Taking a strengths-based approach to developmental disability: the F-words for child development

“When challenges exist, children and families may benefit from supports that are tailored to their individual strengths and support needs, irrespective of whether or not a child has one or more diagnosed condition(s).”¹

Strengths-based and client-centred approaches in the field of childhood disability have been proposed in healthcare for decades, but in many places in the world, our service structures and therapeutic endeavours still are directed at fixing/compensating deficits in a prescriptive way. In the field of child developmental (disability) services, we have recently seen the publication of Canadian and Australian policies and frameworks that explicitly endorse this strengths-based approach, recommending in particular the use of the F-words for Child Development first published by CanChild scientists Peter Rosenbaum and Jan Willem Gorter in 2012.² This commentary reflects on how strength-based approaches and client-centred care, developed over the last 50 years, have culminated in a paradigm shift in how we define and promote ‘health’.

In the 1980s, Charles Rapp and Ronna Chamberlain wanted to counteract what they called the ‘Damage Model’ with an approach that consisted of identifying—collaboratively with patients—what their strengths and their individual goals might be—a ‘Strengths Model’.³ With other colleagues, they brought this idea to life by describing six fundamental principles:

1. Goal orientation, allowing clients to set and pursue personally meaningful goals.

2. Systematic assessment of strengths, requiring practitioners to map existing assets across different life domains.

3. Resource-rich environment, where community and relationships are seen as the primary sources of opportunity and support for the patient.

4. Explicit use of strengths, anchoring tasks and plans on the identified strengths. This approach fosters a sense of connection and support, enabling the patient to feel part of a larger network.

5. Hope-inducing relationships, the alliance between the helper, therapist, clinician and the client/patient should actively foster optimism, self-efficacy and expand their possibilities.

6. Meaningful choice, so that clients or patients keep the authority over their goals, the pace in which they aim to achieve these goals, and the selection of the strategies and resources they will use.

The strengths model can be seen as an operationalisation of an earlier concept of ‘client-centredness’ as described by Carl Rogers in the 1950s and 1960s.⁴ Client-centred approaches in child health became known as ‘family-centred’ as children are always seen in the company of family members.⁵ Family-centred services are characterised by the following principles:

1. Each family is unique.

2. The family is the constant in the child’s life.

3. Family members are the experts of the child’s abilities and needs.

4. The family works with service providers to make informed decisions about the services and supports the child and family receive.

5. The strengths and needs of all family members are considered.

The focus on strengths and the client were uncommon approaches for healthcare providers. In the 1970s, George Engel described the limitations of the traditional medical model in the following way: “Thus, while the physician’s obligation to any patient is to establish the clinical diagnosis (es), this is not an end in itself but is the physician’s way of indicating those aspects of the patient’s illness which he knows and is able to identify according to experience and convention. Such diagnostic terms do not include other important aspects or other important knowledge about the patient, nor do they exclude other diagnostic categories or even other phenomena which have not yet been categorized in diagnostic terms.”⁶ This understanding led Engel to the proposition of the biopsychosocial model, integrating the medical and social model into one holistic view of health.⁷ It would take another 30 years until that type of thinking began to be adopted more broadly and informed the creation of the WHO’s International Classification of Functioning, Disability and Health (ICF) framework in 2001.⁸ Despite the benefits of the holistic perspective provided by the biopsychosocial model and the substantial evidence accumulated over the last decades of its usefulness in explaining a wide range of health conditions, the scientific discourse often persists in a debate of medical vs social models of health.⁹

The ICF allows to describe a person in their context, expanding beyond the biomedical domains such as body functions and structures by adding descriptions of their activities and participation and how environmental factors may act as barriers or facilitators, considering the unique personal characteristics of everyone.¹⁰ As the wording of the categories of the ICF is neutral, it makes it possible to describe both strengths and weaknesses (impairments, limitations and restrictions). Such a detailed understanding of health requires health professionals to engage more directly and intensely with the patient/family (ie, be family-centred) and allows them to focus on their strengths (ie, a strengths-based approach).

How can we apply the principles of being family-centred and strengths-based to the provision of care of children living with disabilities and their families? We need a language that is accessible to the children and their families; a mindset that allows them to sit in the driver’s seat; and services that promote their participation in the domains of life they consider meaningful and important. Obviously, we also need health professionals who define health and their role within this modern biopsychosocial model of health.

In 2012, Rosenbaum & Gorter proposed what they called ‘The F-words for Childhood Disability’, later renamed to as ‘The F-words for Child Development’ to make the concepts of the ICF accessible and easy to convey to families, patients and clinicians (Figure 1).² The F-words (also referred to by some as ‘My Favourite Words’) are Functioning, Family, Fitness, Fun, Friends and Future. These words are loosely matched to the domains of the ICF and meant as a cheeky effort to bring to life (and help people remember and use) the WHO’s ICF framework for health. Using the F-words framework in gathering information about a child and their context allows everyone to do exactly what Rapp and colleagues had envisioned with the strengths model: Families and children can describe their unique and personally meaningful goals, they are able to identify their own strengths and those in their environment, they can make choices about what to prioritise, and have a perspective and hope for the future. The difference of such an approach to traditional ‘inquiry’ about the psychosocial elements of ‘taking’ a history is that the use of a more accessible language (even to children) allows a different type of interaction that respects the autonomy of the patient and family, allowing them to drive a conversation by ‘giving/sharing their history’ instead of being asked a number of questions, sometimes executed by poorly trained professionals in an interrogative fashion. To better prepare health professionals to assume a collaborative role when engaging with children and families, changes to the health curriculum by embedding the ICF into the teaching have been proposed.¹¹ An example of how this approach is valued by parents is the large number of tools that have been codeveloped by parents and caregivers to facilitate the communication about the goals and needs of the families and their children.¹² More recently, the concept of the ‘F-words lens’ was published.^{13 14} It offers a way of identifying the best ‘ingredients’ for therapies that match the goals identified by the child and their family, always with the main purpose of improving their participation in their chosen activities. By doing so, clinicians are free to integrate their specific therapeutic techniques and treatments within everyday activities that are common realities in the lives of the children and families they are supporting. This is a major paradigm shift away from traditional prescriptive therapeutic ‘methods’ in developmental interventions. The F-words allow everyone to have a collaborative and meaningful approach that envisions interventions, not as means to fix or heal, but as a path to empower for participation. The organisers of the 38th Annual Conference of the European Academy for Childhood-Onset Disability scheduled for 2026 present their programme with the following words: “This year’s conference embraces a strengths-based approach to childhood disability, rooted in respect, empowerment, and opportunity. We are proud to announce that conference tracks will align with the internationally recognised ‘F-words for Child Development’, offering a holistic lens through which to support children and young people with disabilities, and their families.”¹⁵ A testament that the strengths-based approach has become mainstream in childhood-onset disability work.

Figure 1. The ICF framework and the F-words. ICF, International Classification of Functioning, Disability and Health.