A Guide to Writing Reasonable and Practical Adult Therapy Goals
We’ve gotten multiple requests for help writing goals, so we’ve put together this goal-writing guide for you.
Because we’re all about being practical, we’ve also included dozens of example goals throughout the article. Feel free to copy them for your own use (editing as appropriate for each patient, of course!) You’re welcome!
First of all, what makes a therapy goal excellent?
– It’s appropriate and relevant for your patient, given her unique situation
– It’s the right level of challenge for your patient- not too hard and not too easy
– It’s specific
– It’s measurable
– It’s within an appropriate time frame
– It’s Medicare-friendly! (useful for some of us!)
There are several (okay, many) other factors to consider as you craft an excellent goal, so keep reading!
What to include in your goals
Include the specific area you’re working on.
First and foremost, your goal will focus on an issue that the evaluation has determined is a significant area of concern for the patient.
Example of Specific versus Unspecific:
Safely swallowing teaspoon amounts of thin liquids or swallowing sequential straw sips of thin liquids (Specific! You can measure it!)
Vs drink liquids (Not specific enough. How much? What type of liquids?)
More Examples of specific skills:
“cup sips of thin liquids”
“writing at the sentence level”
“simple short term memory tasks”
“multisyllabic words containing /k/ final”
Include Accuracy level.
Typically 80%-90% accuracy.
There are differing opinions on how to measure goal accuracy, but research suggests that accuracy less than 80% can be ineffective in helping patients reach goals. While performance above 90% show mastery, which is most often not our role. That said, it depends on your patients, and I certainly use percentages outside of that range in my goals.
I typically only use 100% accuracy for safety goal, such as swallowing safety or medication management.
Include Amount of cueing.
Cueing can be measured in percentages, time units, and/or frequency (e.g. rare, occasional, frequent, etc.). It’s up to you to decide how to calculate your cueing level. For example, you may choose to calculate cues per question or cues per set of questions. Just remember to be consistent with how you calculate cues from session to session!
Providing cues in a task set:
– 1-25% of the time (e.g. Patient required cueing for 1 to 4 questions in a set of 10 questions) translates to minimal cues
– 26-50% is moderate
– and 51% or more is maximal
Providing cues each question: this may be a more subjective way of measuring cues and depends upon your professional judgment.
Example of cues each question:
Your patient is attempting to calculate the cost of an item after tax.
Your first cue, “What does 8% translate to in decimals?” is a minimal cue.
Your second cue, “The decimal amount is 0.08 and the item costs $75. How much money is 8% of 75?” is a moderate cue.
Your final cue, “$6 is how much your tax is. What is the total price of the item after tax?” is a maximal cue.
Providing cues per time unit: this works well for attention goals and high-level language goals.
Example of cues per time unit:
– “The patient will sustain attention to a simple visual scanning task for 5 minutes with 10 or fewer minimal verbal cues,” or
– “The patient will participate in complex conversational speech for 10 minutes with 5 or fewer minimal visual cues.”
Include Type of cueing.
Typically verbal, visual, written, tactical, phonemic, and/or articulatory placement.
– Verbal cues include verbal instructions of how to produce an accurate response.
– Visual cues include hand gestures, such as pointing up to remind your patient to increase her volume. Or tapping the calendar to remind your patient to use aids to recall the date.
– Written cues include providing models for writing therapy, written instructions for how to complete a complex task, or writing out numbers for math problems.
– Tactical cues are when you provide touch in a way that helps patients achieve accuracy. This is helpful for severely apraxic or dysphagia patients.
– Phonemic cues are different from verbal cue in that you only provide specific sounds during aphasia or motor speech therapy, versus providing instructions.
– Articulatory placement cues are different from visual cues in that you only provide specific positioning cues, versus providing hand gestures.
– A mixture of cueing types is often helpful. Just remember to record the amount of cueing providing for each type of cue. An example of a mixed cueing goal is, “The patient will write single words at 80% accuracy given minimal verbal cues and minimal written cues.”
Tips for Writing Reasonable Goals
Review your patient’s performance on the evaluation. For language, motor speech, and cognition, identify questions where your patient was about 50% accurate, and write goals based on those questions. For dysphagia, identify the diet level that the patient is currently safe with and write goals for the next diet level.
For example, if your patient with aphasia answered yes/no questions at 80% accuracy but open-ended questions at 50% accuracy, write a goal for open-ended questions.
“The patient will answer auditory open-ended questions at 80% accuracy given moderate written cues.”
Write goals to be achievable within two weeks. You do this to make sure the goals aren’t too challenging and to help measure progress. It’s encouraging to regularly be able to tell your patient that he’s meeting his goals and can work on bigger and better things!
Measure only one issue per goal.
For example, your patient with dysphagia is at risk for aspiration due to reduced hyolaryngeal movement but is also at risk for weight loss due to slow eating pace. Write one goal to increase hyolaryngeal movement. And a separate goal to increase speediness of meals.
Tips for Writing Practical Goals
Interview the patient!
– Ask the patient what his personal goals are.
– What’s important to him?
– Social life?
– What does a typical day look like for him and does anyone helps him with any tasks?
Combine what’s reasonable with what’s useful or important to the patient.
For example, your patient with dysphagia hates her dentures and hasn’t worn them for months, even before her stroke. She prefers soft foods but currently can only safely swallow pureed foods.
A practical goal would be, “The patient will consume dysphagia mechanical textures with appropriate mastication in 90% of opportunities given minimal verbal cues to utilize safe swallowing strategies.”
Her final goal can include safely swallowing mechanical soft textures, not regular textures, because of her personal preference (hating her dentures!)
