**4. Discussion**

ed that the protocol is not useful because it is binding and parents who are not educated cannot understand it. Some mental health professionals said that the protocol should clarify how much time mental health professionals should devote to parents, what happens when parents do not follow the protocol, and for which third parties mental health professionals should get the consent of the parents before they disclose information about their children.

The most important points of the partnership protocol were: the negotiation of the bounda‐ ries of the relationship between parents and mental health professionals, the clarification of the roles of both sides, and the emphasis placed on active parental involvement in their child's therapy. Mental health professionals referred to the protocol every time there was a disagreement with parents. The changes that mental health professionals observed in their relationship with parents after the implementation of the protocol were: parental expecta‐ tions became more relevant to the child's condition (93%); parents realized that the whole family should be part of the therapy (80%); initial tensions were normalized (75%); parents felt that their expectations and emotions were taken into account (65%); parents were more committed to the therapy (58%); parents were more open to new suggestions and treatments

*3.2.3. The attitudes of mental health professionals towards parents of children with autism spectrum*

Analysis with MANOVA revealed that there was a statistically significant change in four out of the five subscales that measured the attitudes of mental health professionals towards the parents of children with autism spectrum disorders, even after being controlled for age, gender, and years of professional experience. More specifically, there were statistically sig‐

forming parents (*F(1, 39)* = 5.03, *p* < 0.05, *η<sup>2</sup>* = 0.11); recognition of parental status (*F(1, 39)* = 4.83, *p*

was no statistically significant difference in the attitudes that mental health professionals ex‐

Parental incrimination 26.69 (3.54) 22.24 (3.44) 5.56\* Necessity of informing parents 14.15 (3.24) 17.93 (2.74) 5.03\* Recognition of parental status 14.06 (2.52) 19 (2.04) 4.83\* Attitudes towards drug use 6.11 (2.18) 8.41 (1.54) 0.96 Providing guidance to parents 3.25 (1.07) 8.17 (2.34) 5.35\*

**Table 5.** Means and Standard Deviations of the Attitudes of Mental Health Professionals Towards Parents of Children

pressed towards drug use before and after the intervention (*F(1, 39)* = 0.96, *p* > 0.05, *η<sup>2</sup>*

= 0.10); and providing guidance to parents (*F(1, 39)* = 5.35, *p* < 0.05, *η<sup>2</sup>* = 0.12). There

**Baseline Post-intervention**

**Μ (SD) Μ (SD)** *F*

= 0.12); necessity of in‐

= 002).

for their child (35%); parents made less calls of hypothetical crises (23%).

542 Recent Advances in Autism Spectrum Disorders - Volume I

nificant changes in parental incrimination (*F(1, 39)* = 5.56, *p* < 0.05, *η<sup>2</sup>*

Means and standard deviations are presented in Table 5.

with Autism Spectrum Disorders Before and After the Intervention

*disorders*

< 0.05, *η<sup>2</sup>*

\* ρ < 0.05

The research hypotheses were confirmed, since both parents of children with autism spec‐ trum disorders and mental health professionals expressed more positive attitudes about each other after the implementation of the partnership protocol. Most participants felt that the partnership protocol was particularly useful and they also identified some points that could be further clarified, while they also pointed out the exact nature of the changes that they have observed in their interactions.

#### **4.1. The attitudes of parents of children with autism spectrum disorders towards mental health professionals**

Most parents of children with autism spectrum disorders believed from the beginning that it was imperative to work together with mental health professionals in order to enhance their child's progress, while the rest believed that their child's progress was predetermined and there was nothing they could do to change that. Parents define a cooperative relationship as a relationship that is characterized by honesty, mutual briefing, mutual trust, and setting common goals [27]. The information that parents receive from mental health professionals is more important to them than sympathy or psychological support [144-145].

Parents describe cooperative mental health professionals as constant providers of update regarding their child's progress, consistent, honest, understanding, willing to help, and aware that parents possess certain skills. So, the parents in this study have identified es‐ sentially the defining characteristics of cooperative relationships [77]. Parents cannot co‐ operate with mental health professionals who do not brief them, are inconsistent and insincere, ignore them, withhold information and are not well trained – in agreement with other research [24, 28, 117].

