Rehabilitation goal setting with community dwelling adults with acquired brain injury: a theoretical framework derived from clinicians’ reflections on practice

Abstract

The goal setting practice framework may guide clinician's understanding of how to engage in client-centred goal setting in brain injury rehabilitation. There is a predilection towards a client-centred goal setting approach in the community setting, however, contextual factors can inhibit implementation of this approach. Implications for Rehabilitation The theoretical framework describes processes used to develop achievable client-centred goals with people with brain injury. Building rapport is a core strategy to engage clients with brain injury in goal setting. Clients with self-awareness impairment benefit from additional metacognitive strategies to participate in goal setting. Clients with emotional distress may need additional time for new identity development.

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

“…When using a deductive approach to framework analysis, the codes and themes of previous theories are applied to the data (Gale et al). In this case a deductive approach was used, based on the codes of the Client-Centred Goal Setting Practice Framework (Prescott et al, 2018). Therefore step four of the framework analysis procedure was not required.…”

“…The provision of education was highlighted as another important strategy to establish trust. This strategy equips clients with the information required to participate as equal partners in goal setting (Cott, 2004;Prescott et al, 2018), and when incorporated in goal setting has been shown to result in greater client satisfaction with the goal setting process Asking the client to think about the specific functional components which underpin a goal area And that is useful for your return to study because you're having to do a little bit of that evaluating Link to therapy Establishing the link between therapy activities and the client identified goal area The way we're gonna work on that is working on listening to the recordings of your speech so that you can improve your self-rating Establishing steps to long term goals Breaking the long-term goal down into smaller steps, to become the goal to be worked on in therapy So what, knowing how you're walking now, what do you think would be a good goal to work, work on as the next step? Explaining scope of expertise…”

“…Furthermore, appraisal and feedback have been identified as necessary components of goal setting in community-based stroke rehabilitation (Scobbie & Dixon, 2015). The provision of feedback is particularly important in ABI rehabilitation, because clients with ABI often need support to monitor their progress in relation to the goal due to impaired cognitive functioning (Prescott et al, 2018). Therefore, occupational therapists working in ABI rehabilitation may consider implementing 'progress feedback' as a standard practice, with use of the COPM or other tools which may facilitate this.…”

“…Practitioners are unlikely to work in ideal clientcentred environments because of contextual factors which influence the implementation of client-centred goal setting in practice (Plant et al, 2016;Prescott et al, 2018). Previous studies have highlighted that contextual barriers in an acute setting resulted in goals that were focused on discharge priorities (D'Cruz et al, 2016; Levack et al, 2011;Plant et al), whilst in other community-based studies organisational priorities precluded the development of client-centred goals (Hunt, Le Dorze, Trentham, Polatajko & Dawson, 2015).…”

“…The practitioners did not receive education about goal setting or information about research evidence relating to goal setting from the researcher. Findings were validated through member checking and presentation of the framework at two rehabilitation network meetings (Prescott et al, 2018). Figure 1 illustrates the framework and describes a process whereby practitioners actively engage clients in goal setting discussions, so that intervention can be tailored to meet client-identified rehabilitation needs.…”