ABC’s of OT: GOAL WRITING

There are a handful of mnemonic devices to help with goal writing. I personally learned the COAST method.

Client will…

Occupation

Assist Level

Specific Condition

Timeline

So when we use this method to write a goal about, let’s say donning footwear, we could say:

Client will (C) don bilateral shoes (O) with moderate assist (A) with the use of a shoe horn and minimal verbal cues (S) within 1 week (T).

Sounds great, right! A nice little goal. But how do we get there?

To be honest, goal writing took me a while to perfect. The documentation system that I use at work has really helped me to refine my goals into more concise and measurable statements, but it took time.

When I’m completing and initial evaluation, I start by thinking about all of the tasks that my patient needs to be able to do upon return home. Then I try to imagine what it would look like if he/she went home the day after my eval. How poor would his/her safety be? Would he/she be able to get him/herself washed and dressed in the morning? Would he/she be able to safely move around the house? Does he/she work? What does his/her typical routine look like and how much is he/she able to complete on his/her own at this point in time?

From there, I chunk occupational tasks into straight-forward assist levels.

So let’s use the example of a patient with a hip fracture. Our patient comes in and is 3 days post surgical correction of the fracture. He lives alone, drives, and exhibits intact cognition, good upper body strength, and moderate hip pain with decreased ROM. His orthopedic surgeon has only permitted about a 25% allotted weight-bearing status to the affected side, which means our patient is about a maximum assist level of 2 people for all transfers.

If this patient were to go home right now, there is no way he would be able to get himself safely out of bed let alone perform his entire functional routine.

So when I write my goals for our first 10-day progress period, I start with self care tasks. For someone with a lower body orthopedic injury/pathology, upper body bathing and dressing usually is not an issue. So I look at things like lower body dressing, toilet hygiene, toilet transfers, showering.

In the context of performing a full toileting task, our long-term goal might look something like this:

Client will (C) perform complete toileting task (O) independently (A) with the use of toilet rails/grab bars PRN (S) by the end of course of therapy (T).

The goal is independence. But the patient right now is unable to safely achieve and maintain a standing position for a toilet transfer independently. He is also unable to weight shift while seated on the toilet for clothing management and hygiene without experiencing significant hip pain.

So we could assume that our starting level is maxA x2 for toilet transfers with modA x2 for hygiene and clothing management.

Now that we know what tasks to work on and what our current functional levels are, we can form smaller, short-term goals that will ultimately work towards the long-term goal:

Client will (C) perform toilet transfer (O) with mod/maxA x2 (A) with grab bars (S) within 1 week (T). 

Client will (C) tolerate standing position x2 minutes during toileting task for hygiene and clothing management (O) with modA x1 (A) with grab bars and/or rolling walker (S) within 1 week (T). 

Client will (C) perform toilet hygiene (O) with setup assist (A) while seated on toilet with use of toilet rails/grab bars for stability (S) within 1 week (T).

Client will (C) perform clothing management during toileting task (O) with modA x1 (A) with grab bars and/or rolling walker (S) within 1 week (T). 

See how it all comes together? We use our clinical activity analysis skills to assess where the patient needs to be, where the patient is now, and what we need to do to get there. Then we just fill in the blanks with the assist levels and adaptive equipment and voila! We’ve got a full set of short-term goals that support our overarching long-term goal.

 

What methods do you use for goal writing?

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