Introduction

The SMARTAAR Goal Worksheet was designed as a quick approach to writing and reviewing high quality, client centred SMART goals.

It was developed by Helen Badge, Outcomes Manager with the ACI Brain Injury Rehabilitation Directorate (2012).

The worksheet provides a practical approach to consider the elements in a goal statement that reflect criteria for high quality goals identified in the SMARTAAR Goal Process.

The SMARTAAR Goal Worksheet can be used to develop, review and refine SMART goals that are focused on client participation and support clinical reasoning in rehabilitation.

It evaluates the separate elements and overall meaning of a single goal statement and highlights areas for improvement. It has two main applications:

Clinicians can use the Worksheet to improve the quality of the goals they formulate with clients and to guide them when documenting these goals

Funders can use the Worksheet to review goals and provide specific feedback to clinicians. This feedback could include what further information is required to understand what the client wants to achieve and will be able to achieve from the requested intervention.

 

The SMARTAAR Goal Worksheet was developed to address a learning need identified in the NSW Brain Injury Rehabilitation Program (BIRP). Although the concept of SMART goals is not new, clinicians have struggled with writing high quality, SMART goals in clinical practice. The goal setting process is complex and we have already identified a number of factors that influence the goal setting process. The Worksheet was informed by a review of a range of goals in BIRP services. This review indicated a number of inconsistencies in goal writing practice as well as variation in the use of goals in clinical practice. In addition to client factors, variations in service structure and practice, including how goals were developed and whether they were used in practice, existed.

The SMARTAAR Goal Worksheet has not been formally validated but clinicians and funders have reported it is a useful tool and fit for purpose. It draws on existing approaches to writing goals but has tailored them to suit clinical and rehabilitation service needs identified by clinicians and the literature. It has been found to be flexible enough to be used by clinicians and those approving funding for rehabilitation and related services, including relevant government entities and insurance based roles.

 

 

Worksheets scope

The SMARTAAR Goal Worksheet is a tool to develop and use goals consistent with criteria described in the SMARTAAR Goal Process.

Essentially, the SMARTAAR Worksheet is a checklist of the important elements of a rehabilitation goal and how goals can be used in practice.

It addresses the development and review of a single goal statement. The Worksheet indicates the need to use the goal in practice, but this is not addressed by the Worksheet itself.

The SMARTAAR Goal criteria include:

1. The goal is SMART but still meaningful to the client
2. The goal is client centred and ideally describes client generated goals (or at least client focused goals). It describes how the client will benefit from rehabilitation
3. The goal is focused on client participation (this criteria sits within the Specific element)
4. The action plan is not included in the client goal statement
5. The focus of the SMARTAAR Goal Worksheet is that the client is at the centre of the goal - the goal should be about what the client is going to achieve, not what the clinician plans on doing. Ideally, goals should focus on the client's participation, but there may be instances where this isn't possible or desired. The client’s name is the starting point of the SMARTAAR Goal Worksheet
6. Clinicians and teams need to use the client’s progress towards their goals and goal achievement in clinical decision making and reporting. This is essential if goals are to fulfil their primary aims (motivate clients, support team planning and funding applications). This highlights that writing the client goal is only the first step - they then need to be USED in clinical practice .

The first part of the Worksheet describes the key elements of high quality goals, enabling each of these elements to be reviewed.

Missing or incomplete elements may indicate areas where a goal could be improved. However, just adding more information is not always a solution – the goal still needs to make sense and reflect the client’s priorities. Clinicians can use the Worksheet to review which parts of a goal statement can be reviewed and improved. Funders can use it to consider what additional information is needed to help them understand how the client will benefit from the services requested.

The second part of the Worksheet focuses on using goals in clinical practice.

Goals can be used as a measure of outcome by reviewing progress towards goal achievement and to guide clinical reasoning and communication.

Monitoring goal achievement is an integral component of the goal setting process.

