Family-centered occupational therapy services are based on a collaborative relationship that does not always come easily. Role performance in parenting a child with special needs and being a consumer of occupational therapy services can be partially understood in terms of environmental context. Although occupational therapists recognize the need to adjust services to the cultural and economic backgrounds of families, most of the available literature has examined the contribution of ethnic differences. A particular challenge for occupational therapists may be treating clients and their families who live in chronic poverty. This article examines chronic poverty as it shapes parenting the child with special needs and subsequently the caregiver’s participation in occupational therapy services. A framework for understanding cultural differences is used to suggest constrasting value orientations between families who live with persistent poverty and occupational therapists. A family-centered approach challenges the professional to understand varied influences on caregiving. Suggestions are offered to enhance communication between therapists and caregivers.