The Relationship Between Client-Centered Goal-Setting and Treatment Outcomes

2012 ◽  
Vol 22 (1) ◽  
pp. 28-35 ◽  
Author(s):  
Jennifer L. Womack
Keyword(s):  
Treatment Outcomes ◽  
Goal Setting ◽  
Well Being ◽  
World Health ◽  
International Classification Of Functioning ◽  
Client Relationships ◽  
Centered Care ◽  
Communication Challenges ◽  
Treatment Priorities

Shifting definitions of health and well-being, prompted by the World Health Organization's International Classification of Functioning (2001), have stimulated changes in traditional clinician-client relationships in rehabilitation. Among these changes, in keeping with the concept of client-centered care, is a trend toward more collaborative goal-setting and joint determination of intervention plans. Evidence suggests that supporting clients' autonomy in prioritizing personally meaningful goals leads to increased engagement in intervention, less emotional anxiety about the rehabilitation process, and improved treatment outcomes. Supporting people with aphasia in a process of collaborative goal formulation may also serve to alter treatment priorities so that they address more relevant communication challenges embedded in post-rehabilitation life.

Principles of neurological rehabilitation

2011 ◽  
Author(s):  
Michael Donaghy
Keyword(s):  
Controlled Trial ◽  
Well Being ◽  
Primary Diagnosis ◽  
World Health ◽  
International Classification Of Functioning ◽  
Neurological Rehabilitation ◽  
Rehabilitation Team ◽  
Wide Range ◽  
Neurological Patients ◽  
Reasonable Evidence

Neurology has an undeserved reputation for being a speciality where diagnosis requires great intellectual effort, although from which little therapeutic intervention flows. The reader will form their own opinion about the difficulty of making diagnoses, but now neurological rehabilitation can offer all patients great help subsequently. Other chapters discuss the roles of specific medical and surgical treatments in transforming neurological patients’ lives; this chapter discusses the role of neurological rehabilitation in focusing primarily on reducing limitations on patient activities rather than by detailing the specific nature of these individual interventions.Neurological rehabilitation can be defined as a process that aims to optimize a person’s participation in society and sense of well-being. This definition highlights several important features: rehabilitation is not a particular type of intervention; the focus is on the patient as a person; the goals relate to social functioning, as well as health or well-being; it is not a process restricted to patients who may recover, partially or completely, but applies to all patients left with long-term problems. The contrast to traditional neurology is in the broader scope, extending well away from the underlying pathology but always being fully informed by the paramount importance of the primary diagnosis.This chapter will start by giving a fuller description of rehabilitation in terms of structure, represented by the resources needed, process, consisting of what happens, and outcome, defined by the goals. Subsequently the general evidence supporting neurological rehabilitation as a process is reviewed. It is not practicable to review the wide range of high class randomized controlled trial evidence investigating different and detailed aspects of the process. Some specific diseases and specific clinical problems are considered in Section 6.4.Neurological rehabilitation has a sound theoretical and conceptual basis derived from the World Health Organisation’s International Classification of Functioning, the WHO ICF (Wade and Halligan 2004) and from a general problem-solving approach (Wade 2005). There is strong evidence supporting its effectiveness as a process, and reasonable evidence in support of some specific treatments. The approach of neurological rehabilitation extends the intellectual challenge of neurology; in most clinical situations the physician and the wider rehabilitation team have to make pragmatic decisions based on incomplete information concerning many important factors.

scholarly journals The Person-Environment Profile: Preliminary Development of a Clinical Tool for Enhancing Goal-Based Rehabilitation Programs

2016 ◽  
Vol 5 ◽  
pp. RPO.S40455
Author(s):  
Delena I. Amsters ◽  
Melissa B. Kendall ◽  
Pim Kuipers ◽  
Sarita B. Schuurs
Keyword(s):  
Environmental Factors ◽  
Goal Setting ◽  
Psychometric Evaluation ◽  
Face Validity ◽  
World Health ◽  
International Classification Of Functioning ◽  
Personal Factors ◽  
Clinical Tool ◽  
Validity Testing ◽  
Rehabilitation Programs

The World Health Organization's International Classification of Functioning, Disability and Health identifies environmental and personal factors as contextually relevant to functioning following disability. Goal setting is also central to rehabilitation practice and enhances functioning. No current assessment exists that recognizes the interaction of environmental factors as they relate to goal setting in rehabilitation. The person-environment profile (PEP) was developed to explore an individual's subjective view of personal and environmental factors on the achievement of rehabilitation goals. A draft PEP underwent initial face validity testing, and the resulting version was then piloted with 13 participants across 34 rehabilitation goals within a goal-based community rehabilitation setting. Results of this pilot suggest that PEP may have the ability to detect differences in perceived barriers and facilitators across personal and environmental factors for different rehabilitation goals. While showing promise as a clinical tool, the pilot identified feasibility concerns over implementation as a standardized assessment. Substantial additional psychometric evaluation and testing needs to be undertaken before the tool can be recommended for clinical use.