Without monitoring, client goals can continue to provide a direction for further therapy but won’t indicate whether the previous action plan has been effective. The Worksheet itself primarily focuses on improving the content of each goal statement rather than how and when the goal is used in practice. The person writing or reviewing a goal needs to also consider the goal in relation to other aspects of the client’s situation, rehabilitation requirements and funding issues that influence the client’s goals and action plans. However, these are beyond the scope and purpose of the SMARTAAR Worksheet. Section 7 describes how goals can be incorporated into Rehabilitation Plans.

While actual use of the SMARTAAR Worksheet focuses primarily on the first two steps in the SMARTAAR Goal Process, it does highlight that further work to use the goal in clinical practice is also needed (although this is unlikely to involve using the Worksheet but will involve using the goal statement generated from the Worksheet).

The worksheet

The worksheet below is designed to review an Existing rehabilitation goal and reformulate it into a SMARTAAR Goal.

Client Priorities / Rehab Goal to be Reviewed:
SMARTAAR goal elements		Existing Goal Elements	SMARTAAR goal
S	Client name in goal statement
	Specific What client outcome is being aimed for? What is the purpose of any intervention? ** CLINICIAN’S ACTIONS/ INTERVENTIONS DO NOT GO HERE**
	Focus on Client’s Participation (Y/N)
	Where will participation take place – context of goal? e.g. at home, local community (might be implicit)
M	Measureable How well? What is the desired quality of performance in relation to level of independence, amount / nature of supports
	How much? Quantity of performance by client e.g. time taken, frequency, amount, speed, efficiency
A	Achievable and Relevant: You must know the client to be able to decide whether any goal is achievable for that client and given the availability of current resources. In some cases, recording a goal that is not achievable may be clinically useful. Ensuring goals refer to the desired outcome for each client rather than describing action plan with timeframes helps keep the goal relevant to the client (rather than the clinician).
R
T	Time bound: How long do you think it will take the client to achieve the goal?
A	Action Plan: What does the multidisciplinary team, client, family and other agencies NEED TO DO to achieve this goal? All treatment plans go here: who does each action, frequency/ duration and by when. Actions pertaining to reducing impairments or managing environmental factors (e.g. train carers, equipment) can go here too – list as client steps towards goal if desired.
A	Achievement rating: Has the goal been achieved?
R	Reporting goal outcomes: Who needs to know about progress the client made on this goal?
Is the goal clear and concise? Does the goal identify what the client needs / wants to be able to do?
Revised goal:

Please acknowledge Helen Badge as author (2012). Permission granted to use and to copy.

How to Use the SMARTAAR Goal Worksheet

The SMARTAAR Goal Worksheet is flexible and can be used for different purposes. It
helps identify elements that may be useful to explain what the client wants and needs to
be able to do to support rehabilitation.

Using the Worksheet supports clinical reasoning. However, the clinician or funder still
needs to make judgements about whether the goal is appropriate for this client, for this
aspect of functioning and for the purposes it is being reviewed (i.e. is it appropriate for
the funding body to support). It is not a stand-alone solution but provides a process to
write and review goals and highlight how they can be used to support rehabilitation.
Guidelines on using the Worksheet have been provided for WRITING GOALS, and
REVIEWING GOALS. These can be adapted to suit clinical need, clinician level of skill
and team and service processes.

 

Instruction: Clinicians

1. Start at the top of the Worksheet in ‘Rehab goal to be reviewed’.

1. If you are WRITING A NEW GOAL, record the client’s words or their main priorities for treatment e.g. I want to be earning money, I want to get back to work by the end of the year.
2. If you are REVIEWING AN EXISTING GOAL, record the current goal statement.

2. Use the Worksheet boxes under the ‘Existing goal elements’ column to record elements that will help develop a SMART goal statement the client identified they want to achieved. For new goals, more than one goal may be necessary to reflect the client’s priorities to support rehabilitation.

1. What is the client’s desired outcome? The ‘level’ or amount they want to achieve in a given period may need to be narrowed down to fit within funding and service requirements.
2. When writing the rehabilitation goal, start with the client’s name
3. Is it a participation goal? If not, consider whether it could be.
4. Add elements you can think of using SMART criteria. The client may be able to identify some details of what goal achievement would look like for them.
5. Sometimes it’s easier to initially record ideas for the action plan to support goal achievement, as most clinicians will have early ideas on this. This can help identify the details to be included in the goal statement and ensures the action plan doesn’t sneak into the goal statement.

