4.99 Epilogue: Formulating Treatment Goals

In this chapter, I’ve tried to show how outcomes and goals can be used to develop an organized intervention approach for your client. As discussed in 4.1, it is critical to locate your interventions within the larger scope of the client’s functional skills, to map out the interdependencies between the client’s needs, their existing constellation of physical, behavioral and social abilities, and the intervention resources at your disposal. Several resources were provided to assist with developing outcome hierarchies including the International Classification of Communication Function (ICF) (2011). Outcomes provide the intervention targets for developing goal plans, which in turn, provide the overall content for developing written goal statements. By designing a well-built, measurable goal, grounded in the research and clinical intervention literature, you can minimize bias and measurement imprecision while improving the effectiveness and efficiency of your interventions.

Thought Questions and Exercises

Here are descriptions of 3 different clients:

  • 3 year old with specific language impairment. MLU 2.0
  • 7 year old with spastic cerebral palsy. Speech is unintelligible, significant motor difficulties
  • 69 year old with Broca’s aphasia. 2 months post, exhibiting moderate to severe production problems

For any one of these clients:

  1. Sketch out an outcome hierarchy. Use the resources provided in Section 4.1 to help you identify the ultimate, functional and intermediate goals. How many ultimate goals did you develop for each individual? Are there non-communication (e.g., cognition, motor, technological etc.) that need to be addressed by other professionals for your intervention to be a success? Does the hierarchy make it easier to structure your therapy goals? Why or why not?
  2. Take at least one intermediate and one functional outcome and structure a set of goals for them. Utilize one of the approaches in Section 4.2 to model your goal. Remember your goal isn’t your goal statement. Make sure you develop your goal as a thinking tool – like designing an experiment, with an hypothesis (i.e., your goal statement). It may be that you won’t be doing any direct therapy for the functional outcome. If this is the case, how will your functional goal differ from an intermediate one in terms of its components?
  3. Now write out your goal statements for each of the goals that you developed. Think about the goal components that you are are going to include versus the ones that you are leaving out. What is your motivation? Would you write different goal statements if you were in private practice, working for a school, or writing a goal statement for your clinical supervisor?

Publications and Resources

Critical Thinking about Goal Development

Hawkins, D. R., Paul, R., & Elder, L. (2010). The Thinker’s Guide to Clinical Reasoning. Foundation for Critical Thinking.

Orme, J. G., & Combs-Orme, T. (2012). Outcome-Informed Evidence-Based Practice. New York: Pearson.

Goals and Outcomes

Bloom, M., Fischer, J., & Orme, J. G. (2009). Evaluating Practice: Guidelines for the Accountable Professional (6th ed.). Pearson.

Bovend’Eerdt, T. J., Botell, R. E., & Wade, D. T. (2009). Writing SMART rehabilitation goals and achieving goal attainment scaling: a practical guide. Clinical Rehabilitation, 23(4), 352–361.

Campbell, T. F., & Bain, B. A. (1991). How Long To Treat A Multiple Outcome Approach. Language, Speech, and Hearing Services in Schools, 22(4), 271–276.

Writing Treatment Goals

Thompson, D. G. (1978). Writing Long-Term and Short-Term Objectives: A Painless Approach. Champaign, Ill.: Research Pr Pub.