The implementation of the partnership protocol helped the parents of children with autism spectrum disorders to redefine their cooperative relationship with mental health professio‐ nals. They learned to function as therapists at home, facilitating thus the therapeutic process [25-26]. They received emotional support from mental health professionals and they set a time frame for some therapeutic goals, which could help them feel less stressed [146]. Most parents reported that after the intervention mental health professionals treated them as more equals, briefed them about their child's progress, engaged them more actively in the therapeutic process, and took their feelings and opinions into consideration. This change may be due to the fact that a trusting relationship was created through the protocol, which helped the parents express themselves more freely and become more assertive. Trust is im‐ perative for the creation of a constructive cooperative relationship between mental health professionals and parents of children with disabilities [104]. Many parents actively seek to create this bond of trust, since they feel that it will benefit their child [11, 117].

An additional change that was reported by the parents of children with autism spectrum disorders was that the mental health professionals started briefing them more about the ways in which the proposed therapy will help their child and encouraged them to get ac‐ tively involved in decision-making regarding their child's treatment. Active participation in their child's therapy can help parents develop a sense of efficacy and personal control that can help them become even more effective parents [87] and less stressed and concerned [147]. When parents feel heard and respected, then they can cooperate better with mental health professionals to do what is best for their child and this is something that mental health professionals should aim at [66].

their training and by the «social representations» that they hold about parents of children

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Almost all the mental health professionals believed that their cooperation with the parents of children with autism spectrum disorders was essential to the successful course of the therapy [86, 128], since they bring their own knowledge and experience into the therapeutic process [29]. Therefore, they claimed that in order to ensure this cooperation they try to earn parental trust and to make them feel comfortable, while taking into account their needs and wishes. By briefing parents about their child's progress, they engage them more actively in decision-making regarding the treatment course [93]. However, it is worth mentioning that at the beginning of the study parents complained that mental health professionals do not try enough to cooperate with them. This could be due to a wider communication problem that has been documented also in other studies, since good intentions alone are not enough to establish cooperation [86, 94]. Finally, mental health professionals claimed that they tried to increase their knowledge through training in order to be able to better deal with the prob‐ lems of children with autism spectrum disorders. This needs to be done if mental health pro‐ fessionals are to design an intervention that is based on the child's needs and skills and is

Mental health professionals define cooperation as a relationship that is characterized by ex‐ change of views about the child, shared decision-making, mutual trust and respect, desire to resolve disagreement, frequent contact and discussion on equal terms (there is no expert) [15, 59, 89, 93]. This definition that they provided includes some of the key characteristics of

Parents should provide accurate information about their child that is essential for the es‐ tablishment of a cooperative relationship with mental health professionals [77]. Other‐ wise, mental health professionals have to waste a lot of valuable time and resources to find out what they need to design an effective intervention [1]. Parents who are unaware of their child's actual condition may place irrational demands on both their child and mental health professionals and fail to keep agreements and deadlines, jeopardizing their child's progress [111]. Finally, there are some parents who question the training of men‐ tal health professionals and their suitability to work with their child, but may continue to cooperate because they have no other options or because they believe they can moti‐

Mental health professionals noted that after the implementation of the partnership protocol parents started to have more realistic expectations that made them realize the importance of engaging the whole family in the therapeutic process [54]. Parents understood that they have to follow the advice of mental health professionals to help their children and became more open to new treatment suggestions [104]. These behaviors are indicative of greater trust for the mental health professionals, who need initially to recognize the shock that pa‐ rents experience [17] and to help them reach the stage of full acceptance [16]. Parents also seemed to have responded positively to the efforts made by mental health professionals to take their feelings and views into account when designing the intervention [75]. Finally, mental health professionals reported that the parents were better able to judge when they

with autism spectrum disorders [152], as well as by cultural and social factors [18].

more likely to be successful [49].

the negotiation model [40].

vate the mental health professional [11, 99].

