Australian Occupational Therapy Journal (2014) 61, 316–324

doi: 10.1111/1440-1630.12140

Research Article

The Belief in Goal Self-Competence Scale (BiGSS) – Exploring a new way to support individual goal pursuit and document occupational therapy outcomes in paediatric practice Jenny Ziviani,1 Anne A. Poulsen,2 Katja Kotaniemi2 and Mary Law3 1 Children’s Allied Health Research, Children’s Health Queensland and School of Health and Rehabilitation Sciences, The University of Queensland, 2School of Health & Rehabilitation Sciences, The University of Queensland, Australia and 3 CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada

Aim: The Canadian Occupational Performance Measure (COPM) is an outcome measure of clients’ self perceptions of performance and satisfaction with occupational performance and is widely used in paediatric research. The aim of this study was to explore how a new outcome measure, the Belief in Goal Self-Competence Scale (BiGSS), was perceived by paediatric occupational therapists to compliment the COPM as a way of documenting client confidence in goal pursuit. Methods: Two hundred and forty-one occupational therapists participated in an online survey through paediatric listserv groups and professional networks. Therapists’ views about goal setting and the utility of the BiGSS were analysed descriptively and open ended questions were analysed thematically. Results: Overall, goal setting was viewed as a highly important aspect of therapy (n = 221, 90.7%) although only 22% (n = 52) of respondents indicated using formal goal setting tools. For the subset of respondents who frequently used the COPM (n = 101, 42%) almost all (97.87%) indicated that they would find the BiGSS to be moderately or highly useful to their current practice. Suggestions for improvement of the measure involved wording and formatting.

Jenny Ziviani PhD, MEd, BAppSc (OccThy); BA Conjoint Professor. Anne A. Poulsen PhD, BOccThy (Hons); Senior Research Fellow. Katja Kotaniemi BOccThy (Hons); Occupational Therapy Graduate. Mary Law OT Reg (Ont) PhD; Professor. Correspondence: Jenny Ziviani, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld 4072, Australia. Email: [email protected] Accepted for publication 2 June 2014. © 2014 Occupational Therapy Australia

Conclusion: This study supports existing evidence that goal setting is highly valued by occupational therapists, however, formal tools are not always used. There was preliminary support for a measure such as the BiGSS as a means of documenting children’s and families confidence in goal pursuit. KEY WORDS clinical practice, outcome measurement, paediatrics, Canadian Occupational Performance Measure, family centred practice.

Introduction Family Centred Practice (FCP) involves recognising children in the context of their families, and requires therapists to work collaboratively with family members in planning, implementing and evaluating interventions (Jaffe, Humprhy & Case-Smith, 2010). Interventions which employ FCP principles are associated with positive outcomes for both children with disabilities (e.g. improvements in functional performance and developmental gains) and their families (e.g. increased parent engagement with the service) (Brewer, Pollock & Wright, 2013). An important element in the delivery of family centred services is collaborative goal setting, whereby the goals set for therapy are identified and prioritised according to the needs of the child and his/her family (Hanna & Rodger, 2002). In accord with goal setting theory, setting explicit goals is believed to increase motivation and performance in goal-related activities (Locke & Latham, 2002). Parents of children with disabilities have reported that collaborative goal setting increases their attention to their child’s performance and, when the right level of support is provided, they feel more competent to support their child to achieve mastery (Øien, Fallang & Østensjø, 2010). Despite the important role of collaborative goal setting in the context of FCP, this is not always evident in

