New Zealand Rehabilitation Association, Inc.

This Dutch study is based on one clever little idea: to use the International Classification of Functioning for Children and Youth (ICF-CY) to compare the problems and needs identified in meetings between children with disabilities, their parents and therapists, with the documented goals set by those therapists and ostensibly derived from those problems and needs. In this study, the case notes from 41 children of with cerebral palsy aged between 4 and 8 years were examined. The researchers used the ICF-CY to classify the ‘needs' and ‘principles problems' as they appeared in the children's Rehabilitation Activity Profiles - a standardised form used in all regional paediatric rehabilitation settings in the Netherlands. These were then statistically compared with ICF-CY categories derived from the interdisciplinary goals documented for those children. (Two researchers independently coded all documents using the ICF-CY to test the reliability of their coding procedure, which was found to be satisfactory.)

The results from this study are fascinating. The authors found that despite the rhetoric around the importance of collaborative goal planning in paediatric rehabilitation, the documented goals in this cohort of children did not map particularly well onto their identified ‘needs' and ‘problems'. Less than a quarter of the identified ‘child needs' and less than a half of all identified ‘primary problems' had been incorporated into the rehabilitation goals. In fact, from a total of 95 goals documented, Nijhuis et al. (2008) report that 52% were not related to either an identified need or an identified problem. Also troubling, for five of the 41 children, no needs had been documented and for ten of the 41 children no ‘principle goal' had been documented at all. This was despite the participating rehabilitation services expressed belief in their goal planning processes.

Nijhuis et al. (2008) did attempt to examine the content of the identified needs and problems, to see if there was any link between this content and the likelihood that a need or problem would be included or excluded as a goal. However, no statistic association was identified. Nevertheless, the authors did speculate about possible explanations for their findings. One possible explanation was that the clinicians considered that not all of the needs and problems presented by the child or their family were appropriate or realistic to be addressed in therapy. A second possible explanation was that the documented goals may have related to preconditions, which needed to be met before progress could be made towards identified needs and problems (and therefore did not match when using the ICF-CY as a point of comparison). The third explanation was that the needs and problems were not prioritised in the Rehabilitation Activity Profiles, but that this prioritisation might have occurred informally before influencing the selection of goals. Regardless of the explanation however, this data has demonstrated that, at best, the clinical reasoning behind goal selection for this group of children was far from explicit and, at worst, the goals for rehabilitation were not necessarily meaningful or relevant to the lives of the children receiving the services. Read the full article for recommendations from the authors for future research and clinical practice.