Table I.

Interventions, purposes and active goal-setting ingredients addressed

Intervention	Purpose	Materials	Best practice key elements addressed	Sites implementing
Staff education and training Content: An introduction to goal-setting Collaborative interdisciplinary goal-setting Goal-setting and action planning Motivational interviewing Goal-setting measures and tools Talking Mats training online	Focus of sessions: The difference between goals and actions, How to frame long-term and short-term goals. Action plans and coping plans to achieve goals. Skills to facilitate SDM How teams can work together to include the client. Using measurement tools and prompts	Training manual, handouts, references and PowerPoint presentations, online resources	Interdisciplinary goal-setting SDM Specific and meaningful goal-setting Action planning, feedback and review	Inpatient sites 1, 2, 3 Community sites 4, 5
Keyworker model and workplace instruction Content: Workplace instruction defining role and responsibilities The primary role of the keyworker is to orientate the client to the rehabilitation service and enhance the communication between the interdisciplinary team and the client and family prior to and following case conference meetings.	To enhance client and family involvement in goal-setting and rehabilitation	Workplace instruction providing description of role and responsibilities	Interdisciplinary goal-setting SDM Specific and meaningful goal-setting Action planning, feedback and review	Inpatient site 2 Community site 4
Case conference restructure Content: Background client information, current function, common goal focus, long-term hope/dream goals, client goals for the episode of care, client weekly goals, client actions, staff actions and discharge plans.	To provide a framework for meaningful interdisciplinary goal-setting and action planning	Workplace instruction Chairing guidelines Electronic template	Interdisciplinary goal-setting Specific and meaningful goal-setting Action planning, feedback and review	Inpatient sites 1, 2
Communication goal and action boards Content: Long-term goals, goals for the episode of care, weekly/short-term goals, client actions and estimated discharge dates	To enhance client and family involvement in goal-setting and rehabilitation, to enhance the role of the nurse to support action planning	Paper copy	Interdisciplinary goal-setting SDM Action planning, feedback and review	Inpatient sites 1, 2
Client workbook Content: –What is rehabilitation? –Why do I need rehabilitation? (fillable), –Who may I meet in rehabilitation?, –Your rehabilitation service (tailorable), –What is a goal? –How do I set a goal? (tailorable templates)	To enhance client knowledge and expectations, to provide a framework for staff to facilitate goal-setting and action planning	Editable PDF, provided as hard copy to clients	SDM Specific and meaningful goal-setting Action Planning, feedback and review	Inpatient sites 2, 3 Community sites 4, 5
Client rehabilitation flyer Content: What is rehabilitation? What is a goal? Who may I meet in rehabilitation? (tailorable) Available facilities (tailorable) What to bring (tailorable) Your rehabilitation routine (tailorable)	To enhance client knowledge and expectations prior to rehabilitation admission	Paper flyer A4 size	SDM Specific and meaningful goal-setting	Inpatient site 2

SDM: shared decision-making.