Body Image and Functional Loss

2018 ◽  
Author(s):  
Melissa Henry ◽  
Ali Alias
Keyword(s):  
Body Image ◽  
Well Being ◽  
World Health ◽  
International Classification Of Functioning ◽  
Functional Loss ◽  
Psychological Mechanisms ◽  
Body Image Disturbances ◽  
The Individual ◽  
Biopsychosocial Assessment

Abstract: The implications of functional loss following cancer is an area of psychosocial oncology that is rarely ventured. This is especially true in the context of limb and sensory losses, which have important repercussions on the patient’s well-being, namely as the individual is required to reassess and redefine his or her identity in face of these adversities. This chapter explores the implications of these losses via the intersection of the World Health Organization’s International Classification of Functioning, Disability, and Health with key oncological attributes of body image disturbances that seek to render explicit psychological mechanisms underlying impairments, limitations, and restrictions. Emphasizing the use of a standard framework for the assessment of functioning is essential, especially in understudied areas. Through this perspective, further insight is provided for the methodological and biopsychosocial assessment of functioning and body, and implications for clinical inquiry and practice are proposed for the advancement of cancer survivor care.

scholarly journals Integration as a Key Strategy for Achieving Person- and People-Centered Care

2015 ◽  
Vol 4 (2) ◽  
pp. 63-65
Author(s):  
Juan E Mezzich ◽  
James Appleyard
Keyword(s):  
Personal Communication ◽  
Well Being ◽  
World Health ◽  
Central Concept ◽  
Major Objective ◽  
Functional Roles ◽  
The World ◽  
Centered Care ◽  
Health And Well Being

 The fundamental purpose of Person Centered Medicine (PCM) (and by extension of Person- and People-centered Care), is to promote the health and well-being of the totality of the person. Here the person is the central concept, which should be understood in a contextualized manner. This is illustrated by Ortega y Gasset aphorism "I am I and my circumstance, and if do not care for it I do not care for myself". In the discussion of what is central and what is instrumental in PCM, the eminent Indian scholar Shridhar Sharma (personal communication, 2012) has cogently stated that in medicine science is essential and humanism is the essence of medicine. It can be argued that the instrumental role of science could be shared by other important concepts and activities, such as integration, with similar functional roles vis-a-vis person- and people-centered care. Thus, when examining the World Health Organization's emerging six-year work plan seeking as a major objective person-centered integrated care, one could understand people-centered as the soul or essence and integration as a key methodology or strategy.

The usefulness of the ICF framework in goal setting for students with autism spectrum disorder

2019 ◽  
Vol 22 (2) ◽  
pp. 43-53
Author(s):  
Irene Rämä ◽  
Elina Kontu ◽  
Raija Pirttimaa
Keyword(s):  
Autism Spectrum Disorder ◽  
Social Behavior ◽  
Students With Disabilities ◽  
Goal Setting ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
World Health ◽  
International Classification Of Functioning ◽  
Coding System ◽  
Students With Autism

Abstract An Individualized Education Plan (IEP) is a multi-disciplinary, team-developed plan that is required for a child receiving special education services. IEPs are tools for setting objectives that are responsive to students with special needs. The International Classification of Functioning, Disability and Health (ICF) is a hierarchical classification for human functioning and disability developed by the World Health Organization (WHO). The ICF classification can be used as a structural and conceptual instrument in goal setting. In this study the educational IEP objectives of five Finnish students with autism spectrum disorder (ASD) are examined within the ICF framework. The focus is in the goals concerning the development of communication and social behavior because the main criteria for ASD comprise disabilities and challenges in communication and social behavior. The aim of the study was to assess the usefulness of the ICF coding system with regard to educational goals and objectives of students with ASD. The core content of the goals was extracted to linking units, which were coded into categories of the ICF classification. The results revealed that only few of possible ICF categories were used, the goals linked to communication technologies were heavily stressed, and the relation between the goals and general curriculum was vague. As a conclusion it is suggested that teachers and multi-disciplinary teams might benefit from standardizing their mutual conceptual framework with the help of the ICF when setting goals or objectives for students with disabilities.

