In 2013, a systematic review of goal setting processes in Occupational Therapy was undertaken by researchers, who suggested there was no one gold-standard in goal setting in allied health. However, there were three key attributes of goal setting which were common among frequently used tools, and which accounted for best-practice in goal setting -
- Specific information related to the achievement in written format
- Easily accessible format which encouraged client-participation and considered client confidence, including indications for client perceptions of their current skills
- Rating scales which accounted for health professionals knowledge
Long-term and overall goal of attending Occupational Therapy.
Who will achieve?
What does it look like, feel like, sound like when achieved?
How does this achievement make daily life easier?
Who will give feedback relating to current performance?
What will they observe within their feedback?
How can these observations be tracked - objectively & subjectively?
What resources or equipment are required?
Who else needs to be involved in this partnership?
What has been achieved in the past to make the SMART realistic?
This is a predicted time when the SMART goal will be reviewed, to account for any limitations which may have been discovered through assessment or therapy progression, also to account for changes in the client's consideration of meaningful, purposeful achievement. Check-in times are also written into the SMART goal for the short-term PaCe goals.
To provide additional accountability and inspiration to achieve the SMART goal, clients are encouraged to have additional members of their support network and healthcare team sign the S-PaCe Goal Setting form.
Multiple short-term goals are set throughout the achievement timeline of the SMARTS goal and the "PaCe" component is repeated until the SMARTS goal has been achieved. The CAPITAL letters represent a client-lead component of the method, while the lower-case letters represent a therapist-contribution to the knowledge required to inform goal setting
Perception of skills
Clients will know best where the most challenging times of their day are, and most of the time they realise where the greatest amount of improvement is required to progress towards their goals. The "how" is the tricky part.
By choosing one (or maybe two) observable skills which can serve as monitoring points for achievement and progression towards the SMARTS goals, the client can review their progress. Tracking their perception of skills within this activity serves as measure of how much daily life is becoming easier, and allows for the measurement of change which has been generalised to daily life, outside of behaviours or skills which have been directly practiced during therapy sessions of home program exercises.
The Occupational Therapist will use clinical reasoning to decide which underlying abilities are likely to have the most significant positive impact on achieving the PaCe goal once their assessment and reflection process is completed. The clinical reasoning process is a highly developed skill, in which the Occupational Therapist weights up, judges, analyses, and chooses the most appropriate next steps after considering information from all of the following categories - personal history, culture, social, virtual experience, physical environment, roles, activities of daily living, skills, supports, expectations, medical health, body structures, internal functions, development of; sensory, emotions, self-regulation, movement patterns, motor coorindation, cognition, social, self-awareness, community awareness, executive functions, and finally the here/now of your situation... it's an exhaustive list of considerations, but that's why Occupational Therapists study these thinking patterns for four(4) years at University!
Once the Occupational Therapist has clinically reasoned which abilities are likely to have the most positive impact on achieving the PaCe goals, the client is asked to "rate [their] confidence in achieving the PaCe goals given the abilities within the plan/program the OT shared with [them]" - using a 0 - 10 scale, where zero is no confidence, and 10 is highly confident. This score is used to guide the level of education, review, and coping strategies that are required within the therapy program.
A scale score of between 0 - 10 is applied to each of the abilities the Occupational Therapist has recorded as the primary contributors to achieving the goal. There is no set-scale for the observations at each scale level (although perhaps in the future there will be a comprehensive list...), these scores represent the clinical reasoning from the health professional relating to the impact the chosen abilities have on the continuing achievement of the PaCe goal.