Two sides of the mirror: parents' and service providers' view on the family-centredness of care for children with cerebral palsy

Background In order to best meet the needs of both families and their children with cerebral palsy, many rehabilitation service providers have adopted a family‐centred service (FCS) approach. In FCS parents are seen as experts on their child's needs, and the family and professionals collaborate in the rehabilitation process. However, parents and service providers might look at FCS from different points of view, i.e. look into the mirror from two different sides. The objective of this study was to explore the degree to which parents experience the service as being family‐centred and to which extent the service providers experience their service provision as family‐centred. Methods A translated version of The Measure of Processes of Care 20 (MPOC‐20) questionnaire was used to evaluate parents' experience of FCS, and a Measures of Processes of Care for Service Providers (MPOC‐SP) questionnaire was used to evaluate the FCS provided by professionals. Parents visiting two university hospital neuropediatric wards (n= 67) during a 2‐month period and who were willing to participate received the questionnaire. Also the service providers working on the same wards (n= 49) were invited to participate. Results A total of 53 families and 29 service providers completed the questionnaires. Both parents and professionals generally rated the FCS positively. General information was rated lowest and respectful treatment the highest by both parents and professionals. The results revealed that written information about the child's condition, the possibility to choose when to receive information, and contact with other families in the same situation are areas in need of improvement. Conclusions The possibility to regularly evaluate services both from the families' and the professionals' perspectives should be part of quality development. Providing general information is a challenge for all service providers. The MPOC questionnaires can be used to highlight important areas of improvement in FCS.     

Re-thinking family-centred care across the continuum of children's healthcare

BACKGROUND: The terms family-centred care (FCC) and family-centred services (FCS) are used interchangeably across the continuum of children's healthcare to encompass concepts of: parental participation in children's healthcare; partnership and collaboration between the healthcare team and parents in decision-making; family-friendly environments that normalize as much as possible family functioning within the healthcare setting; and care of family members as well as of children. However, authors from different professional and policy perspectives have used different definitions and literatures when arguing the evidence for FCC and FCS. METHOD: A critical literature review and theoretical discussion exploring common concepts and issues forming the basis for a research agenda further strengthening of the evidence base for FCC. A systematic identification of constructs, concepts and empirical indicators is developed and applied to exemplars in pain and asthma that span the continuum of children's healthcare across acute and community settings. CONCLUSIONS: The extent to which the concepts are supported by research and applied in practice remains unclear. We propose that re-thinking of FCC is required in order to develop a more coherent programme of research into the application of FCC theory in children's healthcare.     

Development of a measure of family-centred care for resource-poor South African settings: the experience of using a modified version of the MPOC-20

Background The Measure of Processes of Care (MPOC) is a widely used tool to assess parents' self‐reported experiences of family‐centred behaviours of paediatric rehabilitation services. It has never been used in resource‐constrained settings or in a cross‐cultural environment where cultural and language differences may complicate effective implementation of family‐centred services. In this study, the MPOC‐20 was used as the starting point for the development of a measure of family‐centred care in disadvantaged South African settings. The objective was to establish to what extent the MPOC‐20 needed to be adapted for these settings. Methods After modifying MPOC‐20 through focus groups, the adapted scale was translated into six local languages. Trained interviewers administered the scale to a convenience sample of 267 caregivers of children aged between 1 and 18 years with a diagnosis of cerebral palsy living in poorly resourced areas in two provinces in South Africa. Results The modified MPOC‐20 was neither reliable nor valid in the new setting. Cronbach's alpha for each of the sub‐scales varied between 0.30 and 0.66 while for the test–retest reliability, the Intraclass Correlation Coefficients were between 0.51 and 0.61. The first two criteria for item convergent validity were not met. Repeated multi‐trait scaling identified eight items that when combined into a scale [named the MPOC‐8(SA)] had acceptable reliability and validity. Factor analysis of the MPOC‐8(SA) yielded two factors: an interpersonal factor and an informational factor. Conclusions Although extreme caution has to be used when using measures created in one socio‐cultural setting in a different context, the MPOC‐20 provides a useful starting point for the development of a measure of family‐centred care in a poor resourced setting. Caregivers in different settings have more in common than they have differences. However, the process of asking the questions and the words used to capture caregivers' experiences needs to be different.     

