MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES

RESEARCH REVIEWS 13: 370 – 378 (2007)

META-ANALYSIS OF FAMILY-CENTERED
HELPGIVING PRACTICES RESEARCH
Carl J. Dunst,* Carol M. Trivette, and Deborah W. Hamby
Orelena Hawks Puckett Institute, Asheville and Morganton, North Carolina

A meta-analysis of 47 studies investigating the relationship be- The call for adoption and use of family-centered prac-
tween family-centered helpgiving practices and parent, family, and child tices can be traced to the 1950s [e.g., Birt, 1956]. It was,
behavior and functioning is reported. The studies included more than
11,000 participants from seven different countries. Data analysis was
however, a Surgeon General’s report [1979] that brought fam-
guided by a practice-based theory of family-centered helpgiving that ily-centered care to the forefront of contemporary thinking
hypothesized direct effects of relational and participatory helpgiving prac- about how families should be involved in the care and treat-
tices on self-efficacy beliefs and parent, family, and child outcomes. ment of their children with special health care needs. That
Results showed that the largest majority of outcomes were related to same year Shelton et al. [1987] articulated the core elements
helpgiving practices with the strongest influences on outcomes most
proximal and contextual to help giver/help receiver exchanges. Findings of family-centered practices. Family-centered care is now rec-
are placed in the context of a broader-based social systems framework ognized as a key component of a broad-based approach to
of early childhood intervention and family support. ' 2007 Wiley-Liss, Inc. working with children and their families [e.g., American
MRDD Research Reviews 2007;13:370–378. Academy of Pediatrics, 1992; Dunst et al., 1994; Sia et al.,
2002]. The value of family-centered practices has, however,
Key Words: family-centered practices; relational helpgiving practices; not gone unchallenged [Feldman et al., 1999; Mahoney et al.,
participatory helpgiving practices; self-efficacy beliefs; program satisfac- 1999]. Critics claim that there is limited evidence to support
tion; parenting capabilities; parent well-being; family functioning; child the use of family-centered practices.
behavior; meta-analysis This article includes a meta-analysis of research on the
relationship between family-centered helpgiving and different
aspects of parent, family, and child behavior and functioning.
The meta-analysis was guided by a practice-based theory of
family-centered helpgiving [Dunst et al., 2006a]. According to

