Goal setting

• Goal Setting


  The process of identifying and setting specific, measurable, achievable, relevant, and time-bound goals
• Functional Problem Statement


  Consists of two parts: (1) Areas of Occupation and (2) Contributing Factors
• Areas of Occupation

  • ADLs
  • IADLs
  • Health Management
  • Rest & Sleep
  • Education
  • Work
  • Play
  • Leisure
  • Social Participation
• Contributing Factors


  • Client Factors
  • Performance Skills
  • Contexts
  • Performance Patterns
• Preferred Functional Problem Statement


  • Client is unable to dress self independently (Area of Occupation) due to reduced AROM in bilateral UL (Contributing Factor)
  • Client requires maximal assistance to dress self (Area of Occupation) due to ½ AROM in bilateral UL (Contributing Factor)
  • Client requires maximal assistance to dress self (Area of Occupation) due to ½ AROM in bilateral UL (Contributing Factor) 2° to infection of the spinal cord
• Formula to Write a Functional Problem Statement


  1. Client is unable to ______________ (Engage in What Occupational Task) due to ________________ (Contributing Factor)

  2. Client requires ______________ (Assist Level) in _____________ (Performing What Occupational Task) due to ________________ (Contributing Factor)

  3. ______________ (Contributing Factor) results in ___________ (What occupational deficit)
• ADLs

  • Patient needs 45 minutes to complete dressing 2° incoordination
  • Client tolerates < 10 minutes of ADL participation due to severe shortness of breath
• IADLs

  • Client demonstrates reduced safety in all IADL tasks due to impaired judgement and sequencing
  • Impaired short term memory results in safety concerns during meal preparation and child care
• Rest & Sleep

  • Auditory hallucinations results in client obtaining <3 hours sleep nightly
  • Client requires moderate assistance to manage bed linens in preparation for sleep due to impaired sensation and strength of right hands resulting from multiple sclerosis
• Education

  • Sensory-seeking behaviors and decreased attention result in inability to complete classroom assignments in a timely manner
  • Lily requires moderate assistance to complete art assignment requiring use of a ruler 2° bilateral incoordination
• Work

  • Inattention to personal hygiene interferes with client's ability to find employment
  • <60° AROM in right shoulder abduction limits client's ability to perform work tasks
  • Client is unable to sustain employment longer than 2 weeks due to poor time management skills
• Play

  • Elisa is unable to engage in age-appropriate play activities due to sensory processing deficits
  • Child needs maximal verbal and tactile cues to transfer toys from one hand to the other due to inattention to right side of the body
• Leisure

  • Resident is unable to complete needlework due to impaired coordination of right hand
• Social Participation

  • Anxiety in crowds limits client's willingness to leave home for participation in social event
  • Child is unable to communicate with peers verbally due to progressive oral motor weakness resulting from muscular dystrophy
• Goals


  Long-Term Goals (LTG) or outcomes, usually discharge goals - what the client hopes to accomplish by the time of discharge from OT services in the current setting
• Objectives

  Short Term Goals (STG), goals that are met in smaller increments while progressing toward the discharge goals
• Goals/LTG

  • Client will complete 3-step stove top meal preparation with modified independence using walker within 1 week
• Objectives/STG

  • Client will retrieve & transport items from refrigerator to stove using a walker & wheeled cart with contact guard assistance within 3 days
  • Client will move 35 objects for work from table to counter without increase in pain by discharge in 2 weeks
  • Client will be able to life 10 objects needed for work without increase in pain within 1 week
• COAST

  Client, Occupation, Assist Level, Specific Condition, Timeline
• Goal Writing: The COAST Method

  • Client will perform (C) a 3-step cooking process (O) with 2 or fewer cues for sequencing and safety (A) from wheelchair level in rehab kitchen (S) by 25/3/22 (T)
• Assist Level (A)


  How much assistance will be required, e.g. min assist, moderate assist, verbal cueing, independent
• Specific Condition (S)


  May be written as a % of all attempts, number of successes out of number of trials, "consistently" or "all attempts", or may not be written if consistent ability is implicit
• Timeline


  For LTG should not exceed expected time of treatment, for STG cannot exceed timeframe for LTG and should be attained within weeks, not months
• Goal Writing: The COAST Method


  • Client will (C) open doorknobs (O) without report of wrist pain (S) within 2 weeks (T) *No (A)
  • Client will complete (C) all dressing tasks (O) independently (A) by 5th treatment session (T) *No (S)
• ADLs


  • Patient will fasten 3 buttons in 2 minutes using button hook with minimum verbal cues by 15/3/22
  • With 3 treatment sessions, client will complete toileting using raised toilet seat with minimal assistance for balance during clothing adjustment
  • Child will feed self 50% of meal using adaptive spoon with moderate assistance within 3 weeks
• IADLs


  • Ryan will navigate public bus system from home to hospital with supervision during next therapy session
  • Client will transfer 10 laundry items from washer to dryer with 3 or fewer cues to adhere to postsurgical back precaution by 3/3/20
• Rest & Sleep


  • Client will go to bed before midnight at least 75% of weeknights within 2 weeks in order to obtain adequate sleep for effective participation at job
• Education


  • Child will maintain seated position at desk for 5 minutes with 2 or fewer verbal cues 4/5 attempts
  • Child independently will print upper case alphabet on wide-ruled notebook paper, demonstrating proper letter formation and staying on line with < 3 errors 75% of attempts
• Work


  • Client independently will request at least one job application from a restaurant within 1 week
  • Client will navigate power wheelchair in work environment without bumping into objects or people within 3 weeks
  • Client will demonstrate ability to type 20 words per minute during simulated work tasks using right wrist cock-up splints within 2 weeks
• Play

  • Child will place 3 shapes into puzzle board with no verbal cues in 3 months
  • Infant will engage in bilateral UL play activities while independently sitting unsupported > 1 minute by 4/5/20
• Leisure


  • Within 3 weeks, client will demonstrate sufficient coordination to manipulate toothpaste caps, buttons, and knitting needles without dropping
  • Client independently will identify at least activities that are not associated with drinking by 5/2/20
• Social Participation


  • Client independently will choose and participant in at least one social activity per week within 1 month
  • Child will tolerate unexpected touch from peers during circle time without demonstrating aggressive behaviors 80% of the time per daycare provider report
• A Series of Short-Term Goals

  • Seated edge of bed, client will reach for clothing items at arm's length with contact guard assistance to maintain dynamic sitting by the end of the 3rd treatment session
  • By the 6th treatment session, client will be able to tolerate > 10 minutes of dressing activity without rest break, seated edge of bed with contact guard assistance
  • After skilled instruction, client will be able to don shirt sitting edge of bed using one-handed techniques with minimum verbal cues by 4/4/22
  • Client will be able to button shirt using a button hook with 2 or fewer cues by 7/4/22
  • Client will complete all upper body dressing tasks with modified independence seated edge of bed by 12/4/22 (LTG)