Rehabilitation for children with cerebral palsy in rural Cambodia: parental perceptions of family-centred practices

Background Rehabilitation service providers in Cambodia are increasingly adopting family‐centred practices when working with children with cerebral palsy and their families. This study examined the perceptions of parents living in rural Cambodia regarding family‐centred rehabilitation practices. Methods This qualitative study used in‐depth semi‐structured individual and small group interviews with a convenience sample of 24 parents of children with cerebral palsy from three rural provinces. Participants were drawn from Cambodia Trust's client database and had been involved in a rehabilitation planning process which incorporated family‐centred practices. Results Twenty‐four parents and carers of children with cerebral palsy aged 3–12 years were interviewed. Almost all parents valued family‐centred practices in rehabilitation, with many of the needs and preferences of parents living in rural Cambodia similar to those of parents in Western contexts. Conclusions Family‐centred approaches to paediatric rehabilitation were found to be valued in and appropriate for a rural Cambodian context. Social and cultural mechanisms to be considered when adapting a Western, family‐centred model of rehabilitation planning to the rural Cambodian context include the hierarchical nature of Cambodian culture, the emphasis on group relational patterns rather than individual needs and the context of chronic poverty.     

Professional background and the comprehension of family-centredness of rehabilitation for children with cerebral palsy

Background Children with cerebral palsy have difficulties in several areas of functioning, and they need long‐lasting rehabilitation with a clear focus on the individual's needs. Finnish guidelines emphasize family‐centred service. The values of family‐centred service are widely known, but how the principles of family‐centred service are adopted in clinical practice is not well documented. The objective of this study was to analyse the family‐centred behaviour of professionals working with children and adolescents with cerebral palsy. Methods A translated version of the Measure of Processes of Care for Service Providers (MPOC‐SP) questionnaire was used to evaluate the family‐centred service. The questionnaire was sent to all the professionals in the multidisciplinary rehabilitation teams at all the hospitals and governmental special schools treating children and adolescents with cerebral palsy in Finland (n= 327). Furthermore, 438 physiotherapy service providers working in the children's home region were invited to participate. Results A total of 201 multidisciplinary team members and 311 physiotherapy service providers completed the questionnaire. Both the team members and the service providers generally rated their family‐centred behaviour positively. There was statistically significant difference in how the team members in the multidisciplinary teams self‐assessed their family‐centred service. Physiotherapists working in multidisciplinary teams rated their family‐centred service higher than physiotherapy service providers. The professional's apprehension of family‐centred service increased with work experience. Conclusions Professional background and professional context seem to affect the apprehension of family‐centred service. Also work experience and being part of a multidisciplinary team have an influence on how the professionals embrace the family‐centred service delivered. The MPOC‐SP can be used to identify areas for improvement.     

Parent and service providers' perceptions regarding the delivery of family‐centred paediatric rehabilitation services in a children's hospital

Background Family‐centred service (FCS) provision has long since been acknowledged as the ‘best‐practice’ model within paediatric rehabilitation with numerous reported benefits for both the child and their family. Although family‐centred care continues to be investigated worldwide using the Measure of Processes of Care (MPOC) survey, to date only two published studies have been conducted within an Australian context, neither of which were within a hospital setting. As a large number of Australian children attend hospital clinics to receive rehabilitation services, research that investigates FCS within this type of environment is required. This study investigated parent and service providers' perceptions of FCS provision within a large Australian metropolitan children's teaching hospital using the MPOC survey. Methods A total of 100 parents/caregivers (34% response rate) whose child had accessed hospital paediatric rehabilitation services over a 12‐month period completed the MPOC‐20 survey. Thirty‐two completed MPOC‐SP surveys (80% response rate) were received from the hospital's rehabilitation service providers. Qualitative data were sourced from service providers on their understanding of the term FCS. Results Parents' perceptions of FCS provision were generally positive, rating Respectful and Supportive Care the highest and Providing General Information the lowest. No significant differences were indentified in relation to location of residence, type of disability or number of disabilities per child. Service providers also rated Providing General Information the lowest and felt Treating People Respectfully was strength in the provision of services. Extended responses from service providers indicated that although they possessed a sound understanding of the meaning of FCS, delivering flexible and accessible services and fostering effective communication among all partners were not widely expressed themes. Conclusions These results show consistent strengths and weaknesses in FCS provision to children with disabilities and their families and the need to further address the demand for adequate provision of general information.     

