Chapter 10 Goal Writing TEST 2

Reporting Progress Towards the Goals

1. Achieved 2. Progressing at expected rate 3. progressing below expected rate 4. Not achieved 5. Not addressed at this time 6. No longer appropriate These are terms that can be reported in the documentation

Intervention Approach (OTPF)

1. Create or promote 2. Establish 3. Restore 4. Maintain 5. Modify 6. Prevent

Goals

1. Set goals so that the client can meet them. Goals should not be too easy or too hard. Goals should represent a just-right-challenge. Often first established as part of the evaluation process, and revise as part of the intervention process. First Step 1.. Complete evaluation and review information 2. Outline strengths and challenges 3. Determine target behavior presenting concert 4. Identify the present level of performance 1. Goals guide the intervention process 2. Clarify what you are doing and why 3. Use as a measure of intervention effectiveness Goals are written to help a client improve occupational performance, learn new task, maintain function, modify, adapt context to enable performance, prevent occupational performance problems, or promote health

ABC"s of Goal Writing

1. WHO will show the behavior (Actor) 2. WHAT will be done (Behavior) 3. HOW, WHEN, & WHERE will it be done (Criteria)

Formulating Goals

4. Systems 1. ABDC 2. FEAST 3. RHUMBA (Rumba) 4. SMART 5 COAST (used by EMU)

ABDC (Formulating Goals) by Ginge Kettenbach (1990)

Audience Behavior Condition Degree Audience: the client (person who will do the behavior. This could be the caregiver) Behavior: what the client will do. Something you can see or hear the person doing or saying. Ex. Action Verbs Condition: circumstances around/support the behavior that helped to clarify the goal. Something in the environment that is necessary for the behavior to occur, and can also be the amount of cuing or assistance needed Degree: The measurable part of the goal. Telling the OT how many, what percent, what degree, and other distinguishing characteristic of behavior. The degree must be realistic, functional, and identify a specific time frame.

COAST

Client Occupation Assist Level Specific Conditions Timeline Ex: C: Carl will O: complete a simple coloring activity A: with one or two verbal prompts S: without breaking the crayon T: by December 2016

Determine The Target Behavior

Collaborate with parents/care providers to identify most important concerns Include the child/adolescent when appropriate

GAS Goals Attainment Scaling

Develop to evaluate interventions and mental health settings. Offers an individualized approach to measuring change in a person, group, agency. Can measure the degree of change attributed to participation in the program/intervention 1. Not developed as a one-size-fits-all outcome measure 2. Criterion referred measure of individual change 3. Expected outcomes are predicted ( set at 0) and possible outcomes scaled around that point 4. Can measure range of behavior scales What the client wants to work on and what they feel will be the measure of improvement. More often used to determine positive outcomes because it uses a measuring scale to determine effective outcomes

Developing Goals and Objectives

First Step: 1. Complete evaluation and review information 2. Outline strengths and challenges 3. Determine target behavior 4. Identify the present level of performance Strength and Challenges : (Use the OTPF as a guide) 1. Areas of occupation 2. Client factors 3. Performance skills 4. Performance patterns 5. Context and environment

FEAST (by Sherry Borcherding)

Function Expectation Action Specific condition Timeline Function: areas of occupational performance that the client hopes to improve or maintain, the focus of the goal Expectation: what the client will do "the client will" Action: expressed as verbs and are often part of the function being addressed Specific condition: identifies the level of assistance or other conditions that are necessary for the client to meet the goal Timeline: an indication of when you think the go will be accomplished

Goal Setting

Goals reflect what you would like the client (child) to be able to do within a specific time period, including an expected date of achievement Goals reflect expected level of performance and/or Independence at the end of the treatment period Goals must be related to a specific functional activity or occupation and reflect an observable outcome and functional improvement in occupational performance

Goals (Client-Centered)

Goals that are: 1. Observable 2. Measurable Time Numbers of occurrence Percentage of time 3. Meaningful 4. Functional 5. Achievable 6. Age and context appropriate relevant and appropriate to the clients needs, desires, and expected outcomes. The ultimate goal in occupational therapy is "engaging in occupations that support participation in life"

Maintenance Goals

Goals that seek to keep a client at his or her current level of function despite disease process. These goals would be written in long-term care or outpatient settings. These goals are seen as an indication that progress is no longer being made Though many third-party payers will not pay them Ex: client will maintain independence and dressing for the next 3 months No description of change or measurement is needed in describing these goals.

