2.25.2012

Writing Sensory Goals

I often get visitors to the blog looking for goal writing tips. A recent commenter asked about writing sensory related goals. While this is not something I am an expert in, here is my approach.

I think that sensory based goals can be difficult to write because we have to know exactly what we want to measure, and we know we have to be specific and objective so that we can measure the effects of our interventions. We know when someone increases their ROM or strength and have portable tools to measure that, we have standard measures of ADL performance. As of yet, there aren't widely used, scientifically based tests or tools to measure sensory processing that we can just stick in our bag for re/assessment. (yes, some people do astronaut training or interactive metronome or whatever else, but I don't think that there's an item that meets those qualifications) So since most of us are not equipped to measure sensory responses through advanced measurement of vital signs and neural responses, we have to make our objective something else, something with functional relevance.

Some sample objectives that you may be trying to improve with sensory strategies might be to increase tolerance for a non-preferred activity (seat work, being in a store, novel food), decrease outbursts or other undesirable actions, or demonstrate an ability to self regulate (identifying personal alertness level, self selecting appropriate sensory breaks). A frustrating thing is not just trying to be specific enough in this objective that you have something relevant to measure, but also accepting the fact that none of these activities exist in isolation, so there is no direct correlation for cause and effect. You can do all the "right" interventions and the goal can still be unmet.

We're still going to use a SMART or RUMBA format for the overall goal. The following were my original sensory goals (rescued by the wayback machine), and you can see that they don't fit those formats.

-pt. will tolerate 1 "unpleasant" stimulus per session
-pt. to attend to seated activity for 10 minutes following sensory activity
-family to report better sensory seeking behaviors at home

These are are not very specific, and they don't really show what the performance component to be addressed is or what the OT method for improving this deficit will be. Remember that people are seeking (and paying) you for the Assessment and Plan section of your eval & notes, so it is important to be clear.

When I was writing those goals, I asked a friend who had been in peds longer than me how she did it. Her responses are as follows:

- Patient will demonstrate decreased tactile defensiveness by tolerating hair brushing and face washing without adverse reactions with minimal verbal cues.
- Patient will demonstrate improved modulation of the tactile system by accepting 3 bites of one new food in 4 weeks with minimal verbal cues.
- Patient will demonstrate decreased auditory defensiveness by decreasing ear covering by 50% independently.
- Patient will demonstrate improved sensory modulation by self calming with the use of sensory techniques as needed 100% of time.
- Patient will demonstrate improved modulation of the oral sensory system by mouthing one or less inappropriate objects during a treatment session without verbal cuing.
- Patient will demonstrate improved modulation of the vestibular system by decreasing spinning by 50% without verbal cuing.

You can see that these aren't all completely terrific either, but there is a great improvement over the others. We see the specific sensory area that was identified as problematic, the specific reason to the family that it needs to be addressed, and if we wanted to improve these farther we could give a success rate to know whether the goal is met (4/5 trials, etc). (Know that no one is going to self-calm 100% of the time, no matter how good your intervention is.) I like the specificity of these goals because it leaves less to chance that the success is from something other than OT intervention. With mine above, a kid might tolerate an unpleasant stimulus for many other reasons than the implied OT intervention. So being clear on what is to be achieved and with what frequency is important.

Another objective that can be done is simply a satisfaction measure. A parent can report that they now have increased confidence in handling sensory strategies or problem behaviors. I normally included a goal like that when there would be a home program involved.>


Now that I am in the schools, I have adopted a different method for sensory goals. I have seen some where they are measured by students staying seated for x# of minutes while using sensory strategies or a specific seat. But I think that sensory strategies often involve trial and error, and so I might not be able to identify with much confidence which specific strategies would still work best in 1 year's time while sitting at an IEP meeting. So I have found (by way of more experienced therapists) that it is (much) easier and still effective to add an OT consult for sensory strategies as a supplemental aid to the IEP. This provides for collaboration with the teacher/IA/etc to make a dynamic sensory plan for the student initially and change as the year progresses.

I know this is long, I'm not sure if it's helpful. As I said, I am not an expert in sensory treatment or goal writing. But this is how I have coped thus far. Please feel free to share your sensory related goals or helpful links in the comments.

3 comments:

yocw said...

Thank you- this was very helpful! I am writing sensory goals for a school paper and was not sure how to make them occupation-based.

groupbygroup said...

Thanks so much, I agree---very helpful. I have started a collaborative blog with a teacher and speech therapist and was wondering if you have any helpful hints? We are at http://groupbygroup.wordpress.com

Cheryl said...

I will check out your blog but am behind on my responses to things because of the baby... feel free to email me directly at OTNotes (at) gmail dotcom and i'll be able to reply better. Thanks!