Increasing participation through a
client-centred goal-setting process
Sally Fields, Senior Occupational Therapist
Lynne F...
Outline
 Why we undertook this review
 Application of quality cycle to process
 ICF model
 Client-centred practice
 G...
Why?
 Improving client outcomes
 Maximising client participation
 Strengthening client-centred practice
 Streamlining ...
Service snapshot
Gold Coast Transition Care Program
Provides 96 packages of care –
14 residential, 82 community packages...
Asking the question
“Is our goal-setting process client-centred,
and are we utilising a coordinated, inter-
disciplinary a...
The quality cycle
Process
Documentation audit O
Literature review P
Form development & trial D
Feedback and review S
Further improvements A
Documentation audit
 Single discipline input
 Impairment focused
 Clients not engaged
 Lack of focus and rigor
 Inconsistent documentatio...
Review of the literature
International Classification of Functioning,
Disability, and Health (ICF) 1
International Classification of Functioning,
Disability, and Health (ICF)
 “Provide a unified and standard language
and f...
Participation in older people
 Majority of older adults experience
participation restriction in their daily lives
 80% o...
Participation & quality of life
 Participation is connected to quality of life 4
 Loss of participation increases psycho...
Practical use of the ICF
 As a framework 5
 As a reference 5
 As a theoretical basis 6
Client-centred practice 7
 Acknowledges client strengths and client
choice
 Provides flexibility and values individualit...
Client-centred practice
 Provides the client with power 8
 Enables clients to become active partners 9
 Needs to be inc...
Outcomes of client-centred practice 10
 Respectful & supportive services ➠ Improved satisfaction & adherance
 Informatio...
Client-centred outcomes
 Measure outcomes that are meaningful to
clients 11
 Adopting a client-centred approach leads to...
Client-centred documentation
 Principles of client-centred documentation 13
 Client focused
 Interdisciplinary
 Goal o...
Client-centred rehabilitation
 Aims to enable clients to live lives that are
physically, materially & socially fulfilling...
Goal setting
Goal setting
Client-centred goal setting
 Team approach with an increasing focus on the
client and attainment of goals 13
 Increases ...
Client-centred goal setting
 Leach et al., identified 3 categories of goal-setting 16
 Therapist controlled
 Therapist ...
Goal setting tools
 Designated goal facilitation tool significantly
improves goal attainment 17
 Goals set should inform...
Interdisciplinary teamwork
 “…individuals from several disciplines working toward a
common goal”19… “includes not only th...
We believe…
“The only way to find out what
clients want, is to ask them” 22
Maximising goal achievement
Motivational Interviewing (MI)
 “A goal directed, client-centred counselling
style for eliciting behaviour change by help...
Form development & trial
Feedback & review
Negative feedback
 “Oh no, not another change!”
 “Clients set unrealistic goals”
 “Too busy”
 “Outside my comfort zone”
Positive feedback
 Eliminates unnecessary paperwork
 Promotes client-centred practice
 Facilitates a goal and client
fo...
Further improvements
Outcomes
 Increased client-centred focus to goal review
 Streamlined goal review
 Improved communication between clinic...
Future considerations
Questions?
sally_fields@health.qld.gov.au
lynne_farrar@health.qld.gov.au
Acknowledgements
The presenters would like to also acknowledge
and thank the work of the TCP Clinical Review
Portfolio mem...
References
1. WHO: World Health Organisation, International Classification of Functioning, Disability and Health (ICF).Gen...
References
10. Law, M. (2013). Basic and Advanced Setting Goals and Evaluation Outcomes Using the Canadian Occupational
Pe...
References
19. Rothberg, J. (1981). The rehabilitation team: Future direction. Archives of Physical Medicine and Rehabilit...
Sally Fields & Lynne Farrar, Gold Coast Health Service District - Increasing Participation Through a Client-Centred  Goal-...
Sally Fields & Lynne Farrar, Gold Coast Health Service District - Increasing Participation Through a Client-Centred  Goal-...
Sally Fields & Lynne Farrar, Gold Coast Health Service District - Increasing Participation Through a Client-Centred  Goal-...
Sally Fields & Lynne Farrar, Gold Coast Health Service District - Increasing Participation Through a Client-Centred  Goal-...
Sally Fields & Lynne Farrar, Gold Coast Health Service District - Increasing Participation Through a Client-Centred  Goal-...
Sally Fields & Lynne Farrar, Gold Coast Health Service District - Increasing Participation Through a Client-Centred  Goal-...
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Sally Fields & Lynne Farrar, Gold Coast Health Service District - Increasing Participation Through a Client-Centred Goal-setting Process

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Sally Fields, Senior Occupational Therapist and Lynne Farrar, Senior Social Worker, Transition Care
Program, Community, Subacute and Aged Services,
Gold Coast Health Service District delivered the presentation at the Transition Care: Improving Outcomes for Older People Conference 2013.

The Transition Care: Improving Outcomes for Older People Conference explores a combination of residential and community transition care programs. It also features industry professionals' experiences in transitional aged care, including the challenges and successes of their work.