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clinical practice (Tomasello, Manning & Dulmus, 2010). Kolehmainen, Francis, Duncan and Fraser (2010) found that in a range of paediatric occupational therapy settings, goals for treatment were set in only 23% of cases, progress in goal attainment evaluated in 19% and goalrelated outcomes reported for 26% of clients. Various reasons have been postulated for this finding. Organisational expectations and time pressures may influence the implementation of formal goal setting measures (Fingerhut et al., 2013) along with beliefs that the process can be too time consuming (Playford et al., 2000). Intervention approaches which explicitly engage children and parents as active partners in both goal setting and problem solving, are gaining greater attention in occupational therapy. An example is the Cognitive Orientation to Daily Occupational Performance. This approach involves working towards personally meaningful goals through guided problem-solving and facilitation of self-generated strategies, which the child is taught to apply in various contexts (Polatajko & Mandich, 2004). Another approach is Occupational Performance Coaching, which involves guided problem-solving to support parents to become more autonomous in solving occupational performance issues for their children and maintaining interventions in the long-term (Graham, Rodger & Ziviani, 2009). This approach supports agentic goal setting by parents for the child’s occupational performance, and is also concerned with parents’ performance and ability to support their child’s goal attainment. Parents’ goals may be around remaining calm and feeling in control when supporting their child during goal-related tasks or obtaining information and skills to better support their child (Graham, Rodger & Ziviani, 2010). Both these approaches have influenced the extent to which children and parents perceive themselves as confident in the pursuit of identified goals, not just their appraisal of performance and the extent to which they are satisfied with this performance.

Confidence in goal pursuit The term confidence is often used interchangeably with terms such as “self-competence” and “self-efficacy”. According to Bandura’s Social-Cognitive Theory, selfefficacy refers to how confident an individual is in his/ her ability to achieve a desired goal (Bandura, 1997). Perceived self-efficacy can impact on how much effort an individual invests in goal-related endeavours and his/her motivation to persevere against setbacks (Bandura). According to Deci and Ryan’s Self-Determination Theory (SDT; 2000) this may be because individuals are more likely to engage in activities that support their psychological needs for autonomy (choice); relatedness (support and connection) and competence (a sense of being effective). In recent years there has been an increasing emphasis around the importance of utilising self-efficacy, motiva-

tion and goal setting theories within rehabilitation practice (Scobbie, Dixon & Wyke, 2011). How confident an individual feels in attaining competence in a self-identified goal may contribute to their engagement in and commitment to working towards this goal. As there is a move towards interventions which seek to enhance an individual’s confidence in goal pursuit (e.g. coaching; Baldwin, et al., 2013), being able to measure changes in perceived confidence could provide additional and valuable information about the efficacy of these interventions.

The Belief in Goal Self-competence Scale (BiGSS) There is currently no outcome measure in the occupational therapy literature to capture changes in goal pursuit confidence though it has been argued that this is an important intervention outcome (Poulsen, Ziviani, Kotaniemi & Law, 2014). A means of attending to this gap is proposed in this paper in the form of the Belief in Goal Self-Competence Scale (BiGSS). Building on the experience of use of the Canadian Occupational Performance Measure (COPM; Law et al., 1991), one of the most widely used goal oriented outcome measures in occupational therapy, the BiGSS is proposed as a adjunct but separate measure seeking to document clients’ confidence in goal-related pursuits. A 10-point Likert scale seeks information about how confident the individual feels to address the goals developed from issues identified using the COPM (0 being not confident at all, 10 being highly confident). It is important to note that the BiGSS is not part of the COPM, but represents an additional tool kit to be used alongside the COPM. The wording for this rating scale would be in line with Bandura’s (2006) recommendations for the design of parent/ child-friendly self-efficacy scales. Accordingly, best practice in this regard would be to use standard phrasing for investigating client perceptions, by asking clients to rate ‘how confident’ they are in their ability to do a given task (Bandura). The scoring scale for the COPM provides a useful layout for ascertaining changes in the subjective concept of confidence in goal pursuits, as it is in itself a self report measure used to develop goals. Using a format similar to the COPM is also useful as this is one of the most widely used outcome measures of occupational performance, and would be familiar to practitioners, as well as to parents who have completed this tool. In this sense, it would be userfriendly and easy to implement within current practice. Furthermore, the COPM has sound psychometric properties (Parker & Sykes, 2006) and there is evidence of its reproducibility with parents of children with disabilities (Cusick, Lannin & Lowe, 2007). A measure of goal-related confidence could support parent engagement and foster greater independence by allowing clients to self-monitor their ability to work © 2014 Occupational Therapy Australia

318 towards goals set in therapy. This tool could support interventions, such as coaching, where the focus is increasing confidence in goal pursuit. Development of the BiGSS would also provide additional information to supplement the COPM for therapists to evaluate the effectiveness of interventions.

