The Benefits and Challenges of Interdisciplinary, Client-Centred, Goal Setting in Rehabilitation
Armstrong, Jonathan, New Zealand Journal of Occupational Therapy
This article provides insights into the benefits and challenges of interdisciplinary, client-centred, goal setting in rehabilitation as drawn from both recent literature and the author's clinical experiences. The article first considers the support for goal setting in rehabilitation as demonstrated through national and international policies. It will then extract themes from literature outlining the benefits of goal setting for client participation and motivation, interdisciplinary working, improving communication and improved outcomes. This will be followed by a discussion of the challenges and barriers to goal setting. In addition it will outline how a goal setting process could be established within a rehabilitation environment.
Goal setting, interdisciplinary team, rehabilitation
I have worked as an occupational therapist in a range of rehabilitation settings both in the UK and New Zealand, the past 5 years being predominantly stroke rehabilitation--acute, inpatient and community. Accordingly, my experience has lead to my being involved in establishing interdisciplinary, client-centred goal setting processes within an Intermediate Care Centre and an Older Persons Health rehabilitation service. These projects emerged from the belief that such a process would improve the experience and outcomes of clients and create a more collaborative working environment for the team. Collaborative practice is not a new concept for occupational therapists. The involvement of clients and their relatives in models of practice, treatment planning and prioritising intervention has appeared in occupational therapy literature for over a decade (Canadian Association of Occupational Therapists, 1997). However the idea of a collaborative, interdisciplinary approach to goal setting tends to be more complex as it involves more professionals from a range of health care backgrounds, and raises questions of role responsibilities, role boundaries and role blurring (Conneeley, 2004). The terms multidisciplinary and interdisciplinary are often used interchangeably (Mandy, 1996) and have been described as a group of people, trained in the use of different tools with an organised division of labour, all working towards a common goal. There is group responsibility for the final outcome (Mandy, 1996).
In this article a goal is defined as "the state or change in state that it is hoped or intended for an intervention or course of action to achieve" (Wade, 1999a, p. 8). Goal setting here refers to the identification of, and agreement on, a target which the client, therapist or team will work towards over a specified period of time for the purpose of rehabilitation (Royal College of Physicians, 2004). Alternatively, McLellan (1997) defined rehabilitation as "a process of active change by which a person who has become disabled acquires the knowledge and skills needed for optimal physical and psychological function" (p. 1). This definition acknowledges that rehabilitation involves a client-focused process in which the client is actively involved, thereby supporting client-centred practice.
Client-centred goal setting is considered 'best practice' in rehabilitation. This approach is advocated in a range of rehabilitation literature; however it tends not to be implemented because people are unsure how to go about it. In my experience, it appears that once people have established how, goal setting is slow to be implemented because staff are unsure why they are doing it.
This article aims to consider these two issues by presenting evidence from relevant literature and drawing on personal clinical experience. Firstly, reasons for goal setting in rehabilitation as demonstrated by national policy and themes from the literature are considered to outline the effects of goal setting on increasing client involvement, rehabilitation as a partnership, client motivation, implications for the interdisciplinary team, improving communication and improved outcomes. …