#### **4.2. The attitudes of mental health professionals towards parents of children with autism spectrum disorders**

Mental health professionals tended to incriminate parents of children with autism spectrum disorders less after the implementation of the protocol. This is very important, since it af‐ fects greatly the choice of suggested therapies and strategies that mental health professio‐ nals employ when interacting with the parents of children with autism spectrum disorders [67]. Since parents of children with autism spectrum disorders have been repeatedly blamed for the problems that their children face [148], the partnership protocol encourages the crea‐ tion of a relationship that frees parents from guilt and treats them as equal partners. After the implementation of the partnership protocol, mental health professionals realized that it is essential to inform parents about their child's condition and the course of the therapy. The needs of all family members are taken into consideration [50] and, therefore, frictions are de‐ creased [3, 11, 99]. So, it is possible to create a strong cooperative relationship that can bene‐ fit both parties [40, 47], while children with autism spectrum disorders can also benefit from parental empowerment [149].

The mental health professionals who adopted the protocol said that they recognized more the validity of parental knowledge and information regarding their child with autism spec‐ trum disorders. This change is very positive, since parents of children with autism spectrum disorders know a lot of things about their children that are useful when planning the appro‐ priate intervention [61]. The acknowledgement of the usefulness of parental knowledge by mental health professionals is essential to the cooperative process [60] and is, thus, empha‐ sized in the partnership protocol.

Moreover, mental health professionals understood that they need to provide more clear and more detailed information to parents about the management and upbringing of their chil‐ dren with autism spectrum disorders. The partnership protocol stressed that parents can be trained to satisfy the needs that arise from their parenting role and this is instrumental for various therapeutic approaches [16]. Parents who receive specific guidance on how to deal with challenging and unwanted behaviors believe that they can control them better [150] and so they feel less stressed [146]. However, it is worth pointing out that some parents can‐ not or do not want to fulfill their instructional role [151] and this is something that mental health professionals should respect.

The statistical analysis revealed that the perceptions that mental health professionals hold about the parents of children with autism spectrum disorders were not affected by their age, gender, or years of professional experience. Therefore, it is likely that they are affected by their training and by the «social representations» that they hold about parents of children with autism spectrum disorders [152], as well as by cultural and social factors [18].

tively involved in decision-making regarding their child's treatment. Active participation in their child's therapy can help parents develop a sense of efficacy and personal control that can help them become even more effective parents [87] and less stressed and concerned [147]. When parents feel heard and respected, then they can cooperate better with mental health professionals to do what is best for their child and this is something that mental

**4.2. The attitudes of mental health professionals towards parents of children with autism**

Mental health professionals tended to incriminate parents of children with autism spectrum disorders less after the implementation of the protocol. This is very important, since it af‐ fects greatly the choice of suggested therapies and strategies that mental health professio‐ nals employ when interacting with the parents of children with autism spectrum disorders [67]. Since parents of children with autism spectrum disorders have been repeatedly blamed for the problems that their children face [148], the partnership protocol encourages the crea‐ tion of a relationship that frees parents from guilt and treats them as equal partners. After the implementation of the partnership protocol, mental health professionals realized that it is essential to inform parents about their child's condition and the course of the therapy. The needs of all family members are taken into consideration [50] and, therefore, frictions are de‐ creased [3, 11, 99]. So, it is possible to create a strong cooperative relationship that can bene‐ fit both parties [40, 47], while children with autism spectrum disorders can also benefit from

The mental health professionals who adopted the protocol said that they recognized more the validity of parental knowledge and information regarding their child with autism spec‐ trum disorders. This change is very positive, since parents of children with autism spectrum disorders know a lot of things about their children that are useful when planning the appro‐ priate intervention [61]. The acknowledgement of the usefulness of parental knowledge by mental health professionals is essential to the cooperative process [60] and is, thus, empha‐

Moreover, mental health professionals understood that they need to provide more clear and more detailed information to parents about the management and upbringing of their chil‐ dren with autism spectrum disorders. The partnership protocol stressed that parents can be trained to satisfy the needs that arise from their parenting role and this is instrumental for various therapeutic approaches [16]. Parents who receive specific guidance on how to deal with challenging and unwanted behaviors believe that they can control them better [150] and so they feel less stressed [146]. However, it is worth pointing out that some parents can‐ not or do not want to fulfill their instructional role [151] and this is something that mental

The statistical analysis revealed that the perceptions that mental health professionals hold about the parents of children with autism spectrum disorders were not affected by their age, gender, or years of professional experience. Therefore, it is likely that they are affected by

health professionals should aim at [66].