Advance care planning for Māori,Pacific and Asian people: the views of New Zealand healthcare professionals

Despite the benefits of advance care planning (ACP), international research has suggested that in pluralistic and multicultural societies such as New Zealand, significant differences exist in the uptake of ACP between European‐based populations and other cultural groups [Crawley (2005)]. The purpose of this study was to therefore explore the views of generalist palliative care providers in both the community and hospital settings regarding the barriers to ACP adoption as well as methods to increase knowledge about ACP among Māori, Pacific and Asian cultural groups within New Zealand society. Eleven individual interviews, two joint interviews and three focus groups were conducted with health and social care professionals with a wide range of knowledge and experience in palliative care. Challenges were related to a number of issues based on culture, including family decision‐making style, a need to ‘do everything’ and a reluctance to discuss issues surrounding dying and death. Suggestions to increase the knowledge of ACP included techniques to improve information access and the utilisation of shared norms and values to assist with discussions between Māori, Pacific and Asian health professionals and their patients and families/whānau. Findings indicate a need for more family/whānau‐centred models of ACP, addressed much earlier in the healthcare process and within the community setting.     

Diverse pathways to care for children with stomach pain in a Canadian cosmopolitan city

In Montreal, Quebec, 31% of the population is born outside Canada. Yet, only 9% of patient consultations for symptoms associated with functional gastrointestinal disorders (FGIDs) are from immigrants at the Paediatric Gastroenterology Clinic at Sainte‐Justine's University Hospital Centre. This discrepancy inspired a multidisciplinary exploratory study (anthropological and paediatric) to examine the sociological, interpretative and pragmatic aspects of immigrant and non‐immigrant patients and family life with FGIDs. This paper examines the discrepancy between immigrant and non‐immigrant paediatric patients with FGIDs and presents the different pathways to care utilised by families. Semi‐structured interviews were carried out between November 2008 and June 2009, with children and their parents. In total, 38 families were recruited: with 27 families (including a child experiencing abdominal pain, his/her siblings, mother and/or father as well as any other significant individual living in the family home) from the community and 11 from the paediatric gastroenterology clinic. A comparative analysis between the immigrant and non‐immigrant groups focused on perceptions, meanings and actions taken to relieve/alleviate symptoms. Immigrant and non‐immigrant families alternate and combine different therapeutic environments: home, alternative healing therapies and medical paths to care. Our analysis suggests that culture (as a set of values, beliefs and ways of being), as well as social interactions within family life and the clinic, shape pathways to care. The analysis highlights the centrality of receptiveness – and more widely the social dimensions – of all medical encounters. Treatment disparities between immigrant and non‐immigrant families in pathways to care help us to understand these patients' social world and the intricate relationships between values and social milieux, between culture, practices of symptom management and rationales guiding diverse therapeutic actions.     

A meta-synthesis of how parents of children with autism describe their experience of accessing and using routine healthcare services for their children

In order to present a greater understanding to parental experiences of supporting their child with autism to access healthcare services, a systematic review of qualitative research was undertaken, addressing the review question: ‘How do parents of children with autism describe their experiences of utilising routine healthcare services?’. After a systematic search and selection process, 12 studies were identified and appraised independently by paired reviewers using an adapted version of the Critical Appraisal Skills Programme (CASP) tool. Data were synthesised by two reviewers in line with the Joanna Briggs Approach for meta-aggregation. The 12 studies included in this review (spanning 2012–2020), represented the voices of 240 parents. The synthesis resulted in the following synthesised finding (based on four categories that emerged from the original studies' themes): parents report challenges in accessing and use of mainstream health services, for their child with autism, due to not having a voice, inadequate communication and lack of understanding from health service providers. This review raises our awareness of parents' experiences of healthcare services and will assist healthcare practitioners to reconsider their own communication style, understanding and approach with children with autism and their families. From these findings, we recommend that healthcare practitioners more readily incorporate parents' contributory expertise into healthcare visits. These recommendations will help facilitate effective, supportive and positive healthcare experiences for all involved.     

