Home' Community Care Review : CCR MAY 2016 Contents SPONSORED FEATURE
assisted as there was a formulation of a partnership that assisted in
"In a lot of the restorative care or reablement programs the
outcome measures are around the ability to improve function of
specific body parts -- for instance, how quickly can you sit and stand
as an indicator of the strength of your quad muscles. Whereas
TARGET had a very different approach, in which the client decides
their own goal, a goal that was meaningful and meant that they
could achieve what in essence was important to the person." This
usually related to performance of a task or activity, says Buckley.
"Now we're in the consumer directed care environment, we
wanted to hear the client's voice; what were the things that were
important to them. We believed that even within a restorative
model, if a person chooses their own goals then their motivation
would be enhanced and goal attainment would be more in reach."
This proved true, as indicated by the outcome measures utilised
at baseline and eight weeks, adds Davies.
As a result, some of goals that clients set included: moving
around the house safely, being able to knit again, getting back into
the swimming pool, showering and shaving independently, and
cooking hot meals without help.
The second unique aspect of TARGET was its approach to setting
an overarching goal as well as interval goals. "There's a distal, or
long-term goal, and underneath that sits smaller, proximal, short-
term goals," explains Davies. "That way you establish the mini steps
that progress you towards that overarching distal goal.
It makes achieving that end point less overwhelming." It made
goal attainment achievable within an eight-week timeframe.
Third, the TARGET tool allowed for the adoption of a health coach
approach, which Catholic Healthcare's community services was keen
"We surround the client with a care ecosystem," says Buckley.
At the heart of that ecosystem is the pair of health coaches -- a
physiotherapist and an occupational therapist -- who lead and
supported the other members of the team, which include the
care workers, case managers, family carers and GP.
Under the program, all members of the team are provided with
the TARGET tool which clearly outlined the client's goals and how
they wanted to achieve them. The use of the term health coaches
to describe the two allied health professionals was very intentional,
"There's a societal view that ageing is
intrinsically linked to functional decline...
We wanted a coaching model that would
challenge those beliefs, and provide
motivation, which was key. "It also made the
allied health professionals less daunting
for the participants in the study, so they felt
they could work with them, and the TARGET
tool allows them to be part of the decision-
making process," adds Davies.
The health coaches not only motivated
the client, but also further engaged the
community care workers through upskilling
them so that they could assist study
participants to practice activities of daily
living and practice their exercises. It noted
that over the period of the eight weeks of
interventions that the participants were able
to perform more of their personal care tasks
and meal preparation tasks.
Weekly meetings with the health
coaches and care advisors monitored the
client's progress and utilised the teams'
collective experience in overcoming any
barriers as they arose.
PUT TO THE TEST
The eight-week program using the TARGET
Tool commenced in November 2015 with
10 community clients on the NSW Central
Coast, who each commenced the pilot
within a two-week timeframe.
"We deliberately chose a small sample size
so that we could get that deep understanding
of any barriers, and opportunities for an
innovative model of care that potentially
could be applied across the organisation.
Many researchers describe the value of a
small sample size," explains Davies.
While flexibility was important to the pilot, a
thorough evaluation required that assessments
be conducted at certain points in time. These
were undertaken at the beginning (to capture
baseline measurements) then in week five and
again at week eight before exiting the pilot.
Allowing clients to set their own goals
was clearly a unique and positive feature
of the pilot, Buckley explains, but from a
research perspective it made measuring the
outcomes more challenging; how do you
apply a uniform research approach when
the participants all had different goals with
different timeframes to achieve them?
While participants selected their own
goals and the pace at which they'd achieve
them. The organisation aimed for functional
and quality of life improvements. Health
coaches also had to engage the clients in
negotiating and agreeing what goals could be
achieved, and by when.
24 | MAY 2016
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