544 Recent Advances in Autism Spectrum Disorders - Volume I

**spectrum disorders**

parental empowerment [149].

sized in the partnership protocol.

health professionals should respect.

Almost all the mental health professionals believed that their cooperation with the parents of children with autism spectrum disorders was essential to the successful course of the therapy [86, 128], since they bring their own knowledge and experience into the therapeutic process [29]. Therefore, they claimed that in order to ensure this cooperation they try to earn parental trust and to make them feel comfortable, while taking into account their needs and wishes. By briefing parents about their child's progress, they engage them more actively in decision-making regarding the treatment course [93]. However, it is worth mentioning that at the beginning of the study parents complained that mental health professionals do not try enough to cooperate with them. This could be due to a wider communication problem that has been documented also in other studies, since good intentions alone are not enough to establish cooperation [86, 94]. Finally, mental health professionals claimed that they tried to increase their knowledge through training in order to be able to better deal with the prob‐ lems of children with autism spectrum disorders. This needs to be done if mental health pro‐ fessionals are to design an intervention that is based on the child's needs and skills and is more likely to be successful [49].

Mental health professionals define cooperation as a relationship that is characterized by ex‐ change of views about the child, shared decision-making, mutual trust and respect, desire to resolve disagreement, frequent contact and discussion on equal terms (there is no expert) [15, 59, 89, 93]. This definition that they provided includes some of the key characteristics of the negotiation model [40].

Parents should provide accurate information about their child that is essential for the es‐ tablishment of a cooperative relationship with mental health professionals [77]. Other‐ wise, mental health professionals have to waste a lot of valuable time and resources to find out what they need to design an effective intervention [1]. Parents who are unaware of their child's actual condition may place irrational demands on both their child and mental health professionals and fail to keep agreements and deadlines, jeopardizing their child's progress [111]. Finally, there are some parents who question the training of men‐ tal health professionals and their suitability to work with their child, but may continue to cooperate because they have no other options or because they believe they can moti‐ vate the mental health professional [11, 99].

Mental health professionals noted that after the implementation of the partnership protocol parents started to have more realistic expectations that made them realize the importance of engaging the whole family in the therapeutic process [54]. Parents understood that they have to follow the advice of mental health professionals to help their children and became more open to new treatment suggestions [104]. These behaviors are indicative of greater trust for the mental health professionals, who need initially to recognize the shock that pa‐ rents experience [17] and to help them reach the stage of full acceptance [16]. Parents also seemed to have responded positively to the efforts made by mental health professionals to take their feelings and views into account when designing the intervention [75]. Finally, mental health professionals reported that the parents were better able to judge when they needed to communicate in order to resolve an actual crisis, probably as a result of their ac‐ tive therapeutic engagement [98].

or financial restraints [99]. The second clarification is indicative of feelings of inferiority or intimidation. This partnership protocol has no legal power and it is not a contract with legal ratifications. The whole point of the protocol is to introduce parents to the concept that they can discuss any conflict or disagreement with mental health professionals on equal terms. Mental health professionals also wanted to know what will happen in case that parents of children with autism spectrum disorders do not follow the protocol. This is something that should be discussed and agreed upon from the beginning between the two parties. Most dis‐ agreements are peacefully resolved, while very few have ended up in court [3]. Moreover, it is important that some mental health professionals realize that some parents will not want to cooperate with them [76]. The second question was how much time mental health profes‐ sionals should spend with parents of children with autism spectrum disorders and this is

