Why it matters:
Including children in goal-setting:
- is consistent with family-centred and client-centred care (best practice);
- increases children’s motivation and engagement in therapy;
- ensures therapy focuses on life activities that are meaningful for families and children; and
- improves outcomes.
Yes, but:
It can be hard to pull off in practice due to:
- time and funding constraints;
- a lack of professional knowledge, skill, and confidence;
- concerns about whether families are sufficiently informed and equipped to identify attainable goals;
- power-imbalances between adults and children;
- limited tools, processes, and workflows; and
- conflicts between parent/carer and child priorities (e.g. between impairment- and participation focused goals).
State of play:
Research suggests we can involve children of all ages and abilities in therapy goal-setting by:
- allocating time to talk to children about goals;
- giving children and families information about the purpose of goal-setting;
- communicating directly with children, and encouraging them to share their perspectives;
- using visuals, scaffolds, and assistive technology when needed;
- acknowledging children’s goals may differ from parent goals, and negotiating between them respectfully; and
- working with children and families to co-construct goals, with therapist input on how to break down long-term goals into achievable short-term goals and steps.
Level up:
To skill up and encourage children to set their own goals, allied health professionals should consider:
- evidence-informed frameworks like ENGAGE, DECIDE, and the F- Framework (see below);
- established tools, like the Paediatric Activity Card Sort, the Perceived Self-Efficacy Goal-Setting System, the Canadian Occupational Performance Measure, and Goal Attainment Scale; and
- using a simple sentence completion tool with a picture of the child with the sentence: “I would like to be able to _______ at the end of therapy so I can _______ .”
Go deeper:
Pritchard, L., Phelan, S., McKillop, A., & Andersen, J. (2020). Child, parent, and clinician experiences with a child-driven goal setting approach in paediatric rehabilitation. Disability and Rehabilitation, 44(7), 1042–1049. https://doi.org/10.1080/09638288.2020.1788178 (Abstract only)
Ryan, A. K., Miller, L., Rose, T. A., & Johnston, L. M. (2024). Optimal child-led goal setting practices for school-aged children with a disability or delay: an international Delphi consensus study. Disability and Rehabilitation, 1–9. https://doi.org/10.1080/09638288.2024.2419430 (Open Access)
Related articles and resources:
Focusing Speech Therapy on Functional Outcomes: A Refresher
F-Framework discussion and conversation starters for younger school-aged children
Functional Communication Probes for Young School-Aged Children
Hi there, I’m David Kinnane.
Principal Speech Pathologist, Banter Speech & Language
Our talented team of certified practising speech pathologists provide unhurried, personalised and evidence-based speech pathology care to children and adults in the Inner West of Sydney and beyond, both in our clinic and via telehealth.
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