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.


New blogger welcome

I don't usually throw out welcomes to new blogs, since I either find them late or post too late to comment on their arrival, and there seems to be a high dropout rate in blogging as well. But I saw posts from a new OT blogger and put it on my RSS immediately, so I want to share.

"Embrace Your Chaos" is a name to be envious over, and this blogger seems to be on her game. Her post about turning 30 struck a chord with me as it reflects a lot of feelings I am going through as well. So welcome to OT blogger world! (we should have a facebook page, haha)


Phebruary Photo Phriday!

I hope people aren't sick of this pheature, since it allows me to express my punny self and do shorter updates when pressed for time.

I love this little activity I found in our toy closet which has either missing picture parts or a hemi picture like this. This the third or fourth attempt with my little buddy who obviously has some serious perception problems.

This job has made me totally paranoid about my grip. But look at Tina Fey's (or her stand in?) grip! Proof you can be an awesome, famous writer with a thumb cross grip.

I would think that cursive l & e would be the easiest, but it's still quite difficult for a lot of my friends. You can see the one I turned into Dory, if you have super vision and a warped sense of art. I got a bunch of these whiteboards at Target for $1, which was a real winner in my book.

I originally started this blog to share my literal notes from OT school. This cabinet now holds most (but certainly not all) of my OT knowledge stuffs. Granted, there are a few aged items from book sales and some my mom's relevant stuff from her days in voc rehab, but that is a lot of stuff.

$10 at Dollar Tree provides a really kickin' prize box. The princess rings and squishy grips are my favorites.

Switch toy obstacle course? Yes, this is the best job ever.


Update on Goals

I got a comment recently about writing sensory goals so I will work on that over the weekend. And hopefully work on a few big projects for April. But, tangentially related to this topic, I thought i would offer an update for accountability purposes on my Tangentially Job-Related Goals.

I had lots of actual job goals, things that I wanted to gain experience with and mastery over, but the following were just semi-related to work at all.

1) Learn to Navigate the County: I am doing much better with this. I had mastery over locations until I started covering 2 schedules at once and so now there are a bunch of odd driving combinations instead of just to school and back to office. I still rely on the gps but I was able to help my husband get to the mall from an odd location around town, so this is going well.

2) Find Awesome Eateries: This is not going so well. The vast majority of my eating out dollars are spent at Wendy's or Panera, with some random dollars dropped at Sheetz. I should have more time for lunch (read: more than 15 minutes) mid-March.

3) Improve Time Management/Job Separation: I think this has been going pretty well. While I continue to carry some stress home, it's not as bad as the hospital. And I have not carried any paperwork home with the exception of learning to alter an excel spreadsheet.

4) Dress Like an Adult: My go-to items are essentially fitted long sleeve t-shirts, but I think I still look like an adult. I have a couple of dusters that are getting a lot of wear in this uneven winter weather.

5) Find Time for Physical Activity: These results are somewhat disappointing. I was doing well with running. Then I irritated my IT band pretty badly (I went to a football game where I had to take stairs one at a time, for some perspective). I took time off to rest and prevent it from getting worse. I tried to ease back into running with a new, start from scratch plan (depressing in itself). After 3 weeks, I started getting that familiar pain again. I'm really frustrated by it since it's hard enough to get up and try something, let alone have injury to deal with. I have been doing some strengthening at home but I don't know that it's working. I haven't used my gym membership for months due to the winter doldrums and fatigue. Running is the easiest to do since I can do it at home and I was in a spot where it was a great stress buster. I really need the stress bust, so I hope something works out soon.