Habilitative Goals

Goals that teach new skills that the client never had. Often used by children whose development is delayed, or when teaching new skills to adults with developmental disabilities. Ex: Eric will write his name legibly on all his school papers by June 10, 2004

Goals (Long-term) or discharge goals

Indicate the broad areas where progress is expected over the course of treatment. Long-term goals Guide the more specific short-term goals or performance objectives. Over reaching goals that guide interventions to a definite conclusion. These are goals that when met will determine the time to discontinue therapy. These goals are written for varying amounts of time

Baseline

It may be necessary to day specific data about the behavior of concern. The present level of performance lease to goal setting

Performance Criteria For Objectives

Performance criteria determines at what level of the scale the goals is to be achieved, how it is to be measured, and over what period of time Performance criteria could be written in terms of accuracy, rate, or achievement level, or other Ex: At x grade level

Present Level of Performace

Present level of performance: each goal is generated from a present level of performance and represents positive growth from that level. The present level of performance is put into a functional problem statement

RHUMBA (Rumba) ( by McClain & Perinchief

Relevant/Relates How long Understandable Measurable Behavioral Achievable Relevant/Relates : the goal /outcomes must relate to something, to be relevant. If the goal is relevant, it answers the question "SO WHAT?" / Relate: goals must be late to an area of occupation, relate to each other, and relate to identify wants and needs of the client. How long: specify win the gold/outcome will be met. This is a realistic estimate of time you expect it will take to reach the goal Understandable: Anyone reading it will know what it means. Using easily understood, grammatical correct, accurately spelled language free from jargon and using only acceptable abbreviations in an active voice Measurable: there must be a way to know when the goal is met. This is expressed as a quantitative statement that identifies how you will know when the goal is met. A measurement of function Behavioral: the goal or outcome must be something that is seen or heard. Something you can see the client do or hear the client say. (Action verb) Achievable: It must be realistic and doable. the goal is reasonable and likely to be met in the same time frame established . It is not overly ambitious or too easy

Goals (short term) or objectives

Represent the steps or building blocks that lead to the accomplishment of a long-term goal Designate the specific behaviors used to monitor progress. Describe what the child will do with some detail. Can be organized in a sequence. Written for specific periods of time and can change from time to time leading up to achieving a long-term goal

SMART (by Angier 1995)

Significant (simple) Measurable Achievable Related Time - limited Significant (simple) achieving this goal will make a significant difference in the persons life. Remember to keep it simple you are more likely to achieve the go and it will be easier to understand. Measurable: having a clear target to aim for, and that you will know when the client gets to that target Achievable: it must be reasonable that the client can achieve this goal in the time allotted for it Relates: The goal clearly has a connection to the clients occupational needs as stated in the evaluation report Time-limited: The goal has a chronological end point you know when evaluate whether to goal is met

Observable Behavior For Objectives

These are behaviors that the child will demonstrate when the objective has been reached/achieved The behaviors are stated as action verbs

Heath Promotion Goals

These goals may apply to an individual, group, community, or organization. There is usually no attempt to correct a performance deficit rather the emphasis is on enhancing the context and activities to enable maximum participation in life Often seen any Mergen areas of practice rather than traditional occupational therapy practice Ex. Within the next three months, create raised gardens at the community center so that wheelchair-bound gardeners can access their own gardening pots.

Modification Goals (Compensation or Adaption Goals)

These goals seek to change the context around the activity rather than change the skill and ability of the client. OT's will address adapting the environment or tools used to compensate the task Ex: by August 12, 2004 Sue will open boxes, cans, and bags with the use of adaptive equipment as needed so that she can independently prepare meals at home

Evaluation Schedule

This indicates the frequency or schedule of the evaluation procedure for each objective, such as daily, weekly, monthly, grading period, or other If other is indicated, specify the schedule to be used you may need to designate who will measure a method used

Restorative Goals

Used when you have a client who use to be able to do something, but now cannot. These goals reflect a desired change in function Ex: by discharge, client will feed himself three meals a day independently

Preventative Goals

Written to assist person who are at risk of developing occupational performance problems Ex: by next session, Sur will list five strategies for removing herself from situations that tempt her to engage in the use of cocaine