T
he terms family-centered care, family-centered prac-
the theory, there are both direct and indirect influences of
tices, family-centered services, and family-centered
two-dimensions of helpgiving practices (relational and partici-
helpgiving have been used interchangeably to refer to
patory) on help receiver self-efficacy beliefs and parent, family,
an approach to working with families that honors and respects
and child outcomes. Relational helpgiving includes practices
their values and choices and which includes the provision of
typically associated with good clinical practice (e.g., active lis-
supports necessary to strengthen family functioning. A family-
tening, compassion, empathy, and respect) and help giver posi-
centered approach is characterized by practices that treat fami-
tive beliefs about family strengths and capabilities. Listening to
lies with dignity and respect; information sharing so families
a family’s concerns and asking for clarification or elaboration
can make informed decisions; family choice regarding their
about what was said is an example of a relational helpgiving
involvement in and provision of services; and parent/professio-
practice. Participatory helpgiving includes practices that are
nal collaborations and partnerships as the context for family-
individualized, flexible, and responsive to family concerns and
program relations [Dunst, 2002].
priorities, and which involve informed choices and family
The foundations for family-centered practices are value
involvement in achieving desired goals and outcomes. Engag-
and belief statements about how professional help givers
ing a family member in learning how to find information
should interact with family members as part of family involve-
needed to make an informed decision about care for her child
ment in human services, education, health care, and other
is an example of a participatory helpgiving practice. Our re-
kinds of helpgiving programs and organizations [Dokecki,
search has consistently found that factor analyses of scale items
1983; Hobbs et al., 1984; Center on Human Policy, 1986].
we have used to assess family-centered practices produces clus-
Family-centered practices have become a practice-of-choice in
early childhood intervention programs [Duwa et al., 1993],
family support programs [Weissbourd, 1990], programs serving
persons with mental retardation and developmental disabilities *Correspondence to: Carl J. Dunst, Orelena Hawks Puckett Institute, 18A Regent
[Leal, 1999; Law et al., 2005], hospitals [Hanson et al., 1994; Park Blvd., Asheville, NC 28806. E-mail: dunst@puckett.org
Ballweg, 2001], medical practices [Schulz et al., 2004], and Received 20 August 2007; Accepted 21 August 2007
Published online in Wiley InterScience (www.interscience.wiley.com).
other pediatric programs and settings [Shelton and Stepanek, DOI: 10.1002/mrdd.20176
1994; Lindeke et al., 2002].
' 2007 Wiley -Liss, Inc.
 ences on the outcomes most proximal and
contextual to the focus of the early child-
hood intervention and family support pro-
gram practices, and that self-efficacy beliefs
had a direct effect on the same outcomes.
The outcomes that were most strongly
related to family-centered helpgiving were
self-efficacy beliefs involving different as-
pects of program participant involvement,
satisfaction with program staff and services,
parenting capabilities, child behavior and
functioning, and program-related child
and parent supports. Smaller, but none-
theless discernable influences of family-
centered helpgiving and self-efficacy
beliefs were found for selected aspects of
parent and family well-being and the
helpfulness of social supports provided by
informal and formal social network
members.
The meta-analysis reported in this
Fig. 1. Practice-based theory of family-centered helpgiving depicting the direct and indirect
influences of helpgiving on self-efficacy beliefs and parent, family, and child behavior and func- article included studies that related var-
tioning. iations in family-centered helpgiving to
variations in parent, family, or child
outcomes. The focus of analysis was the
overall influence of family-centered
ters of these two types of helpgiving ered proximal and contextual when the helpgiving on parent, family, and child
[Dunst and Trivette, 1996; Trivette and targets of behavioral assessment are partici- behavior and functioning, the differen-
Dunst, 1998]. Our findings also indicate pant appraisals of benefits directly related to tial influences of relational and partici-
that there are many helpgivers who are the focus of help giver and/or program patory helpgiving on the study out-
good at using relational helpgiving practices (e.g., perceived control over the comes, and the differential influences of
practices but are not so good using par- provision of program resources). Out- family-centered helpgiving practices on
ticipatory helpgiving practices. In con- comes are considered distal when the tar- different measures of the same construct
trast, there are few helpgivers who are gets of appraisal are indirectly related to the (e.g., proximal vs. distal self-efficacy
good at using participatory helpgiving focus of program practices (e.g., general beliefs). We conclude by placing family-
practices and not also good at using family well-being). Findings from many centered helpgiving in the context of a