Participation Versus Individual Support: Individual Goals and Curricular Access in Inclusive Special Needs Education

2017 ◽  
Vol 16 (2) ◽  
pp. 205-224 ◽  
Author(s):  
Ariane Paccaud ◽  
Reto Luder
Keyword(s):  
Inclusive Education ◽  
Goal Setting ◽  
Inclusive Classrooms ◽  
World Health ◽  
International Classification Of Functioning ◽  
Practical Implementation ◽  
Educational Systems ◽  
Educational Goals ◽  
Special Educational Needs

Following the recommendations and conventions of the United Nations on inclusion, many educational systems provide inclusive support for children with special educational needs (SEN) within mainstream classrooms. In this context, multiprofessional planning of inclusive support is crucial and individual educational plans (IEPs) are essential tools for professional implementation of inclusive education. IEP should at the same time provide suitable and achievable educational goals for individual learners with SEN as well as lead to adaptations in teaching methods, fostering participation and curricular access. These two functions are somewhat contradictory. Despite the importance of IEP for the inclusive support of children with SEN, its practical implementation has been often discussed and questioned, focusing on the quality of educational goals and on the curricular access of children with SEN.This article investigates goal setting in IEP for children with SEN in inclusive classrooms. Domain and quality of educational goals are analyzed as well as important factors influencing goal setting in IEP. Furthermore, the curricular access of children with SEN is focused.One hundred and twenty-five situations of children with SEN in inclusive classrooms in Switzerland were investigated using teacher questionnaires. Goals in IEPs were analyzed using categories from the International Classification of Functioning Disability and Health (World Health Education, 2007) and criteria for rating goal quality in IEP. Curricular access was investigated measuring the curricular distance of educational goals from the Swiss–French mainstream curriculum.Results indicate an average to low quality of the goals. Most goals concerned academic topics (56%), and two thirds of the children had goals corresponding to the curricular level. Therefore, the curricular access can be judged as quite good. On the other hand, the question of the right to follow the child’s own pace with adequate curricular adaptations stays under scrutiny.

scholarly journals Reconceptualizing the Family to Improve Inclusion in Childhood Disability Research and Practice

2021 ◽  
Vol 2 ◽  
Author(s):  
Michelle Phoenix ◽  
Meaghan Reitzel ◽  
Rachel Martens ◽  
Jeanine Lebsack
Keyword(s):  
Critical Reflection ◽  
Children With Disabilities ◽  
Service Providers ◽  
Well Being ◽  
World Health ◽  
International Classification Of Functioning ◽  
Childhood Disability ◽  
The Family ◽  
Family Centered ◽  
Children’S Rehabilitation

The World Health Organization's International Classification of Functioning, Disability and Health recognizes that environmental factors impact well-being and life participation for children with disabilities. A primary environment in which children grow and learn is the family. The importance of family has long been recognized in family-centered practice and family-centered research. Although family-centered services and research have been critically explored, the concept of family has received less critical attention in rehabilitation literature. The family construct is due for an updated conceptualization with careful consideration of the implications for childhood disability rehabilitation practice and research. Interrogating the family construct asks questions such as: who is included as a part of the family? Which family structures are prioritized and valued? What is the potential harm when some families are ignored or underrepresented in childhood disability practice and research? What implications could a modern rethinking of the concept of family have on the future of childhood rehabilitation practice and research? This perspective article raises these critical questions from the authors' perspectives as parents of children with disabilities, child focused rehabilitation professionals, and researchers that focus on service delivery in children's rehabilitation and family engagement in research. A critical reflection is presented, focused on how the construct of family affects children's rehabilitation practice and research, integrating concepts of equity, inclusion and human rights. Practical suggestions for children's rehabilitation service providers and researchers are provided to aid in inclusive practices, critical reflection, and advocacy.

