ICF Model and Goal Writing in Paediatrics

Introduction

ICF which stands for the International Classification of Functioning, Disability and Health is a World Health Organization classification of health and health-related arenas. This framework measures health and disability at both the individual and population levels while also looking at environmental factors. This framework emphasises function, impact and health rather than disability and cause. Understanding the functional deficits afflicted by the health condition promotes better patient management. ICF incorporates a more holistic model of health utilising goal setting, evaluation of outcomes and communication among colleagues.

Physical Therapy Diagnosis

A medical diagnosis and a physical therapy diagnosis are two distinct entities. A medical diagnosis provides cause and prognosis, whereby a physical therapy diagnosis identifies functional limitations and quality of life. The objective of the physical therapy diagnosis is establish movement system impairments. According to Jiandani, et al., 2018, the key diagnostic questions are:

1. what are the impairments, their nature and source?
2. What impairments are related to patients functional limitation?
3. Which amongst these can be remedied by interventions?
4. What is the influence of the contextual (environment and personal) factor of a person in his function?
5. Can the contextual factors be changed or remedied to maximize performance?
6. What is the diagnostic label?

Physical therapy evaluations focus on treatment of dysfunction versus the physician model which focuses on differential diagnosis and treatment of disease.

Functional Limitations

When physical therapists assess functional limitation in individuals, they are looking for:

1. activity: able to execute a task or action
2. participation: able to fulfill the socially defined role

Participation can relate to family, work, peer groups within a physical and sociocultural environment. ICF framework considers factors whether immediate or distant that might facilitate or hinder overall functioning.

Interventions

The plan of care is created once the impairments, functional limitations and activity limitations have been identified. Interventions are targeted at minimizing disability and using function as an outcome.Within the peadiatric population, the ICF emphasises the importance of a child's environment on their functional outcomes. The environment encompasses not just the physical world, but the values and attitudes of the family and community. Accessibility to services and support will affect overall daily function for a child with functional impairments.

Goal-Setting

The ICF framework can be helpful for goal-setting. Goals are created to increase activity and participation caused by the functional impairments. (speaker) Functional goals can not only be motivational but lead to improved outcomes. Within the paediatric population, goal-setting is done with a family-centred approach.Collaboration with the family for goal-setting ensures the goals are focused on what is important to the family and what activities they would like the child to participate in. Goal creation favors the strengths of the child and how to build on those strengths to accomplish new tasks. (SPEAKER)

SMARTt

Meaningful new goals are created using the SMART method:

• S: specific
• M: measurable
• A: attainable
• R: realistic
• T: time-limited

Specific refers to making sure the goal has all the components in it that you want the child to do. In order to ascertain if a goal has been met, it needs to be measurable to see changes. When creating the goal, it is important to make sure the task is realistic and achievable. The last component of the goal is the time frame. Goals are typically geared for the short term or long term depending on the particular task. Short term goals could be frame for 4-6 weeks while long term goals might be close to a 3-4 month period of time.

you know, with a certain type of gait or, you know, with one person there to assist by providing close supervision only.

So you can add in lots of other specific components to that or measurable components to that.

Make sure it's attainable. This is something that, yeah, we totally think he can do this and we think he can do it within like a single plan of care.

At the age he's in with the potential barriers that are in his way, and we think that he can do this in that 12 week period of time.

So when you have all of that together, there is no question as to whether or not he did or did not achieve his goal because you have all of the

components of this goal that are set up really beautifully for you to be able to then objectively say yes or no.

And what do we need to modify as we move forward to make it a little more realistic,

attainable or achievable if we're not seeing the progress that we anticipated to?

So just going through a different patient and this is something that you're going to use for another knowledge check here next,

so you can use this information as a reference.

often after participating in a full day of school. He is beat.

He is really tired. It takes a lot out of him. And when he goes home, he likes to take his AFO off, sometimes just because he needs a break from it.

And when he's at home, [INAUDIBLE] kind of furniture start from one thing to the next, and he does have a history of falls.

You know, sometimes from that fatigue,

sometimes from its toe catching whenever he's at home and not wearing his AFL family lives in a two storey home.

And there are six steps to get into the house. Mom and dad both work full time jobs.

They're not at home whenever he gets home, and he has three younger siblings.

One of Jonathan's goals is that he really wants to be able to take his three and four siblings to the park across the street.

That's also up a hill from their home.