relational helpgiving. different kinds of studies show that covaria- broader-based social system framework
The practice-based theory of fam- tion between an independent and depend- where helpgiving practices are one of a
ily-centered helpgiving is shown graphi- ent variable are strongest when the targets number of factors influencing parent,
cally in Figure 1. Family-centered help- of appraisal on outcome measures include family, and child behavior and function-
giving is hypothesized to be directly indicators that are specifically hypothesized ing. (Insufficient information was inclu-
related to both self-efficacy beliefs and par- to be influenced by an intervention vari- ded in most research reports to test
ent, family, and child behavior and func- able [see e.g., Bugental et al., 1998; Pajares either the direct effects of self-efficacy
tioning, and indirectly related to parent, et al., 2001]. beliefs on the outcomes or the mediated
family, and child behavior and functioning Dunst et al., [2006a] recently com- effects of helpgiving practices). We also
mediated by self-efficacy beliefs. The pleted a meta-analysis of 18 family-cen- describe the implications of the meta-
theory also postulates that self-efficacy tered helpgiving practices studies all con- analysis for improving the helpgiving
beliefs are directly related to parent, family, ducted in one early childhood intervention practices of professionals working with
and child outcomes in a manner consistent and family support program testing the young children and their families.
with prior research [Bandura, 1997]. The hypothesized relationships of the practice-
relationship between helpgiving practices based theory of family-centered helpgiv-
and parent, family, and child behavior and ing. The 18 studies included 1,100 pro- FAMILY-CENTERED
functioning is expected to vary depending gram participants. Relational and participa- RESEARCH STUDIES
upon the focus of helpgiver/help receiver tory helpgiving practices were measured Studies were identified using fam-
exchanges. by the Enabling Practices Scale [Dempsey, ily with centered or centred, family-centered,
The strength of the relationship 1995], Family-Centered Practices Scale [Dunst and family-centred as search terms. The
between family-centered helpgiving and et al., 2006b], or Helpgiving Practices Scale Psychological Abstracts Online, Educa-
parent, family, and child behavior and [Trivette and Dunst, 1994]. The outcomes tional Resources Information Center
functioning is predicted to be strongest included different measures of self-efficacy (ERIC), MEDLINE, Academic Search
when the outcome measures are most prox- beliefs, program participant satisfaction, Elite, CINAHL, Social Science Citation
imal and contextual to the focus of help parenting behavior, parent and family Index, Health Source, and Dissertation
giver/help receiver exchanges and less well-being, social supports and resources, Abstracts were searched for studies.
strongly related to outcome measures more and child behavior and functioning. These main searches were supplemented
distal to the focus of help giver/help re- Results showed that family-centered help- by searches of the Cochrane Collabora-
ceiver exchanges. Outcomes are consid- giving had both direct and indirect influ- tion databases, Ingenta, World Cat, and
MRDD Research Reviews DOI 10.1002/mrdd  FAMILY-CENTERED RESEARCH  DUNST ET AL. 371
Google Scholar. Hand searches of semi- by Shadish and Haddock [1994] were was used to test for between outcomes dif-
nal studies and papers were also con- used to weight the effect sizes because of ferences in the sizes of effects [Hedges,
ducted to locate additional studies as differences in the study sample sizes. The 1994]. The Z-test is a measure of whether
were the reference sections of all re- average effect sizes were used for deter- or not the average effect size is statistically
trieved articles, chapters, and books. mining the strength of the relationship greater than zero. The Q-test is ‘‘analogous
Studies were included if either or between family-centered helpgiving and to the omnibus test for variation in group
both relational or participatory dimen- the study outcomes and the 95% confi- means in a one-way ANOVA’’ [Hedges,
sions of family-centered helpgiving were dence intervals were used for substantive 1994, p. 290].
assessed, one or more aspects of parent, interpretation. A confidence interval not Thirty-eight research reports were
family, or child behavior was measured, including zero indicates that the average located that included data from 47 stud-
and the correlations between measures effect size is statistically significant ies or samples of study participants. The
were reported or could be calculated [Hedges, 1994]. studies were conducted by 21 research-
from information in the research reports. The Z-test was used to ascertain if ers or research teams in the United
Pearson’s r was used as the effect size of there was significant covariation between States (71%), Canada (15%), Australia
the relationship between variables family-centered helpgiving and the parent, (6%), and the Netherlands, Portugal,
[Rosenthal, 1994]. Procedures described family, and child outcomes, and the Q-test India, and Sweden (8%).