3. If the goal statement appears to tell only part of the story, use the ‘SMARTAAR goal’ column to add and change the goal statement to make it a clearer better goal.

1. Start by reviewing which SMART boxes are blank – what elements are missing from the goal according to SMARTAAR criteria? What extra information is needed?
2. Does existing information need to be reworded for greater clarity?
3. Are any numbers meaningful and make sense in real life? The client’s satisfaction may be a better indicator than any change on an assessment. For some goals, particularly psychosocial issues, there may be no relevant metric. If one is used, the criterion of success should be understood by the client.

4. Sometimes goals can be improved by adding more detail. And all or most of the boxes need information. However, on other occasions, the goal is improved by simplifying it and taking extraneous information out of the goal, particularly where information is explicit.

For example, the context may be obvious and not need repeating in the goal statement e.g. driving … on roads, playing golf at the golf club. Consider the purpose of this goal – for the client, team planning and funding – and balance SMART criteria with the intent of goal.

5. Once the goal is documented, review the goal statement.

1. Does it tell you succinctly what it is the client needs and wants to do as an outcome of the action plan? Does the goal statement reflect the client’s priorities effectively? You need to determine the balance required between remaining true to the client’s priorities and writing a SMART, measurable goal that fulfils the purpose of writing the goal. The goal needs to be SMART ENOUGH, but not too SMART. Sometimes, simple goals are best.
2. Does the goal fulfil its purpose e.g. motivating clients, rehabilitation planning and communicating with funders?

6. Review steps 3 and 4 if required. Then after any revisions repeat step 5 to help make sure the goal is SMART enough, but still useful and meaningful.

7. Record the revised goal statement that will be used to guide rehabilitation in the box at the bottom of the sheet.

Instructions for Clinical Managers

1. At the top of the Worksheet in the box ‘Rehab goal to be reviewed’, record the goal as it is currently documented.

2. Use the Worksheet boxes under the ‘Existing goal elements’ column to record elements that are currently included in the goal statement.

3. Review the existing GOAL elements against SMARTAAR Goal Sheet elements:

1. Is the client’s name included (or explicit)?
2. Is there sufficient information in each box? Are they clear and meaningful?
3. Are there blank boxes that may indicate what other information may be useful e.g. criterion to determine when the goal has been achieved (how well / how much)
4. Is there enough information to determine when the goal will have been achieved?

4. Review the overall goal:

1. Does it tell you succinctly what it is the client needs and wants to do as an outcome of the action plan?
2. Does the goal statement appear to reflect a goal that may be relevant to the client?
3. Does the report indicate the degree to which the client was involved in generating their own goals?
4. Does the goal fulfil its purpose? Does it provide enough information to support the requested services?

5. Use the ‘SMARTAAR goal’ column to write questions that clarify what additional information you need.

Consider what other information you would like to know about how the client expects to benefit from the requested services:

• Given other information other information you’ve been provided with or know about this client, how realistic is this goal for this client at this time? Reduced insight may influence more client generated goals, particularly early after severe injury.
• How will you measure when this goal will be achieved?
• Identify questions that will provide further information missing from the goal you’d like to see or know about.
• Remember, client centred goals are always relevant and valid to the client. Goals can motivate clients to participate in therapy to minimise the impact of their injury. Consider how the requested services are relevant to their injuries, as well as to the client’s goals. Consider relevant scheme and service specific criteria in relation to services requested.

6. Do you need more information?

1. Do other sections of the report/s provide information you would like?
2. Where can you get the information: Case manager, other clinicians, client or family?
3. Is the goal good enough to provide context, even if it’s not as SMART as possible when the requested services to achieve goals meet relevant criteria?

Example Review

This example has been illustrated in the form on the next TAB (Example Worksheet).

It may be useful to print this page or the Example worksheet page so as you can use both at once.

