Sally Fields & Lynne Farrar, Gold Coast Health Service District - Increasing Participation...

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

Outline

Why we undertook this review

Application of quality cycle to process

ICF model

Client-centred practice

Goal-setting

Practical application in our service

Why?

Improving client outcomes

Maximising client participation

Strengthening client-centred practice

Streamlining goal-setting and review

process

Increased client engagement

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

Asking the question

“Is our goal-setting process client-centred,

and are we utilising a coordinated, inter-

disciplinary approach to empower active

client participation?”

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 documentation

Documentation audit

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 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

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

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

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 individuality

Enablement

Accessibility

Respect for diversity

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

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

Client-centred outcomes

Measure outcomes that are meaningful to

clients 11

Adopting a client-centred approach leads to

increased participation 12

Participation measures 11

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

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

Goal setting

Goal setting

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

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

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

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”

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 helping

people explore and resolve ambivalence” 23

Motivational Interviewing is:

Goal directed

Client-centred

Collaborative process

Respects the client’s choice regarding change

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 focussed approach to goal review

Demonstrates compliance with accreditation standards

Increased goal attainment

Identified need to increase client motivation

Further improvements

Outcomes

Increased client-centred focus to goal review

Streamlined goal review

Improved communication between clinicians

Prioritizing of interventions

More focused approach to interventions

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 members: Catherine Cummings,

Samantha Goodwin, Andrew Laundy and

Rebecca Lackie who contributed to this project.

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,

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4. Horowitz, B.P., & Chang, P.F. (2004). Promoting well-being and engagement in life through occupational therapy

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References

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18. British Columbia Guidelines & Protocols Advisory Committee (2008). Frailty in Older Adults – Early Identification and

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References

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20. Melvin, J.L. (1989). Status report on interdisciplinary medical education. Archives of Physical Medicine and

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