The purpose of this study This study aimed to explore current goal setting practices of paediatric occupational therapists across various settings in Australia and New Zealand as well as their views on the development of the BiGSS to establish its clinical utility. The research questions explored by this article were: 1. To what extent do paediatric occupational therapists employ formal goal setting tools in their current practice? 2. Would paediatric occupational therapists perceive the BiGSS to be a useful adjunct to their current assessment practices?

Methods A cross-sectional survey design was employed to investigate the views of occupational therapists in relation to goal setting in paediatric practice and their perceptions of the BiGSS in this context.

Participants Occupational therapists were recruited around Australia and New Zealand through paediatric occupational therapy interest groups, listservs and professional networks.

Instruments A descriptive survey was purpose designed using an online survey tool (SurveyMonkeyTM Palo Alto, California, USA). The survey was pilot-tested for comprehension and clarity with five paediatric occupational therapists, and modified according to feedback. The survey comprised two parts. Part 1 sought respondents’ views regarding current goal setting practices and then recorded specific feedback on the BiGSS after showing respondents a template of the scale. Responses were rated predominantly using a 7-point Likert scale but there were also open-ended questions which allowed for elaboration. A 7-point scale (with higher scores indicating higher ratings on perceived importance, for example) was chosen, as evidence suggests that 7 or more points is optimal for yielding reliable results in educated populations (Weng, 2004). Part 2 took the form of multiple choice and short answer questions in relation to respondents’ demographics. This included questions about gender, age (in years), geographical location, highest level of academic qualification (bachelors, entry level masters, course work/research masters, doctorate), years of professional experience (in years), major caseload (medical, neurodevelopmental, mental © 2014 Occupational Therapy Australia

J. ZIVIANI ET AL.

health, learning and attention disorders, intellectual disability, other), practice area (private practice, hospital, community, education, non-government organisations, higher education). A copy of the survey can be obtained by contacting the first author.

Procedures The study was approved by The University of Queensland’s Behavioural and Social Sciences Ethics Research Committee (No. 2012001411). A link to the online survey was then distributed through interest groups and networks. Participants who accessed this link were provided with an information sheet describing the purpose of the study and the time commitment necessary to complete the survey. They were then informed that consent would be assumed if they completed and submitted the survey. All responses were anonymous.

Data analysis Completed surveys were collected electronically via the SurveyMonkeyTM online software and downloaded into a spreadsheet for analysis using Stata 10 (Stata Statistical Software: Release 10. College Station, TX: StataCorp LP). Demographic data were reported using means, medians, range, frequencies and percentages. Summary data were compiled (see Table 1). Item categories with low response rates were reviewed and where appropriate categories were collapsed for the purpose of analysis. Where data were not normally distributed but responses amenable to collapsing into categories this was recoded into three groups, low scores (1–2), moderate scores (3–5) and high scores (6–7). Relationships between participants’ characteristics and their perceptions on goal setting and the BiGSS were explored using Chi square test of independence or Fisher’s exact tests (for small cell counts) with significance set at a = 0.05. A post hoc analysis using standardised residuals was conducted to determine the participant characteristics that influenced the significance of the findings. Participant characteristics were reported for standardised residuals which exceeded  1.96. Short-answer responses were subjected to a literal level thematic analysis to determine common views on the clinical utility of the BiGSS (Braun & Clarke, 2006).

Results Two hundred and forty-one occupational therapists completed the survey. Of these, 20 therapists did not complete the demographics section at the end of the survey. In total there was < 5% missing data for individual items which required an answer. The sample size varied between 209 and 241 per question. Table 1 provides a summary of the data collected regarding demographic information and work history. The age of respondents ranged from 22 to 61 years with a median of 35.2 (SD: 5.67) years, and a majority were

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TABLE 1: Participant demographics and work history

Characteristics

Complete dataset (N = 241) Mean; standard deviation

COPM users subset (n = 101) Mean; standard deviation

Age (in years) Years of experience (in years)

35.2; 5.67 (n = 217) 10.5; 3.97 (n = 212)

35.72; 6.06 (n = 93) 10;1–4.54 (n = 88)