Studies Included in the Meta-Analysis

Allen RI. 1996. The family-centered behavior scales: a report on the validation study.
Barbee-Dixon KD. 2001. Parental perceptions of family-centeredness and the effectiveness of early-intervention programs.
Boyd K, Dunst CJ. 1993. Effects of helpgiving behavior on a family’s sense of control and well-being.
DeChillo N, Koren PE, Schultze KH. 1994. From paternalism to partnership: family and professional collaboration in children’s mental health.
Dempsey I, Dunst CJ. 2004. Helpgiving styles and parent empowerment in families with a young child with a disability.
Dempsey I, Foreman P, Sharma N, Khanna D, Arora P. 2007. Correlates of parental empowerment in families with a member with a disability in
Australia and India.
Dunst CJ. 1999. Placing parent education in conceptual and empirical context.
Dunst CJ, Boyd K, Trivette CM, Hamby DW. 2002. Family-oriented program models and professional helpgiving practices.
Dunst CJ, Brookfield J. 1998. Epstein J. Family-centered early intervention and child, parent and family benefits: final report.
Dunst CJ, Trivette CM. 2001a. Benefits associated with family resource center practices.
Dunst CJ. Trivette CM. 2001b. Parenting supports and resources, helpgiving practices, and parenting competence.
Dunst CJ, Trivette CM. 2005. Measuring and evaluating family support program quality.
Dunst CJ, Trivette CM, Boyd K, Brookfield J. 1994. Help-giving practices and the self-efficacy appraisals of parents.
Dunst CJ, Trivette CM, Gordon NJ, Starnes AL. 1993. Family-centered case management practices: characteristics and consequences.
Dunst CJ, Trivette CM, Hamby DW. 1996. Measuring the helpgiving practices of human services program practitioners.
Dunst CJ, Trivette CM, Hamby DW. 2006a. Family support program quality and parent, family and child benefits.
Dunst CJ, Trivette CM, LaPointe N. 1992. Toward clarification of the meaning and key elements of empowerment.
Dunst CJ, Trivette CM, LaPointe N. 1994. Meaning and key characteristics of empowerment.
Dunst CJ, Trivette CM, Starnes AL, Hamby DW, Gordon NJ. 1993. Building and evaluating family support initiatives: a national study of programs for
persons with developmental disabilities.
Everett JR. 2001. The role of child, family and intervention characteristics in predicting stress in parents of children with autism spectrum disorders.
Granat T, Lagander B, Borjesson M-C. 2002. Parental participation in the habilitation process: evaluation from a user perspective.
Humphries TL, Dunst CJ. 2003. Parenting CEC: it’s not what you think.
Judge SL. 1997. Parental perceptions of help-giving practices and control appraisals in early intervention programs.
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.
King S, King G, Rosenbaum P. 2004. Evaluating health service delivery to children with chronic conditions and their families: development of a refined
Measure of Processes of Care (MPOC-20).
King SM, Rosenbaum PL, King GA. 1996. Parents’ perceptions of caregiving: development and validation of a measure of processes.
Law M, Hanna S, King G, Hurley P, King S, Kertoy M, Rosebaum P. 2003. Factors affecting family-centred service delivery for children with disabilities.
Lewis CC, Pantell RH, Sharp L. 1991. Increasing patient knowledge, satisfaction, and involvement: randomized trial of a communication intervention.
O’Neil ME, Palisano RJ, Westcott SL. 2001. Relationship of therapists’ attitudes, children’s motor ability, and parenting stress to mothers’ perceptions of
therapists’ behaviors during early intervention.
Pereira AP. 2003. Pr
aticas centradas na fam
ılia: identificaç~ao de comportamentos para uma pr
atica de qualidade no Districto de Braga.
Petr CG, Allen RI. 1997. Family-centered professional behavior: frequency and importance to parents.
Reich S, Bickman L, Heflinger CA. 2004. Covariates of self-efficacy: caregiver characteristics related to mental health services self-efficacy.
Robinson GM. 2005. Predictors of empowerment among parents of school-age children with disabilities: The role of family-centered behavior.
Romer EF, Umbreit J. 1998. The effects of family-centered service coordination: a social validity study.
Sandler AD, Casar S. 2000. The Functional Outcomes Study: the effects of managed care on the quality care and outcomes for children with
developmental disorders.
Thompson L, Lobb C, Elling R, Herman S, Jurkiewicz T, Hulleza C. 1997. Pathways to family empowerment: effects of family-centered delivery
of early intervention services.
Trivette CM, Dunst CJ, Boyd K, Hamby DW. 1995. Family-oriented program models, helpgiving practices, and parental control appraisals.
Trivette CM, Dunst CJ, Hamby DW. 1996a. Characteristics and consequences of help-giving practices in contrasting human services programs.
Trivette CM, Dunst CJ, Hamby DW. 1996b. Factors associated with perceived control appraisals in a family-centered early intervention program.
Trivette CM, Dunst CJ, Hamby DW, LaPointe NJ. 1996c. Key elements of empowerment and their implications for early intervention.
Trute B, Hiebert-Murphy D. 2007. The implications of ‘‘working alliance’’ for the measurement and evaluation of family-centered practice in childhood
disability services.
van Riper M. 1999. Maternal perceptions of family-provider relationships and well-being in families of children with Down syndrome.
van Riper M. 2001. Family-provider relationships and well-being in families with pre-term infants in the NICU.
van Schie PEM, Sieves RC, Ketehar M, Vermeer A. 2004. The Measure of Processes of Care (MPOC): validation of the Dutch translation.

See the reference section for complete citations for all the studies included in the synthesis.

