Kielhofner ² emphasized the need for practitioners to understand the client’s motives, volition, interests, values, and personal causation (belief in self and perceived efficacy in one’s occupational performance) as ways to develop occupation-based goals for intervention. Once a practitioner has determined the client’s occupational desires, he or she is in a position to develop goals with the client. These goals serve as the road map for the course of therapy. Consequently, developing goals are key components of occupational therapy (OT) practice and as such demand careful consideration because they determine all that follows.

Engaging clients in developing goals helps ensure that clients are invested in therapy. An occupational profile is used to understand the client’s history, roles, and motivations.¹ The occupational profile provides a brief picture of the client and serves as the foundation for developing meaningful intervention. The OT practitioner interviews and observes the client to obtain information on the client’s story, including the client’s identity, occupations, routines, and concerns. This information provides an understanding of the context in which the person performs. All this information is needed for individual goal setting. The following questions serve to explore goals:

What would you like to do during therapy?

What kinds of things would you like to be able to do again?

What is your favorite activity?

What is causing you the most trouble?

What is the one thing you want to do within the next month?

What bothers you the most right now?

Once the practitioner has the relevant information, the goals can be developed with the client. All clients can be involved in the process irrespective of age or disorder. Keep the goals as clear and concise as possible so that the client and his or her family understand the goals. Use plain language and state the outcomes in understandable terms. Avoid medical jargon and write the goal in terms that the client can relate to easily and can explain to family or friends.

Developing clear and meaningful goals that the client understands and hopes to achieve ensures that the client will be invested in reaching the goals. Clients who are positive and invested in goals do better than those who are unclear about the goals and not invested in reaching them. Writing down the goals and placing them close to the person (perhaps on an index card) or reviewing the goals each session helps the client stay focused on meeting the goal. It also serves to remind the practitioner and other health care professionals of the goals so that everyone is reinforcing goal attainment.

Practitioners (and students) may decide to write goals in the client’s words and later edit the wording of the goal so it is measurable. This technique works very well for verbal clients. The practitioner can revise the questions as needed. For example, the practitioner might ask questions such as:

What would you like to accomplish in therapy?

What would tell you that therapy has been successful?

What do you want to accomplish over the next month?

What is bothering you the most right now that you could work on?

The practitioner records the response exactly as stated. The practitioner tries to get these answers from the client directly. Spending time collaborating with the client on the goal benefits the client and ensures that intervention is meaningful and purposeful to the client. Using information learned from the client, the practitioner may follow up with further questions, such as:

How will you measure success?

Can you describe what success would look like in everyday activities?

How would you know the goal was accomplished?

How long do you want to work on this goal?

After determining the client’s long-term goal, standards, and expectations for success, the practitioner outlines the steps in the short-term goal. Using skills or activity analysis, the practitioner is able to divide the activity into even smaller steps to determine how to best address each member’s goals.

Developing Individual Goals

The foundation of OT intervention lies in the development of client-centered, meaningful, long-term, and short-term goals. Long-term goals are the broad targets of intervention. These goals provide a view of the outcome of the intervention over time. The length of time for a long-term goal varies with settings. Short-term goals are designed to measure the steps required to meet the long-term goals and thus require less time to accomplish. Some settings require even more immediate goals, often referred to as objectives. When developing goals and objectives, practitioners must carefully examine the progression and consider how the objectives and short-term goals address the long-term goals. This sequence should be clear to the client.

CASE STUDY

Figure 7-1 illustrates the analysis of goals and objectives. Karli’s long-term goal is measureable, yet very broad. Her goal is to feed herself again. The practitioner reasons that Karli may always need adapted equipment to be independent, but that this is an obtainable long-term goal. To reach the goal, the practitioner decides that Karli must be able to bring the spoon to her mouth and thus this becomes a short-term goal. The practitioner may have other short-term goals that address swallowing or positioning for feeding oneself. The practitioner develops the objectives as small steps that may be addressed in the intervention session to help Karli reach her short-term goals. Clients need to accomplish the objectives to meet the short-term goal. However, objectives should not be the intervention activity. Rather, objectives are measurements that inform the practitioner about how the intervention program is progressing. The entire process of goal setting is based on clinical reasoning and consideration of the client, diagnosis, context, and environmental factors.