14 steps to smarter goal-setting

Seb Della Maddalena, Occupational Therapist

Developing goals with the people you support is a skill that requires practice.

I recently returned to working as an occupational therapist and about the same time landed a teaching opportunity with final-year occupational therapy students at Edith Cowan University. It seemed a good time to sharpen my skills on how I developed goals with clients, and at the same time attempt to teach students the art of forming sound occupational therapy goals.

I quickly learnt that students were confused about how to form goals, and it’s fair to say this remains a challenge for many practising therapists. I started to explore how to teach occupational therapy students how to develop goals and consulted with Denise Luscombe (physiotherapist) and Victoria Kennedy (speech pathologist) at Perth-based disability provider Mosaic. Discussions confirmed that SMART (Specific, Measurable, Achievable, Realistic, Timeframe) goals alone do not equate to good therapy goals. We fail our clients if we focus only on goals being SMART. But unfortunately, it’s an epidemic. Speak to any therapist and they will tell you they write SMART goals, and the conversation usually ends there.

In my opinion, goals must be SMART and FIRM (Functional, Interest-based, Routinesbased and Meaningful). Occupational therapists may prefer goals to be in SMART FORM, the O representing Occupation-based.

From here, 14 steps towards SMART and FIRM (or SMART FORM) goals was created.

I’d like to share an example that highlights why including strategy in the goal may be 1. The goal has been identified by the person or their support network. 2. The goal is relevant to the person and their life stage. 3. There is rationale as to how the goal was chosen (e.g. through interview, assessment etc). 4. The goal includes context (i.e. routines-based) and includes where and with whom. 5. The goal is functional (e.g. related to the person’s independence or participation in home or community life). For example, not “John will stand on one leg for three seconds in six months”. Instead, “John will walk up/down the steps from his back door to the garden in six months”. 6. The goal is an area of interest for the person. 7. The goal has a meaningful timeframe (e.g. end of NDIS plan, special occasion such as a birthday). 8. The goal can be graded if required (i.e. if the goal needs to change over

unhelpful to clients. Imagine you formed the goal “Johnny will use a visual schedule to prepare a simple meal within three months”. Including the strategy (i.e. visual schedule) may seem to make the goal more specific, however, it risks missing opportunities to explore alternative strategies. Including strategy limits how you can support your client to achieve the goal (not to mention that the example goal was not to use a visual schedule).

time). For example, “Sally will use a knife and fork to cut a sausage” could be upgraded to “Sally will use a knife and fork to cut steak”. 9. The goal does not include detail on strategy (e.g., how the goal can be achieved: assistive technology, services, intervention). 10.The goal will improve the person or their family’s quality of life. 11.It is clear as to what the goal being achieved looks like. The goal is clear in stating what achievement of the goal looks like. 12.The goal is documented clearly and easily understood by the person and their support network. 13.There is a direct link with the goal to the funding available for the client as appropriate. For example, therapy goals link to the NDIS capacity building goals.

However not all goals might need funding associated with them. 14.The person has a copy of their goal/s for their records and reference.

Hopefully in reviewing the 14 steps you’ve reflected on your own practice and are now on your journey towards SMART FORM. About the author: Seb Della Maddalena is an occupational therapist and manager at Perth-based disability provider Mosaic. Seb has worked in the Western Australian disability sector for 15 years.