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Collaborative Goal Setting in Pediatric Rehabilitation Lesley Wiart PT, PhD Nov. 29, 2016

+Pediatric Rehabilitation

n Children with disabilities often access rehabilitation services from a heterogeneous group of professionalsn Often across service sectors and Ministries

n Goal of rehabilitation is to maximize the abilities of children to participate in the activities and roles that are meaningful to them and their families

n The involvement of professionals across environments and service sectors makes rehabilitation planning complex

+International Classification of Functioning, Disability and Health World Health Organization (2001)

+ Family Centred Service

Novak, I.

Goal setting approaches

+Implementation has been

challenging n 23% of Alberta pediatric rehabilitation programs (n=59) had

formalized goal-setting processes (Darrah et al., 2010).

n Parents do not always perceive optimal involvement in theprocess (Wiart et al., 2010)

n Rehabilitation Activities Profile (RAP) for ChildrenNetherlands (Nijhuis, et al., 2008)

n 23% of principal goals addressed child/family identified needsn 46% of principal goals were related to principal problem

constructs

n 24% of children did not have a principal goal

Child/Family Information

• Part 1• General Information

Needs, Impairments and Abilities of Child

and Family

• Part 2• CurrentSituation

Principal Problem

• Part 3• TeamConference

Principal Goal

+ We need to define and evaluate abroader range of outcomes

• Increased continuity for families

• Increased efficiency of service delivery

• Engagement of children in identifying meaningfulgoals

• Increased motivation to participate inrehabilitation activities

• Improved child and family outcomes

+ Increased Continuity of Carefor Families

n A collaborative assessmentapproach aligned team activitiesand goals and resulted in acoordinated plan (Berman et al.2000; Nijhuis et al., 2007)

n Parent identified goals canenhance family-therapistcollaboration (Stefansdottir &Egilson, 2015)

n Potential for enhancing inter-sectoral collaboration

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Liam is a 6 year old boy with cerebral palsy. He is in grade 1 at his community school. He drives a powered wheelchair and requires assistance with transfers in and out of his wheelchair. He is a non-verbal communicator and uses a communication device.

Consider…

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+Increased efficiency of service delivery

n Anecdotal evidence that goal setting aligns team processesso there is a shared focus on family identified goals

+The ‘Good Goals’ Project

(Kolehmainen et al., 2012)

n Project to improve access and equity to services byoptimizing clinician resourcesn 1) Identify clear and specific treatment goals that are meaningful

to the family

n 2) Discussion of goals with family and educational staff

n 3) Evaluate child’s progress towards those goals

n Mixed methods evaluation of uptake, changes in servicedelivery, cost of service delivery (n=46 therapists, 558families)

+Results

n Mean length of treatment ê by 2 months despite mediocreuptake (21-59%)

n Intensive implementation process necessary part of theprocess

n One of the most significant barriers was therapists’ beliefsthat therapists and some parents are incapable ofcollaborative goal setting

n Became more open when they considered the role offeedback on goals as a strategy to improve engagement andoutcomes

+Engagement of Children

n Research primarily focused on parent participation in goalsettingn If rationale includes é motivation to participate then we need é

child involvement

n Children can identify attainable goals (Nordstrand et al.,2015)

n Children as young as 5 years old can participate in goalsettingn Description of process is lacking

+Engaging children in setting their own rehabilitation goals (Wiart, L., Phelan, S., Andersen, J.)

n Child identifies rehabilitationgoals

n Goal discussion with parentand child

n Compare parent and childgoals and ratings ofperformance

n Qualitative interviews withchildren and parents abouttheir perspectives on the goalsetting process

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“I want to be able to tell her in my own words what my goals are.

I: Why is it important that you tell her in your own words?

Because sometimes it’s different in the ways people explain things and tell them.

(12 year old girl with cerebral palsy)

+Increased motivation to participate in rehabilitation activities

n  The link betweenmotivation and positiveoutcomes has been firmlyestablished in goal settingresearch

n  This link has not beenevaluated in pediatricrehabilitation

n  Lack of a theoreticalframework for pediatricslinking process withoutcomes

58% 30%

12%

Column2 No Theory Theory (rationale) Integrated Theory

+Improved Child and Family Outcomes

n Studies to date have compared‘traditional’ therapy to adifferent intervention thatincluded goal setting

n Outcomes of goal setting havenot yet been specificallyevaluated in pediatrics

+Future Steps

n Scoping review on the theoretical basis of goalsetting in pediatric rehabilitation (in progress)

n Develop theoretical framework for goal setting

n Develop process for goal setting that optimizeschild engagement (in progress)

n Evaluate outcomes and process ofcollaborative goal settingn Child and family outcomes

n Cost effectiveness and service delivery outcomes(length of treatment, waitlists, inter-professionalcollaboration, inter-sectoral collaboration)

+Thank you!

Collaborators

n Children and Families

n Megan Bulat, OT

n Tanya Skitsko, PT

n John Andersen MD

n Shanon Phelan PhD OT

n Lyne Bourassa

(research coordinator)