Child, parent, and clinician experiences with a child-driven goal setting approach in paediatric rehabilitation

Abstract

Purpose

To explore child, parent, and clinician experiences with a child-driven approach to rehabilitation goal setting.

Methods

Nine children receiving inpatient and outpatient rehabilitation aged 5.0–12.3 years ($\overline{x}$ = 8.3, SD = 2.3; 5 females) and their parents (n = 9) participated in a goal setting process intended to maximize child engagement with their physical or occupational therapist. Qualitative interviews were conducted with children (n = 7), their parents (n = 9), occupational therapists (n = 2), a nurse practitioner and a physician to explore their experience with the child-driven approach to goal setting.

Results

Three themes that reflect child, parent, and clinician experience with a child-driven approach to goal setting were identified: (1) children have voice and insight, (2) child identified goals are rewarding and motivating for children, and (3) we are a team: goal setting as a co-constructed process.

Conclusions

Engagement in goal setting resulted in the identification of functional goals that were perceived as motivating for children. Children described feeling valued and heard. Parents and clinicians recognized they had previously underestimated the capacity of children to identify their own goals. Parents wanted input from therapists, particularly related to shaping their goals to focus on shorter-term outcomes. Relational autonomy, which emphasizes the social and relational aspects of decision-making, may be more useful than traditional, individualistic views of autonomy for conceptualizing clinician roles in collaborative goal setting.

IMPLICATIONS FOR REHABILITATION

• Children are often not optimally involved in setting their own rehabilitation goals.

• In this qualitative study, we report that children, parents, and clinicians recognized the value of optimizing child engagement in goal setting including children feeling heard, valued and more motivated to participate in therapy.

• Parents expressed a need for a collaborative approach to goal setting that respects child, parent, and clinician input.

• Relational autonomy may be a useful framework for reframing the role of clinicians in collaborative goal setting processes.

Keywords:

• Paediatric rehabilitation
• goal setting
• qualitative research
• child empowerment
• motivation

Acknowledgements

Dr. Pritchard was supported by the Canadian Child Health Clinician Scientist Training Program, the Women and Children’s Health Research Institute through the generous support of the Stollery Children’s Hospital Foundation, and Alberta PolicyWise for Children & Families. The authors would like to acknowledge the contributions of the children and parents who participated as well as the invaluable contributions of Serina Mah and Megan Bulat, occupational therapists at the Glenrose Rehabilitation Hospital in Edmonton, Alberta, Canada.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was funded by the Glenrose Rehabilitation Hospital Foundation.