A Family-Designed System of Care: Families First in Essex County, New York
This chapter describes the Families First Program in Essex County, New York, a care-provider agency that implemented a system of care designed by the families of children with serious emotional or behavioral problems. According to the author, working within the professional-client hierarchy is so ingrained in the service delivery systems that it is rarely questioned. It is assumed that doctors, lawyers, and therapists "know best" and the clients are the recipients of their expert advice and knowledge. Even the very best systems of care have been designed by professionals with little, in any, input from consumers. Families First challenged this paradigm by implementing a system of care that was designed by families. In this chapter, the author describes the planning for the system, the implementation process, and how the vision of a parent-designed system of services has been maintained. The goal of Families First has been to develop a system of services for families with children with serious emotional or behavioral problems in a rural area that has extremely limited resources. The initiative was designed to develop a system based on what families said they needed and wanted. The concept of developing a family-designed system of care was based on the assumption that all families would have some shared basic needs, regardless of differences in socioeconomic status, culture, race, ethnicity, or sexual orientation. According to the author, family-designed systems challenge a traditional and deeply held belief system, and rather than assuming the superiority of professionals, and attributing blame and shame to supposedly dysfunctional families, it calls for consumers and providers to work as allies.