So this is information you've gathered so far in your examination and evaluation of Jonathan whenever he came into the clinic with mom and dad.

So what we're going to do is a little knowledge track to come up with two smart goals for Jonathan based on the previously provided information.

So I'm just going to pop that back up for you so that you can kind of jot down some notes if you need to before we go into our knowledge check.

And then that'll be it for us talking about the ICF model and goal setting for today.

SPECIFICS OF GOALS

So you want to make sure that you're setting realistic goals that are attainable and achievable for that particular patient.

You also want to think about how long it's going to take to achieve that goal. So we're thinking about our goal setting.

We're going to look at how long we think that particular plan of care for that patient

is going to be and identify goals that can be completed within that timeline.

Often when we make goals, we're talking about developing some short term goals and some long term goals, depending on the patient.

The length of those goals can be different. So a lot of times, you know, I'm setting some short term goals that are four and six weeks and time,

and then we're going to do a check in to see how they're doing and then some longer term goals that might be more in the 12 16 weeks time period.

And that's going to change depending on why you're seeing a patient.

So keep these factors in mind whenever you're thinking about how long it's going to take to achieve a particular kind of goal.

So when we talk about smart goals, really what we mean is, you know,

making a goal that has a lot of different features to it that are going to allow you to reassess it in a very specific kind of way.

We want these goals to be objective as much as possible so that we know whether or not we achieved that goal.

So the smart goal is really an acronym.

So the smart goal is really an acronym.

And what it stands for is the essence in the smart is we're specific, so we want to make sure our goal is specific.

So we want to make sure that when we're thinking about something that it has,

like all of the components, tell us to say yes, this is the thing we are doing.

The next thing that we're going to look for in our goal is that it's measurable. So we have to have some way to give some context to the goal.

And we think that's a reasonable amount of time. Family thinks that's reasonable. So, OK, now it's measurable.

And the next part of the goal is you want to make sure it's attainable. Can Thomas actually do this?

So you want to make sure that you're thinking about, all right, like, is this something that we're actually going to be able to get him to?

Because if it's not attainable, if it's not achievable, you're not setting a good goal for him.

So I want to make sure this is something that he can do. And, you know, like, it has to be realistic.

So, you know, is this something that your goal is both achievable and you think you can do it in a timeframe that's realistic?

So you know you're going to set a plan of care for maybe 16 weeks? Is he going to be able to get there in 16 weeks?

Or maybe it's going to take him being four years older and that, you know,

he's not going to have that detour anymore before it's actually a realistic goal for him to do this.

nd then lastly, you want to make sure you have that time frame. So how long is it going to take for you to achieve this goal?

you know, with a certain type of gait or, you know, with one person there to assist by providing close supervision only.

So you can add in lots of other specific components to that or measurable components to that.

Make sure it's attainable. This is something that, yeah, we totally think he can do this and we think he can do it within like a single plan of care.

At the age he's in with the potential barriers that are in his way, and we think that he can do this in that 12 week period of time.

So when you have all of that together, there is no question as to whether or not he did or did not achieve his goal because you have all of the

components of this goal that are set up really beautifully for you to be able to then objectively say yes or no.

And what do we need to modify as we move forward to make it a little more realistic,

attainable or achievable if we're not seeing the progress that we anticipated to?

So just going through a different patient and this is something that you're going to use for another knowledge check here next,

so you can use this information as a reference.

often after participating in a full day of school. He is beat.

He is really tired. It takes a lot out of him. And when he goes home, he likes to take his AFO off, sometimes just because he needs a break from it.

And when he's at home, [INAUDIBLE] kind of furniture start from one thing to the next, and he does have a history of falls.

You know, sometimes from that fatigue,

sometimes from its toe catching whenever he's at home and not wearing his AFL family lives in a two storey home.

And there are six steps to get into the house. Mom and dad both work full time jobs.

They're not at home whenever he gets home, and he has three younger siblings.

One of Jonathan's goals is that he really wants to be able to take his three and four siblings to the park across the street.

That's also up a hill from their home.

So this is information you've gathered so far in your examination and evaluation of Jonathan whenever he came into the clinic with mom and dad.

So what we're going to do is a little knowledge track to come up with two smart goals for Jonathan based on the previously provided information.

So I'm just going to pop that back up for you so that you can kind of jot down some notes if you need to before we go into our knowledge check.

And then that'll be it for us talking about the ICF model and goal setting for today.