For more information about the event, please visit: http://www.communitycareconferences.com.au/transitioncareconference13

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Sally Fields & Lynne Farrar, Gold Coast Health Service District - Increasing Participation Through a Client-Centred Goal-setting Process

  1. 1. Increasing participation through a client-centred goal-setting process Sally Fields, Senior Occupational Therapist Lynne Farrar, Senior Social Worker Transition Care Program, Gold Coast Hospital & Health Service
  2. 2. Outline  Why we undertook this review  Application of quality cycle to process  ICF model  Client-centred practice  Goal-setting  Practical application in our service
  3. 3. Why?  Improving client outcomes  Maximising client participation  Strengthening client-centred practice  Streamlining goal-setting and review process  Increased client engagement
  4. 4. Service snapshot Gold Coast Transition Care Program Provides 96 packages of care – 14 residential, 82 community packages Team includes Rehab Consultant, CN, PT, OT, DT, SP, SW, Psych, Pharmacist, Welfare Officer, AHA Brokered PCW services, transport, equipment loan, podiatry, some nursing services
  5. 5. Asking the question “Is our goal-setting process client-centred, and are we utilising a coordinated, inter- disciplinary approach to empower active client participation?”
  6. 6. The quality cycle
  7. 7. Process Documentation audit O Literature review P Form development & trial D Feedback and review S Further improvements A
  8. 8. Documentation audit
  9. 9.  Single discipline input  Impairment focused  Clients not engaged  Lack of focus and rigor  Inconsistent documentation Documentation audit
  10. 10. Review of the literature
  11. 11. International Classification of Functioning, Disability, and Health (ICF) 1
  12. 12. International Classification of Functioning, Disability, and Health (ICF)  “Provide a unified and standard language and framework for the description of health and health-related states in order to improve communication between different users…” 1  Participation versus handicap  A focus on participation challenges us to find ways for people to do the things they need to do while they recover 2  Importance of contextual factors
  13. 13. Participation in older people  Majority of older adults experience participation restriction in their daily lives  80% of participants reported participation restriction in at least one area of their life 3
  14. 14. Participation & quality of life  Participation is connected to quality of life 4  Loss of participation increases psychological distress and reduces wellbeing 4  Client participation in goal-setting
  15. 15. Practical use of the ICF  As a framework 5  As a reference 5  As a theoretical basis 6
  16. 16. Client-centred practice 7  Acknowledges client strengths and client choice  Provides flexibility and values individuality  Enablement  Accessibility  Respect for diversity
  17. 17. Client-centred practice  Provides the client with power 8  Enables clients to become active partners 9  Needs to be incorporated into the goal-setting process
  18. 18. Outcomes of client-centred practice 10  Respectful & supportive services ➠ Improved satisfaction & adherance  Information exchange ➠ Improved functional outcome  Partnership/enabling ➠ Improved client participation  Individualised intervention ➠ Improved client self-efficacy
  19. 19. Client-centred outcomes  Measure outcomes that are meaningful to clients 11  Adopting a client-centred approach leads to increased participation 12  Participation measures 11
  20. 20. Client-centred documentation  Principles of client-centred documentation 13  Client focused  Interdisciplinary  Goal oriented  Documentation should include 13  Client’s concerns  Client’s desired outcomes  Evaluation forms  Need reliable evaluative measurement tools
  21. 21. Client-centred rehabilitation  Aims to enable clients to live lives that are physically, materially & socially fulfilling 11  Inpatient rehabilitation focuses on acquisition of motor skills in order for discharge 11  The extent to which goals are truly jointly set with clients is debatable 11  TCP well placed to extend goal setting to include participation
  22. 22. Goal setting
  23. 23. Goal setting
  24. 24. Client-centred goal setting  Team approach with an increasing focus on the client and attainment of goals 13  Increases participation, performance, and persistence 14  Results in benefits to the interdisciplinary team 15
  25. 25. Client-centred goal setting  Leach et al., identified 3 categories of goal-setting 16  Therapist controlled  Therapist led  Patient focused  Therapists setting impairment and activity goals, whereas patients set participation goals  Implementing a patient centred goal-setting approach
  26. 26. Goal setting tools  Designated goal facilitation tool significantly improves goal attainment 17  Goals set should inform development of plans for further assessment, intervention and discharge and maximises goal attainment 18
  27. 27. Interdisciplinary teamwork  “…individuals from several disciplines working toward a common goal”19… “includes not only the professionals but the patient and his/her family and significant others”20  Identify as a “team”, not as individual team members 21  Respect, value, and solicit contribution from all members  Flexible leadership – task dependent  Provide a forum for problem solving  Work interdependently  Shared decision making  Develop new ways of “seeing”
