Friday, August 12, 2011

Writing Outcomes or Writing Goals

Are there times you write goals for a child that are not tied to specific routines? If so, can you give me an example?

Toileting for children who need to toilet at any time. They wouldn’t have actual toileting routines. People need to understand the vital importance of participation or engagement, in order for this question not to come up. Here’s the abstract to a good article by Jeanne Wilcox and Juliann Woods about the importance of participation for writing outcomes: http://lshss.asha.org/cgi/content/abstract/42/3/365. They focus on language, but the same argument can be applied to all areas of development.

We are still working from a mind set that we need to be writing goals based on provider concerns - even if the parent is not concerned or invested in the goal. We are basically saying that we should be telling the parents what they should be concerned about. I am not sure how to get past that.

Shouldn’t be allowed because it’s not family centered, as I explain below.

The basic issues are these:

1. How do we decide on an appropriate measurement if we do not break down the goal into smaller steps?

Would coming up with a breakdown of short-term objectives serve the same purpose as writing a measurement with the three criteria or should the list of short-term objectives be something in addition to the functional goal with measurement included?

The question is related to the seven steps for writing participation-based outcomes/goals, as described in the book Routines-Based Early Intervention. An example is below.

This question assumes that all skills are going to be taught in the steps in a task analysis, so the measurement becomes the accomplishment of step after step. This is an acceptable measurement method to supplement the criteria for outcome accomplishment. You see, the difference is between progress monitoring and the criteria for the END of the instruction—what answers the question How will we know when we got there—when to reassess, when to stop? The three criteria ask the questions, When is this overall skill (i.e., all the steps or a subset of the steps) needed (i.e., what routines), what level of performance is required (e.g., how many steps in the chain, what level of prompt, what frequency, what duration—whatever makes sense for the skill in context), and over what amount of time (which should be specified in any measurement system, even a task analysis one)? So it’s a false question to say it’s chaining versus our three criteria.

I am worried that those who don’t want to specify routines (a) don’t think of the necessity factor in outcomes (is it necessary?); they think more in terms of deficit—what can the child not do, regardless of context; and (b) think that professionals have to teach the child during routines, which would be difficult to do (instead of thinking that we need to be consulting with families so they can teach the child during routines).

2. How do we include professional opinion in goal-writing?

First, the rewording of the goal into a participation-based goal with three criteria is professional behavior. Second, professional opinion can go into the process of functional assessment, by the questions we ask families, the stars we highlight if we do an RBI, and the reminders of concerns we provide while the family is choosing outcomes/goals. But this requires a strong commitment to ethics, to ensure professionals are not talking parents into choosing outcomes they actually are not interested in or that are not actually functional. Third, professional input really comes into the strategies for intervention. It is a paradigm shift (sorry about the cliché) to let families make decisions about goals. Understanding whose child it is and that families need to be reinforced for the decisions they make about their children’s goals is the hallmark of a family-centered professional. Others are nice to families but don’t really trust them or care about the families’ priorities and long-term growth as parents; they are not truly family centered, even though they sometimes think they are God’s gift to families.

3. Does having a list of short-term objectives with the final objective being the end goal supercede the need to write the measurement piece?

This is partially addressed in my first answer. No, it doesn’t. If you want short-term objectives, here’s how it can work:

Joshua will participate in hanging out time and bath time by playing with a variety of toys. We will know he can do this when he plays with three toys in two hanging-out times and one bath time in a day for five consecutive days. [This is an example of a participation-based outcome with multiple criteria.]

Short-term objectives:

1. Joshua will play with two toys during one hanging-out time by October 1.

2. Joshua will play with two toys during one bath time by December 1.

3. Joshua will play with three toys during two hanging-out times by February 1.

4. Joshua will play with three toys during one bath time by April 1.

5. Joshua will play with three toys in two hanging-out times and one bath time in a day for five consecutive days by June 1.

If you have any pearls of wisdom that might help me find a way to navigate this I would really appreciate it. I fear I am just causing myself more confusion the more we go around on the subject.

Reread Chapter 7 in the RBEI book and look at the Goal Functionality Scale III.

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