Gender Female Male Total Current work location Queensland New South Wales Victoria Western Australia South Australia Northern Territory Australian Capital Territory Tasmania New Zealand Total Academic level Bachelor’s or entry level master’s degree Course work/research master’s or doctorate Total Major caseload Neurodevelopmental (e.g. cerebral palsy, spina bifida, autism) Learning and attention disorders Other Total Major practice area Hospital Community Non-government organisations Other Total

n (%) 215 (97.73) 5 (2.27) 220 17 71 51 32 27 3 1 1 18 221

(7.70) (32.12) (23.07) (14.47) (12.21) (1.35) (0.45) (0.45) (8.14)

n (%) 91 (96.81) 3 (3.19) 94 6 37 21 16 6 1 – – 4 91

(6.59) (40.65) (23.07) (17.58) (6.59) (1.09)

(4.40)

169 (77.17) 50 (22.83) 219

69 (74.19) 24 (25.81) 93

81 (36.98)

45 (48.38)

23 (10.50) 115 (52.51) 219

5 (5.37) 43 (46.23) 93

35 103 31 52 221

21 39 19 13 92

(15.84) (46.61) (14.03) (23.53)

(22.83) (42.39) (20.62) (14.13)

Response rates varied per question. Where responses do not match total sample this represents missing data.

female (97.73%). Years of experience ranged from less than a year to 40 years, with a mean of 10.5 (SD: 3.97) years. A majority of respondents were based in Australia, mostly from New South Wales (32.12%) and Victoria (23.07%). Less than 9% of respondents were based in New Zealand. Over 70% of respondents had graduated with a bachelor’s or entry level master’s degree and the most common caseloads were neurodevelopmental (36.98%) and learning and attention disorders (10.50%). A majority of respondents identified as working in the community sector (46.61%). Other major practice areas included hospitals (15.84%) and non-government organisations (14.03%).

Perceptions around goal setting practices can be seen in Table 2. A majority of therapists rated goal setting as being of the highest importance in their practise with children and families (91.7%). A small percentage believed goal setting, in general, was of moderate importance and no practitioners felt goal setting to be unimportant in paediatric practice. Despite having these beliefs, only 32.08% (n = 77) of respondents indicated frequently using formal goal setting tools, such as the COPM or Goal Attainment Scaling (GAS; Kiresuk & Sherman, 1968) in everyday practice, although 239 indicated some use. Of these respondents, approximately half reported moderate use of these measures (46.02%, © 2014 Occupational Therapy Australia

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TABLE 2: Current goal-setting practices and views on the BiGSS

Question 1. How important do you consider goal-setting when working with children and their families? [1 being not at all important, 7 being extremely important] (n = 241) 2. How often do you employ formal goal-setting (e.g. use tools that enable you to identify and record goal progression) in your practice with children and caregivers? [1 being never, 7 being all the time] (n = 239) 3. How often do you employ the Canadian Occupational Performance Measure (COPM) in your current practice with children and their families? [1 being never, 7 being all the time] (n = 189) 4. How useful do you find the COPM in identifying therapy goals and outcomes? [1 being not useful at all, 7 being extremely useful] (n = 177) 5. When using the COPM individuals are asked to evaluate goals on the basis of “performance” and “satisfaction”. Do you see any benefit in also asking respondents to rate goals on the basis of “confidence in their ability to continue to work towards the identified goals”? (n = 100) 6. How useful do you think a tool measuring children’s/ parents’ confidence in addressing therapy goals would be in enhancing clinical practice? [1 being not useful at all, 7 being extremely useful] (n = 101) 7. How important do you consider client perception of confidence in their ability to attend to goals as an outcome of intervention? [1 being not important at all, 7 being extremely important] (n = 100) 8. The Belief in Goal Self-competence Scale (BiGSS) could be used as an adjunct to the COPM when the objective of interventions is related to developing an individual’s belief in his/her competence in ongoing goal attainment. On the scale which follows please indicate how valuable you think such a scale would be to your current goal setting practices. [1 being not valuable at all, 7 being extremely valuable] (n = 94)

Low score (1–2) n (%)

Moderate score (3–5) n (%)

High score (6–7) n (%)

2 (0.83)

18 (7.46)

221 (91.70)

52 (21.75)

110 (46.02)

77 (32.21)

57 (30.16)

68 (35.98)

64 (33.86)