372 MRDD Research Reviews DOI 10.1002/mrdd  FAMILY-CENTERED RESEARCH  DUNST ET AL.
 gram for whom a helpgiver worked, and
1. Family-Centered Practices Scales Used in the Studies perceived control over life events not the
focus of the help receiver/helpgiver rela-
Independent Variablea
tionships. The participant satisfaction
Number Relational Participatory Total Scale measures included satisfaction with the
Scales of Studies Practices Practices Score helpgiving staff and satisfaction with the
helpgiving program. The parenting behav-
Helpgiving practices scale 14 10 10 4 ior measures included parenting compe-
Measure of process of care 10 8 8 2
Enabling practices scale 6 3 3 3 tence, parenting confidence, and parenting
Family-centered behavior scale 6 1 1 5 enjoyment. The well-being measures
Family-centered practices scale 3 3 3 0 included negative and positive psychologi-
Family/provider relationship scale 2 0 0 2 cal health and family functioning. The
Family-centered helpgiving scale 1 0 0 1
Family-centeredness scale 1 0 0 1
social support measures included child and
Family/professional collaboration scale 1 1 1 0 parent supports provided to program par-
Parent/professional collaboration scale 1 0 1 0 ticipants by a helpgiver or his or her pro-
Physician attribute scale 1 1 0 0 gram. The child functioning measures
Investigator developed measures 3 0 0 3 included parent judgments of child nega-
a
Number of subscale scores and total scale scores used as independent measures of family-centered helpgiving practices.
tive behavior, child positive behavior, and
child progress, and child development and
functioning.
Information about the study partic- early intervention programs, preschool Each outcome measure in every
ipants, the family-centered practices and special education programs, elementary study was coded on an a priori basis as ei-
outcome measures, and the effect sizes for schools, family support programs, men- ther a proximal or distal dependent vari-
the relationships between measures can be tal health programs, neonatal intensive able. An outcome measure was coded as
obtained from the first author. care units, specialty clinics, rehabilita- proximal if the target of program partici-
The total number of study partici- tion centers, or physician practices. The pant appraisals was a benefit related to or
pants was 11,187. The average sample size helpgivers whose family-centered prac- associated with a helpgiver or his or her
per study was 235 (SD 5 364, Range 5 tices were the focus of study participant program (e.g., the provision of advice or
9–2,265). Participant gender was reported judgments included early childhood guidance in response to a help seeker
in 42 studies. Eighty-nine percent of the practitioners, educators, nurses, physi- request). An outcome measure was coded
participants were mothers. The average cians, therapists, rehabilitation specialists, as distal if the target of appraisal included
age of the participants ranged between 25 and service coordinators. no reference to the helpgiver or his or her
and 41 years (Range 5 15–68 for all stud- The instruments most frequently program (e.g., family quality of life). The
ies). The average number of formal years used to measure family-centered helpgiv- percent of outcomes in each domain that
of education completed by the partici- ing were the Helpgiving Practices Scale [Triv- were coded as proximal in descending
pants ranged between 8 and 16 (Range 5 ette and Dunst, 1994], Measure of Process of order were participant satisfaction with the
0–25 for all studies). Care [King et al., 1996], Enabling Practices helpgiver or his or her program (100%),
The race or ethnicity of the study Scale [Dempsey, 1995], Family-Centered social support and resources provided by
participants was reported in 34 studies. Behavior Scale [Petr and Allen, 1995], and the helpgivers or their programs (100%),
The largest majority (86%) were white Family-Centered Practices Scale [Dunst et al., self-efficacy beliefs (64%), child behavior
or Caucasian of European descent. 2006b]. Table 1 lists all the family-centered and functioning (17%), personal and family
Seven percent were African American, practices scales used in the studies and well-being (8%), and parenting behavior
2% were Latino, 1% was Asian, and 1% shows the number of relational, participa- (0%).
was Native American or First Nations. tory, and total scale scores that were used as
Three percent had other ethnicities. family-centered helpgiving practices mea- SYNTHESIS RESULTS
One study had a sample that were all sures. The majority of the instruments are
East Indian [Dempsey et al., 2001, Sam- multi-item scales where different helpgiv- Family-Centered Helpgiving
ple 3] and one study had a sample that ing practices are assessed by a help receiver Practices
were all Portuguese [Pereira, 2003]. using Likert scales. Whether subscales Figure 2 shows the average effect
The average age of the participants’ measured either relational or participa- sizes and confidence intervals for the
children ranged between 7 and 157 tory helpgiving was determined from ei- overall relationship between family-cen-
months (Range 5 birth to 20 years for all ther factor analyses included in the tered helpgiving practices and the six
studies). Child gender was reported in 23 research reports or inspection of the item categories of outcomes. The relational,
studies. Sixty-one percent were male and content of the subscales. Which family- participatory, and total scale scores taken
39% were female. Child diagnosis was centered measure subscales were coded together were the independent variables
reported in 38 studies. Sixty-five percent as relational or participatory practices can in the six sets of analyses. The different
of the children had a developmental dis- be obtained from the first author. outcome measures in each outcome do-
ability or identified condition (e.g., Down The outcome measures included main taken together were the depend-
syndrome, cerebral palsy), 11% had a de- self-efficacy beliefs, participant satisfaction, ent variables. The relationships between
velopmental delay, 6% were at-risk for parenting behavior, personal and family family-centered helpgiving and the out-
poor outcomes, 8% had mental health well-being, social support, and child comes were statistically significant in all
related disorders, and 9% were typically behavior and functioning. The self-efficacy six analyses, Zs 5 9.07–126.84, P <
developing. measures included perceived control over 0.0001. Family-centered helpgiving was,
The study participants were the help provided by a helpgiver, perceived however, differentially related to the
involved in or receiving services from control over the help provided by the pro- outcomes as evidenced by the stair-
MRDD Research Reviews DOI 10.1002/mrdd  FAMILY-CENTERED RESEARCH  DUNST ET AL. 373
 tionship between participatory helpgiv-
ing and the other five outcomes (life
events control, satisfaction with pro-
gram, child positive behavior function-
ing, family well-being, and parenting
behavior) were larger than the effect
sizes for the influences of relational
helpgiving on these same outcomes.
The fact that participatory (compared
to relational) helpgiving was more
strongly related to more outcomes was
expected because research has consis-
tently found that active learner partici-
pation in acquiring new knowledge and
skills is more likely to have capacity-
building effects [e.g., Donovan et al.,
1999; Wilson, 2006].

