers of the move to FCS, and the potential uses of the FCS framework as a guide for teaching and research.
King, S., Rosenbaum, P., King, G. (1996) Parents’ Perceptions of Caregiving: Development and Validation of a Measure of Processes. Developmental Medicine and Child Neurology.
The authors describe the development of a 56‐item questionnaire, the Measure of Processes of Care (MPOC‐56), designed to find out what parents of a child with a chronic health problem think of the services they and their child receive and of how those services affect psychosocial outcome. The instrument is internally consistent and is reliable on retests. Its validity was shown by positive correlations of its five scales with parents' satisfaction, and negative correlations with parents' stress in relation to services received. The MPOC‐56 is a generic measure which can be used for clinical, quality assurance and research purposes.