Whilst healthcare and disability and even education research emphasises considering children’s perspectives, the reality is that goal setting practices haven’t kept pace, and children often remain excluded from decision-making in many paediatric settings.

The research team had previously completed a scoping review that examined child-led tools for goal setting and evaluation in rehabilitation. That review revealed that children’s involvement across goal phases is highly inconsistent, there’s a lack of comprehensive child-led tools, and available tools frequently rely on verbal communication, limiting inclusion of children with diverse abilities. These findings highlighted an urgent need to develop a more inclusive child-led goal setting tool.

This study aimed to co-design an online tool that can facilitate child-led goal setting and evaluation in collaboration with community partners.  For those unfamiliar with co-design, it’s an approach that brings together diverse community partners with varying experiences and skills in the design of systems and products.

The study had three specific objectives: a) to involve children, caregivers, and multidisciplinary allied health professionals in iterative tool design and development; b) to identify key considerations that can guide effective design for child-centred technology; and c) to produce an online child-led goal setting tool that reflects participant priorities and preferences.

Methods

The researchers used a co-design approach informed by human-centred design principles. Human-centred design aims to create technology that better meets end users’ needs through prioritising their preferences, maintaining ongoing engagement, and developing technology through rapid, iterative cycles.

Participants included

• 7 children with disabilities or developmental delays aged 5 to 15 years
• 7 caregivers
• 13 allied health professionals—six occupational therapists, five physiotherapists, and two speech and language pathologists.

The co-design process occurred across three key stages, though this paper focuses on the first two.

In stage 1, a preliminary information-gathering process called contextual inquiry explored participants’ current preferences, needs, and challenges over 14 co-design sessions. Children used digital storyboarding techniques to visually construct “screens” for the online tool, whilst allied health professionals discussed their reflections on current goal setting practices and ideas for a new tool.

Following stage 1, a prototype was developed and displayed to participants in stage 2. Over 19 co-design sessions, participants explored and interacted with this prototype, providing verbal feedback and design suggestions. They also identified specific goal topics that reflected children’s activities or life roles.

Data was analysed using qualitative inductive content analysis – this is where the categories are identified from the data, rather than being predetermined. In stage 1, a concept mapping approach organised ideas into logical groupings, forming key design considerations. These were then integrated with goal phases from the researchers’ previous work to develop the prototype for stage 2.

The Results

The article mostly explores the features that were discussed during the development of the tool. I’ve run through the relevant items for clinical practice as some items were linked to development of a technical tool.

Key Design Considerations

The analysis resulted in 10 key considerations for designing an online tool for child-led goal setting. These incorporated ideas from children, caregivers, and allied health professionals, with each group emphasising different aspects based on their unique perspectives.

Facilitating a Multi-Phase Child-Led Goal Setting Process

Participants outlined steps they viewed as important, which aligned with six distinct goal phases: directing children to goal setting, eliciting goal topics and priorities, constructing a goal statement, indicating baseline goal performance, developing an action plan, and evaluating goal progress. These phases are called the DECIDE framework.

Stage 2 provided further insights into implementation. For eliciting priorities, children and professionals recommended including a “maybe important” category alongside “important” or “not important” because children can struggle to make firm decisions between two binary options. For constructing goal statements, participants recommended a sentence structure template with placeholder text to support children with communication challenges. For rating performance, children found visual rating scales meaningful, with younger children preferring picture scales and older children preferring number scales.

Visual Without Being Distracting

Both children and professionals preferred a visual tool with pictures over excessive text. As one child noted, “Pictures help. They make it easier to understand. Kids are visual learners.” However, professionals cautioned that excess visual stimuli could be overwhelming for some children, so a balanced approach was recommended. It was observed that adolescents preferred more “mature” colour palettes, whilst stronger contrasting colours were preferred across all age groups for visibility.

Supporting Children’s Autonomy and Choice

Children expressed a desire to view pictures of activities and select “whatever they wanted” as goals.