Transition to adult care: experiences and expectations of adolescents with a chronic illness

Background Effective means of transitioning adolescent patients with chronic illness from paediatric to adult medical care are poorly documented and supported by limited evidence. The purpose of this study is to describe expectations and concerns of adolescents with chronic illness regarding transition from subspecialty paediatric to adult‐centred care during the transition process in order guide effective programme design and implementation. Methods Qualitative content and thematic analysis of semi‐structured individual interviews with 22 adolescents with chronic illness, including cystic fibrosis, sickle cell disease, juvenile rheumatoid arthritis, and inflammatory bowel disease. Interviews took place at 1–3 time points over an 18‐month study period. Results Transition topics included: timing of transfer to adult care, the transition process, attitudes about transition, and factors that might aid transition. During the study period, one‐third of participants made the transition to adult‐oriented health care. All participants who had transitioned to adult‐oriented care reported participating in a structured transition programme. Concerns of those who had not initiated the transition process centred on re‐establishing relationships and bringing a new team ‘up to speed’. Most adolescents anticipating transfer to adult care identified only downsides and felt unprepared to transition at the time of the interview. Subjects who had transitioned noted benefits of the adult‐oriented system, even if they had been ambivalent prior to transfer of care. Participants suggested that earlier discussions about transition, opportunities to meet new healthcare teams and visits to adult‐oriented venues prior to transition might aid in the transition process. Conclusions Subspecialty paediatric providers should anticipate common fears and concerns of adolescents and discuss the benefits of transfer to adult‐oriented care. Further evaluation of existing transition programmes is an area for future study and is necessary for improvement of the continuum of care for adolescents with chronic medical conditions.     

Family‐centred outcome measurement following paediatric stroke

Background/aim: Therapy programmes aim to provide services that are family‐centred and address the specific needs of children. The Canadian Occupational Performance Measure (COPM) and the Perceived Efficacy and Goal Setting system (PEGS) are two measures that are available to assist in determining therapy priorities for children and their parents; however, the use of these measures has not been documented for children who have sustained a stroke. This project aimed to describe the functional concerns identified by children and their parents following paediatric stroke. Methodology: A cross‐sectional design was used. A total of 26 children were recruited from a paediatric stroke outpatient clinic, and functional concerns were identified using either the COPM or the PEGS. Results: Children and their parents identified similar issues. Of the 26 participants, 23 (88.5%) reported ongoing functional concerns at three months or more following stroke, whereas three participants did not identify any ongoing functional concerns. Functional concerns were grouped into categories of self‐care, productivity and leisure as outlined in the Canadian Model of Occupational Performance. Concerns were identified across all functional domains by both children and their parents. Conclusions: The COPM and PEGS provided useful information about functional issues that are important to children and their parents following paediatric stroke. Use of these client‐centred measures provides an opportunity to better understand the impact of paediatric stroke on children’s functional abilities, and allows greater scope for service provision and planning for this group of children.     

Parent participation in paediatric rehabilitation treatment centres in the Netherlands: a parents' viewpoint

AIM: The importance of family-centred care and services has been increasingly emphasized in paediatric rehabilitation. One aspect of family-centred care is parent involvement in their child's treatment. The aims of this study were (1) to describe how, and to what extent parents are involved in the paediatric rehabilitation treatment process in the Netherlands; (2) to determine the level of parents' satisfaction about the services they and their child have received; and (3) to describe what ideas parents have to enhance their involvement in the treatment process. METHODS: A total of 679 parents of children aged 1-20 years who participated in our longitudinal study on family centred care in the Netherlands. The children had various diagnoses and were treated in nine out of 23 Dutch paediatric rehabilitation centres. A random sample of 75 parents was interviewed within 4 weeks after completion of the Measure of Processes of Care and the Client Satisfaction Questionnaire. A Quality of Care cycle with six stages was used to structure the evaluation. RESULTS: The data showed that parents are involved in all stages of their child's rehabilitation process in various ways. The average level of parent satisfaction about the services received was high. According to the interviewed parents, the communication between professionals and parents, parents' involvement in goal setting, and parents' involvement in treatment could be improved upon. CONCLUSION: Parents are to a large extent involved in all stages of the treatment process in Dutch paediatric rehabilitation settings. Although parents valued the services received, they suggested various ways to enhance parent participation.     