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The most important positive outcomes of the partnership protocol are: ensured cooperation, honest relationships, understanding of parental limitations, parental participation in deci‐ sion-making, and recognition of parental needs and emotions. It seems that what parents really need is to feel like equal partners in the therapeutic process and this is something that the partnership protocol offers. Parents who are involved in decision-making about their child and are supported by mental health professionals feel happier [2, 33, 154]. The most important positive outcomes of the partnership protocol are: the negotiation of the bounda‐ ries of the relationship between parents and mental health professionals, the clarification of the roles of both sides, and the emphasis placed on active parental involvement in their child's therapy. Mental health professionals need to define their relationships with parents

The aim of this study was to create a partnership protocol to delineate the relationship between parents of children with autism spectrum disorders and mental health professionals with the ultimate goal to improve the child's condition [84]. The need for this protocol derived from per‐ sonal experience and from meticulous literature search [16, 105]. Although the findings were positive and encouraging, there are some limitations that should be taken into consideration:

**1.** The mental health professionals were working in the private sector and so they might be more willing to follow the protocol in order to keep their clients – things could be

**2.** The mental health professionals who agreed to participate in the study might have been the ones who work better with parents, and the parents who participated might have been the ones who were happy with mental health professionals to begin with. Howev‐ er, analysis showed that all the participants identified some problems at baseline. **3.** Some confounding variables, such as the training of mental health professionals or the educational level of the parents were not taken into consideration when analyzing the findings. For example, it was found that single mothers of children with autism spec‐

trum disorders experience more stress than married mothers [14].

again to be negotiated between them from the beginning.

as much as parents do [28, 77-78] and they use the protocol to do so.

different if they worked in a public setting.

**4.4. Limitations**

#### **4.3. Evaluation of the partnership protocol**

Most parents of children with autism spectrum disorders and mental health professionals who used the partnership protocol said that it was useful, because: a) it clarifies the relation‐ ship between the two parties; b) it defines the roles of both parties; c) it promotes effective cooperation; d) it advances negotiation; and e) it values mutual respect. All these elements were rated by many studies [28, 101, 103] as essential for the creation of a functional and effective cooperative relationship among parents and mental health professionals. It is ex‐ tremely important to point out that both parents and mental health professionals recognize similar benefits from the implementation of the protocol, corroborating the finding that the needs of parents and mental health professionals are closer that one would think, but they need to be clearly defined in order to be satisfied [100].

The parents of children with autism spectrum disorders reported that the partnership proto‐ col informs them of their rights and helps them fight for provisions and services. Parental participation is instrumental in reassuring the existence of options for adults with autism spectrum disorders [153]. Parents become empowered [39, 86] and thus able to negotiate with mental health professionals [40]. Mental health professionals said that they could use this protocol to resolve conflicts or disagreements with parents. This is important, since some mental health professionals do not know how to resolve interpersonal conflicts [3] and they become increasingly stressed [147].

The four parents who thought that the partnership protocol is not useful justified their opin‐ ion by saying that it is binding and difficult to adhere to. It is a fact that the implementation of a protocol or any form of agreement requires commitment from all involved parties. Therefore, it is likely that some parents of children with autism spectrum disorders are ex‐ hausted from the constant care of a child with multiple and complex needs and do not pos‐ sess the required strength to enter this process [146]. Moreover, it is plausible that some parents prefer to hold a more distant role from the therapeutic process [54]. The eight men‐ tal health professionals who considered the partnership protocol not to be that useful thought as well that it is binding and that parents who are not educated cannot understand it. It seems that they do not want to be committed to a predetermined cooperative relation‐ ship with the parents because they have adopted the expert model. Even if some parents are not educated or able to understand some points, it is the role of mental health professionals to explain everything to them in simple and understandable language [56].

Approximately 20% of the parents of children with autism spectrum disorders identified two things that needed further clarification in the partnership protocol: a) which qualifica‐ tions mental health professionals should hold in order to work with children with autism spectrum disorders and b) what parents can do if mental health professionals do not follow the protocol. The first point partly reflects the insecurity that results from insufficient brief‐ ing regarding the options that parents have to choose the suitable mental health professional after the diagnosis [55]. They could also result from limited options due to place of residence or financial restraints [99]. The second clarification is indicative of feelings of inferiority or intimidation. This partnership protocol has no legal power and it is not a contract with legal ratifications. The whole point of the protocol is to introduce parents to the concept that they can discuss any conflict or disagreement with mental health professionals on equal terms.