However, professionals acknowledged tensions between meeting their professional obligations for scope of practice, setting realistic achievable goals, and supporting child autonomy.

Collaborative Functions

Professionals emphasised the need for features allowing children, caregivers, and professionals to interact with the tool at appropriate points.

Caregivers identified that the tool can “trigger a conversation” but recognised that children may need space to express their goals whilst also requiring features to support goal negotiation with caregivers.

Scaffolding and Support

Participants recommended clear instructions, support resources, and simple language avoiding clinical jargon. In stage 2, participants suggested changing wording to improve clarity—for instance, shifting from “What would you like to set goals about?” to “Choose the area you would like to think about?” Participants felt a supporting manual would be helpful to provide guidance on language that supports child-led goal setting.

Multiple Accessibility Features

Professionals recognised that children with disabilities may require different interaction methods, suggesting dictation capability, touchscreen functionality, and integration with augmentative and alternative communication devices. A combination of visuals, text, and text-to-audio features was suggested to support children’s understanding.

Other Clinical Implementation Considerations

Professionals raised considerations including compatibility with current devices, easy sharing of information, cost, confidentiality, and the ability to collect and evaluate client goal data.

MyGOALS4Kids Outcome

The key design considerations identified withing the co-design sessions were used to develop a high-fidelity prototype web-based app called MyGOALS4Kids. It uses web-based software accessible on tablets or laptops, designed to empower children to elicit, construct, address, and evaluate their own goals with allied health professional support. The tool displays goal content relevant to children in home, school, and community life areas. This tool was piloted with the participants, but the researchers note further research is needed to pilot MyGOALS4Kids within actual goal setting scenarios and investigate its usability in clinical practice, including school settings. I have had a look for the tool, but it doesn’t yet to be available to a wider audience.

Practical Takeaways

Firstly, the 10 key design considerations can inform how we approach not just digital tools but any child-led goal setting practices. The emphasis on visual supports, strength-based language, and accessible communication strategies applies whether we’re using technology or paper-based approaches. There are a lot of visuals in the article, the structure of the tool uses the 10-point scale and prioritises goals are similar to other tools we are familiar with like COPM to rate performances. The use of visuals to identify goal areas in the tool are similar to tools like the PEGS and COSA.

If you’re a student or newly qualified therapist, the DECIDE framework gives a great structure to think about goal setting with children. It would also be a good framework for teams or more experienced therapists to review their current goal setting processes and can offer evidence to support change to existing processes if you need it for management or commissioners.

The finding that children respond better when formal goal terminology was avoided is particularly relevant. Shifting from “What would you like to set goals about?” to “Choose the area you would like to think about?” demonstrates how small language changes can enhance children’s understanding and participation.

The collaborative functions highlighted in the research remind us that goal setting in schools requires balancing children’s preferences with caregiver concerns and professional perspectives; all three voices matter and need appropriate space in the process.

Finally, if you are a researcher writing work up for publication, this article was clear to read. I’d say it’s a good example if you’re needing some ideas on how to structure your article and how to integrate visuals to support your text.

This quasi-experimental study examined whether skills acquired during CO-OP intervention, transfer to new untrained activities in children with executive function deficits following acquired brain injury. At 6 months post-intervention, results showed that 22 of 32 transfer goals had improved, demonstrating that CO-OP facilitates transfer of acquired skills to new, untrained activities even after the end of intervention.

This pilot randomised controlled trial investigated the effect of CO-OP intervention on motivation and goal achievement in children with cerebral palsy, finding that CO-OP significantly enhanced motivation to engage in therapeutic activities and facilitated achievement of motor-based goals. The client-centred approach, focusing on meeting basic psychological needs, contributed to improved therapy outcomes in functional abilities, goal attainment, and engagement in daily activities.

This qualitative research collaborated with occupational therapists to develop the Child Assessment of Self-Care (CAS), a child self-report assessment tool based on the model of human occupation. Focus groups revealed that involving children in assessing self-care skills brings important awareness of their occupational identity and competence, promoting both current and future self-advocacy.