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Participation-focused practices in paediatric rehabilitation for children with neurodisability in New Zealand: An
Fiona Graham1, Emily Timothy1, Jonathan Williman1
1University of Otago, Wellington, New Zealand.
Insights
Participation-focused and family-centered care are valued but not standard in New Zealand pediatric rehabilitation. Training in collaborative goal setting is recommended to improve outcomes for children with disabilities.
Area of Science:
- Pediatric Rehabilitation
- Occupational Therapy
- Disability Studies
Background:
- Participation outcomes and family-centered services are recognized standards in pediatric rehabilitation.
- International adoption of these practices into routine care has been slow.
- No prior studies have examined participation-focused or family-centered practices in New Zealand.
Purpose of the Study:
- To assess the extent of participation-focused and family-centered goal setting in New Zealand pediatric rehabilitation services.
- To understand clinicians' beliefs and attitudes regarding these practice foci.
Main Methods:
- An observational study combining a retrospective case note audit and a clinician questionnaire.
- Case notes of 220 children across five services were audited for participation-focused goals.
- A 42-item questionnaire gathered clinician perspectives on practice behaviors and challenges.
Main Results:
- 61% of 368 audited goals focused on participation, with significant variations between services and professions.
- Clinicians reported valuing participation outcomes and family involvement.
- Key challenges included skill gaps, lack of self-monitoring, and unsupportive work cultures.
Conclusions:
- Participation-focused practice is not yet standard in New Zealand pediatric rehabilitation, despite clinician endorsement.
- Enhanced training in collaborative goal setting is crucial for improving participation outcomes for children with disabilities.
Background:
Participation outcomes and family-centred services are now widely agreed standards of care in paediatric rehabilitation. Evidence suggests that adoption of these practices into usual care has been slow internationally, and no studies of participation-focused or family-centred practices in New Zealand have been undertaken to date. The aims of this study were to identify the extent that goal setting in paediatric rehabilitation services is participation focused and family centred and to profile clinicians' beliefs about these foci.
Methods:
Observational study including a retrospective case note audit and questionnaire. Case notes ('charts') were audited for participation-focused goal-related practice. Subgroup analysis of audit data by service, profession and child ethnicity were completed using weighted mean differences. Clinicians whose case notes were audited completed a 42-item questionnaire on factors related to practice behaviour including text responses with each item. Numerical and text data were analysed descriptively.
Results:
Five services were recruited (N = 46 clinicians) with case notes for 220 children audited. Auditors extracted 368 potentially participation-related goals (Mdn = 2 goals per child) with no goals extracted for 43 (20%) of case notes. Subsequent coding of extracted goals identified 61% reflected participation (225/368). Subgroup analysis revealed significant differences between services (p = 0.006) and professions (p < 0.001). Clinicians' reported valuing participation outcomes and family involvement and largely felt they did target participation. Skill gaps, absence of self-monitoring strategies and unsupportive professional and work cultures were cited as key challenges.
Conclusions:
Although valued by clinicians, participation-focused practice is unusual care in paediatric rehabilitation in New Zealand. Substantial gains in the quality of care for children with disabilities could be afforded through training in collaborative goal setting to target participation outcomes.
