Introduction

Residential youth care is a form of out-of-home care where young people live in a group setting supported by group workers (Knorth & Harder, 2021). It offers a structured environment focused on treatment and education (Whittaker et al., 2016). Youth in residential youth care often come from highly disadvantaged backgrounds, marked by poverty, family instability, abuse, and parental mental illness or substance use (Leloux-Opmeer et al., 2016). They frequently experience cognitive difficulties and problems in peer relationships (Leloux-Opmeer et al., 2016), while parents of these youth commonly report limited parenting skills (Griffith et al., 2009). Since the 1970s, residential care has often been considered a measure of last resort in Western Europe and North America, reserved for cases where less intensive forms of care have proven unsuccessful (Ainsworth & Huefner, 2025). This preference reflects principles in the United Nations Convention on the Rights of the Child (1989) that emphasize children’s right to grow up in a family environment and maintain close relationships with their parents whenever possible. Within residential youth care, these principles are reflected in family-centered approaches in which professionals work to engage parents in the treatment and daily lives of their children during their stay.

In the Netherlands, where the current study was conducted, recent youth care policies have increasingly prioritized family-centered approaches (Dekker & Blokhuis, 2021). The Dutch youth and mental health system care is currently fragmented across finances, responsibilities, and expertise in youth and adult mental health services, and considered costly, inefficient, and often ineffective (Van Der Steege & Regeer, 2024). Providers face long waiting lists and growing demand, while parents and youth report dissatisfaction with a system in which decisions are often made for them rather than with them. Organizing youth care around families, rather than focusing solely on youth, is therefore considered a key solution to uphold children’s rights to remain connected with their families, as well as to improve the efficiency and effectiveness of services (Van Der Steege & Regeer, 2024).

Family-Centered Practice in Residential Youth Care

Family-centered practice (FCP) focuses on the family as a whole rather than only the child. At the core of this approach is shared decision-making, where families are empowered to set goals and choose strategies, and families’ preferences are respected throughout the process (Allen & Petr, 1998; Knorth et al., 1997). When youth are placed in residential care, parents are still consulted about their child’s behavior and their lifestyle, to continue families’ routines at home where possible in the residential setting. Decisions are thus made with families, rather than about them, supporting family’s agency and continuation of family life as much as possible.

FCP may be particularly promising for families in residential care who face multiple and complex mental health challenges, as they often require integrated forms of support (Nooteboom et al., 2020). Attention to whole-family functioning, as well as to individual issues that affect the family system, enables professionals to gain a comprehensive understanding of families’ needs and to prioritize core problems rather than focusing on symptoms rooted in underlying issues. Understanding the broader context surrounding youth supports more integrated forms of care and promotes flexibility in tailoring approaches to the needs of each family. For instance, FCP can also be applied in semi-residential models that combine in-home support with temporary residential stays for youth (e.g., Blankestein et al., 2021) or the entire family (e.g., Barth et al., 2024). Unlike full-time residential care, where youth primarily remain in a group setting, semi-residential models allow for a high intensity of care while also providing support directly within the family context. Youth may transition from part-time residential care to full reunification, or families may be admitted together with full-time support and transition to home-based, part-time support.

Higher levels of family engagement in residential youth care are consistently linked to better outcomes for youth (e.g., Carr, 2019; Curry, 1991; Frensch & Cameron, 2002; Hair, 2005; Knorth et al., 2008; Maltais et al., 2019). Because FCP addresses the family as a whole, including dynamics within the family, active family participation is expected to improve areas such as parent – child interactions, parents’ self-esteem, and parenting skills (Maltais et al., 2019). Research also suggests that aligning professional support with families’ priorities fosters more meaningful engagement of families and enhances their satisfaction with care (Butler et al., 2015; Langer & Jensen-Doss, 2018).

Conceptualization of Family-Centered Practice

While FCP has been endorsed in both policy (e.g., Van Der Steege & Regeer, 2024; Whittaker et al., 2016) and research (e.g., Ainsworth & Small, 1995; Geurts et al., 2012), the concept of FCP in (semi-)residential youth care has multiple interpretations (Tang et al., 2024). For example, families may participate in parenting workshops, attend treatment-planning meetings, or share a meal at the residential facility. While all are examples of FCP, these activities vary in the nature of families’ involvement and parent-child contact. Our recent systematic review of FCP in residential youth care indicated that family-centeredness is a multidimensional construct, encompassing family-centered practices and family involvement as distinct but related components (Authors, 2024). We proposed three perspectives for understanding family-centeredness: (i) intervention characteristics, (ii) families’ emotional and behavioral involvement in youth’s treatment, and (iii) professionals’ behaviors and attitudes. From the first perspective, the extent to which an intervention is family-centered is described by components of the intervention, which we categorized as family therapy, parenting skills training, involvement in treatment planning, promoting parent – child contact, and building strong family – staff alliances. From the families’ perspective, family-centeredness is described by the degree to which the family actively engaged and participated in treatment. While often measured quantitatively (e.g., counting family’s attendance), family’s emotional involvement in treatment (e.g., motivation to change) must also be considered. Lastly, from the professionals’ perspective, family-centeredness is reflected in their attitudes toward family involvement and the actions they take to promote family participation (cf. Tang et al., 2025).