  28. 28. We believe… “The only way to find out what clients want, is to ask them” 22
  29. 29. Maximising goal achievement
  30. 30. Motivational Interviewing (MI)  “A goal directed, client-centred counselling style for eliciting behaviour change by helping people explore and resolve ambivalence” 23  Motivational Interviewing is:  Goal directed  Client-centred  Collaborative process  Respects the client’s choice regarding change
  31. 31. Form development & trial
  32. 32. Feedback & review
  33. 33. Negative feedback  “Oh no, not another change!”  “Clients set unrealistic goals”  “Too busy”  “Outside my comfort zone”
  34. 34. Positive feedback  Eliminates unnecessary paperwork  Promotes client-centred practice  Facilitates a goal and client focussed approach to goal review  Demonstrates compliance with accreditation standards  Increased goal attainment  Identified need to increase client motivation
  35. 35. Further improvements
  36. 36. Outcomes  Increased client-centred focus to goal review  Streamlined goal review  Improved communication between clinicians  Prioritizing of interventions  More focused approach to interventions
  37. 37. Future considerations
  38. 38. Questions? sally_fields@health.qld.gov.au lynne_farrar@health.qld.gov.au
  39. 39. Acknowledgements The presenters would like to also acknowledge and thank the work of the TCP Clinical Review Portfolio members: Catherine Cummings, Samantha Goodwin, Andrew Laundy and Rebecca Lackie who contributed to this project.
  40. 40. References 1. WHO: World Health Organisation, International Classification of Functioning, Disability and Health (ICF).Geneva: World Health Organisation; 2001. 2. Baum, C.M. (2011). Fulfilling the promise: Supporting participation in daily life. Archives of Physical Medicine and Rehabilitation, 92, 169-175. 3. Fairhall, N., Sherrington, C., Kurrle, S.E., Lord, S.R., & Cameron, I.D. (2011). ICF Participation restriction is common in frail, community-dwelling older people: an observational cross-sectional study. Physiotherapy, 97, 26-32. 4. Horowitz, B.P., & Chang, P.F. (2004). Promoting well-being and engagement in life through occupational therapy lifestyle redesign: a pilot study within adult day programs. Topics in Geriatric Rehabilitation, 20(1), 46-58. 5. Graham, S.K. & Cameron, I.D. (2008). Assessing outcomes in an Australian rehabilitation service: Using an ICF-based approach. International Journal of Therapy and Rehabilitation, 15(9), 392-399. 6. Wade, D.T. & de Jong, B.A. (2000). Recent advances in rehabilitation. British Medical Journal, 320, 1385-1388. 7. Law, M. (1998). Client-Centered Occupational Therapy. United States of America: Slack Incorporated. 8. Palmadottir, G. (2006). Client-therapist relationships: experiences of occupational therapy clients in rehabilitation. British Journal of Occupational Therapy, 69(9), 394-401. 9. Maitra, K.K., & Erway, F. (2006). Perception of client-centred practice in occupational therapists and their clients. British Journal of Occupational Therapy, 69(4), 169-176.
  41. 41. References 10. Law, M. (2013). Basic and Advanced Setting Goals and Evaluation Outcomes Using the Canadian Occupational Performance Measure (COPM). OT Australia Professional Development Event, Brisbane, Australia. 11. Cott, C.A., Wiles, R., & Devitt, R. (2007). Continuity, transition and participation: Preparing clients for life in the community post-stroke. Disability and Rehabilitation, 29(20-21), 1566-1574. 12. Liu, K.P.Y., Chan, C.C.H., & Chan, F. (2005). Would discussion on patients’ needs add value to the rehabilitation process? International Journal of Rehabilitation Research, 28(1), 1-7. 13. Gage, M. (1994). The patient driven interdisciplinary care plan. Journal of Nursing Administration, 24(4), 26-35. 14. Locke, E.A., & Latham, G.P. (2002). Building a practically useful theory of goal setting and task motivation: a 35-year odyssey. American Psychologist, 57, 705-717. 15. Holliday, R. (2004) Goal-setting: Just how client orientated are we? Therapy Weekly, March 25. 16. Leach, E., Cornwell, P., Fleming, J. & Haines, T. (2010). Patient centred goal-setting in a subacute rehabilitation setting. Disability and Rehabilitation, 32(2), 159-172. 17. Parsons, J.G.M. & Parsons, M.J.G. (2012). The effect of a designated tool on person-centred goal identification and service planning among older people receiving homecare in New Zealand. Health and Social Care in the Community, 20, 653-662. 18. British Columbia Guidelines & Protocols Advisory Committee (2008). Frailty in Older Adults – Early Identification and Management. Retrieved April 21, 2013, from http://www.bcguidelines.ca/guideline_frailty.html
  42. 42. References 19. Rothberg, J. (1981). The rehabilitation team: Future direction. Archives of Physical Medicine and Rehabilitation, 62, 407-410. 20. Melvin, J.L. (1989). Status report on interdisciplinary medical education. Archives of Physical Medicine and Rehabilitation, 70, 273-276. 21. Crawford, G.B. & Price, S.D. (2003). Team working: Palliative care as a model of interdisciplinary practice. Medical Journal of Australia, 179(6), 32-34. 22. Wennberg, J.E. (1990). Outcomes research, cost containment, and the fear of health care rationing. New England Journal of Medicine, 323(17), 1202-1204. 23. Hettema, J., Steele, J., & Miller, W.R. (2005). Motivational Interviewing. Annual Review of Clinical Psychology, 1, 91- 111.

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