Mental health professionals also wanted to know what will happen in case that parents of children with autism spectrum disorders do not follow the protocol. This is something that should be discussed and agreed upon from the beginning between the two parties. Most dis‐ agreements are peacefully resolved, while very few have ended up in court [3]. Moreover, it is important that some mental health professionals realize that some parents will not want to cooperate with them [76]. The second question was how much time mental health profes‐ sionals should spend with parents of children with autism spectrum disorders and this is again to be negotiated between them from the beginning.

The most important positive outcomes of the partnership protocol are: ensured cooperation, honest relationships, understanding of parental limitations, parental participation in deci‐ sion-making, and recognition of parental needs and emotions. It seems that what parents really need is to feel like equal partners in the therapeutic process and this is something that the partnership protocol offers. Parents who are involved in decision-making about their child and are supported by mental health professionals feel happier [2, 33, 154]. The most important positive outcomes of the partnership protocol are: the negotiation of the bounda‐ ries of the relationship between parents and mental health professionals, the clarification of the roles of both sides, and the emphasis placed on active parental involvement in their child's therapy. Mental health professionals need to define their relationships with parents as much as parents do [28, 77-78] and they use the protocol to do so.

#### **4.4. Limitations**

needed to communicate in order to resolve an actual crisis, probably as a result of their ac‐

Most parents of children with autism spectrum disorders and mental health professionals who used the partnership protocol said that it was useful, because: a) it clarifies the relation‐ ship between the two parties; b) it defines the roles of both parties; c) it promotes effective cooperation; d) it advances negotiation; and e) it values mutual respect. All these elements were rated by many studies [28, 101, 103] as essential for the creation of a functional and effective cooperative relationship among parents and mental health professionals. It is ex‐ tremely important to point out that both parents and mental health professionals recognize similar benefits from the implementation of the protocol, corroborating the finding that the needs of parents and mental health professionals are closer that one would think, but they

The parents of children with autism spectrum disorders reported that the partnership proto‐ col informs them of their rights and helps them fight for provisions and services. Parental participation is instrumental in reassuring the existence of options for adults with autism spectrum disorders [153]. Parents become empowered [39, 86] and thus able to negotiate with mental health professionals [40]. Mental health professionals said that they could use this protocol to resolve conflicts or disagreements with parents. This is important, since some mental health professionals do not know how to resolve interpersonal conflicts [3] and

The four parents who thought that the partnership protocol is not useful justified their opin‐ ion by saying that it is binding and difficult to adhere to. It is a fact that the implementation of a protocol or any form of agreement requires commitment from all involved parties. Therefore, it is likely that some parents of children with autism spectrum disorders are ex‐ hausted from the constant care of a child with multiple and complex needs and do not pos‐ sess the required strength to enter this process [146]. Moreover, it is plausible that some parents prefer to hold a more distant role from the therapeutic process [54]. The eight men‐ tal health professionals who considered the partnership protocol not to be that useful thought as well that it is binding and that parents who are not educated cannot understand it. It seems that they do not want to be committed to a predetermined cooperative relation‐ ship with the parents because they have adopted the expert model. Even if some parents are not educated or able to understand some points, it is the role of mental health professionals

Approximately 20% of the parents of children with autism spectrum disorders identified two things that needed further clarification in the partnership protocol: a) which qualifica‐ tions mental health professionals should hold in order to work with children with autism spectrum disorders and b) what parents can do if mental health professionals do not follow the protocol. The first point partly reflects the insecurity that results from insufficient brief‐ ing regarding the options that parents have to choose the suitable mental health professional after the diagnosis [55]. They could also result from limited options due to place of residence

to explain everything to them in simple and understandable language [56].

tive therapeutic engagement [98].

**4.3. Evaluation of the partnership protocol**

546 Recent Advances in Autism Spectrum Disorders - Volume I

need to be clearly defined in order to be satisfied [100].

they become increasingly stressed [147].

