Solution Focused Coaching in Pediatric Rehabilitation (SFC-peds)

In this article I have relied heavily on brief extracts from the article:  Solution-focused coaching in pediatric rehabilitation: an integrated model for practice (2013) This includes many direct quotes.  

The article provides an in-depth rationale for the development of the model: here I have tried to represent the main ideas that relate directly to practice. Cutting complex ideas to the bare bones runs the risk of misrepresentation and simplification.  The extracts provide a guide to the main ideas that inform SFC-peds, and I hope that therapists will use these to reflect on their own practice. 

The pediatric rehabilitation research team from the Thames Valley Children's ​ Centre in Canada  have created a practice model for solution-focused coaching in pediatric rehabilitation (SFC-peds) that integrates the fundamental principles and practices of solution focused coaching with contemporary developments in pediatric rehabilitation.

The aim of coaching is to explicitly create an optimal interactional environment that enhances client readiness and motivation for change and growth, including goal attainment, personal development, and behavioral change.

The term “client” encompasses the child and family, but may also include other key people in the child and family’s life.

SFC-peds is defined as a strengths-based, relational, and goal-oriented approach in pediatric rehabilitation that uses positive reframing and strategic questions to assist clients in envisioning a preferred future and developing practical solutions to move toward this vision.

It provides a distinct shift from a problem-oriented, therapist-directed approach to a possibilities-oriented approach where client empowerment takes precedence.

Problem-oriented interventions focus on identifying and solving problems or issues with respect to impairments in body functions and body structures, activity limitations, or participation restrictions.

In solution focused therapy therapists engage with clients to to explore client needs, priorities, and preferences in ways that shift the orientation from problems to possibilities.

This emphasis on possibilities allows parents to explore different creative and unique ways to support their infant's learning.

SFC-peds is also distinguished from other coaching models by the unique way that therapy-specific information is used to enhance client capacity in developing goals and plans relevant to their circumstances.

Other distinguishing practice features of SFC-peds include: an early exploration of the clients’ preferred future and the purpose and placement of assessment.

SFC-peds process model 

The SFC-peds model uses a synergistic and collaborative process that encourages clients to discover and develop new insights, ideas, and customized plans that meet their needs.

The process consists of seven elements: (a) setting the stage, (b) forming the client–therapist relationship, (c) envisioning a preferred future, (d) goal discovery, (e) strategy creation, (f) plan confirmation, and (g) an action/reflection cycle.

A. Setting the stage.

The client’s worldview provides the context for their sense of meaning and purpose in life.

Understanding and working from within that worldview is an important element in building trust and increasing client engagement and participation. 

The client and therapist each enter into a collaborative  relationship with their unique strengths and resources, which are fundamental to their work together.

Clients bring the strengths and resources of their life experiences, and worldview (i.e., hopes, values, and priorities).

Therapists bring their clinical training, professional experience, employment setting, and their own worldview into the relationship.

Strategic questions support therapists to maintain a primary stance of curiosity and to use client language as a means of working within the client worldview.

Therapists listen carefully for the clients’ ideas and priorities in ways that will enhance exploration and expansion of client knowledge and choices.

B. Forming the client–therapist relationship.

The client–therapist relationship is considered to be at the heart of clinical practice in the health professions (Higgs & Jones, 2000).

During relationship building, the primary focus is on connecting with the client as a person, through respect, warmth, and openness by affirming and amplifying their strengths, resources, and past successes.

The clients’ expertise regarding their situation is emphasized and the client–therapist relationship is the focal place for the discovery of changes that the child, family, and broader community wish to make with respect to enhancing the child’s participation and quality of life.

Therapists embark upon a process of inquiry to explore client needs, priorities, and preferences in ways that shift the orientation from problems to possibilities.

C Envisioning a preferred future.

Through envisioning a preferred future, clients are supported in their creative thinking about their situation and have the opportunity to tap into their internal source of hope and meaning, which provides personal motivation in moving themselves forward.

The client’s preferred future provides the lens through which the client and therapist co-construct therapy goals aligned with the client’s longer-term vision.

Envisioning a preferred future also allows the client and therapist to articulate and negotiate expectations for therapy, which can decrease the potential for working at cross-purposes and better align client expectations and therapy options. .

Ideas generated by the client through exploration of their preferred future supports increased client awareness of their potential for change and facilitates the development of small steps toward their goal

D Goal discovery.

During goal discovery, clients are invited to consider their goals as well as the therapist’s information and assessment findings, such that mutual expectations and outcomes can be developed with greater clarity, paving the way for client-driven therapy plans that are cohesive, realistic, and manageable.

In SFC-peds, goal setting emphasizes the client’s desired focus and priorities, rather than being based upon a clinical needs assessment.

This emphasis on working within the context of the client’s worldview, future vision, and readiness using a process of inquiry suggests a different purpose and placement of therapy assessment.

Contrary to traditional approaches that use clinical assessment to provide therapists with information for goal-setting, the purpose of assessment in SFC-peds is to enhance client knowledge about clinical aspects of their situation to inform and empower client-driven goal-setting.

E. Strategy creation 

Once goals have been clarified, microquestions are used to expand the client’s ideas and strategies for goal attainment (Warner, 2007), thus  increasing the specificity and ownership of the therapy plan.

By maintaining a process of inquiry about client ideas and respectfully sharing clinically relevant information, a therapy plan is co-constructed that is aligned with client readiness, supports client choices, is responsive to their unique situation, and fits with their real-life environment.

F. Plan confirmation

The therapist uses strategic questions and positive feedback to confirm, clarify, and explore any needed refinements to the goals and plan

Positive feedback is enlisted to affirm client strengths, resources, and self-efficacy.

Confirming the importance and priority of proposed goals and plans and making any necessary refinements provides consolidation of a realistic

and manageable plan.

G. Action and reflection cycle

Client reflection on action is an important means of enhancing performance toward goal attainment.

A plan of action can be somewhat experimental, which empowers the child and family to refine the plans as needed.

At subsequent sessions, the therapist elicits details of what went well and what did not, highlights client strengths and learning, and supports the client to determine next steps.

In each subsequent session, the client and therapist are considered to be entering into a new cycle of SFC-peds bringing greater capacity based upon their new learning. Reassessment can be utilized here to provide the client with a more objective measure of progress. In this way, SFC-peds facilitates progressive evaluation and refinement of goals and plans. 

Abstracts of the research that supports SFC-peds 

Combining SFC (Peds) and Task Oriented Movement Therapy 

The SF-TO approach to assessment and training