How Early Head Start Home Visitors Foster or Impede Shared Decision-Making with Families

Abstract

Rather than professional-driven decisions, shared decisions are central to family-centered philosophy and practices. This qualitative study investigated how four home visitors and 12 families engaged in institutional decision-making about 16 infants and toddlers enrolled in Early Head Start. The following research question was addressed: How do home visitor discursive strategies contribute to family participation during institutional decision-making about their child? Discourse analysis of detailed home visit transcripts focused on two phases of decision-making: (1) how home visitors opened decision-making, and (2) how home visitors signaled the opportunity for families to participate in making a choice. Although eight approaches were identified across both phases, only two aligned with features of shared decision-making. Instead, home visitors predominantly used unilateral approaches that drew on professional and curricular authority to narrow how families could participate in decision-making about their child. Unilateral approaches set the stage to enact professional recommendations without meaningful family participation, and created a context where home visitors could subtly exert decision-making control over families. Examining details of how decision-making unfolded contributes nuanced information about what shared decisions do–and do not–sound like, and offers insight into discursive strategies that better enact equitable partnerships with families.