Writing Goals

This blog was started with interests in helping students and also in describing my current OT life, so this entry should be an interesting mix. My husband left for an extended trip to Europe today, and I was trying to make a list of things to do while he's away and realized it would be a good time to offer some instruction on goal writing. Some of this information is taken from my notes on the required documentation book from my first year (long since sold, so I can't check on anything else in it).

There are a few basic types of goals, but most of what I write are restorative, modification, or new skill goals. If you are writing a goal with the intent to maintain something in a client's life, or prevent something from happening, you're on shaky ground (ie- may not be reimbursed by insurance or covered in scope of practice). If you've got a grant for a special program focusing on preventive care or health promotion, more power to you, but most people want evidence that the goal has been achieved within a reasonable time frame and primarily due to your OT intervention before they pay you.

When starting at a new setting or when out on fieldwork, focusing on writing good goals can be a little overwhelming. A note to the fieldwork students- every supervisor has different expectations for documentation (also, they have every right to be demanding, as their name goes on it too). A good supervisor will tell you though that as you start being 'a real OT/A' that you will develop your own style of documentation that still retains the basic needs (hopefully!). This can be easier to do if you have a framework to go off of. I used the SMART model in school, here are a few more:

• SMART: Significant, Measurable, Achievable, Relates to person, Time based
• ABCD: Audience, Behavior, Condition, Degree
• FEAST: Function, Expectation, Action, Specific conditions, Timeline
• RHUMBA: Relevant, How long, Understandable, Measurable, Behavioral, Achievable

Ideally, you would include each of these elements (from 1 acronym) in each goal. One of my coworkers uses a method that explains the reasoning of each goal prior to the specific action. It is key to notice that time is an element in all of these... you cannot have a goal for an interminable period. A goal should never be permanent- you should be reviewing it to see if it has been met, explaining the limiting factors if not met, and adapting it if necessary to provide the "just right" challenge for the client. Incidentally, your setting and overarching frame of reference will dictate the wording you use to describe the person achieving the goal. In a hospital, "patient" is the common term (undoubtably noticed in this blog), while "client" is often used in outpatient settings. Some settings prefer using the person's name. Other titles may be "student" "participant" "family" or "resident." Even though I occassionally do this, you really should not write goals with the therapist as the action-taker (ie "therapist will further evaluate cognition). This belongs in a formal plan of care rather than the goals.

Another problem that fieldwork students often have is knowing what issues to write a goal about. As a rule, if you want to work as an OT practitioner, you need some occupation-based goals. It simply cannot be all about ROM, strengthening, or mobility in your wording, and should not be in your approach. With my hospital patients, I try to have 2 ADL goals, 1 mobility goal, 1 exercise goal, 1 home safety goal. (That's the baseline, I add and subtract based on pt ability) In the few hand evals that I did, I would have a ROM goal, strength goal, HEP goal, and 1-2 specific occupation goals. (the CHT at my site often uses "pt. will identify x# new daily tasks she is capable of performing w/ RUE") With the kids, it is all very different due to their needs, but there is often a sensory goal, 1-2 school readiness goals, parent program goal.

Examples- these are all based off of my life, and written while watching softball, so they aren't exactly what you would want in your setting, but it should give a reasonable idea.

• To demonstrate increased leisure participation, Cheryl will attend activities with friends 1x/week for 3 weeks.
• In 3 weeks, Cheryl will complete 10 crossword puzzles at modified independent level with use of google.
• Cheryl will complete 80%+ of her exercise program at the wellness center 3 days/week.
• Cheryl will play fewer than 50 computer games per week to decrease c/o wrist pain.
  

I could go into more detail on determining length of time for goals (totally different in different settings), good goals vs bad and why, other documentation notes, but I have rambled on this for awhile already and will hold off on that unless there is reader interest in those. School is starting again, so it will be interesting to see what kinds of emails I start getting.

One thing about goals that I need some HELP in!! Does anyone know the legality of whether you can write a goal for a child that directly relates to their MRDD Waiver Program family goal? Since the family is financially reimbursed for meeting the goal, it seems like shaky ground. Anyone have information on this?