Use worksheets sparingly. Worksheets can be great for warm up exercises or for those who are severely impaired. But, they’re not so practical.
Incorporate materials around the house into your goals. What’s more practical than working with the items your patient used at previous level of functioning? Not much!
These items include calendars, planners, cell phones, ipads, computers, decks of cards, pens and paper, novels, magazines, newspapers, photo albums, even bills and personal letters. (Of course obtain appropriate permissions to use any items- especially financial documents if you’re going to work on problem solving related to financial management.)
Consider WHY you’re targeting the goal. And if that WHY is practical for your patient. Increasing complex math abilities sounds useful, but if your patient didn’t use these abilities at previous level of functioning, it may not be a practical goal for him.
How to Increase Goal Difficulty
Let’s say that your patient performs at goal level for 3 sessions in a row. First of all, CONGRATS YOU’RE AN AWESOME THERAPIST! Secondly, see below for ideas on how to increase the difficulty of goals by varying different aspects of the goal (e.g. accuracy level, complexity of utterances, etc.).
Goals for Adult Patients WITH EXAMPLES
– Goals can include swallowing safety, timeliness, and appropriateness.
– Vary liquid textures: thin, nectar thick, honey thick
– Vary diet textures: regular, mechanical soft, dysphagia mechanical, puree
– Vary presentation: cup, straw, spoon, teaspoon, sequential sips, single sips
– Vary amount: in ounces, meal times, or by food item (e.g. “small side salad” or “one twinkie”)
– Vary muscle groups: labial, lingual, buccal, oral, oropharyngeal, pharyngeal, pharyngoesophageal, esophageal.
The patient will safely consume 8 ounces sequential cup sips of thin liquids without overt signs or symptoms of aspiration in 100% of opportunities given occasional verbal cues to utilize safe swallowing strategies.
The patient will initiate swallow within 3 seconds given single cup sips of honey thick liquids given moderate verbal cues in order to increase oral phase timeliness and reduce risk for aspiration.
The patient will safely consume an entire regular texture meal within 30 minutes given 5 or fewer cues to utilize safe swallowing strategies in order to increase speediness of meals and reduce risk of weight loss.
The patient will complete lingual strengthening exercises (e.g. lateral tongue press with resistance) x30 independently in order to increase muscle strength to reduce oral residue given regular textures.
The patient will demonstrate appropriate mastication in 4/5 trials of dysphagia mechanical textures given maximal verbal and maximal tactile cues in order to reduce the risk for aspiration.
– Vary language comprehension or expression
– Vary presentation modality: auditory, written, gestural
– Vary response modality: verbal, written, gestural
– Vary response length: words, phrases, sentences, paragraphs, conversation, pages
– Vary response time, usually in seconds
The patient will answer abstract yes/no questions (e.g. “are there 20 hours in one day?”) at 80% accuracy given moderate verbal cues in order to increase ability to communicate with family members accurately.
The patient will write sentences in response to verbal prompts with 80% accuracy given minimal written cues.
The patient will point to appropriate photos on a simple AAC system at 70% accuracy given verbal prompts in order to communicate basic wants and needs.
The patient will reduce response time to 10 seconds or less in response to simple open-ended responses given x1 repetition in order to increase ability to communicate with rehab team.
The patient will read paragraph level information then answer questions about the material at 90% accuracy given minimal visual cues in order to increase ability to read functional material.
– Vary response length: single phonemes, syllables, words, multisyllabic words, phrases, sentences, simple conversation, complex conversation, monologues
– Vary response time, usually within seconds
– Vary phoneme and word position: initial, medial, final
– Vary presentation modality: verbal or written
Motor speech Goals:
The patient will produce /h/ initial syllables at 70% accuracy given maximal articulatory placement and maximal visual cues in order to increase ability to communicate verbally.
The patient will repeat “r” medial multisyllabic words in sentences at 90% accuracy given occasional minimal verbal cues in order to increase ability to communicate complex wants and desires.
The patient will read single velar final words at 80% accuracy given minimal phonetic placement cues in order to increase ability to communicate basic wants and needs.
The patient will produce 5 or more words per breath group given moderate verbal and minimal modeling cues to utilize breath support strategies.
The patient will increase prolonged “ah” to 16 seconds or longer in 4/5 trials independently in order to increase breath support to produce functional sentences.
– Vary complexity: simple, moderate, complex
– Vary response time, usually in seconds
The patient will complete a complex word search puzzle within 15 minutes given occasional minimal visual cues in order to increase sustained attention abilities.
The patient will be 100% oriented to temporal concepts (e.g. time, date) given moderate verbal cues to utilize visual aids.
The patient will fill out pill box at 100% accuracy given 5 medications and minimal verbal cues.
The patient will recall and complete steps to listen to a voice message at 80% accuracy given minimal visual cues.
The patient will listen to multiple paragraph level information and recall details at 90% accuracy given minimal repetition in order to increase auditory memory ability.
– Vary response time, in seconds or minutes
Visual neglect Goals:
The patient will read page-level information from a novel at 100% accuracy given occasional minimal verbal cues to utilize finger scanning technique to attend to left-most side of page.
The patient will complete a simple maze in 10 minutes or less given minimal verbal cues and moderate visual cues to utilize compensatory strategies in order to increase attention to the left side.
The patient will eat 100% of the food on her plate given occasional cues to attend to the left.
To sum it all up, excellent speech therapy goals must be:
– Appropriate and relevant for your patient, given her unique situation
– The right level of challenge for your patient- not too hard and not too easy
– Within an appropriate time frame
Could you also use some pointers on how to be more productive on the job? Check out “19 Valuable Productivity Tips for Therapists in Home Health.”