These perspectives highlight that FCP is not only a set of practical actions but also a normative stance that shapes professionals’ attitudes toward providing appropriate care to families facing complex mental health challenges. Within FCP, professionals are expected not only to involve families through certain activities, but also to view their participation as essential for quality care. Reflecting Tronto’s (1993) ethics of care, FCP conceptualizes care as a relational practice, where quality emerges through mutual engagement, collaboration, and co-creation between families and professionals. As a normative framework, it upholds values such as family autonomy, collaboration, equality, and respect. Thus, FCP concerns not only what professionals do, but also the attitudes they hold toward families and their involvement in youth treatment (Authors, 2025).

Professionals’ Attitudes and Actions in FCP in Daily Practice

While this conceptual work provides an initial framework for understanding FCP, little is known about how professionals interpret its principles and engage families in their day-to-day work (Blankestein et al., 2021; Foster et al., 2016). Because FCP is often framed in broad value terms, such as building on family strengths, it remains unclear what professionals actually do (McCarthy & Guerin, 2022; Authors, 2024). To strengthen FCP in (semi-)residential settings, it is therefore important to examine how professionals understand FCP and translate it into concrete actions. In practice, professionals must decide how FCP takes shape during home visits, goal evaluations, or conflict resolution. Such decisions, particularly those involving risk, safety, or parental contact, cannot be fully prescribed by guidelines and instead rely on professional judgment informed by experience.

Several factors may influence how professionals interpret and enact FCP principles in practice. At the individual level, professionals’ prior training and experience may play a significant role. Negative or ambivalent attitudes toward family participation have long been cited as barriers for implementing FCP (e.g., Allen & Petr, 1998; Holt & Kelly, 2018; Horwitz & Marshall, 2015). In residential youth care in particular, placements often occur following accusations of abuse or neglect, and professionals may experience doubts about whether parent-child contact is in the child’s best interest (e.g., Allen & Petr, 1998; Landsman & Boel-Studt, 2011; Leichtman, 2008). Concerns about youth safety, past abuse, or a tendency to blame parents for a child’s difficulties can further complicate collaboration. Experience grounded in child-centered approaches may further complicate the shift toward FCP. For example, Ahn et al. (2016) found that more years of experience were associated with lower adherence to family-centered principles. Consistent with this, studies show that youth welfare services continue to be shaped by long-standing child-focused traditions, with family needs often remaining secondary even in systems that formally endorse FCP (e.g., Toros et al., 2018).

In addition, families’ responsiveness and the complexity of their situations also affect professionals’ ability to apply FCP. Shared decision-making with families facing multiple and complex problems can be particularly challenging and requires ongoing decision processes and sufficient time to build a working alliance (Barnhoorn-Bos et al., 2025). Professionals often struggle to arrange adequate care for such families (Tausendfreund et al., 2016), for instance when trying to understand all relevant problem areas, how they interact, and how to balance these with the family’s capacities when setting treatment goals (Van Tausendfreund et al., 2016; Yperen et al., 2006). Moreover, professionals may encounter resistance or hostility from families due to earlier negative experiences with youth care (Schout et al., 2011).

Lastly, professionals’ attitudes and actions are also affected by organizational cultures that enable or constrain professionals’ ability to engage in FCP. Cultures that prioritize family engagement, provide training, and allocate sufficient time and resources are more likely to support FCP practices (Holt & Kelly, 2018; Lietz & Rounds, 2009; Wright et al., 2010). When professionals’ earlier experience is rooted in child-centered approaches, organizations play an especially important role in fostering a safe, supportive culture that encourages learning and innovation, and in ensuring this vision is shared across all levels (Ahn et al., 2016; Van Veelen et al., 2017). Conversely, high caseloads, limited managerial support, and rigid procedures can impede family-centered work (Holt & Kelly, 2018; Olin et al., 2014). Thus, organizational cultures both shape and enable professionals’ competence and commitment to family-centered practice.

The Current Study

Although FCP is increasingly promoted in (semi-)residential youth care, how professionals understand and enact FCP remains unclear. Research links greater family engagement to better youth outcomes, but offers little insight into how professionals build engagement, share decisions, or navigate complex family dynamics. Despite the central role of professionals in determining how families are engaged and supported, we know relatively little about how they themselves interpret FCP, what skills they view as essential to doing it well, and which aspects of their daily work help or hinder this way of working. In the current study, our central aim is to explore how and why youth care professionals apply FCP in a Dutch (semi-)residential youth care intervention. Specifically, we investigate how youth care professionals describe the guiding attitudes that shape their work, the strategies they use, the skills they consider necessary, the organizational conditions that support or constrain them, and how they experience families’ responses to the care they deliver.

Method

Research Design

The current study is part of a larger research project examining what works for whom and why in (semi)residential youth care in The Netherlands. The methods and procedures of the current study were approved by the DPECS Research Ethics Review Committee in September 2021 (ETH2021-0112) and preregistered on the Open Science Framework (https://osf.io). In the current study, we collected original data using semi-structured interviews with youth professionals working in a Dutch youth care facility, who provided treatment to families in the intervention “GezinTotaal” (translated as “FamilyTotal”).