The aim of this study was to create a partnership protocol to delineate the relationship between parents of children with autism spectrum disorders and mental health professionals with the ultimate goal to improve the child's condition [84]. The need for this protocol derived from per‐ sonal experience and from meticulous literature search [16, 105]. Although the findings were positive and encouraging, there are some limitations that should be taken into consideration:


**4.** Despite the fact that the participants were reassured that data would be kept confiden‐ tial, they might be skeptical about expressing very negative attitudes [155].

**5. Conclusion**

spectrum disorders [77, 104, 147].

**Acknowledgement**

**Appendix**

throughout this lengthy process.

**Parent-Professional Partnership Protocol**

This study confirmed the findings of previous international research regarding the prob‐ lematic relationships between mental health professionals and the parents of children with disabilities. It was found that Greek mental health professionals are troubled by the parents' demands and their unwillingness to actively engage in their child's treatment. Greek parents of children with autism spectrum disorders claim that mental health pro‐ fessionals are not interested in involving them in decision-making regarding their child's therapy. Similar complaints have been expressed in other studies that have explored the relationship between mental health professionals and parents of children with autism

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Despite the fact that the difficulties that were documented in this study have been identified a long time ago and in several contexts, there has been no published coordinated effort to resolve them. This partnership protocol was based on the codes of ethics of international or‐ ganizations of mental health professionals, it is written in simple language and it was con‐ sidered to be useful by most participants. The implementation of the partnership protocol helped mental health professionals and parents of children with autism spectrum disorders to define their interpersonal relationship and to overcome many of the difficulties and the problems that they had identified at the beginning of their cooperation. They started to com‐ municate more honestly, to respect each other more and to resolve their conflicts more effec‐ tively. Even though these findings are encouraging, more longitudinal studies with varied participants are needed to explore further the effectiveness of the partnership protocol.

I would like to thank all the participants and Dr Angeliki Gena who was the primary super‐ visor of my second PhD that is the basis of this research. I extend my gratitude also to my family and especially my husband and colleague Vlastaris Tsakiris for his constant support

When professionals and parents of children with autism come together for the first time, they bring with them their own worries, concerns, priorities, and responsibilities, which must be woven together into a relationship that could be characterized as a partnership. The roles of the parent and the professional impose certain rights and duties, obligations and an‐ ticipated behaviours, as well as expectations. It is extremely difficult to define the exact na‐ ture of this partnership, since every parent and every family has its own idiosyncrasies and


#### **4.5. Practical implementation and future research**

This research confirmed the findings of previous studies [77, 104, 147] that the relationship between parents of children with autism spectrum disorders and mental health professio‐ nals is quite challenging. However, the aim was not just to identify the existing problems, but to propose also some possible solutions. It seems that the implementation of the partner‐ ship protocol had a positive effect on the delineation of the relationship of the involved par‐ ties and helped them overcome some the existing obstacles by becoming more cooperative and willing to negotiate for the child's benefit.

As mentioned in the introduction, mental health professionals and parents of children with disabilities hold their personal beliefs regarding the kind of relationship that they should have. The partnership protocol helped them understand their rights and obligations, since they might hesitate to discuss them openly. There are many mental health professionals who do not know how to set limits to their relationships with parents and many parents who do not know how to express their opinions or their questions regarding their child to mental health professionals. Therefore, the partnership protocol may be suggested by men‐ tal health professionals as a means to negotiate their relationship with parents, while it serves also as an opportunity to discuss further and to resolve any conflicts. However, it should be stressed that the partnership protocol is not a legally binding document and so parents and mental health professionals should follow it because they believe in its value. It can be implemented in any therapeutic framework, where it is essential for parents of chil‐ dren with disabilities and mental health professionals to work together. It could also be used to train mental health professionals who will work with children and adolescents with disa‐ bilities and their families [156].

This is the first study in Greece, and worldwide, that introduced the use of a partner‐ ship protocol to resolve possible conflicts that arise between mental health professionals and parents of children with autism spectrum disorders. Therefore, future studies should be conducted with parents of children with other disabilities, as well as with parents of children with chronic illnesses and with other mental health professionals, such as doc‐ tors, nurses, or teachers.
