Recently, I have been thinking of goals and how we write them. Many of us use a "goal bank" at our jobs, which is helpful because we don't have to type the same wording over and over; however, we have to be very careful not to fall into the pitfall of "cookie-cutter" goals. We all learned to write clear, measurable goals in graduate school, and hopefully we have continued to refine our goal-writing skills throughout our professional careers.
I know most SLPs want to spend more time on treatment than on documentation, so how do our skills-writing goals directly benefit a patient? Firstly, good documentation is required for reimbursement. Without good goal-writing skills, we cannot explain what our targeted outcomes are in order to justify our services. Simply saying that we want a patient to improve does not support the need for skilled therapy. We have to communicate how they will benefit from therapy, and why, and in which ways we will measure that progress.
Secondly, a well-written goal is the framework for a well-structured and well-implemented therapy program. When I sit down with each patient, I have already reviewed my short term goals and pulled therapy materials that support that goal. I can document in my daily notes the type of stimuli presented, the patient's response, and the accuracy of those responses. Because I have a well thought out goal that is clear and measurable, I can clearly show the patient's progress.
Sometimes I have to document a lack of progress. I may have to discharge a patient who does not make progress, but before I do that, I can modify the short term goals to reflect the patient's current function. I can also modify the therapy activities to determine if the patient might respond better to a different approach. I can discontinue certain goals and create new ones that will facilitate progress toward long-term goals.
To me, goal writing is not some form of necessary drudgery, but a sort of road map toward a patient's recovery. I always discuss the goals with a patient when appropriate, and include family when available. I want the patient to understand and identify with therapy goals as much as they can; in the case of persons with dementia or cognitive impairments, I try very hard to get the family and caregivers to invest in the goals.
I will be discussing goal writing and giving examples of specific ways to write goals in the coming weeks. I'm looking forward to feedback and input on the ADVANCE for SLPs Facebook page and on the ADVANCE website.
And don't forget to tell us how you are celebrating BHSM in the Geriatric and Adult settings!