 

Take the example of the following goal (at the top of the Example Worksheet on the next TAB):

Increase client motivation to participate in physiotherapy by incorporating some of his
therapy into his program at school and after school care centre.

 

When reviewing this goal, consider the following questions:

1. Do you think this goal is client generated, client focused or clinician generated?
2. Does it succinctly tell you what the CLIENT wants and needs to be able to do?
3. Do you think it would be a meaningful goal to a school aged boy?

 

It is more likely this is a clinician generated goal to describe what the clinician wants the therapist to do. It doesn’t yet describe what the client wants to be able to do when he does complete his physio.

Given the existing goal, the phrases and elements of this goal can be broken down, and
recorded in the blue Existing Goal column:

1. Client name? Not stated (referred to as client)
2. Client outcome: not described
3. Focus on client participation: No, focused on the completion of the action plan
4. Where: relates to action plan (school and after school care)
5. How well and how much: not described.
6. Time-bound: Not described
7. Is it clear and concise: Yes
8. Does it tell us what the client wants and needs to be able to d? NO

 

The SMARTAAR Goal column on the right side of the Worksheet can be used to improve the goal statement. Other information about the client’s priorities are then needed to ‘fill the gaps’ to generate a client centred goal that describes the desired level of change in their participation. In this case, the client may want to be able to play football in after school care.

Consider:

1. What is the client’s main participation goal? He has said she wants to be able to play footy. Add this to the Client Outcome box.
2. How will we know when he’s playing enough footy to be happy he’s achieved his goal. In conjunction with the physio they have decided that playing for 20 minutes 3 times a week is a good starting goal. He does sport at school on Tuesdays and Fridays so playing more sport after school may be too much at this time. These details can be added into the How Much box.
3. Other details go into action plan. Motivating Jack is a purpose for writing a client centred goal, not a goal in itself.

 

 

Example Worksheet

Client Priorities / Rehab Goal to be Reviewed:  Increase client motivation to participate in physiotherapy by incorporating some of his therapy into his program at school and Aboriginal after school care centre.
SMARTAAR goal elements		Existing Goal Elements	SMARTAAR goal
S	Client name in goal statement	client	Jack
	What client outcome is being aimed for? What is the purpose of any intervention? CLINICIAN’S ACTIONS/ INTERVENTIONS DO NOT GO HERE		Will be able to play footy with his mates
	Focus on Client’s Participation (Y/N)	No	Yes
	Where will participation take place – context of goal? e.g. at home, local community (might be implicit)	‘at school and Aboriginal after school care centre’	In after school care
M	How well? What is the desired quality of performance in relation to level of independence, amount /  nature of supports
	How much? Quantity of performance by client e.g. time taken, frequency, amount, speed, efficiency		For 20 minutes three times a week
A	Achievable and Relevant: You must know the client to be able to decide whether any goal is achievable for that client and given the availability of current resources.  In some cases, recording a goal that is not achievable may be clinically useful. Ensuring goals refer to the desired outcome for each client rather than describing action plan with timeframes helps keep the goal relevant to the client (rather than the clinician).
R
T	Time bound: How long do you think it will take the client to achieve the goal?		By Easter (14th April 2017)
A	Action Plan: What does the multidisciplinary team, client, family and other agencies NEED TO DO to achieve this goal? All treatment plans go here: who does each action, frequency/ duration and by when.  Actions pertaining to reducing impairments or managing environmental factors (e.g. train carers, equipment) can go here too – list as client steps towards goal if desired.	‘participate in physiotherapy’ ‘incorporating some of his therapy into his program at school and Aboriginal after school care centre.’	Physiotherapy sessions Jack will complete ‘home’ exercise programme at school and after care Training for support staff for exercise program
A	Achievement rating: Has the goal been achieved?
R	Reporting goal outcomes: Who needs to know about progress the client made on this goal?
Is the goal clear and concise? Does the goal identify what the client needs / wants to be able to do?
Revised goal:  Jack will be able to play footy with his mates for 20 minutes three times a week at after school care by Easter, 29th March 2013.

Please acknowledge Helen Badge as author (2012).  Permission granted to use and to copy.