ICF-inspired goal-setting in developmental rehabilitation: an innovative framework for pediatric therapists.

Background:Collaborative goal-setting is a fundamental component of developmental physical and occupational therapy practice. Evidence suggests, however, that therapists struggle to elicit patient and family goals, and they often establish goals that are not reflective of patient and caregiver functional preferences. Training and efficiency also act as barriers to collaborative goal-setting. A number of solutions have been proposed to enhance the goal-setting process, but none specifically address relevant areas of functioning within the International Classification of Functioning, Disability and Health (ICF), a robust, multidimensional tool that emphasizes the importance of function. To support pediatric therapists in the collaborative establishment of functionally relevant goals, an ICF-inspired goal-setting tool was developed through the assimilation of a large body of existing scientific evidence, ICF Core Sets, and expert consensus. Objective:The aims of this paper are to: 1) describe an ICF-inspired framework for collaborative goal-setting in developmental rehabilitation that seeks to reduce the methodological challenges frequently associated with goal-setting; and 2) discuss the conditions for the use of the framework in daily therapeutic practice. Conclusions:The goal-setting framework presented in this paper may help pediatric therapists to create meaningful goals in collaboration with patients and families. Importantly, the goal-setting framework described promotes the use of the ICF in therapeutic practice.

Patient-Centered Goal Setting in Developmental Therapy: Discordance between Documented Goals and Caregiver-Perceived Goals.

INTRODUCTION: Productive interactions between engaged patients and clinical teams are key to effective clinical practice. Accordingly, the identification of needs and priorities through the process of collaborative goal setting is fundamental to patient-centered care. Executing a goal-setting process that is truly collaborative is challenging; many caregivers do not feel that they are adequately involved in the goal-setting process. This study presents the results of an initiative intended to understand goal concordance between therapists and caregivers. METHODS: We conducted an observational, cross-sectional design study. Twenty-nine pediatric physical and occupational therapists developed and documented collaborative goals for their patients. Over 6 months, 120 randomly selected caregivers from a weekly list of patients scheduled for a follow-up physical or occupational therapy visit participated. Caregivers completed structured interviews related to their children's therapy goals. We calculated agreement coefficients between caregiver-perceived goals and therapist-documented goals. RESULTS: Overall strength of agreement was poor (M = -0.03, SD = 0.71). There were no significant differences within variables of a goal setter, goal importance, or goal utility. Median agreement coefficients were greatest for goals perceived to be identified solely by the caregiver, perceived as important, and perceived as functionally useful. CONCLUSIONS: The results of this study underscore the state of discordance in the collaborative goal-setting process in pediatric physical and occupational therapy. Healthcare encounters continue to be framed by provider perspectives and priorities. Developing therapy goals that enhance family involvement, relate to function, and are important to the healthcare consumer may improve the agreement.