My husband is reading a book about creating habits that lead to setting and achieving goals for yourself. Feeling inspired after the first few chapters, he began recounting his surprise at the simple correlation between setting goals for mundane tasks, improved productivity, and increased personal follow-through. He proceeded to outline examples of how we could improve various aspects of our lives by setting goals. After listening to his excited summary I found myself reminding him that, as a rehab therapist, a large portion of my job is goal-writing. The implication was supposed to link my years of goal-writing experience to being a successful author of gold-standard therapy goals. Matter of fact, I can still hear the mantra touted by graduate school professors from years ago: “Write goals that are 1) measurable 2) attainable, and 3) specific” ringing in my ears. As I reflected back on this conversation, I was forced to ask myself if writing “measurable, attainable, and specific” goals is enough.

Having had the opportunity to work across various settings including schools, outpatient clinics, skilled nursing facilities, and home health, I have seen and written a fair share of goals. Glancing back at my track record I can confidently say that some goals were good enough to frame but many were written hastily, at the end of an exhausting day when time for completing high-caliber work was simply not available. When you have expectations of productivity percentages, high patient caseloads, extensive documentation, and a goal of work-life balance, there is little space for this type of creativity.

These 5 techniques for improving goal-writing are tips to put a little life and functionality back into your treatment sessions.

1. Survey the team:
“If you could see improvement in one area once therapy is completed, what would it be?”

You can ask this same exact question to the client, a family member (with the client’s permission), a member of the nursing team, or the other treating rehab therapists. This will give you a snapshot of the deficits that are viewed as the highest priority and will give you a confident start to building an individualized plan of care.

2. Make it functional. No, really:
I know this is old hat but it still needs mention. It can be a challenge but when writing goals therapists should regularly ask questions along the lines of “What does this skill actually accomplish?” and “When will the client use this skill in real life?” Then, write the goal accordingly. Here’s an example:

Busy Work Goal
Client X will identify 10 items in a provided category in 3/5 opportunities within a given session with moderate verbal cues to address and improve word-finding skills.

Bells & Whistles Goal
Client X will identify 3 appropriate/relevant questions or comments for medical appointments or conversation with family over 3 consecutive sessions with moderate verbal cues to improve word-retrieval relevant to conversational exchanges.

These goals are addressing the same thing: finding words that are related to a certain topic. Both of these goals are measurable, attainable, and specific. The difference between them is one of them is a possible activity that could lay groundwork for progress and one of them is the final product. You get the picture. Make it functional!

3. Make a hierarchy:
Create an appropriate hierarchy of trials completed/percentages achieved and cueing needed. Is the client meeting a goal and being discharged when more progress could be made? Is the client not meeting a goal because it was set too high? Start simple and work your way up. This will give the patient tangible landmarks of their improvement and creates a clear outline of progress, making the justification of providing ongoing therapy clearer to all parties involved.

4. Quantify:
When documenting, use numbers as frequently as possible so you can accurately track progress. This may seem like an obvious notation but in some settings progress notes are required every 5 days, leaving little time to demonstrate progress on goals. The opposite is also true. For example, some settings do not require any documentation of performance between evaluation and discharge, leaving significant question of proof of progress. When you regularly quantify performance it provides a solid foundation of accurate data throughout the plan of care. This can lead to more accurate goal revision when re-certifying clients for therapy and/or identifying when goals have been successfully mastered.

5. Don’t forget the basics:
All therapy goals should be measurable, attainable, and specific. These are what I would call “the basics”. If you have significant hurdles in your day that make it hard to integrate these characteristics in goal-writing, consider setting a goal for yourself, one evaluation at a time.

Effective therapists write quality goals. These goals have a direct impact on patient outcomes and improved quality of life and accordingly warrant extra attention on the part of the therapist. After all, meeting measurable goals is often the only way to demonstrate you have accomplished (or at least worked towards) doing your job.

Mediocre goals beget mediocre therapy. Identify patient needs which are actually functional for their life, shape corresponding goals which are within reach and appropriately prioritized, and ensure they are specific and quantifiable.

GOOD NEWS: The Parkinson’s Report is currently collaborating with physical therapists, speech-language pathologists, and occupational therapists to create a goal bank of high-caliber goals that are easily customizable. It will be available in late Spring 2018 so keep an eye out!