Positionality

As researchers, we draw from both post-positivist and social constructionist approaches. In this study, we primarily adopted a post-positivist stance, using interviews to explore youth care professionals’ attitudes and practices regarding family-centered care. While aiming for objectivity in analyzing emerging themes, we also acknowledged our preexisting understanding for transparency. Our comprehension of family-centered practice is shaped by existing theory (e.g., Allen & Petr, 1998; Dunst, 2002; Knorth et al., 1997), our systematic review of family-centered practice and family outcomes (Authors, 2024), and our own practical experience in youth care settings, which provided us with firsthand familiarity with the challenges and dynamics of involving families in care. To this end, we applied a thick analysis approach (Van Staa & Evers, 2010), combining inductive and deductive strategies to analyze our data.

Setting

FamilyTotal (FT) is a family-centered intervention developed in the Netherlands to support families with children in out-of-home care or at risk of placement. It is currently delivered by a single youth care organization at two sites within the country. FT serves families with children under 18 who face severe, complex needs across multiple domains, including psychiatric, cognitive, health, and financial problems. All families include youth with behavioral and emotional problems and face family-related challenges such as low functioning, parenting difficulties, and limited social support, though the specific issues vary widely. The population is diverse in both age and family composition, including young children and adolescents, and families with two parents, single parents, foster parents, or stepfamilies. Families are referred through child protection services or neighborhood social support teams and may participate voluntarily or by mandate. Contraindications include severe individual problems (e.g., addiction, psychosis, or dissociative disorders) requiring prior stabilization, and cases involving secret placements (e.g., honor-related violence or human trafficking) where immediate system involvement is not possible.

Families are treated by two youth care workers, known as the family mentors, and a clinical supervisor overseeing the case. The intervention typically lasts six months and starts with a week of observation at the youth care residence. During this week, the family is observed by the family mentors in everyday activities, such as family dinners, as well as in systemic activities initiated by the mentors that require family collaboration. The main goals of this week are to quickly reveal the families’ destructive patterns and to build strong alliances between the mentors and family members. At the end of the week, the family, in collaboration with their mentors, decides on their individual or family treatment goals. The remainder of the intervention typically takes place at the family home, where the mentors coach the parents and youth through home visits into achieving their goals. On average, mentors spend six hours a week treating a family, although contact hours are typically higher at the beginning and taper off over the course of the intervention, aiming toward the families’ independence.

FT incorporates the five components of family-centered interventions identified in our review (Authors, 2024) to varying degrees. Central to the program are building family – staff alliances and involving families in treatment planning, especially during the observation week. Activities with families in FT focus on improving parent-child relationships and family functioning (parenting skills training). While some contact may be of a therapeutic nature (family therapy), family mentors are pedagogical workers, not licensed psychologists, and primarily support families with complex emotional and behavioral problems in daily parenting. Lastly, most children reside at home or return home during the intervention, so parent – child activities aim to enhance the quality, rather than the quantity, of contact (promoting parent-child contact).

Participants

We used an intensity sample (Suri, 2011) of youth professionals involved in the FT intervention at the time of data collection. Eligible participants were actively working as family mentors or clinical supervisors; interns were excluded. Of the 35 eligible FT employees across two locations, we interviewed 20 (57%), achieving our goal of interviewing the majority of eligible participants. We ensured an equal distribution across locations, by interviewing ten participants from each location. The sample included 3 males and 17 females, of whom 16 were family mentors and 4 were clinical supervisors (see Table 1 for sample characteristics).

Data Collection

In preparation for data collection, the first author trained two student assistants, who were final-year undergraduate students conducting this research as part of their studies, to conduct semi-structured interviews. The training followed four steps: (1) studying ethical guidelines for behavioral research, qualitative interviews, and this specific study; (2) familiarizing themselves with the FT method, setting, and target group through literature and field visits; (3) participating in the development of the interview guide, discussing feedback to deepen their understanding of the questions and structure; and (4) conducting a pilot interview with a colleague researcher to practice interviewing skills and test recording equipment.

The two student assistants under supervision of the first author recruited the participants. The student assistants consulted team supervisors to determine the best recruitment strategy. Based on their input, we invited participants via e-mail, internal staff messages, and information sessions. Potential participants received a digital information letter outlining the study’s objectives and ethical considerations, including confidentiality and voluntariness. We assured participants that interviews would remain strictly confidential, citations would exclude identifiable information, and withdrawal from participation would be anonymous. To minimize pressure, we adopted a participant-initiated approach, allowing individuals to schedule interviews at their convenience through an online booking system, offering flexible date and time options.

The first author and the two student assistants conducted the interviews between 28 April 2023 and 1 September 2023. Interview durations ranged from 38:10 to 88:52 minutes, with an average of 59:14 minutes. All interviews were conducted face-to-face in a private room at the youth care organization’s office, ensuring both accessibility and privacy. Before starting, the interviewer (either the first author or one of the two trained student assistants) reviewed the information letter, confirmed participants’ understanding, and addressed any questions. Once fully informed, participants signed the consent forms, which also included background questions (see Table 1). We recorded the interviews, which were transcribed verbatim using AmberScript software and reviewed for accuracy by a third research assistant who checked the transcripts against the audio.

Instruments

The first author developed an interview guide that included a protocol for informed consent and a structured format with four main themes: (a) motivation and experience, (b) operationalization of family-centered practice, (c) challenges and facilitators, and (d) competence and needs. The first block explored participants’ motivations for working in family-centered treatment, their prior youth care experience, and any transitions they faced (e.g., “How did you come to work at FT?”). The second block focused on defining and implementing family-centered practice, using accessible questions to explore how professionals understand the philosophy behind family-centered practice and how they describe putting it into practice (e.g., “How would you describe family-centered practice in your own words?”). The third block addressed challenges and facilitators, including obstacles, supportive elements, and expected treatment outcomes (e.g., “What are the pros and cons of working in partnership with parents?”). Finally, the fourth block examined required skills, self-assessed competence, and organizational support needs (e.g., “What do you need to effectively implement family-centered practice?”).

