Rehabilitation of children and teenagers living with an acquired brain injury (ABI) should always focus on maximising function in tasks that are important to the child and their family. It is best practice to use assessment tools that help the family and child to establish key priority areas across daily performance and participation, and to set goals in these areas. Assessment and intervention planning from all health professionals involved then needs to focus on these goal areas, including timing and prioritising of who needs to be involved and when.
It is important that models such as the International Classification of Function and Disability ICF (WHO 2001) are used as a framework for goal setting, assessment and intervention planning. It is important that interventions bring about change with participation in real life tasks and activities.
Methods for goal setting
There are various methods for establishing needs and priorities and for setting goals.
Canadian Occupational Performance Measure (COPM)
- Semi-structured interview exploring priorities with families across all areas of daily living – self-care, productivity and leisure. This method can be used in conjunction with a rating system of performance and satisfaction from the perspective of the child’s family, before and after intervention.
Routines Based Assessment (RA McWilliam 2003, revised 2006)
- Interview where the structure takes the family through a typical day – capture key concerns/priorities from the perspective of the child’s family.
Family Goal Setting Tool (FGST) (Judy Jones -OT Autism Australia 2012)
- For children with significant or complex needs such as autism spectrum disorder (ASD), this method uses 80 visual cards as cues for discussion and setting goals with families across everyday activities.
Perceived Efficacy and Goal-Setting Scale (PEGS) (Missiuna, Pollock and Law 2004)
- This method focuses on the child (6+ years) and their parents/teacher. It involves a semi-structured interview using pictorial cards of tasks across domains of self-care, school and leisure (can be used in conjunction with COPM with parents). It is a great way of giving children a voice and including them in planning.
Goal Attainment Scale (GAS) (Kiresuk & Sherman 1968)
- This method is appropriate for all ages and levels of severity. It allows health professionals to set realistic, individual and measurable goals. It can be used effectively with COPM to measure the child’s level of participation as well as level of impairment or activity (in relation to ICF model).
Children’s Assessment of Participation and Enjoyment and Preferences for Activities of Children (CAPE PAC) (King et al 2004)
- This method is appropriate for children aged 6-21 years. It is a self-reported measure of the child’s participation preferences outside of their mandated school activities. This is a useful addition to goal setting.
Child Occupational Self-Assessment (COSA) (Keller, Kafkes, Basu, Federico & Keilhofner 2006)
- This method involves a checklist and card sort task done with the child to allow development of an understanding of their own sense of occupational competence.
There are also other tools specific to a particular task. For example, the Here’s How I Write: A Child’s Self-Assessment of Handwriting and Goal Setting Tool.
Health professionals should also be familiar with, and utilize the SMART (Specific- Measurable-Achievable-Relevant-Time Bound) goal setting approach. This can be used instead of, or in conjunction with the more formal tools.
The above tools may still be somewhat limiting for families from non-western cultures who may see chronic disease and disability as a collective experience. Professionals may find using metaphors together with drawings useful when working with families to identify barriers and come up with solutions for how to overcome them, or reduce their impact. For example, the KAWA model uses a river to symbolise the family’s life. Barriers to the flow are depicted as branches and rocks which are discussed with the family in terms of the child’s daily life.
Collaborative treatment planning
In a multidisciplinary team, an occupational therapist would be ideally placed to perform goal setting and functional assessment, or task analysis of the goal area (at the participation level). From this they will also be able to ascertain or determine what activity limitations are impacting on it (activity level). Performance components and impairments (body structures and functions level) are assessed by different health professionals within the multidisciplinary team. Each discipline’s assessment can then feed into and contribute to hypothesising on the key impairments or performance components impacting on the functional limitations and task. Consideration of contextual or environmental factors (social, physical) impacting on participation also need to be considered.
Do NOT forget strengths. Strengths can be highlighted in the goal setting and assessment phase as part of the semi-structured interview with the COPM, or routine-based assessment, etc. They can also be utilized and built into the treatment plan.
A child’s function in a particular role, activity or task is often impacted on by a combination of performance components and environmental factors which are assessed by each discipline. It is therefore important, where possible, to collaborate with the multidisciplinary team, the child and their family to provide intervention that has an impact on the child’s participation in real life tasks.
A case example of a collaborative treatment plan based on priority/goal setting is available below. This was initially done with the family as a basis for the planning.
The Kawa Model (2006) Michael K Iwama. Published by Churchill Livingstone.
Queensland Paediatric Rehabilitation Service
Queensland Children’s Hospital
Level 6, 501 Stanley Street, South Brisbane 4101
t: 07 3068 2950
t: 07 3068 1111 (general enquiries)
f: 07 3068 3909