Refining a clinical practice framework to engage clients with brain injury in goal setting

Abstract

Background/aim: Client-centred goal setting is fundamental to occupational therapy practice and has been increasingly embraced by all rehabilitation practioners. Goal setting in clinical practice is a highly individualised process and may be more challenging with people with acquired brain injury. However, research examining practice is limited. We developed the Client-Centred Goal Setting Practice Framework to explain how client-centred goals are developed in brain injury rehabilitation. This framework was based on interview data and may reflect practitioner's theoretical knowledge rather than goal setting processes used in routine practice. The aims of this study were to explore the application of the framework to every-day practice, examine the extent to which goal setting was client-centred and refine the framework. Methods: A mixed methods approach was employed. Participants were community dwelling clients with ABI and their practitioners, drawn from a hospital outpatient service and community private practices. The communication exchange between practitioners and clients during routine goal setting was audio-recorded, transcribed verbatim and analysed using framework analysis. Quantitative measures evaluated the client-centredness of goals. Results: A total of 65 goal setting sessions with 36 clients and 17 practitioners (n = 8 occupational therapists) were analysed. The three goal setting phases of the framework and associated processes and strategies were represented. The 'establishing trust' process was interwoven throughout all phases and an additional strategy, 'social connection' was identified. Conclusion: The framework provides preliminary evidence about the core processes and strategies which uses establishing trust to engage clients with ABI in goal setting, and may be a useful tool to guide client-centred goal setting practice in similar services.

Sharing stories of lived experience: A qualitative analysis of the intersection of experiences between storytellers with acquired brain injury and storytelling facilitators

“…The findings posit the possibility of dedicating time to authentically listen and invest in rapport-building, through narrative approaches. Consistent with the findings of a recent study exploring engagement in goal-setting (Prescott et al., 2019), listening in this manner may indeed be beneficial for better understanding the needs and wishes of clients to guide more meaningful goal-setting, in addition to building a constructive therapeutic relationship. Drawing upon our understanding of the complex and chronic experience of social isolation for survivors of ABI, narrative storytelling is an accessible addition to holistic rehabilitation programmes seeking to build positive relationship experiences and successful community re-integration.…”

Goal Setting Among Experienced and Novice Occupational Therapists in a Rehabilitation Center

“…On the other hand, our analysis showed that novices were often more directive when setting goals. This could potentially be explained by their insecurity and the need to maintain professional authority (Levack et al, 2006) or by a desire to comply with organization-determined rehabilitation goals (Hunt, Le Dorze, Trentham, et al, 2015;Prescott et al, 2018;Prescott et al, 2019).…”

“…Active participation and involvement in goal setting may be challenging in some client groups, especially when cognitive impairments are present, which can limit insight, communication skills, and understanding of the process (Hunt, Le Dorze, Trentham, et al, 2015;Playford, 2017;Prescott et al, 2018). Contextual issues-such as lack of time, organization-determined goals prioritizing discharge planning, and focus on disciplines and services instead of the person-are also influencing the implementation of the client-centered approach to goal setting (Barclay, 2002;Hunt, Le Dorze, Trentham, et al, 2015;Playford, 2017;Prescott et al, 2018;Prescott et al, 2019). In addition, studies show several factors related to the therapist, including the relationship with the client, work culture, work experience, time and resources, preferred models of practice, and professional beliefs (Lloyd et al, 2014;Ohura et al, 2014;Rosewilliam et al, 2016).…”

“…Among the factors facilitating the goal setting process, the level of the therapist's client-centeredness is particularly pertinent. It shows in the way we engage the client in the problem identification, how we set goals that are based in activity and participation, and whether we consider the client's interests and roles Hunt, Le Dorze, Trentham, et al, 2015;Leach et al, 2010;McAndrew et al, 2000;Prescott et al, 2018;Prescott et al, 2019).…”

“…Also, their goal setting techniques may vary. Training in interviewing and goal setting, empowerment and advocacy, using formal tools and clinical experience can all support the therapist, especially when working with challenging client groups (e.g., brain injury) and within organizational and other contextual barriers to client-centeredness (Barclay, 2002;Hunt, Le Dorze, Trentham, et al, 2015;McAndrew et al, 2000;Leach et al, 2010;Prescott et al, 2018;Prescott et al, 2019;Thyer et al, 2019). Not many studies to date explored the differences between expert occupational therapists and novices (Hodgetts et al, 2007;Swan et al, 2019).…”