Shared Responsibilities for Full Participation in Society: Planning Further Integration of the ICF Into AAC

2016 ◽  
Vol 1 (12) ◽  
pp. 83-93 ◽  
Author(s):  
Mary Blake Huer ◽  
Travis T. Threats
Keyword(s):  
Environmental Factors ◽  
Augmentative And Alternative Communication ◽  
Functional Limitations ◽  
Community Support ◽  
World Health ◽  
International Classification Of Functioning ◽  
Personal Factors ◽  
Social Service Agencies ◽  
Persons With Disabilities ◽  
Full Participation

The World Health Organization's (WHO's) 2001 International Classification of Functioning Disability and Health (ICF) has as one of its central tenets the full inclusion of persons with disabilities in society. It acknowledges the need for medical and rehabilitation intervention in its biopscychosocial framework. However, the WHO realizes that society must do its part to facilitate this full participation and empowerment. Persons with complex communication needs (PWCCN) often need augmentative and alternative communication (AAC) in order to express themselves. However, in order to access and successfully use AAC, PWCCN need access to the necessary AAC devices and services, as well as a willing society to interact with them as full contributing members of society. The factors outside of a person's specific physical and/or cognitive functional limitations are addressed in the ICF via the Personal and Environmental Factors. Personal Factors include the individual's personality traits, lifestyle, experiences, social/educational/professional background, race, gender, and age. Environmental Factors include community support systems, social service agencies, governments, social networks, and those persons that interact with the PWCCN. This article addresses the sociopolitical influences on PWCCN and their functioning from a human rights perspective. The necessary introspective role of speech-language pathologists in this process is explored.

Sixth Edition: the New Standard

2008 ◽  
Vol 13 (1) ◽  
pp. 1-12
Author(s):  
Christopher R. Brigham ◽  
Robert D. Rondinelli ◽  
Elizabeth Genovese ◽  
Craig Uejo ◽  
Marjorie Eskay-Auerbach
Keyword(s):  
Review Process ◽  
Peer Review Process ◽  
World Health ◽  
International Classification Of Functioning ◽  
Revision Process ◽  
Sixth Edition ◽  
Impairment Ratings ◽  
Health Organization ◽  
Impairment Severity

Abstract The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, was published in December 2007 and is the result of efforts to enhance the relevance of impairment ratings, improve internal consistency, promote precision, and simplify the rating process. The revision process was designed to address shortcomings and issues in previous editions and featured an open, well-defined, and tiered peer review process. The principles underlying the AMA Guides have not changed, but the sixth edition uses a modified conceptual framework based on the International Classification of Functioning, Disability, and Health (ICF), a comprehensive model of disablement developed by the World Health Organization. The ICF classifies domains that describe body functions and structures, activities, and participation; because an individual's functioning and disability occur in a context, the ICF includes a list of environmental factors to consider. The ICF classification uses five impairment classes that, in the sixth edition, were developed into diagnosis-based grids for each organ system. The grids use commonly accepted consensus-based criteria to classify most diagnoses into five classes of impairment severity (normal to very severe). A figure presents the structure of a typical diagnosis-based grid, which includes ranges of impairment ratings and greater clarity about choosing a discreet numerical value that reflects the impairment.

The Historical Development of Burden of Treatment Compliance

2014 ◽  
Vol 19 (5) ◽  
pp. 13-15
Author(s):  
Stephen L. Demeter
Keyword(s):  
Internal Medicine ◽  
Treatment Compliance ◽  
World Health ◽  
International Classification Of Functioning ◽  
Sixth Edition ◽  
Burden Of Treatment ◽  
Specific Goal ◽  
Surrogate Measure ◽  
Health Organization

Abstract A long-standing criticism of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) has been the inequity between the internal medicine ratings and the orthopedic ratings; in the comparison, internal medicine ratings appear inflated. A specific goal of the AMA Guides, Sixth Edition, was to diminish, where possible, those disparities. This led to the use of the International Classification of Functioning, Disability, and Health from the World Health Organization in the AMA Guides, Sixth Edition, including the addition of the burden of treatment compliance (BOTC). The BOTC originally was intended to allow rating internal medicine conditions using the types and numbers of medications as a surrogate measure of the severity of a condition when other, more traditional methods, did not exist or were insufficient. Internal medicine relies on step-wise escalation of treatment, and BOTC usefully provides an estimate of impairment based on the need to be compliant with treatment. Simplistically, the need to take more medications may indicate a greater impairment burden. BOTC is introduced in the first chapter of the AMA Guides, Sixth Edition, which clarifies that “BOTC refers to the impairment that results from adhering to a complex regimen of medications, testing, and/or procedures to achieve an objective, measurable, clinical improvement that would not occur, or potentially could be reversed, in the absence of compliance.

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