16 (9.04)

78 (44.07)

83 (46.89)

Yes 90 (90)

No 10 (10)

1 (0.99)

38 (37.62)

62 (61.39)

1 (1.00)

30 (30.00)

69 (69.00)

2 (2.13)

51 (54.26)

41 (43.62)

Response rates varied per question.

n = 110), and 21.75% (n = 53) low use. The COPM was the most frequently identified tool (n = 101) as seen in Table 3. Of those who reported using the COPM (irrespective of how frequently), approximately half found it highly useful in identifying therapy goals and outcomes (46.89%, n = 83) with only a tenth expressing low usefulness (9.04%, n = 16). GAS was the second most frequently used goal setting tool (24%, n = 60), as well as workplace specific family care plan tools (8.29%, n = 20). Several respondents (12%, n = 18) listed tools not designed for goal setting, for example the © 2014 Occupational Therapy Australia

Movement Assessment Battery for Children (M-ABC; Henderson & Sugden, 1992) and the Bruininks–Oseretksy Test of Motor Proficiency (Bruininks, 1978). The 101 practitioners who reported knowledge of the COPM were formed into a subset to investigate their responses in relation to the BiGSS, as these therapists were considered more likely to employ this new scale and therefore able to provide more relevant information on its utility. The demographics and work history information for this subset are also summarised in Table 1 and reveal that the subset were more likely to work

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TABLE 3: Formal goal setting tools as reported by practitioners (n = 151) Tool

n

Canadian Occupational Performance Measure (COPM) Goal Attainment Scaling (GAS) Variations of an individual/family care plan or workplace specific tool Perceived Efficacy and Goal Setting Tool (PEGS) SMART goals Children’s Assessment of Participation and Enjoyment and Preferences for Activity of Children (CAPE/PAC) Child Occupational Self-Assessment (COSA) The Paediatric Activity Card Sort (PACS) Unknown assessments (ABCDE, HIP, WHOM, Responsiveness Teaching goals) Tools identified that are not goal-related Individualised Prioritised Problem Assessment (IPPA) Movement Assessment Battery for Children (M-ABC) Developmental checklists The Wall Model of Occupational Performance (WOP) The Beery Developmental Test of Visual-Motor Integration Bruininks-Oseretsky Test of Motor Proficiency (BOT) Early Start Denver Model (ESDM) Functional Independence Measure for Children Safety Assessment of Function and the Environment for Rehabilitation (SAFER)

101 60 21 7 5 2

Overall, there was little variation in responses related to respondents’ demographic data. Only practice area was significantly related to goal setting perceptions, with therapists working in non-government organisations most likely to report high use of the COPM (75.86%, n = 22), when compared with community (28.4%, n = 23) and hospital (15.15%, n = 5) settings, v2 (6) = 37.27, P < 0.001.

Suggested improvements for the BiGSS Two themes were evident from the analysis of respondents’ open ended comments on the BiGSS: (1) concept clarification and, (2) clinical utility.

Concept clarification 1 1 4

7 2 2 2 1 1 1 1 1

Some respondents reported using more than one tool.

with children with neurodevelopmental difficulties and work for NGOs than the total respondents. For the subgroup who were familiar with and had used the COPM, client goal-related confidence was rated as highly important to clinical practice (61.39%, n = 62), and most believed that this would be an important outcome of intervention (69%, n = 69). The majority of respondents (90%, n = 90) perceived benefits in having clients rate their confidence in goal pursuit alongside performance and satisfaction. All but two respondents considered that the BiGSS would be either highly useful to their current practice (44%, n = 41) or moderately useful (54.26%, n = 51). Reasons for not using the BiGSS included: time constraints 17.86% (n = 5) and; not suitable for the client group currently seen and not a focus of their practice 25% (n = 7).

The majority of therapists considered ‘confidence’ an important concept to measure as an intervention outcome; however, a number also suggested that a more precise definition be provided in the BiGSS. Using simple language to describe ‘confidence’, that both parents and children could understand in the context of goal pursuit, was considered important. A respondent working in a community setting with a neurodevelopmental caseload expressed it this way: Perhaps a little bit of a definition of confidence as it may be a little bit of a difficult concept for clients to understand. I think it would be a valuable measure and assist in how to approach interventions that are working towards the goal but I think a simple explanation of confidence may be useful.

