Model of Seven-Level Hierarchy of Family-Therapist Involvement

This model presents a hierarchy of family-therapist involvement in occupational therapy services, with associated attitudes, specific knowledge, and skills that enable therapists to operate at each level. 

The first level, no family involvement, outlines the traditional medical model of intervention. This level focuses on technical skills which are expected of entry-level therapists, with no awareness of the role of the family and client’s social context. It provides the basis for alternative types of family involvement. 

The second level, family as informant, indicates that the family has a passive role as a potential source of information, to be subsequently used for development of intervention goals. Therapists require interviewing skills, knowledge of human development, and recognition of the importance of culture and socioeconomic background to functioning. 

The third level, family as therapist’s assistant, indicates that families are participating in assisting the client to meet treatment goals. Therapists provide family education and prescript appropriate home program according to family’s cultural and educational background. 

The four level, family as co-client, indicates that therapists start to view the client as part of the family and value the interrelationships between family members and the environment. Therapists use general system theory to frame their observations and inquiry, to examine the family’s perspective of the experiencing of having a member with specific needs. The skills in awareness of how families respond to stress, develop coping strategies and stress are also important to assess for families’ adjustment to the client’s disablement. 

The fifth level, family members as consultants, indicates that the family input is used in the intervention process. Therapists use a general system approach to understand how families function and accomplish different tasks. Therapists are required to equip with skills to work with different cultures and thus to incorporate family’s input into treatment. 

The sixth level, family as team collaboration, indicates that therapists recognize the family has the ability to determine which issues should be addressed as well as the most beneficial solution. Therapists anticipate a reciprocal exchange of ideas and reflect an eagerness to have the family participate in decision making. Negotiation and collaboration skills are essential at this level. 

The seventh level, family as director of services, indicates that the families are considered as supervising coordinator and consumers. Therapists are transformed from an administrator to a resource provider and facilitator. This model suggests that educators should arrange courses and teaching entry-level therapists to develop required skills at different levels of this hierarchy.