The Guide for Occupational Alliance (GOAL) in pediatric rehabilitation: a shared decision-making and measurement tool
Warnken, Elizabeth Ann
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The plan of care in occupational therapy for caregivers of children with acquired brain injury (ABI), created through goal setting, is the foundation for providing services in a pediatric neurorehabilitation setting. During the first year after the injury, caregivers often experience gaps in education, feelings of decreased competence, and decreased understanding of the recovery process. These factors can make developing goals a challenge for caregivers and service providers alike. Although a number of goal-setting mechanisms exist, they currently lack options sensitive to this population’s unique needs. This project set out to explore the clinical barriers involved in goal setting in pediatric rehabilitation and to develop a relevant solution that guides the process. The results identified two theoretical models to use as “lenses” by which the problem was explored and understood. An explanatory model was developed to highlight relationships among contributing factors. A thorough review of evidence was conducted and synthesized to support the explanatory model, and existing solutions explored. Shared-decision making in healthcare through the use of decision aids was identified and investigated as a promising direction for solution development. The Guide for Occupational ALliance (GOAL) in Pediatric Rehabilitation is a shared decision-making and measurement tool designed to facilitate collaborative goal setting with caregivers of children with ABI. The GOAL fosters a family-centered approach that provides education while facilitating discussion around caregiver preferences. Additionally, it gathers helpful outcome data on caregivers’ comfort and satisfaction with goal setting in order to gauge change over time. The GOAL implementation will involve gathering insights, testing the tool, and disseminating the findings. It will be evaluated in three phases: Phase 1, a needs-assessment process involving collection of caregiver and clinician data; Phase 2, a pilot test of the GOAL to explore its effectiveness, content relevance, validity, and benefits; and Phase 3, a repeated measure-outcomes study to understand its reliability, validity, and effectiveness. The GOAL provides an opportunity to enhance collaboration during goal setting with caregivers of children with ABI and their occupational therapy service providers for optimal outcomes.