Optimising caseload management in children's rehabilitation services: Development, piloting and evaluation of the Good Goals behaviour change intervention

Community rehabilitation services have highlighted difficulties in achieving acceptable waiting times and efficient service provision. It is plausible that these problems are partially a function of individual clinicians' caseload management (i.e. practices related to assessment, treatment provision and discharging).

Until this project, research about community professionals' caseload management has been scarce. Since 2006, we have been conducting a series of studies (i) to develop an intervention to improve (community-based) rehabilitation therapists' caseload management, and (ii) to investigate the feasibility of using the intervention in practice.

The specific aim of the intervention is to improve the likelihood that patients with similar needs receive similar care (consistency) and to improve clinicians' use of current resources (efficiency).

This research maps on the MRC framework for developing and evaluating complex interventions. To date, the following steps, and studies within them, have been completed:

1. Generate an evidence base of therapists' caseload management and its current problems: (i) a systematic review, (ii) an interview study with therapists, (iii) an interview study with service users, and (iv) analysis of patients’ case notes.

2. Build a theoretical model of therapists' caseload management behaviours: a synthesis of the above evidence and existing theory and evidence in behaviour change.

3. Design an evidence- and theory-based intervention to change therapists' caseload management: a collaborative study with therapists and experts in behaviour change (i.e health psychologists).

4. Investigate the feasibility of using the intervention in practice: three mixed-methods case studies of children’s occupational therapy services (n=46 therapists).

The intervention, titled Good Goals, targets therapists’ three behaviours: identifying good quality goals; agreeing these goals with patients and their carers; and evaluating the patient’s progress toward the agreed goal.

Good Goals consists of four clusters of clearly specified behaviour change techniques. The pathways through which these techniques are hypothesised to cause changes in the outcome are explicitly specified.

Good Goals is delivered over 25 weeks and through face-to-face training sessions, DVDs, practical group tasks, and therapist-led team meetings. Some aspects are delivered by a trained facilitator whilst others are self-administered by the therapists. The delivery follows an explicit manual.

The evidence from the step 4 indicates that Good Goals is feasible to deliver in a range of clinical settings; may help therapists to have a shared rationale for clinical decisions and to increase clarity in service provision; and has strong potential to change practice. Good Goals has been shortlisted for a NHS Advancing Healthcare Awards 2012.

A formal evaluation is required to investigate the effectiveness and cost-effectiveness of Good Goals. We are currently seeking funding and potentially interested services for this.

Contact Person

Niina Kolehmainen – n.kolehmainen@abdn.ac.uk

Other Principal Participants

Jill Francis^1,2,Graeme McLennan^1,Edward Duncan^3,Lorna McKee^1,Laura Ternent⁴

1 Health Services Research Unit, University of Aberdeen
2 Aberdeen Health Psychology Group, University of Aberdeen

3 Nursing, Midwifery and Allied Health Professions Unit, University of Stirling

4 Institute of Health and Society, University of Newcastle

Status

Steps 1-4 have now been completed. Further funding is currently sought.

Publications

Step 1:

N, Kolehmainen; J, Francis; E, Duncan; C, Fraser Community professionals' management of client care, Article, 2010, Journal of Health Services Research & Policy, 15, 1, pp47 - 55

Kolehmainen N, MacLennan G, Francis J, Duncan EAS. Clinicians' caseload management behaviours as explanatory factors in patients' length of time on caseloads: a predictive multilevel study in paediatric community occupational therapy. BMC Health Serv Res [serial on the Internet] 2010;10:249.http://www.biomedcentral.com/1472-6963/10/249/abstract

Kolehmainen N, McKee L, Francis J, Duncan AS E. Beliefs about responsibilities, the aims of therapy, and the structure of the therapy process: a qualitative study of caseload management issues in child health occupational therapy. Child: Health, Care and Development 2012 38(1) 108-116 doi:10.1111/j.1365-2214.2011.01220.x

N, Kolehmainen; E, Duncan; L, McKee; J, Francis Mothers' perceptions of their children's occupational therapy processes: a qualitative interview study., Article, 2010, British Journal of Occupational Therapy, 73, 5, pp192 - 199, ISSN/ISBN: 0308-0226

Kolehmainen N, Duncan E AS, Francis J. What clinicians’ actions are linked to successful management of the patient care process? Content analysis of interviews with children’s occupational therapists (under review in Disability and Rehabilitation)

Step 3:

Kolehmainen N, Francis J. Specifying content and mechanisms of change in interventions to change professionals’ practice: an illustration from the Good Goals study. (under review in Implementation Science)

Step 4:

Kolehmainen N, MacLennan G, Ternent L, Duncan EAS, Duncan EM, Ryan S, McKee L, Francis J. Using shared goal setting to improve access and equity: a mixed methods study of the Good Goals intervention. (under review in Implementation Science)