Within Outcome Domain

Comparisons
The extent to which relational
and participatory helpgiving were dif-
ferentially related to the outcome meas-
Fig. 2. Influences of family-centered helpgiving practices in the six domains of parent, family, ures within categories was determined
and child behavior and functioning. (Note: The numbers in the bars are the number of effect by a series of between outcome mea-
sizes included in the analyses.) *Zs 5 9.07–126.84, P < 0.00001.
sures comparisons. Family-centered help-
giving was differentially related to the
outcome measures within domains in 6
stepped relationship between the inde- Relational Versus Participatory of the 12 analyses (see Table 2). Rela-
pendent and dependent measures. Practices tional and participatory helpgiving were
Two of the three outcomes most The influences of relational and both differentially related to the three
strongly related to family-centered help- participatory helpgiving practices on the self-efficacy belief measures, Qs 5
giving were ones most proximal and outcomes are shown in Table 2. There 117.69 and 126.95, P < 0.00001. In
contextual to the study participants in- was statistically significant covariation both analyses, the strength of the rela-
volvement in a helpgiving relationship between the two types of family-cen- tionship between helpgiving practices
(satisfaction with program practitioners tered helpgiving and the outcome and the two proximal control measures
and services and self-efficacy beliefs), Zs measures in 41 of the 42 Z statistic (practitioner control and program con-
5 94.91 and 124.84, P < 0.0001 analyses. The outcome categories are trol) was about twice as strong as the
respectively). The provision of child and ordered on the table according to the relationship with the distal control mea-
parent supports from the help giver or proximal and distal relationship to fam- sures (life events control) as expected.
his or her program was also significantly ily-centered helpgiving. It can be seen Both relational and participatory help-
related to family-centered helpgiving, Z that the strength of the relationship be- giving were also differentially related to
5 33.97, P < 0.0001. In all three sets tween relational and participatory help- the two social support and resources
of analyses, the more family-centered giving and the outcomes both between measures, Qs 5 4.87 and 8.58, Ps <
the practices, the more the participants and within categories are very consist- 0.03 and 0.01. In both analyses, rela-
were satisfied with the practitioners and ent with predictions based on our prac- tional and participatory helpgiving were
their programs, had stronger self-effi- tice-based theory of family-centered more strongly related to participants’
cacy beliefs, and the more helpful they helpgiving [Dunst et al., 2006a]. ratings of the helpfulness of program
judged the supports and resources pro- Whether or not either relational supports and resources (ESs 5 0.47 and
vided by the helpgiver and their pro- or participatory helpgiving practices 0.52, respectively) compared to the
grams. were more strongly related to the out- actual provision of child and parent sup-
The three outcome measures more come measures was determined by a se- ports (ESs 5 0.26 and 0.37, respec-
distal to family-centered helpgiving ries of between type of helpgiving prac- tively).
(child behavior and functioning, per- tices comparisons. The 21 between type Participatory helpgiving was more
sonal/family well-being, and parenting of helpgiving (relational vs. participa- strongly related to both satisfaction with
behavior) were all statistically related to tory) practices Q statistic analyses pro- both program services (ES 5 0.67)
the independent variable, Zs 5 20.53, duced seven significant differences. The compared to satisfaction with the help-
26.20, and 9.07, P < 0.0001, respec- size of effect for relational helpgiving givers (ES 5 0.38), Q 5 141.60, P <
tively, albeit not nearly as strongly. The and satisfaction with program staff (ES 0.0001, and program participants’ rat-
results nonetheless indicate that the 5 0.67) and all the satisfaction measures ings of positive child behavior (ES 5
ways in which helpgivers interact and combined (ES 5 0.64) was larger than 0.34) compared to child behavior com-
treat families influences to some degree the effect sizes between participatory petence (ES 5 0.18), Q 5 9.16, P <
judgments of their own behavior, that helpgiving and these same outcomes 0.01. In contrast, relational helpgiving
of their family, and their children’s (ESs 5 0.38 and 0.59, respectively). In was more strongly related to personal
behavior. contrast, the sizes of effect for the rela- well-being (ES 5 0.27) compared to
374 MRDD Research Reviews DOI 10.1002/mrdd  FAMILY-CENTERED RESEARCH  DUNST ET AL.
 2. Effect Sizes for the Relationship Between Relational and Participatory Helpgiving Practices and the Outcomes Measures
Relational Helpgiving Practices Participatory Helpgiving Practices
a
Number Effect Size Number Effect Sizea Between Practices Comparison

Outcome Measures Studies Sample Size Effect Size Mean 95% CI Studies Sample Size Effect Size Mean 95% CI Qb