Evaluating family-centred service in paediatric oncology with the measure of processes of care (MPOC-20)

Background   In order to evaluate the family-centeredness of paediatric oncology services, a psychometrically sound measure of family-centred services is needed. We performed a comprehensive evaluation of the psychometric properties of the 20-item Measure of Processes of Care (MPOC-20) in parents of children undergoing treatment for cancer at five paediatric oncology centres in Canada.
Methods   The sample included 411 parents (80% response rate). Exploratory factor analysis was used to determine the best way to group the items into scales. Psychometric tests were used to examine data quality, targeting, internal consistency reliability, within-scale construct validity and known-groups validity.
Results   Exploratory factor analysis identified two factors: a summary measure of family-centred services and a scale measuring activities that meet parents' general informational needs. Scores spanned the entire scale range, floor and ceiling effects were low, and the sample distribution was not unduly skewed. Scales showed acceptable internal consistency reliability (Cronbach's alphas ≥0.93). Known-group hypotheses supported the scales' ability to differentiate between groups hypothesized to differ. Moderate effect sizes were found when MPOC-20 scale scores for parents and for children with good quality of life were compared with those with poor quality of life.
Conclusions   The MPOC-20 is the only evaluated instrument currently available to measure family-centred services in paediatric oncology. Paediatric cancer programmes can now use this tool to determine parental perception of the extent to which services are family-centred.     

Partnerships for improving dementia care in primary care: Extending access to primary care‐based memory clinics in Ontario,Canada

In Ontario, Canada, the Primary Care Collaborative Memory Clinic (PCCMC) model of dementia care provides a team‐based assessment and management service that has demonstrated increased capacity for dementia care at the primary care level. PCCMCs are established following completion of a multi‐faceted memory clinic training programme. Evidence of the success of this care model has been demonstrated primarily in practice settings with integrated interprofessional healthcare providers (HCPs). Desire to implement PCCMCs in less‐resourced family practice settings without integrated interprofessional HCPs has resulted in partnerships with community agencies and services to create the multifaceted teams needed for this care model. The purpose of this study was to describe the key lessons learned in the development and implementation of 18 PCCMCs in primary care practice models without integrated interprofessional HCPs. Mixed methods included tracking of clinic referrals, pre‐ (N = 122) and post‐ (N = 71) training surveys to assess practice changes and factors facilitating and challenging clinic implementation. Interviews were conducted with 40 team members to identify key lessons learned. Key enablers were access to training, organisational/ management and care provider support, availability of infrastructure supports and clinic coordination. Data were collected between January 2012 and January 2017. PCCMCs were challenged by a lack of sustainable funding, inadequate infrastructure support, competing priorities, maintaining adequate communication among team members, and coordinating multiple schedules. Suggestions to support longer term sustainability were identified, many addressing identified challenges such as securing sustainable funding, and ensuring partners understand the importance of their role and succession planning. This study demonstrated that by establishing community partnerships and leveraging existing community resources, the PCCMC model is generalisable to multiple family practice settings including those without integrated interprofessional staff. Lessons learned can inform the development of interventions for complex chronic conditions requiring interprofessional support in primary care.     

Exploring ways to overcome barriers to mammography uptake and retention among South Asian immigrant women

South Asians comprise one of the fastest growing immigrant groups in North America. Evidence indicates that South Asian (SA) immigrant women are vulnerable to low rates of breast cancer screening. Yet, there is a dearth of knowledge pertaining to socioculturally tailored strategies to guide the uptake of screening mammography in the SA community. In 2010, the authors conducted semi‐structured focus groups (FG) to elicit perspectives of health and social service professionals on possible solutions to barriers identified by SA immigrant women in a recent study conducted in the Greater Toronto Area. Thirty‐five health and social services staff members participated in five FG. The discussions were audio taped and detailed field notes were taken. All collected data were transcribed verbatim and thematic analysis was conducted using techniques of constant comparison within and across the group discussions. Three dominant themes were identified: (i) ‘Target and Tailor’ focused on awareness raising through multiple direct and indirect modes or approaches with underlying shared processes of involving men and the whole family, use of first language and learning from peers; (ii) ‘Enhancing Access to Services’ included a focus on ‘adding ancillary services’ and ‘reinforcement of existing services’ including expansion to a one‐stop model; and (iii) ‘Meta‐Characteristics’ centred on providing ‘multi‐pronged’ approaches to reach the community, and ‘sustainability’ of initiatives by addressing structural barriers of adequate funding, healthcare provider mix, inter‐sectoral collaboration and community voice. The findings simultaneously shed light on the grassroot practical strategies and the system level changes to develop efficient programmes for the uptake of mammography among SA immigrant women. The parallel focus on the ‘Target and Tailor’ and ‘Enhancing Access to Services’ calls for co‐ordination at the policy level so that multiple sectors work jointly to streamline resources, or meta‐characteristics.     

