*3.3. Relinquishing Control to Families*

A central tenet of the RBM is that families make meaningful decisions [2]. For example, they decide on the functional needs of (goals for) the child and family, they decide on what to work on between visits, and they decide on what to focus on, in each visit. For many international implementers (and American implementers), giving families this amount of control is unusual and therefore uncomfortable. The medical or psychological model, which is common across the globe, places much control in the professional's hands.

In Singapore, a cultural challenge is that many middle-class families have a "foreign domestic helper" in the home. This young woman from Indonesia or Malaysia might care for the child for 8–14 h a day, yet she has little decision-making power. The parents participate in the needs assessment (i.e., the RBI), yet they might know little about their child's functioning in everyday routines. Furthermore, the domestic helper would be the person caring for the child, yet she has little say in the needs or the goals. The RBM has been described as a paradigm shift in disability services in Singapore, which, before the model, had adopted the special-education and medical-therapeutic approach. The model challenges teachers and therapists to listen reflectively and to use motivational interviewing techniques. It also challenges social workers in early intervention services to improve their child development knowledge and collaborate effectively as a team with therapists and teachers. In Singapore, social workers play a prominent role, as in Europe psychologists do. In the U.S., these disciplines are less frequently represented in early intervention programs.

In Taiwan, families and professionals alike are used to professionals giving suggestions, especially on the first visit, such as a visit to the doctor. Furthermore, the time it takes to conduct an RBI is considered a barrier in Taiwan, as it is elsewhere. In some situations, professionals (and families) think professionals should provide suggestions on the first visit: in the RBM, we do not provide suggestions during the RBI or until the family has chosen goals. Recently, the Taiwan government and early intervention professionals have promoted family-centered approaches and the ECM [40].

In Paraguay, the biggest challenges have been (a) abandoning a clinical approach and moving to a family-centered approach (including a flattening of the hierarchy between professional and family) and (b) broadening professionals' scope beyond their formal training. In many countries outside the U.S., both professionals and families expect the former to tell the latter what to do.