Participant satisfaction
All measures combined 10 2128 24 0.64**** 0.62–0.65 9 2053 13 0.59**** 0.56–0.61 13.67***
Satisfaction with staff 3 601 4 0.67**** 0.63–0.72 2 526 5 0.38**** 0.34–0.42 97.61****

MRDD Research Reviews DOI 10.1002/mrdd

Satisfaction with program 8 1598 20 0.63**** 0.62–0.65 8 1598 8 0.67**** 0.65–0.70 7.09**


Self efficacy beliefs
All measures combined 16 1765 32 0.61**** 0.59–0.63 17 2015 43 0.59**** 0.57–0.61 1.61
Practitioner control 10 1368 10 0.62**** 0.59–0.65 10 1368 11 0.62**** 0.59–0.66 0.08
Program control 8 754 10 0.70**** 0.66–0.73 8 754 13 0.67**** 0.64–0.70 1.63
Life events control 8 675 12 0.32**** 0.26–0.38 9 913 19 0.39**** 0.35–0.43 3.97*
Program resources
All measures combined 3 347 6 0.36**** 0.30–0.43 3 347 6 0.44**** 0.38–0.51 2.78
Parent/child supports 2 181 4 0.26**** 0.17–0.36 2 181 4 0.37**** 0.28–0.46 2.74
Program helpfulness 2 252 2 0.47**** 0.37–0.56 2 252 2 0.52**** 0.43–0.61 0.54
Child behavior
All measures combined 3 345 19 0.24**** 0.20–0.29 3 345 12 0.27**** 0.22–0.32 0.48
Positive child behavior 3 345 8 0.25**** 0.19–0.31 3 345 5 0.34**** 0.27–0.41 4.29*
Negative child behavior 1 93 8 0.25**** 0.18–0.31 1 93 4 0.20**** 0.11–0.30 0.46
Behavioral competence 2 252 3 0.24**** 0.14–0.34 2 252 3 0.18*** 0.08–0.28 0.69
Well-being
All measures combined 10 1543 30 0.26**** 0.24–0.29 10 1543 20 0.27**** 0.23–0.30 0.05

FAMILY-CENTERED RESEARCH  DUNST

Personal well-being 10 1543 26 0.27**** 0.25–0.30 10 1543 16 0.26**** 0.22–0.30 0.18
Family well-being 2 245 4 0.18**** 0.11–0.27 2 245 4 0.29**** 0.23–0.37 3.81*
Parenting behavior

ET AL.
All measures combined 3 331 8 0.13**** 0.07–0.19 3 331 11 0.21**** 0.16–0.27 4.06*
Confidence 3 331 3 0.16** 0.06–0.27 3 331 4 0.26**** 0.18–0.35 2.23
Competence 2 236 2 0.05 20.07–0.18 2 236 3 0.11* 0.01–0.21 0.50
Enjoyment 3 331 3 0.15** 0.05–0.26 3 331 4 0.24**** 0.16–0.32 1.62
*P < 0.05, **P < 0.01, ***P < 0.001, ****P < 0.0001.
a
Significance Z-test for covariation between helpgiving practices and the outcome measures.
b
Between type of helpgiving practices Q test of statistical significance (Hedges, 1994).

