Using child‐ and family‐centred goal setting as an outcome measure in residential rehabilitation for children and youth with acquired brain injuries: The challenge of predicting expected levels of achievement

Abstract

Purpose:Collaborative, child-and family-centred goal setting is essential in paediatric, acquired brain injury (ABI) rehabilitation. This study aims to understand which goals children and families prioritize and how accurately therapists predict expected levels of achievement for these goals.Methods: Routinely collected Goal Attainment Scale-Light data from 122 children with severe ABI receiving residential rehabilitation were retrospectively analysed.Goals were mapped onto the International Classification of Functioning, Disability and Health. Descriptive analysis of accuracy of therapists' prediction of goal achievement was conducted.Results: Eight-hundred sixty goals were set: 82% in activities and participation domains, most commonly mobility, self-care, and communication chapters. Forty-six per cent of therapist-set expected levels of achievement for these goals were met at the expected level, and 24% were exceeded. Chapters with the highest prediction accuracy included two environmental chapters and one body structure and function.Accurate prediction of activity and participation goals varied (35% in general tasks and demands to 58.8% in major life areas).Conclusions: Children and families prioritize mobility, self-care, and communication during ABI residential rehabilitation. Setting expected outcomes for these goals is challenging, as demonstrated by the variety in accurate prediction rates between and within chapters. Families need to be aware of this uncertainty during goalsetting discussions.

Following severe childhood stroke, specialised residential rehabilitation improves self-care independence but there are ongoing needs at discharge

“…The range of admission UKFIM+FAM scores indicate that there was a wide clinical presentation even within this severe cohort. During the rehabilitation programme, the children and young people would have received a self-care intervention as directed by their goals (see Kelly et al., 2018 for further details). The self-care intervention would have varied on an individual basis between a restorative and an adaptive approach, with elements of active practice, explicit learning of strategies and equipment provision.…”

“…In this service review, the individual goals for rehabilitation intervention were determined in collaboration with the CYP (where possible) and family using the Goal Attainment Scale described in Kelly et al. (2018).…”

“…Self-care independence is a common priority for many CYP with neurodisability and their families (Allard et al., 2014; McAnuff et al., 2017) and unsurprisingly features as a common rehabilitation goal for CYP with stroke (Galvin et al., 2011; Kelly et al., 2018). At this sub-acute stage of rehabilitation, mobility and self-care goals are often prioritised by children and their families above cognitive skills.…”

“…At this sub-acute stage of rehabilitation, mobility and self-care goals are often prioritised by children and their families above cognitive skills. Perhaps this is because the full range of cognitive deficits are yet to be fully appreciated at this stage in the recovery trajectory and within the supportive environment of residential rehabilitation (Kelly et al., 2018).…”

DPHMD Board Members

“…The pertinent professional literature continues to abound across fields, including special education, school psychology, social work, and pediatrics, although not necessarily within them (e.g., Smith & Canto, 2015). The foci of these various articles include characteristics and incidence (e.g., Blankenship & Canto, 2018), symptomology (e.g., Rees, 2016); instrumentation (e.g., Cohen et al, 2019;Lindsey, Hurley, Mozeiko, & Coelho, 2019); teacher training (e.g., Davies, Fox, Glang, Ettel, & Thomas, 2013;Ettel, Glang, Todis, & Davies, 2016), treatment (e.g., Kelly, Dunford, Forsyth, & Kavcic, 2019), and, especially, interventions (e.g., Canto & Eftaxas, 2018;Chavez-Arana et al, 2018;Jantz, Davies, & Bigler, 2014;Utley, Obiakor, & Obi, 2019) of ABI.…”