It was also suggested that providing some practical examples of how to explain the concept of ‘confidence’ to parents and children might facilitate the use of the BiGSS. Some therapists, who reported using the COPM, also commented that the concepts of ‘satisfaction’ and ‘performance’ could sometimes be confusing for clients, especially for those from non English backgrounds.

Clinical utility Numerous respondents noted that the BiGSS addressed an important intervention outcome. In terms of practical application several respondents noted that the BiGSS template appeared simple and easy to use: No suggestions, looks simple and clear. Particularly pertinent for my service as we are moving to limited intervention where clients are expected to do the main work on achieving goals.

There was evident enthusiasm for the BiGSS being incorporated alongside the COPM, as a supplementary measure, with some therapists calling for formal psychometric investigations as the next step in this process. In terms of content the BiGSS was thought to be rele-

© 2014 Occupational Therapy Australia

Australian Occupational Therapy Journal (2014) 61, 316–324

doi: 10.1111/1440-1630.12140

Research Article

The Belief in Goal Self-Competence Scale (BiGSS) – Exploring a new way to support individual goal pursuit and document occupational therapy outcomes in paediatric practice Jenny Ziviani,1 Anne A. Poulsen,2 Katja Kotaniemi2 and Mary Law3 1 Children’s Allied Health Research, Children’s Health Queensland and School of Health and Rehabilitation Sciences, The University of Queensland, 2School of Health & Rehabilitation Sciences, The University of Queensland, Australia and 3 CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada

Aim: The Canadian Occupational Performance Measure (COPM) is an outcome measure of clients’ self perceptions of performance and satisfaction with occupational performance and is widely used in paediatric research. The aim of this study was to explore how a new outcome measure, the Belief in Goal Self-Competence Scale (BiGSS), was perceived by paediatric occupational therapists to compliment the COPM as a way of documenting client confidence in goal pursuit. Methods: Two hundred and forty-one occupational therapists participated in an online survey through paediatric listserv groups and professional networks. Therapists’ views about goal setting and the utility of the BiGSS were analysed descriptively and open ended questions were analysed thematically. Results: Overall, goal setting was viewed as a highly important aspect of therapy (n = 221, 90.7%) although only 22% (n = 52) of respondents indicated using formal goal setting tools. For the subset of respondents who frequently used the COPM (n = 101, 42%) almost all (97.87%) indicated that they would find the BiGSS to be moderately or highly useful to their current practice. Suggestions for improvement of the measure involved wording and formatting.

Jenny Ziviani PhD, MEd, BAppSc (OccThy); BA Conjoint Professor. Anne A. Poulsen PhD, BOccThy (Hons); Senior Research Fellow. Katja Kotaniemi BOccThy (Hons); Occupational Therapy Graduate. Mary Law OT Reg (Ont) PhD; Professor. Correspondence: Jenny Ziviani, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld 4072, Australia. Email: [email protected] Accepted for publication 2 June 2014. © 2014 Occupational Therapy Australia

Conclusion: This study supports existing evidence that goal setting is highly valued by occupational therapists, however, formal tools are not always used. There was preliminary support for a measure such as the BiGSS as a means of documenting children’s and families confidence in goal pursuit. KEY WORDS clinical practice, outcome measurement, paediatrics, Canadian Occupational Performance Measure, family centred practice.

Introduction Family Centred Practice (FCP) involves recognising children in the context of their families, and requires therapists to work collaboratively with family members in planning, implementing and evaluating interventions (Jaffe, Humprhy & Case-Smith, 2010). Interventions which employ FCP principles are associated with positive outcomes for both children with disabilities (e.g. improvements in functional performance and developmental gains) and their families (e.g. increased parent engagement with the service) (Brewer, Pollock & Wright, 2013). An important element in the delivery of family centred services is collaborative goal setting, whereby the goals set for therapy are identified and prioritised according to the needs of the child and his/her family (Hanna & Rodger, 2002). In accord with goal setting theory, setting explicit goals is believed to increase motivation and performance in goal-related activities (Locke & Latham, 2002). Parents of children with disabilities have reported that collaborative goal setting increases their attention to their child’s performance and, when the right level of support is provided, they feel more competent to support their child to achieve mastery (Øien, Fallang & Østensjø, 2010). Despite the important role of collaborative goal setting in the context of FCP, this is not always evident in