Data Analysis

We employed a thematic analysis approach, coding the interview data in three phases: (1) open coding, (2) axial coding, and (3) selective coding (Boeije, 2014). Prior to coding, we developed an initial coding framework based on the key topics in our research question (i.e., guiding principles, strategies, skills, organizational support, and family outcomes). For instance, the strategies professionals described often mirrored the skills they valued, and elements of shared decision-making appeared across different areas of practice. However, substantial overlap among these topics in the interviews made this framework inefficient for structuring the data. Therefore, we proceeded with open coding to organize the material more inductively, followed by axial and selective coding to identify relationships and refine overarching themes. Accordingly, four themes emerged from our data that integrate multiple dimensions of family-centered work.

The first author conducted the initial analysis and documented each step in a log. To systematically structure and code the data, we used Microsoft Excel following the first six steps described by Ose (2016). The second, third, and fourth authors closely monitored the coding process. The first and second author met multiple times during all phases to discuss coding decisions. In addition, the entire author team met at each phase transition, which included moving from open to axial coding, from axial to selective coding, and from selective coding to the formulation of themes. During these meetings, the first author presented coding lists and visual representations that illustrated how the codes related to each other and to the construct of family-centered practice.

Results

Four major themes emerged from the data, each representing a guiding principle of family-centered practice. The discussion begins with principles that professionals viewed as most fundamental to their family-centered approach and progresses toward those that elaborate or extend these core beliefs through specific strategies and practices.

Theme 1: “Parents Should Parent”

The first major theme reflects the guiding principle that parents are responsible for their children, and therefore also have a right to care for their children. The belief that, even in more intensive forms of youth care, the parent is first responsible for youths’ wellbeing and development and not the professional, automatically has implications for how professionals address parents in their work. Professionals describe that by restoring parental responsibility, the situation becomes more natural for both the professional and the family, as the parent assumes a more central role in the youth’s life while the professional becomes less prominent. The professional does not take over the parental role but rather empowers parents to regain agency and enact their parental responsibilities:

I feel that parents really feel like the experts with us again. That the fear of: ‘‘Oh, someone has an opinion about this,’’ is much less present, and it is more like: ‘‘Hey, I can be vulnerable, I can say: Oh, I find this difficult or challenging right now.’’ (…) That gives so much autonomy back to a parent. (Respondent 1)

However, professionals describe that some parents do not happily accept this responsibility, but that this might be explained by earlier experiences with youth care that deprived them from this role, and that many parents have lost their confidence in their parenting skills:

Some parents actually find it convenient that their children are here. Whether it’s because they don’t want to be parents, or simply because it’s too overwhelming for them to manage. You see, those reasons are of course varied, but in the residential groups, the care is simply taken over, whereas we don’t do that. (Respondent 2)

Professionals recognize that an essential part of their role is to remain positive while acknowledging the challenges families face. By putting these challenges into perspective, reassuring parents that they should not feel ashamed of their circumstances, and using humor to lighten difficult moments, professionals aim to help parents feeling more confident in their parenting and taking responsibility for their children:

And humor, you will also need that. […] Very much so. It helps to take the tension out of the room, to break it for a moment. To make things a bit lighter, because it’s often heavy and tense for a family. Using humor helps to ease that, so you can move forward again. (Respondent 3)

To fully give families autonomy, professionals describe that they have to distance themselves from their own judgments regarding the family’s situation or lifestyle. They often express this attitude with the rhetorical question “Who am I to judge?” to clarify their role and boundaries in working with families. Professionals emphasize that how they would raise their own children is not relevant; the goal is for parents to be able to care for their children effectively, so services must focus on what works for this family. Accordingly, rather than instructing parents what to do, professionals ask families how they can best be supported: ‘“We get a lot of feedback from parents that they do not associate us with youth care, because we ask different questions. We do not say what we think. No, we ask: ‘What do you want?’” (Respondent 4). Although professionals always have their own opinions on what would be best for the family, they focus on what the family wants and do not force their own ideas on them, because they perceive it as counterproductive. While this is not always easy, some professionals explicitly mention that this challenge is also what keeps their work interesting:

Sometimes you do think: Well, that mother could benefit from making some different choices in her life, for example, exercising more or doing trauma treatment. But they won’t really allow you to go there. So yes, the ‘‘disadvantage’’ is that they don’t always do what you want, of course. But that is actually also interesting and enjoyable in a way, and ultimately, the most important thing is that the family feels helped. (Respondent 5)

Professionals describe that changing their attitudes regarding parents, acknowledging their autonomy and having no judgments, was not particularly the problem when they started working in a family-centered program. None reported that they had trouble in adopting this attitude in terms of their beliefs regarding family involvement. However, professionals, especially those with many years of prior experience in residential youth care, described that they actively had to unlearn their tendency to default to a help reflex and take over from parents. According to the professionals, the most effective way to develop a family-centered attitude is through practice, by observing changes in parents and improvements in family wellbeing:

In residential care, you are very used to taking things over (…) And now it is very much about letting parents do the work themselves (…), really standing alongside parents instead of taking over for them. That did take, eh, a bit of an adjustment. (Respondent 6)

Theme 2: “Service Should Focus on the Whole Family and Context Around Youth”

The second major theme underscores the importance of the family system and the interaction patterns among its members in treatment. Professionals noted that focusing solely on the child was often like “carrying water to the sea,” whereas involving the whole family increases the likelihood of addressing underlying problems rather than merely treating symptoms. This perspective was a strong motivation for their work, as it enabled them to intervene in a way they considered more constructive and more just, recognizing that a child’s difficulties are often shaped by family dynamics rather than being their sole cause:

What I have noticed all this time is that when parents or caregivers change, in nine out of ten cases something also changes in the child’s behavior. In secure residential groups, I experienced that I thought: ‘‘Why is this child even living here?’’ Because within the stability of the group, with structure and clear rules, things actually went very well. (…) So, if you ask me what I became enthusiastic about, it is mainly the approach where not only the child is seen as the one to blame, but the entire system is recognized as having its part. (Respondent 7)

When professionals described their work with families, they outlined a recurring cycle of actions: observing, asking, listening, discussing, deciding, practicing, and repeating, which they applied consistently across different types of families. They emphasized the importance of these skills, noting that professionals must be able to identify behavioral patterns and dynamics and provide feedback that may at times be confronting, while still preserving the family’s agency and a constructive working alliance:

I would observe a situation and then ask all parties: ‘‘What made you do this? What made you say that? Were you aware of your tone of voice, how fast you were speaking, and what effect that had on the other person?’’ (…) Then I would work together with the family, often mainly with the parents, to come up with a plan: ‘‘How could you improve this?’’ Then I would let them try it out, observe again, and repeat the process. The idea is to keep practicing until it really takes hold. (Respondent 8)

Professionals noted that while each family has its own goals, their daily practice often centered on basic parenting support, such as creating family structure, managing rules and challenging behaviors, and strengthening family connections. To strengthen family connections and enhance parents’ insight into their child’s behaviors, professionals aimed to foster mutual understanding. By asking questions, they helped parents and youth explore the underlying reasons for their behavior and recognize negative interaction patterns. According to the professionals, this whole-family approach could also help youth feel less like a burden and less positioned as the primary problem:

Young people tend to think that they are the problem. (…) In family-centered work, we try to take that weight off them. It can mean telling young people: ‘‘You are not the problem child. It’s an interaction.’’ Because that’s what it is, and in family-centered care we look at that interaction within the whole family. (…) That is where systemic conversations come in, sitting down with the whole family.’’ (Respondent 9)

In addition to working with the family, professionals also sought to engage the family’s broader support network. They emphasized the importance of this step, as professional services are temporary and social networks can help sustain resilience after care ends. At the same time, they acknowledged significant challenges in mobilizing these networks. Families may feel ashamed to involve others, have few relatives or friends available, or rely on contacts who face difficulties of their own and are unable to provide adequate support. Moreover, given the large number of goals already prioritized in treatment, attention to strengthening social networks can be overlooked:

It is often grandparents or uncles and aunts who have been involved in a family’s life all along, and whom parents can call when they feel overwhelmed and need advice. It is better for them to call these relatives than us, because they have been part of their lives the whole time. So, we try to involve them as much as possible. At the same time, it can be difficult, since some families have only a very small or even no network, and certainly not one that is actively involved. (Respondent 3)

Theme 3: “Professionals Should Treat Families in Collaborative Partnership”

The third major theme concerns the working alliance professionals establish with families and emphasizes the value of grounding this alliance in equality. Professionals describe the relationship as both crucial and vulnerable, since families’ motivation and trust strongly influence the achievement of treatment goals: “I really think that contact is the key to ultimately building a working relationship, and that working relationship is the key to treatment” (Respondent 10). They note that families vary widely in their motivation. Some are eager to make the most of the opportunity, while others show resistance. Building trust, therefore, requires professionals to demonstrate genuine interest in the family, involve them in decision-making, and consistently follow through on commitments to prove their reliability:

It is really about taking the time. Trying not to judge, really listening, making parents feel truly heard, showing them: ‘‘We want to hear your side, we want to get to know your family.’’ Parents are often afraid because they know a whole file about them already exists, and they do not always agree with what is written there. So, it is important to show them: ‘‘We don’t know your family yet, teach us about it, explain why you do what you do.’’ That can be challenging, because some parents quickly feel judged (…) or because they have already had negative experiences. (…) But by keeping the contact accessible and informal, many parents eventually open up. (Respondent 10)

Professionals describe the observation week, with which the FamilyTotal program starts, as especially valuable. It allows them to get to know the family intensively from the outset and to observe their dynamics in daily life. This provides a clear picture of the family’s personalities, lifestyle, and challenges, while also showing families that they are genuinely seen and heard. At the end of the week, professionals and families jointly evaluate the observations and formulate goals together. This process helps to identify both strengths and weaknesses accurately and ensures that the goals reflect the family’s own priorities, reinforcing that the program is shaped around what matters most to them:

I think shared decision-making is a really strong element of the method, because it helps build parents’ trust. As you said, parents are often distrustful at first, but when they see that the focus is on what they want to work on, I feel they become more motivated to engage. I also find the family exploration week to be a valuable tool for making real contact with families and mapping out what is going on. It provides a clear picture of what happens within a family. (…) Although it is intensive, they [parents] ultimately find it useful and understand why it is part of the process. So, I would say those are really the two most important elements. (Respondent 11)

Professionals emphasize that, although their relationship with families is professional, they need to be authentic and genuinely open if they want families to be authentic and open as well. The ability to connect with diverse families while remaining true to oneself, and to build an alliance in which the professional can safely confront families with their behaviors and provide constructive feedback, is the competence most frequently highlighted by professionals. Most professionals express high self-confidence in both their personal approach and their capacity to engage families effectively.

