Goal attainment scaling

Overview

Goal attainment scaling is a client-centred approach that facilitates the setting of individualized meaningful goals in treatment and allows you to monitor the extent that the intervention is progressing in the direction of goal attainment and recovery.

Since the late 1960s, it has been used in many rehabilitation contexts for complex physical and mental conditions and a range of severity in symptoms and impairment. The approach provides:

  • cooperation and clarity for setting therapeutic objectives
  • increased focus on functional restoration
  • realistic expectations of treatment
  • increased client motivation to work toward personally meaningful and individualized goals
  • improved understanding of the extent to which change is occurring over time in the course of treatment.

Goal attainment scaling also helps to monitor and determine the extent to which the intervention is helping with and supporting recovery.

WSIB Mental Health Programs and goal attainment scaling

Goal attainment scaling was adapted and developed for the WSIB Mental Health Programs in collaboration with the Ontario Psychological Association and the Mental Health Specialty Programs.

It was introduced to enhance achievement of treatment goals for recovery and return to function. It facilitates improved communication between the injured or ill person, the health care provider, and the WSIB by providing a ‘common language’ for goals and the extent of goal attainment.

The goal attainment scaling approach uses SMART (specific, measurable, achievable, relevant, and time-bound) goals. At the end of each reporting period, the SMART goals are included in the psychological treatment report. This provides the focus of treatment, the extent of goal  
achievement and progressive recovery and can indicate the injured or ill person’s functional abilities at any given time. This feedback informs case management and return-to-work planning activities based on where the person is in their recovery.

Incorporating goal attainment scaling into the WSIB Mental Health Programs

Below are some steps for incorporating goal attainment scaling into the provision of psychological interventions:

Step 1

  • Discuss the current level of occupational-injury-related symptoms, functional impairments, and barriers to occupational functioning and/or return to work with the ill or injured person.
  • Based on the discussion, work with the injured or ill person to set overall and explicit goals for treatment to address occupational-injury-related concerns, including goals relevant to return to work. Here are some examples of goals*:
    • Symptom reduction or symptom management goals: address cognitions, emotions, behaviours or physiological responses that have emerged or been exacerbated by a work-related incident/exposure. These goals are aimed at reducing or managing symptoms.
    • Functional restoration goals: address impairments in the person’s ability to engage in their personal, social and/or occupational environments. These goals involve skill development, adaptation or accommodation.

* In Mental Health Specialty Programs, there typically should be a minimum of two functional goals and a maximum of two symptom reduction/management goals identified.

  • Work with injured or ill person, translate the top four goals into specific, measurable, achievable, relevant, and time-bound (SMART) goals. Make note of the SMART goals, as you will discuss them with injured or ill person, as well as the extent that each goal has been achieved, prior to the next treatment.

Step 2

  • Prior to submitting the next treatment report, discuss the goals and goal attainment. Revisit the SMART goals, discuss with the injured or ill person the extent that each goal was met and work together to rate each goal based on the scale below:
    • A little better or much better than expected – goal attainment exceeded the details in the SMART goal
    • As expected – in keeping with the details in the SMART goal
    • Partly achieved – there was some progress and goal attainment, but it fell below the details in the SMART goal
    • Much less than expected – there was no change or progression in meeting the goal (same as baseline levels or worsened)
  • During the same discussion, work together with the injured or ill person to identify the status or plan for each SMART goal.
    • Goal complete – the injured or ill person completed the SMART goal and there is no identified need to continue working on it at that time
    • In progress: continue in next reporting period – the SMART goal is an ongoing goal of treatment. Although some of the SMART details may change, the same goal will continue to be a focus of treatment
    • Revision required – some aspect of the goal may remain a focus of treatment, but the nature of the goal and the SMART details will be revised
    • No further gains anticipated – despite the injured or ill person’s efforts, progression on this SMART goal was not met and no further gains from continuing a focus on that goal are expected. The goal will not be a focus of treatment at this time.

Step 3

  • In the treatment report, list the SMART goals, level of goal attainment, and the status or plan of each SMART goal. If relevant, in the comments section provide additional information about the overall goal attainment, including as related to functional restoration. It is possible also to comment here on factors that facilitated or hampered the level of goal attainment.
  • If treatment is continuing, revisit the earlier discussion about abilities, impairments, barriers to recovery and return to work, and set new SMART goals or revise existing SMART goals as appropriate with the injured or ill person.
  • It is also helpful to consider the trend of goal attainment across several treatment reporting periods when you are creating treatment plans or making recommendations about return-to- work planning, referral for additional services such as medication consultations, return-to- work and discharge planning.

Resources

Useful supplemental resources, such as client worksheets to help implement goal attainment scaling within clinical practice are available in the CHMP section on the Ontario Psychological Association website.