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the need for conceptual clarification of the construct of goal-related confidence, and the need to understand and address potential external barriers to its clinical utility. A clear, simple definition of goal-related confidence was perceived as being necessary, not only for the clients, but also to help therapists understand and communicate goal-related confidence. Existing health literacy research suggests that having simple definitions in health-care practice is vital for effective clinical practice, as a high proportion of Australian adults have trouble understanding simple health-care information (Australian Bureau of Statistics, 2008). Supporting clients to understand terms around goal setting is crucial in empowering them to not only engage in allied health services but to take control of their goal pursuits. The issue of clinical utility was raised by numerous therapists who expressed the view that limited time to complete assessments and engage busy parents in goal setting could prevent clinical uptake of an additional assessment tool. The literature is supportive of this viewpoint. Organisational pressures, such as time constraints have been consistently identified as significant barriers to client-centred practices (Sumsion, 2006). The issue of assessment relevance however requires further exploration. Some clients may prefer greater time allocation towards interventions than time involved in goal setting processes. Other parents may, however, be more willing to complete assessments, including goal setting evaluations that are relevant and tailored towards their needs. There is currently limited evidence to provide guidance in this regard and further research to improve our knowledge may be warranted. A key recommendation by survey respondents to improve the clinical utility of the BiGSS was to make it more compatible with the COPM, as practitioners noted that they would be more willing to use this new tool if it was more closely aligned with established COPM usage.

Limitations of the study Methodologically, the need to collapse categories related to respondents’ work history because of small cell sizes, made it difficult to tease out the possible influence of this factor on goal setting practices. In future research phrasing questions so that respondents are specifically asked to identify the most reflective category could be a more prudent means of gathering this information. A predominant portion of respondents worked in the neurodevelopmental area, and although this may have skewed the results it reflects practice reality. Much of the literature in goal setting comes from this area, and it may be beneficial for this to be the focus of future research as the BiGSS may currently be more relevant in this field. As this study was restricted mainly to occupational therapists in Australia, the findings may also not be generalisable internationally. Further research would need to be carried out in other countries

to explore the clinical utility of the BiGSS tool outside of Australia and New Zealand.

Recommendations The positive responses to the BiGSS suggest that practitioners consider it a potentially useful addition to their current practice and that further development is warranted. The next step for the BiGSS involves refinement based on feedback from this study. A future direction may be to carry out purposive sampling and interviews to better understand the issues raised by this study. Psychometric development and finalising the BiGSS template would follow.

Conclusion Findings from this study provided insights into the current goal setting practices of occupational therapists in Australia and to a lesser extent New Zealand, including challenges in applying family centred goal setting. Enablement is the current focus of practitioners of various professions working with children with disabilities and their families. Knowing how to support the autonomy of clients in goal setting practices, may potentially have significant impacts on the competence of parents and children to work towards goals that are important to them, and ensuring that gains made in therapy translate to their daily lives and future development. The clinical utility of the BiGSS tool has also been tentatively supported in this study. Further development and pilot-testing of this tool, is needed to provide allied health professions with an additional tool for their practice which will allow them to measure an aspect of therapy not currently addressed. Measuring and monitoring goal-related confidence with children and their families may provide a way of further establishing the effectiveness of enablement and coaching therapies. Monitoring confidence in goal pursuits may also foster client engagement and further enhance clinical outcomes.

Declaration of conflicting interests The author(s) declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Acknowledgement The author(s) received no financial support for the research, authorship and/or publication of this article.

References Australian Bureau of Statistics. (2008). Health literacy, Australia. Retrieved 15/2/14, from http://www.abs.gov. au/ausstats/[email protected]/mf/4233.0

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The Belief in Goal Self-Competence Scale (BiGSS) - exploring a new way to support individual goal pursuit and document occupational therapy outcomes in paediatric practice.

The Canadian Occupational Performance Measure (COPM) is an outcome measure of clients' self perceptions of performance and satisfaction with occupatio...
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