I am good at making contact and empathizing. Sometimes my colleagues call on me when they get stuck with a youth, because I can connect well. I can create an atmosphere in a family where everything can be said, if they trust me. I am able to confront them, but I always do it in a kind way. (Respondent 4)

Theme 4: “Service Should Be Tailored to the Family’s Needs and Wishes”

The fourth major theme highlights the importance of tailoring services to families in order to engage families effectively in treatment. Professionals consistently describe their caseloads as diverse, whether in family composition, social class, or cultural background. Still, professionals emphasized that FamilyTotal can, in principle, be suitable for any family: “What I really appreciate about FamilyTotal is its diversity. I think it is a beautiful aspect of the program that, in principle, everyone is welcome.” (Respondent 7). They felt that all families could benefit from the program, but certain individual challenges, such as individual trauma or crises, can temporarily limit a family’s capacity to fully participate. In these cases, the timing of the intervention is not optimal, but according to the professionals, this does not mean that family-centered interventions would never be effective for that family:

Some parents have so many personal problems that they are not ready for this type of help. They really need to be in therapy themselves first before they can even start thinking beyond their immediate concerns, so to speak. That is one reason, but I still believe family-centered work is necessary. As soon as they are ready, we continue from there. (Respondent 12)

Professionals perceived a trend toward referrals involving more complex family situations. Some suggested that prolonged waiting periods allow problems to worsen before treatment begins, while others noted that referral practices increasingly aim to keep families together rather than placing children in residential care, which may have expanded the range of families receiving this hybrid (semi-)residential family-centered intervention:

This is partly due to the reduction of secure residential groups. They want to work more at home, so our target group is simply becoming more challenging, and we are seeing more complex families. (Respondent 11)

And by more complex I mean that there are many different problems involved. It is not just like: parents come in, they are open to learning, and their child has an occasional tantrum, and we help them. No, it is really that there are multiple underlying issues, with the parents, with the children, and often also mental health problems. (Respondent 10)

The diversity of families highlights the need for professionals to act flexibly in their daily practice. To truly accommodate the wide range of family needs and wishes, professionals must adapt their approach to the specific circumstances of each family. This adaptation often takes the form of trial and error, as professionals explore which types of communication or activities are most effective in motivating families to engage and initiate change. Flexibility also extends to the time and place of support, such as being available outside regular office hours if needed, for instance, during breakfast or bedtime:

You can offer something that helps parents to become engaged. That can be through play or activities, there are really parents who look forward to that. (…) So sometimes it is about figuring out: does it help to sit on the couch with a cup of tea and talk with each other? Or does it help more to do a fun activity together? So yes, in that sense you also need to be creative yourself. (Respondent 7)

The need for flexibility also highlights a key limitation: in practice, flexibility is not infinite. The FamilyTotal program’s fixed six-month duration constrains how much support professionals can tailor to each family. To address these limitations, the professionals emphasized expanding team expertise through training, such as developing specialists in high-conflict divorces, giftedness, or mild intellectual disabilities, and strengthening collaboration with other adult or youth mental health care organizations:

I think it is valuable for all families. Only sometimes there are really intense cases, for example when parents have serious relationship problems or are going through high-conflict divorces. That is still a bit challenging for us at the moment, because we are not yet trained for those situations, so it is hard to know the best way to handle them. But I believe it is ultimately feasible once we have the right expertise. (Respondent 2)

However, in cases of parental mild intellectual disability, professionals frequently questioned whether FamilyTotal could be sufficient. One professional referred to this as the “risk paradox,” where families with fewer capabilities face more complex problems and more ambitious, difficult-to-achieve goals. Six months was often insufficient to reach these goals, yet most professionals also doubted that simply extending the program would help, suggesting that a different approach might be needed:

You notice that, though this has more to do with the way we deliver treatment than with family-centered work itself, that we don’t really connect well with families with mild intellectual disabilities. We focus too much on insight, and even though we try to simplify things, they still don’t understand. (…) You realize: ‘‘Maybe we should have stopped earlier.’’ Not because the parents are unwilling, but because what we are doing is just too difficult. You have to spend much more time practicing things repeatedly, and for those families, even six months is too short, because it’s not about insight. They need repeated practice in all situations. (Respondent 12)

At the same time, professionals highlighted team diversity and support as a strength, emphasizing the value of consultation and reflective peer meetings with colleagues, particularly their co-caseworker and clinical supervisors:

And I also think that contact with colleagues is very important, that you can consult regularly or briefly ask for feedback like, “Did I do this right?” or “How do you see this?” So I think that’s really important. And, yeah, I also think having a supervisor you can turn to is very important, that you have the feeling of “oh, I can go to them if I run into something” or if there are problems. (Respondent 13)

