Introduction

Practice questions include:

• What type of goals can I use it for?
• How SMART does a goal need to be?
• How long will I need to use it?

Revisiting the elements in SMARTAAR Goals in the light of the Worksheet.

 

What type of goals can I use it for?

The SMARTAAR Goal Worksheet assesses a single goal statement.

It is flexible enough to be used for a range of goal statements at different levels.

The goal statement can describe a goal or step; it can be either client generated or client focused. It can be used when the goal statement in question needs to be SMART and support rehabilitation practice.

The need for rigour in the quality of goal statements, that is, the degree to which it includes SMART elements, needs to be decided by each person. Not all goal statements may need to be as SMART as others e.g. client life goals or long term goals may be more general than shorter term rehabilitation goals. SMARTAAR goals can be used with any type of client regardless of age, diagnosis or gender, and with any classification system of goal organisation.

 

 

How SMART does a goal need to be?

When deciding how SMART a goal needs to be, goal writers need to consider the degree to which the goal statement reflects the client’s priorities, and balance these against SMART criteria and the needs of clinicians and funding bodies.

The elements in the SMARTAAR Goal Worksheet describe different components that can be included in goals. However, not all will be needed for every goal statement.

In some cases, including every element described on the SMARTAAR Goal Worksheet can be useful, but simply adding more information does not always improve goal quality, and sometimes reduces the clarity and utility of the goal.

In other cases, the more elements included can make a goal wordy and lose sight of the intent of the client’s priorities. Sometimes, more elements can reduce the meaningfulness of a goal: The goal needs to be SMART enough, but not too SMART!

The goal needs to be flexible enough for clinicians to use to support rehabilitation but still be meaningful to the client and remain true to the client’s priorities.

For goal statements, it is most important that the goal clearly states what the client wants to be able to do.

Different types of goals can influence the ease in which a goal statement balances being SMART and measurable on one hand, and still be meaningful to the client on the other.

This can be particularly true for goals regarding people’s relationships and more psychosocial aspects of functioning – they are often difficult to make measureable while still being meaningful to clients. Just adding numbers to measure change doesn’t always provide meaningful measurement of progress.

While the use of objective scores in goal statements can provide a monitoring tool, this should be part of the action plan as this is unlikely to be meaningful to a client – not many clients will be motivated to work towards a goal involving changing 15 points on a scale they don’t understand. In relation to funding requests, it is more important to clearly articulate the relationship between how the funded services will benefit the client than focus on detail in the goal statement that may obscure this (even if it seems more measurable).

Similarly, when objective outcome measures (change in scores on assessment tools) are used in practice, they need to be precise enough to give a reliable indicator of change but still be manageable so they can be readily completed by clients and clinicians – and sometimes this means reduced sensitivity.

All measures (goals and objective assessments) will vary in the degree to which they are specific and will have some degree of error. This is balanced by their utility in practice – very specific assessments are useless if they take so long there’s no time to provide treatment. It is more critical that client goals describe what the client wants and needs to be able to do than meet SMART criteria to the letter.

 

How long will I need to use it?

The SMARTAAR Goal Worksheet is particularly useful in the early stages of goal writing
skill development but may not be needed routinely longer term.

In this case, it may only be needed for very complex goals, on an as-needed basis. Once you are familiar with the concepts, you may be able to go through the same process without using the physical structure of the worksheet. At times, it can be useful when goals and clinical needs are very complex, and for scheduled team based discussions where variation in goal writing skills exists.

 

Elements revisited

Specific

Is the client’s name included in goal statement? It should be there to support client centred goals and rehab.
WHAT does the client want to achieve? What is the point of doing the intervention? Is the goal focused on participation (or activity)?
Ensure the goal is clear and well defined. It provides reason for providing and evaluating the efficacy of intervention.

Measurable

Is it easy to determine when the goal is achieved? (This is also linked to ‘Specific’ criterion)
If you cannot measure whether the goal has been achieved or not, you may need to refine the goal further
What is the desired standard or quality for achievement?

• Specify what the desired standard / quality is needed to be met for the goal to be achieved e.g. frequency, level of independence, speed, number of errors, location, quantity
• How will you measure whether goal has been achieved? If this question is hard to answer, you may need to refine goal further

Achievable

Is the goal realistic for this client at this time? Consider the client’s injury, age, supports, lifestyle and stage of rehab
Is the goal achievable given current resources?

• Is the goal is within the capacity of your service / role? Note most case managers can’t provide the intervention to achieve therapy goals, and need to demonstrate how the various disciplines are working together towards the client’s goals

Relevant

Has the client said that they want to achieve this goal? The goal needs to have meaning for the client
Is the goal relevant for the services being requested? Is the goal within scope of service / funding body?

Time bound

How long do you think it will take for the client to achieve the goal? Include a specific time period

• Ensure that there is enough time to achieve the goal
• If it will take too long, smaller goals may need to be written

Action Plan

What does the multidisciplinary team, client, family and external agencies need TO DO to achieve this goal?

• Who does each action? When is it due to be completed?
• Clinician actions with a timeframe for completion should be recorded in this section (not the goal itself) e.g. ‘complete neuropsych assessment by .....’
• Impairment goals can often be reworded as steps to monitor progress e.g. use of DASS to monitor changes in mood, 6 minute walk test

Achievement Rating

A good goal should be measured. Use a rating scale to describe the degree to which the client has achieved their goal

• Services / schemes may have their own goal achievement scale
• Reporting reasons for not achieving a goal can enable goals to be used as an outcome measure, to communicate with the client, and to support ongoing clinical reasoning and service evaluation e.g. ‘Poorly written goal / Client moved / Client changed mind re goal / No appropriate service available’

Reporting Goal Outcomes

Who needs to know about the progress the client has made to date? Providing the client with feedback ensures that rehab remains client centred and can maintain motivation

• How many goals were fully / partially achieved?
• What factors affected progress towards the goals?
• What are the implications for ongoing rehab? Does the action plan need to be amended?