5. Goal setting

Who owns the goal?

The client owns the goal but others will contribute to goal development (VRP, family, employer, and clinicians/doctor). It’s important to gain consistency: everyone working towards the same goal. The client might need an explanation of what “goals” are and time and support to identify priorities and goals.

Clients sometimes need assistance with goal ideation

A 29 year old man from a rural area was unsuccessful in resuming his pre-injury work role as a pest controller (due to physical injuries).

The Vocational Rehabilitation Provider identified the vocational goal as “truck driver”, but the client could not do this due to back pain.

The client reported that the Provider did not offer any additional goals and that he then had to do this on his own: “I thought about it and I thought about it ... it took me 4-5 months and then I decided on real estate”.... “The Provider did nothing...that’s a lie.. they helped out a little bit but didn’t help out where I needed them to help out”

Client stated goal:  “Work in real estate … learn what I can learn in real estate and be the best agent that I can be”.

Setting goals

Setting goals with clients needs consideration of questions such as:

What level of goal?
How many goals
How to deal with uncertainty?
What about goal setting with limited insight?
How to generate ideas for goals when faced with no ideas for goal?

Levels of goals

Goals can be usefully divided into three levels:

  • Global (primary) vocation goal
  • Sub-goals (secondary)
  • Action plans/steps

How many goals?

Practically it can be useful to work with:

  • 1 global goal (plus 1-2 back-up global goals) with:
  • 3-5 sub-goals

To make work-related goals detailed and measurable, consider the following aspects:

  • hours,
    duties,
    location,
    environment,
    transport,
    time-frame etc.

Goal uncertainty:

Often in vocational rehabilitation, the achievable end point is unknown.

For instance, it may be clear that there is scope for the person to return to their pre-injury employer, but not whether they will upgrade to pre-injury status.

We need to use caution in stating ambitious global goals and then managing expectations.

Goal setting with limited insight

One of the biggest challenges in person-centred goal setting arises when the client has limited insight into the changes caused by the brain injury. If a client suggests a global goal that seems unrealistic, consider the following:

Explore why that goal is of interest

Explore why that goal is of interest, which may present the opportunity to identify alternate global goals with common elements to the original global goal.

Or, if the goal is TOO BIG

The identified goal might be too big. In which case, focus on developing the sub-goals to explore what firstly needs to be achieved. A sub-goal can then be promoted to a global goal as a starting point.

Always speak with family and therapy team

Speak with family and therapy team for their input into modifying goals.

Risk taking & learned experience

Clients with limited insight may only learn about their limits through (unsuccessful) experiences over time.

However, clinicians and funders are often risk adverse, that is, reluctant to “set someone up to fail”.

Yet client feedback suggests it is better to have the opportunity to try and fail than have no opportunity to try. Learned experiences are often the only effective approach to achieve longer term adjustment. In such cases, the Provider finds themselves in a situation of “supported” or “responsible” risk taking.

 

Generating ideas for goals when faced with no ideas?

If a client needs assistance to generate ideas, then what tools and techniques are useful to prompt ideation?

A. Questions to spark ideas

Key questions to spark ideas:

  • What are the most important things for you in a job?
  • What aspects of your previous jobs kept you working there?
  • Where were you heading before you had your accident?
  • What are you good at?
  • What obstacles are in the way of you working?
  • Who can help you to get back?

B. Vocational assessment inventories (e.g., OSI)

For example, the Occupational Stress Inventory (OSI-R™) is divided into three sections, the Occupational Role Questionnaire (ORQ), the Personal Strain Questionnaire (PSQ), and the Personal Resources Questionnaire (PRQ). These questionnaires provide a concise measure of three important dimensions of occupational adjustment: occupational stress, psychological strain, and coping resources. For each of these dimensions, scales measure specific attributes of the environment or individual that represent important characteristics of occupational adjustment

C. Mind mapping

A mind map is a diagram used to visually organise information, starting with a central idea (global goal), to which associated ideas (sub-goals) are added. The major ideas are connected directly to the central concept, and other ideas (actions) branch out from those.

Mind maps can be drawn by hand or using software packages. Be creative when mind-mapping – use colours, pictures, images, symbols, emphasise key ideas by size of font etc. Choosing mind mapping software will depend on the level of complexity required and the platform/device application. Examples of freeware that is simple to use:

  • Edraw
  • Bubbl.us
  • Mind meister

Mind mapping is a useful activity for brain storming goals with clients. In some cases clients can identify the global vocational goal, but not the sub-goals or actions to achieve this. In other cases, clients are unable to identify a global goal but can identify strengths and interests that can then be used to formulate the global goal.

Advantages of mind mapping:

  • Some people have strong visual (but not verbal) skills
  • Organises information into levels of goals and actions (aids sequencing)
  • Helps in making decisions clearer
  • Helps with memory retention and ownership of goals