The fact that professionals, just as families, differ in their backgrounds, capabilities, or preferences is viewed as an asset rather than a limitation:

When a family comes in with a complex support request, I know within my team: ‘‘Oh, that colleague would enjoy that challenge,’’ or ‘‘That one definitely would not.’’ Or ‘‘This person needs a calmer case,’’ or ‘‘a younger child,’’ or ‘‘rather the teenagers’’. (…) Some colleagues are really developing themselves as systemic practitioners, and others are developing in giving PEL [Experiential Learning]. So, you end up with these sub-teams within the larger team. And that works very well, because it creates possibilities. (Respondent 14)

Discussion

In this study we explored youth professionals’ experiences with family-centered practice (FCP) within the FamilyTotal (FT) program. Specifically, we analyzed professionals’ conceptualization of FCP, their translation of this conceptualization in daily practice, as well as the contextual factors shaping these practices, including their own skills, organizational support, and families’ responsiveness. Interviews with twenty professionals working in the FT program revealed a high degree of consensus among the participants regarding the conceptualization of FCP and the barriers and facilitators they encounter in their work. The results were organized into four major themes: (1) “Parents should parent”, (2) “Services should focus on the whole family and the broader context around youth” (3), “Professionals should work in collaborative partnership with families,” and (4) “Services should be tailored to the family’s needs and wishes.” Overall, participants expressed strong adherence to and appreciation of family-centered principles, as well as satisfaction with their work, but they also highlighted limitations in their practice.

Professionals’ Conceptualization and Strategies in Family-Centered Practice

Professionals’ conceptualization of FCP is reflected across the four major themes, and these themes together form a normative framework for how families should be treated in youth care. The first theme emphasizes parents’ rights and responsibilities in the care of their children, and implies that supporting parents means empowering them to carry out parenting tasks themselves, rather than exempting them from responsibility. The second theme highlights the importance of understanding families’ problems within their broader context and approaching family problems as joint challenges for all members. The third theme underscores the importance of family-staff alliances in providing care, emphasizing collaboration based on equal partnership and genuine connection. The fourth theme highlights the professional’s responsibility to tailor services to the family’s needs, requiring flexibility and input from multiple areas of expertise. Collectively, these principles reflect a redistribution of power between professionals and families, granting parents greater rights and responsibilities. Youth are no longer solely responsible for driving change and professionals face heightened expectations to adapt care to the family’s diverse needs. These reported changes in power and responsibilities are consistent with established theoretical perspectives on FCP (e.g., Allen & Petr, 1998; Dunst, 2002; Knorth et al., 1997) and align with the conceptual model of family-centeredness (Authors, 2024), which frames FCP as encompassing interventions that focus on the whole family, with both families and professionals acting as active agents in the care process.

The strategies professionals described for engaging families in care followed a sequential logic, whereby certain objectives needed to be achieved before others. Supporting families to work toward goals from intrinsic motivation required goals to be co-constructed through shared decision-making and aligned with families’ needs and preferences; however, such collaboration depended on the prior establishment of trust and a strong working alliance. Accordingly, professionals prioritize building this alliance first, allocating sufficient time to get to know the family before moving on to goal formulation and working on these goals. In describing goal-oriented work with parents and adolescents, professionals outlined a cyclical process that included observing families’ behaviors and using reflective listening, offering gentle confrontations (i.e., respectfully naming discrepancies between goals, intentions, and observed behaviors) within a safe relationship, and helping families identify approaches that fit their own ways of working toward their goals. These practices closely align with Motivational Interviewing techniques (Miller & Rollnick, 2013), which similarly focus on eliciting change through collaboration and autonomy support, instead of telling clients what to do. Overall, these findings suggest that professionals’ daily work involves an iterative, collaborative process that unfolds over time, in which observing, reflective listening, and feedback are embedded within a safe alliance that supports family autonomy.

Barriers and Facilitators in Family-Centered Practice

Professionals described a range of facilitators that supported FCP. A facilitator was the intense contact with families during the observation week, which allowed them to get to know the family, accelerate bonding, and identify dynamics and underlying issues that would have otherwise taken much longer to uncover. Compared to residential youth care groups, the overall contact hours between professionals and youth in FT were lower, which professionals noted alongside greater flexibility in scheduling visits and completing administrative tasks, and the absence of night shifts. This flexibility fostered a sense of autonomy, reflected in how professionals described their work: not in terms of obligations, but in terms of choices about what they would do to support families.

In addition to structural facilitators in FT, professionals highlighted the importance of professionals’ personal qualities. They emphasized a strong sense of professional self-efficacy, particularly in establishing connections with families, and noted that effective FCP relies on interpersonal skills to recognize family dynamics, build relationships, and coach families toward meaningful change. Professionals also stressed the role of intrapersonal skills, such as self-awareness and reflective practice, which allow professionals to continuously adapt their approach to the family’s evolving needs. Learning FCP was described as an ongoing process, strongly supported by an open atmosphere among colleagues that encouraged asking for help, as well as by on-the-job coaching. Similar to studies in other child welfare settings (e.g., Dunkerley et al., 2021; Goodyear et al., 2017; Lietz & Rounds, 2009; Mytton et al., 2013), professionals highlighted the importance of supervision and training to enhance their competence in FCP. In particular, supervision with a co-caseworker or other team members was experienced as a crucial component for improving skills.

