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By Debbie Hommel, ACC, CTRS
See
DH Special Services Independent Study
Documentation
Techniques for the Activity and Recreation Professional
NCCAP approved 10.5 contact hours
 Being able to write resident/client
oriented goals is a necessary skill for activity professionals.
As a member of the interdisciplinary team, we often support primary
interdisciplinary issues by adding interventions. However, we
may also initiate new concerns and problems, which would require
us to offer individualized, outcome oriented and resident centered
goals for the resident/client care plan. In our first goal writing
lessons, we learn that goals need to be measurable and specific.
A common mistake is to use activity
attendance as the measure. "Resident will increase socialization
by attending three social groups per week" is a goal that may
be measurable but it does not focus on a specific outcome. The
resident could be attending three groups per week but they could
be dozing, sitting off to the side of the program and not interacting
with peers. The attendance at group does not provide a suitable
outcome measure for increased socialization.
To introduce a measurable outcome,
the activity professional should focus on behaviors, reactions,
responses or tasks completed within an activity. The activity
attendance should be a means to change a behavior or provoke a
response rather than be the ultimate goal. Rather than "resident
will increase socialization by attending three groups per week",
an outcome oriented goal would be "resident will demonstrate social
skill by greeting peers at the start of three groups per week"
or "resident will demonstrate social skills by sharing opinion
during reminiscent or discussion group once per week".
Another goal writing lesson we
learn is that the goals need to be realistic. The activity professional
is sometimes pressured by the team to promote certain behaviors
or participation in activities. "You need to get them out of their
room and get them into activities", we sometimes hear from the
care plan team or from the families. We need to rely on our assessment
skills to define an appropriate and individualized goal for the
residents/client. If an individual resident/client had never attended
or participated in many groups or was not a "joiner", the chances
of them becoming one at this stage of life is minimal. That is
not to say we shouldn't try to engage them in our programs, however
each resident deserves a program (whether it be a 1-1 or group)
based on their needs. If the individual prefers a 1-1 or individual
program, the resident care plan should reflect that need.
Finally, the goals we establish
should be resident/client centered. We hear that term a lot, especially
with the revised guidance for nursing homes. But, is this a new
idea? Is this something that was born out of new regulations?
Person centered therapy was first defined by Carl Rogers, an American
psychologist. In the 1960's, Carl Rogers wrote that "the client
knows what hurts, what directions to go, what problems are crucial,
what experiences have been buried". He helped people in taking
responsibility for themselves and their lives. He believed that
the experience of being understood and valued, gives one the freedom
to grow.
So what does this mean to us
as we write care plan goals? It means we need to involve the resident/client
in the goal development process as much as possible. As caregivers,
we sometimes assume the role of "expert" and believe we know what
is best for the patient. Even though the resident/client is invited
to the care plan meeting, the care plan is often already completed
and the meeting is simply a means to inform the resident of what
services will be provided. Goals are often created with little
input from the resident/client. To truly embrace resident/client
centered care planning, the resident/client, whenever possible,
should be involved in discussing potential goals. What the resident
wants may be different than what the team member or therapist
thinks they need. That input should be respected.
There are a number of books on
care planning available to the activity professional. Books are
helpful but the activity professional should not rely solely on
the goals listed in the books. The activity professional should
strive to become competent in goal writing in order to be able
to develop truly individualized and resident/client centered goals.
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