Goal Writing in Pediatric Physical Therapy

Goal Writing in Pediatric PT

• The ICF model emphasizes function, impact, and health rather than disability.
• Understanding functional deficits associated with a health condition promotes better patient management.
• The ICF model considers factors that facilitate or hinder overall functioning, including environmental and personal factors.
• Environmental factors include:
  • Setting at home or school
  • Motivation of the individual
  • Amount of family support
  • Accessibility to assistive devices
• Personal factors include:
  • Age
  • Gender
  • Lifestyle
  • Fitness
  • Coping styles
  • Cultural beliefs
  • Pain experience
• Interventions involve identifying impairments, functional limitations, and activity limitations, and creating a plan of care to minimize disability and use function as an outcome.
• In pediatrics, the ICF model emphasizes the importance of the child's environment on their functional outcomes.

Goal-Setting in Pediatrics

• The ICF model helps with goal-setting, focusing on increasing activity and participation.
• Goals are created to build on the child's strengths and accomplish new tasks.
• A family-centered approach is used, focusing on the child and family's interests and values.
• SMART goals are used, which are:
  • Specific
  • Measurable
  • Achievable
  • Relevant
  • Time-Bound
  • Additional considerations: Ethical, Enjoyable, Engaging, Recorded, Rewarded, Realistic, Relevant, and Research-based

Play-Based Interventions

• Play is an important part of development and is considered "work" for children.
• Play allows children to participate and take ownership of their learning.
• Play can happen with any activity, anywhere, and increases practice and repetition, helping with the learning curve.
• Physical therapists can direct play, but the child's engagement with the activity allows them to take ownership and incorporate what they learn at a deeper level.
• Physical therapists must be creative and flexible to take the child's input and interests and make it therapeutic.

NICU and the Role of PT

• The focus of NICU PT is on consultation and family education.
• Neonatal physical therapists play a key role in the interdisciplinary neonatal care team.
• PTs are responsible for educating the caregiver team and family on positioning, handling, and therapeutic interventions.
• PTs are referred to infants born prematurely or at full term with signs of CNS impairment, neuromuscular or orthopedic problems, and other medical issues.

PT Exam and Eval in the NICU

• The PT exam and evaluation in the NICU involve a chart review, including the infant's history and current medical status.
• The PT monitors the infant's physiological and behavioral response to handling.
• The PT assesses the infant's behavioral state and alertness, including stages of alertness and the ability to move through various degrees of alertness.
• The PT evaluates the infant's ability to maintain flexion in prone, supine, and sidelying positions.
• The PT assesses the infant's muscle tone and reflexes, including resistance to passive movement and primitive reflex testing.

Early Intervention and the Role of PT

• Early intervention physical therapy is provided under the Individuals with Disabilities Education Act (IDEA) Part C.

• IDEA Part C is a federal program that supports early intervention for infants and toddlers from birth to 3 years.

• The law requires that multiple agencies work together to meet the needs of infants and toddlers and their families.

• Eligible children have a developmental delay or a medical diagnosis that has a high probability of a developmental delay.

• EI services are provided in natural environments, such as the home, and are tailored to the child's and family's needs.

• PTs provide services as part of the child's Individualized Family Service Plan (IFSP) and work with the team to develop outcomes, objectives, and strategies.### Medicaid and Parental Consent

• Inability of parents to pay or utilize personal insurance cannot prevent delivery of Part C services

• States may decide on additional rules and requirements for funding

Child Find

• Public schools must search for, evaluate, and identify kids who need special education
• Covers kids from birth to 21 years old
• Applies to all kids, including homeschooled, public, private, migrant, and homeless children

EI Summary

• Part C of IDEA: optional federal program supporting EI for infants and toddlers (birth to 3 years)
• All states currently participate in Part C
• Eligible infants and toddlers receive EI services in natural environments
• Goal: meet developmental needs of child and family

School-Based Setting and Role of the PT

• Implementation of IDEA, Part B: ensures free appropriate public education (FAPE) for children with disabilities
• Individual student's needs are determined using student data and evaluation
• Parents/guardians are integral participants in the evaluative process and IEP development
• Specially designed instruction and related services are individualized and linked to measurable student goals
• IDEA requires coordinated services for transition from Part C to Part B and from public school to work, further education, and community engagement

The IEP Team

• At least every 3 years, the IEP team reviews and revises the student's IEP

School-Based PT

• PT is a related service under Part B of IDEA
• Student is eligible if PT is needed to address educational needs and PT expertise is required
• PTs work collaboratively with the IEP team, participate in screening, evaluation, and intervention, and design a plan of care
• PTs support students in accessing and participating with peers in their educational environments
• PTs determine needs for assistive technology, supplementary aids, and accommodations

Transition Services

• Transition services include: EI to preschool, preschool to elementary school, elementary school to middle school, middle school to high school, and high school to adult community
• After high school education: college, job training programs, and employment

PT Under IDEA B

• Under IDEA B, PT is a related service
• Intervention in education setting is not provided to remediate medical diagnoses and/or physical impairments
• Intervention is provided to help students achieve their learning and participation goals despite existing impairments
• Schools are responsible for services needed for students
• Discontinuation of related services occurs when skills are incorporated into school routines or when needed supports are in place without services

Pediatric PT in Rehabilitation Settings Versus Schools

• PTs play an important role in helping a child and family in rehabilitation settings
• PT: a teacher, guide, advocate, and coach who empowers children to maximize their fullest potential