Unlike previous studies (Allen & Petr, 1998; Holt & Kelly, 2018; Horwitz & Marshall, 2015), professionals did not report negative attitudes about FCP as a barrier. However, they frequently noted that their practice could be constrained by prior work experience, as they were accustomed to stepping in and taking over tasks to relieve parents. This tendency to fix clients’ problems or correct their behaviors is similarly described by Miller and Rollnick (2013) as the “righting reflex.”

In addition, professionals experienced barriers in tailoring their services to fully meet a family’s needs. Flexibility was constrained by structural factors, such as contact hours and service duration, as well as by professionals’ expertise in specific problem areas. While limitations could often be offset by co-caseworkers or team members with specialized skills, some family issues, particularly severe parental trauma or mild intellectual disabilities, made participation in systemic interventions challenging. Parental emotional or cognitive challenges could limit families’ willingness or capacity to engage in FT activities, and due to the program’s emphasis on gaining insight into one’s own and the family’s behavioral patterns as a basis for change, these families might not fully benefit from FT.

Similarly to other family-centered interventions (Visscher et al., 2020; Zeinstra et al., 2025), professionals reported that while working with the family system was standard practice, involvement of families’ extended networks was often not realized in practice. They experienced multiple barriers, including family resistance, unstable networks, and the prioritization of other treatment goals, which displaced time and attention from working with the families’ networks.

Study Limitations and Recommendations for Policy and Research

This study has some limitations that should be considered. We collected data solely through qualitative interviews with professionals working in the FT intervention. While in-depth interviews provide rich insights into professionals’ experiences and reasoning, they rely on self-report and may be influenced by social desirability. Furthermore, because the sample was limited to caseworkers and clinical supervisors, other staff members may have offered different perspectives on factors that hinder or promote FCP. Professionals’ experiences with FCP were largely positive. Although families were often demanding and their behaviors could pose substantial barriers, professionals maintained strong family-centered attitudes and described these challenges as rewarding and stimulating. While multiple facilitators contributing to professional satisfaction were identified, this positive view may partly reflect a self-selection effect: professionals who choose to work in FT are likely those who value family-centered approaches and are motivated by complex and challenging work. Lastly, although information was gathered on professionals’ experiences with families and perceived changes in wellbeing and behavior, youth and caregivers were not included in the sample. Thus, the findings reflect only professionals’ perspectives and may not fully represent families’ lived experiences.

The key strength of the current study lies in its in-depth qualitative examination of professionals directly responsible for implementing family-centered practice within a well-defined program context. By interviewing caseworkers and clinical supervisors across two FT program locations, the study captured rich, practice-based insights into the relational and organizational processes that shape family-centered work with highly vulnerable families. This focus enabled the identification of concrete strategies and implementation conditions that are directly relevant to professional practice and program development. Although FT is currently implemented at only two sites in the Netherlands, the findings highlight key conditions that may inform the broader rollout of family-centered approaches in (semi-)residential youth care. In addition, this study offers insights for future research hypotheses.

Based on the current findings, we recommend that youth care organizations allocate sufficient, dedicated time for contact between families and professionals in family-centered programs. The FT intervention is currently only available at one youth care organization in the Netherlands, and to our knowledge, practices such as an observation week are not common in other Dutch interventions or youth care services. However, the observation week may be a key element of FT to accelerate engagement and the assessment of family dynamics.

We also recommend that youth care organizations provide ongoing opportunities for professionals to develop both interpersonal and intrapersonal skills, such as reflective practice and alliance-building, and ensure sufficient support from co-caseworkers and multidisciplinary teams. In addition, we recommend that organizations facilitate professionals’ flexibility in providing tailored services, as our findings, in line with Bartelink et al. (2026), suggest that this may enhance their work motivation by allowing for greater autonomy.

Future research should continue to include professionals to better understand what works in FCP and why. Qualitative studies across diverse programs, organizational contexts, and professional roles could clarify how FCP is implemented and identify factors that promote or hinder its success, as well as which elements may generalize across settings. In addition, as studies have suggested that reported actions may differ from observed practice (Brookman-Frazee et al., 2021; Wang et al., 2023), future research on FCP in daily practice could therefore incorporate additional methods, such as direct observation of professional practice to help capture actual behaviors and complement self-reported data.

In addition, future research should include families’ perspectives to provide a more comprehensive understanding of FCP, including what works, for whom, and under which circumstances it may be less effective. Building on the current findings, studies could examine how professionals’ sense of autonomy and families’ experienced flexibility relate to treatment satisfaction and outcomes, as well as how families’ perceived power and autonomy are associated with family – staff alliance and treatment outcomes. Future studies are needed to test the effectiveness of FT using SCED or quasi-experimental designs, building on the insights and hypotheses generated by the current qualitative work.

Conclusion

Taken together, our findings suggest that in (semi)residential youth care, family-centered practice in the FamilyTotal program plays a role in how care processes unfold, particularly by shaping engagement, fostering collaborative alliances, and redistributing responsibility between professionals and families. Our findings underscore that family-centered practice is not merely a set of principles, but a dynamic process that may facilitate meaningful engagement and change when professionals are equipped with both relational and reflective skills, supported by appropriate organizational structures, and able to work collaboratively with families as active agents in care. Ultimately, family-centered practice appears to be strengthened when both professionals and families are empowered with autonomy, supported by structures that enable collaboration, trust, and shared ownership of care.