375
family well-being (ES 5 0.18), Q 5 equation modeling would seem espe- 1988, 1994; Dunst, 2000, 2004], it is
4.02, P < 0.05. The latter is an exam- cially useful for this purpose, and there ‘‘part of the equation’’ of a broader-
ple of a within domain proximal/distal are now methods for aggregating results based approach to early childhood
difference, where the target of appraisals from these kinds of analyses for con- intervention and family support that
of one’s own behavior (personal well- ducting even more sophisticated meta- considers many different environmental
being) shows a stronger relationship analysis [Shadish and Sweeney, 1991]. factors as determinants and mediators of
with family-centered practices com- It is of special importance to note desired outcomes. In statistical terms,
pared to appraisals of other’s behavior the nature of the relationship between family-centered practices should account
(family well-being). family-centered helpgiving and the for some but not all the variance in
child outcome measures in this and our outcomes considered important pro-
DISCUSSION other meta-analysis [Dunst et al., 2006a]. gram benefits.
Findings from our meta-analysis Critics of family-centered practices The broad-based applicability of
showed that both relational and partici- [e.g., Baird and Peterson, 1997; Maho- family-centered practices is understood
patory family-centered practices were ney et al., 1999] often argue that this by considering the settings in which the
related to parent, family, and child approach to working with families studies included in our meta-analysis
behavior and functioning in a manner ‘‘leaves out the child’’ and in the process were conducted and the settings in
highly consistent with the theory guid- fails to consider interventions that spe- which family-centered helpgiving is
ing the conduct and interpretation of cifically target child learning and devel- now used by professionals. The settings
the three sets of analyses [Dunst et al., opment. Findings from both our meta- in which the studies were conducted
2006a]. The strongest relationships with analyses show that parents’ judgments of included, but were not limited to, pedi-
family-centered practices were with their child’s behavior (more positive and atric practices, NICUs, mental health
outcomes most proximal and contextual less negative) are influenced by family- programs, early childhood intervention
to the focus of help receiver/helpgiver centered practices. We believe this is programs, specialty clinics, rehabilitation
exchanges. More distal outcomes also the case because family-centered prac- centers, and public schools. Findings
were related to family-centered helpgiv- tices are strengths-based, and the prac- showed that the strength of the relation-
ing albeit not nearly as strong. tices help focus family member atten- ship between family-centered helpgiv-
We were able to conduct only tion on positive child qualities. This was ing and the same or similar outcomes
main or direct effect analyses of family- especially true for the influence of par- were much the same in the different
centered helpgiving because many of ticipatory helpgiving on positive child settings, indicating that the practices op-
the research reports did not include behavior. erate in the same way when used by
correlation tables that could have been In our other meta-analysis we professionals from different disciplines in
used to test for the indirect influences found that family-centered practices different kinds of programs.
of relational and participatory helpgiv- were not directly related to child devel- Family-centered practices and care
ing. This is a common problem in opment outcomes but rather indirectly are now used widely in many different
meta-analyses [Shadish and Sweeney, mediated by self-efficacy beliefs. We kinds of programs and organizations
1991]. It is unfortunate that we could believe this is the case because family- working with young children and their
not do mediated analyses because in centered practices have empowerment families, and especially children with
another research synthesis [Dunst et al., type effects (e.g., strengthened efficacy special health care needs and identified
2006a] we were able to test for the beliefs), and that parents who feel em- disabilities and their families [e.g., Shel-
indirect effects of helpgiving and found powered about their parenting capabil- ton and Stepanek, 1994; Sweeney,
that more distal outcomes were influ- ities are more likely to provide their 1997; Henneman and Cardin, 2002;
enced by family-centered practices and children development-enhancing learn- Lewandoski and Pierce, 2002; American
particularly by participatory helpgiving. ing opportunities [Teti and Gelfand, Academy of Pediatrics Committee on
For example, parenting behavior was 1991; Coleman et al., 2002]. There is Hospital Care, 2003]. Findings from
completely mediated by self-efficacy no reason to believe or expect that fam- our meta-analyses help inform this way
beliefs, where family-centered practices ily-centered practices would be directly of working with families by placing
influenced control appraisals and control related to child development outcomes. equal emphasis on the use of relational
appraisals in turn influenced parenting Child focused or parent/child focused and participatory helpgiving practices.
confidence, competence, and enjoy- interventions are what is done and fam- The latter is generally practiced less of-
ment. In other analyses, family-centered ily-centered practices are how the inter- ten by professionals [Dunst and Trivette,
helpgiving had both direct and indirect ventions are implemented. The latter is 2005] but is a more important determi-
effects on the same kinds of outcomes expected to influence the ways in which nant of parent, family, and child behav-
included in this meta-analysis (e.g., the former is carried out. ioral functioning and especially out-
helpfulness of program supports and The implications of our meta- comes mediated by self-efficacy beliefs
resources). The next generation of fam- analysis for practice are perhaps best [Dunst et al., 2006a]. Incorporating
ily-centered research could add substan- understood by first considering the family choice and decision-making, and
tially to our understanding of how this extent to which family-centered help- knowledge and skill development, into
approach to working with families giving would be expected to be related how professionals work with families
influences parent, family, or child func- to different outcomes. Family-centered would most likely have value-added
tioning by explicitly including mediator practices are only one of a number of benefits.
variables and conducting effects decom- factors that would be expected to con- We conclude the paper by com-
position analyses [Kline, 2005] to ascer- tribute to improved child, parent, and menting on the quality of the studies in
tain both the direct and indirect effects family behavior and functioning. Placed our meta-analysis. The largest majority
of family-centered helpgiving on de- in the context of a family system of the studies were correlational investi-
pendent variables of interest. Structural approach to intervention [Dunst et al., gations where variations in help re-
376 MRDD Research Reviews DOI 10.1002/mrdd  FAMILY-CENTERED RESEARCH  DUNST ET AL.
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Bugental DB, Johnston C, New M, Silvester J. cacy appraisals of parents. In Dunst CJ, Triv-
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