Goal Development Process

Source: Shenandoah University, Lacy Woods Hochkammer, OTD, OTR/L, Division of Occupational Therapy.

Evaluation
- Client/caregiver interview.
- Assessment.
- Observation of occupational performance.
Goal development in collaboration with client/caregiver based on evaluation results & discharge plan.
Treatment
- Working toward goals.
- Consistent evaluation of progress.
- Adjustment of goals if needed.
Discharge
- Once goals have been met, client/caregiver/facility in agreement.

Discharge (D/C) planning starts at initial evaluation.
How/why?
- During your eval, you are identifying strengths & limitations related to occupational performance.
The ultimate goals: of eval = the ultimate goal of treatment = what happens when they don’t need you anymore?
In short, from the time of the initial evaluation, you are working toward DISCHARGE.

SMART framework:
- Significant, Measurable, Achievable, Related, Time-limited.
Additional notes:
- Achievable within the time they will be in your specific setting (acute care hospital, acute rehab, SNF, outpatient, etc.).
- Related to what they want and NEED to be able to do upon discharge.
Example: Joelle is admitted to an acute psychiatric unit due to a suicidal attempt. The d/c recommendation is for a halfway house and partial hospitalization program (PHP).
- STG: In 3 days, Joelle will verbally identify 2 personal strategies, tools, or resources to implement as part of her wellness toolbox with supervision.
- Notation: 3 days is represented as $3\,\text{days}$ .

Ensure goals are aligned with post-therapy environment (d/c environment).
Reviewing client needs and resources.
Align goals with resources available at d/c.
Facilitate a smooth transition to post-d/c life (e.g., home, supported living, outpatient care, etc.).
Example of incorrect goal-setting (to illustrate common mistake):
- Trent is receiving OT services at a community mental health center due to alcoholism and multiple DUIs. He has lost his license.
- LTG (incorrect): Trent will secure full-time employment in an area of interest independently in $8\ \text{weeks}$ .

Client-Centered
- Reflect the client’s personal values, preferences, & recovery priorities.
- Focus on meaning and sources of motivation when possible.
Function-Oriented
- Focus on improving participation in meaningful occupations.
Behavioral
- Be specific & describe observable behaviors (e.g., "participate in a group conversation with peers for 8 minutes without interruption").
Measurable
- Make goals quantifiable (e.g., "complete mindfulness exercises" or "complete a 5-minute mindfulness activity independently 3x/week").
- Example: $\text{complete a 5-minute mindfulness activity independently 3x/week}$
Achievable & Realistic
- Attainable within the client’s abilities & given their resources.
Collaborative
- Develop with input of the client and other HCPs (social workers, psychiatrists, etc.).

Schizophrenia with auditory hallucinations
- Evaluate to identify impact.
- Possibilities: decreased social participation, difficulty obtaining work, difficulty sequencing tasks (meal prep, self-care, etc.).
- Example goal: $\text{Client will complete a 3-step meal prep task with minimal assistance using compensatory strategies and environmental modifications prn}.$
Postpartum OCD & intrusive thoughts
- Evaluate to identify impact.
- Possibilities: decreased self-efficacy with caregiving, impaired ability to complete self-care tasks, decreased attachment and bonding with infant.
- Example goal: $\text{Client will feed her baby 1\text{/day} with supervision utilizing auditory affirmations prn}.$

Group of teenage clients with ASD and poor social awareness
- Evaluate to identify impact.
- Possibilities: decreased ability to interact with peers, isolation, poor self-awareness.
- Example goal: STG: Clients will correctly correlate the facial expressions of a peer to possible feelings/emotions during $\frac{1}{3}$ role-play scenarios with supervision.
Chronic back pain and depression
- Evaluate to identify impact.
- Possibilities: decreased socialization, self-isolation, decreased self-care participation.
- Example goal: $\text{Client will shower independently 2\text{/week} using AE/AD/DME/environmental modifications prn}.$

Focus on behavioral and cognitive aspects of function (vs. physical rehabilitation).
Development of routines, coping mechanisms, social skills, emotional regulation strategies, cognitive skills (executive functioning).
Aim to improve: self-esteem, interpersonal relationships, overall mental well-being.
May include self-reports of mood, use of coping strategies, and/or quality of social participation.
Roles & Routines.

PROBLEM → SOLUTION
Vague/unmeasurable goals
- Too broad or unclear e.g., "improve coping skills" or "reduce anxiety".
- Solution: Use specific, measurable terms e.g., "use breathing exercises to manage anxiety $75\%$ of opportunities".
Lack of Cultural & Personal factors
- Failing to consider cultural background or personal values.
- Solution: Ask the client to describe personal meaning and values. Set goals accordingly.
Unrealistic expectations
- Too ambitious or not aligned with client abilities.
- Solution: Break large goals into smaller, achievable steps and consider client’s resources, support systems, and readiness for change.
Poor Alignment with Context/Environment
- Failing to consider client’s discharge setting or living situation.
- Solution: Align goals with the context (home, community, supervision/support available).
Hyper-focus on symptoms
- Focusing only on reducing symptoms (vs. function).
- Solution: Focus on meaningful outcomes, e.g., engage in at least one leisure activity per day to support mood regulation.

AOTA (2020). Occupational Therapy Practice Framework. American Journal of Occupational Therapy, 74(2).
Gateley, C.A. & Borcherding, S. (2017). Documentation manual for occupational therapy: writing SOAP notes, 4th 3d. Thorofare, NJ: Slack