Creation of a client goal-setting framework

During the past decade, there has been a noticeable shift in the philosophical approach to health care. This change in thinking, from problem-focused to goal-oriented and from discipline-specific to team driven, has been apparent in rehabilitation as well. The Spinal Cord Program at G. F. Strong Rehab Centre in Vancouver, Canada, has developed a goal-setting framework to define and meet clients' needs by promoting a partnership between the client and family and the clinical team. Donabedian's paradigm provides the model on which the interdisciplinary goal-setting framework is based. The purpose of the framework is to clearly outline clients' and staffs' expectations of the rehabilitation program, identify responsibilities, ensure accountability of clients and staff, and facilitate measurement of goal achievement. Evaluation of the framework indicates that most staff and clients believe the framework provides more structure and direction to the client's rehabilitation program than the previous approach; others believe the use of a goal checklist imposes too much structure and compromises the specificity of goals. This paper will discuss the design, implementation, and evaluation of the framework and recommendations for improvement.