Family-centred care and health-related quality of life of patients in paediatric neurosciences

Background   Little is known about the influence of contextual factors such as health services characteristics on health-related quality of life (HRQL) for children with a neurological condition. To address this gap, we conducted an exploratory study of the relationship between family-centred care (FCC) and HRQL outcomes in children from neurosciences clinics in a large acute care hospital.
Methods   A total of 187 family caregivers completed questionnaires regarding their socio-demographic status, the severity of their children's condition (FIM™), perceptions of their children's HRQL (PedsQL 4.0) and their experiences of FCC (MPOC-20). Hierarchical regression analyses explored the hypothesis that FCC is a significant predictor of children's HRQL, independent of illness severity.
Results   Illness severity and FCC jointly explained one-third of the variance in children's total HRQL. When FCC was controlled for illness severity, it remained a significant predictor of physical, psychosocial and total HRQL scores.
Conclusions   This study provides evidence that the level of FCC is positively related to paediatric HRQL independent of neurological illness severity. The implication is that the uptake of FCC practices by service providers can positively impact the quality of life of children with neurological disorders.     

Maternity care through the eyes of Southern European immigrant parents in Norway

ObjectiveTo explore Southern European immigrant mothers and fathers’ experiences of reproductive health services in Norway, and their perceptions of health providers’ beliefs and attitudes regarding pregnancy and childbirth.MethodWe employed a qualitative research methodology with two focus group discussions and 11 in-depth interviews with 4 fathers and 11 mothers from Italy, Spain, Portugal, and Greece, whose children were born in Norway. Thematic Analysis was conducted to identify and analyze patterns across the data.ResultsWe identified three themes as key elements in parents’ experiences: experiences with the coverage and organization of the Reproductive Health Services; relational experiences with health providers; and pregnancy and delivery as a culturally-shaped event. The immigrant parents experienced a clash between their expectations and the procedures and health facility environment encountered in Norway regarding check-ups, diagnosis tests, childbirth preparation courses, and health facilities. Informants perceived that the maternity care practices of the host country were underpinned by the health care providers’ cultural understandings of labor and pregnancy. Particularly, they experienced a less interventionist approach towards pregnancy and childbirth.ConclusionsThe experiences of immigrant parents provide relevant information to improve reproductive health services in a cross-cultural context. Inmigration brings new challenges that must be addressed from a perspective of cultural competence. These services should acknowledge diversity in cultural beliefs around childrearing and involve both fathers and mothers in decision-making.     

The burden of care: a focus group study of healthcare practitioners in Scotland talking about parental drug misuse

Parenting and family support are key prevention and intervention strategies for improving outcomes for children and families affected by parental drug misuse. However, little is known about the delivery of parenting support for drug‐dependent parents, particularly within universal healthcare services. This study aimed to explore the way healthcare practitioners engage with this challenging agenda. Four multidisciplinary focus groups involving a purposive sample of 18 experienced healthcare professionals were conducted in Scotland. Participants included general practitioners, midwives, public health nurses and addiction staff who work together to provide care for vulnerable families. A focus group topic guide was developed to explore the views and experiences of these healthcare professionals in relation to providing parenting support for drug‐using parents, predominantly those receiving opioid substitution therapy. Data were analysed using a constant comparison method and thematic approach. The overarching narrative which united the focus group discussions was about the ‘burden of care’ that these families pose for frontline healthcare professionals. Recurring themes centred on three key issues: the problematic nature of drug‐using parents themselves; clinical challenges in living up to the ideals of professional practice; and the wider context in which current practice is governed. Professionals expressed ambivalence over their parenting support role; anxiety over responsibility for intervening with this ‘hard‐to‐engage’ population; and concern over ‘dwindling’ resources and lack of organisational support. Nevertheless, strategies and opportunities for providing parenting support were acknowledged and there was consensus about the need for further skills training. Despite a proliferation of policy and good practice guidance on the delivery of parenting support for drug‐dependent parents, the findings of this study suggest that significant challenges remain. Notably, our findings raise questions about whose role it is to provide parenting support to drug‐using mothers and fathers, especially those who are not involved in the child protection system.