Translating Family Centeredness to Health Equity in MCH Education

By Lois McCloskey, DrPH
Associate Professor
Director, Maternal and Child Health Concentration
Department of Community Health Sciences
Boston University School of Public Health 

Deborah Allen, ScD
Director, Child, Adolescent and Family Health
Boston Public Health Commission 

For decades, MCH training lagged behind practice in relation to family-centered care (FCC). Few MCH students left training understanding FCC as a theoretical construct or an approach to practice. The field paid a price; MCH graduates had to play catch-up to engage in effective MCH practice. 

When new grant guidance called on MCH training programs to close this gap between training and practice in 2004, the MCH Department at the Boston University School of Public Health designed a family-centered training initiative drawing on the experience of MCH practitioners. Initiative goals were to assure that MCH programs address needs and reflect preferences and aspirations of families and that MCH leaders share commitment to and understanding of family-centered care. 

As foundation for the initiative, the department identified a faculty point person with experience working with families and family organizations at the state level, and hired a seasoned parent advocate as part-time consultant. Together, they oversaw planning and implementation of the initiative while modeling family-professional partnership. The department chair was a champion of the initiative, enhancing its credibility among faculty and students. 

The initiative began with a survey of faculty knowledge and attitudes. Results indicated general awareness of family-centered care, but little sense of its relevance in many areas of MCH training. One view that emerged, for example, was that a family-centered perspective made sense in courses on child health but not in courses on research methods. Students were introduced to the parent consultant at orientation. Annual baseline surveys of student knowledge and attitudes at orientation revealed limited awareness of FCC or of options for partnership with families. 

Findings from faculty and student surveys were addressed in department-wide discussions about strategies to incorporate family-centered concepts throughout the curriculum. Enhancements included policy changes, such as a requirement that at least one family-centered learning objective be included in every MCH course and that all students write a reflection on FCC within their culminating experience paper. In addition, faculty revised courses to assure an explicit progression of FCC–related content throughout the curriculum. 

The initiative concluded with an analysis of changes in students’ theoretic and applied understanding of FCC, based on a comparison of baseline and exit survey responses. One-third of MCH concentrators demonstrated full progression from “little” to “full” understanding of FCC, and an additional 26 percent progressed from “little” to “good” understanding, noting at least one key element in their definition of FCC. While many recognized the strengths and assets of families, the most commonly “missed” aspect of FCC was shared decision-making between family members and practitioners or policy-makers. With these positive results and signals that there was more to be done, faculty challenged themselves to identify next steps.  

If MCH practitioners are to be prepared to address health disparities, MCH training must go further. Faculty identified the integration of principles of FCC, cultural competence, and racial equity as a critical next step and prioritized such an initiative for their MCHB-supported training program in 2010-2015. A diverse group of community practitioners serve as consultants to faculty as they develop an integrated framework, apply it to the curriculum, and create a toolbox for other educators and practitioners to use. It is a challenge shared by all in MCH—to think and act in family-centered, culturally competent, and racially equitable ways—if we are to make our mark on the elimination of health disparities. 

For more information about the Family Centered Care Initiative at Boston University, please contact Lois McCloskey