As therapists, we must rely on our clinical reasoning to direct and guide our treatment. These reasoning skills are thought processes based on knowledge and experience with the underlying impairments and the treatment process. We must understand the nature of the patient's illness or condition, and allow ourselves to experience it from the patient's point of view. Goals become a description of how therapy with improve the patient's functioning and quality of life.
Functional goals clearly communicate:
- Why a patient is being treated.
- How the patient and others (family, caregivers, etc.) will benefit from the treatment.
- Why this activity is meaningful or helpful to the patient outside of the therapy setting.
- What the patient is expected to be able to do by the end of therapy.
- How long and how often the patient will be seen; target dates for achieving short-term goals and long-term goals are clearly stated.
When developing goals, it is important to keep in mind:
- What could the patient do before that she cannot do now?
- What caused the change in abilities or function?
- Why does the patient require the services on a SLP in order to improve?
- Does the goal support skilled intervention?
- Will the patient and caregivers be able to carryover the skills into the discharge setting?
- What level of assistance will the patient require in order to be successful?
A goal must include a functional outcome, such as:
The patient will utilize repeat swallow to increase safety and efficiency of oral intake with 100% accuracy...
The goal must also include the observable behavior that the patient will do, and under what conditions the behavior will occur:
... when provided verbal and visual cues by trained staff on 8/10 trials.
So, in the example, the clinician expects the patient to be able to accurately use a repeat swallow during meals, and that that patient will require cues to use this strategy 80% of the time. As the patient progresses, the amount and type of cues can be decreased or eliminated altogether.
Clearly stating the functional outcomes that a goal targets supports the medical necessity of treatment. Outlining the patient's observable behavior that is targeted, when and where the behavior will occur, the tasks presented to address the behavior, and how the behavior is measured all describe skilled intervention.