OTS 03: SMART-E Goals and Determining Level of Services

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Welcome to the show notes for Episode 3 of the OT Schoolhouse Podcast.

In this episode, Abby returns to discuss SMART-E goals and how these goals should drive a service provider's decision on how frequently to see a student.

Links to Show References:

SMART Goals Blog post - Referenced in the podcast is a post written by Abby all about smart goals. Click here to check it out.

Collaboration Geared Toward Classroom Participation (Article Review) - This is a post that looks a little bit at OTs who work in a collaborative model and how it can be effective.

Best Practices for OT in Schools - This is a book that every OT should have. We regularly refer to it when we are stumped and even if it doesn't directly tell us the answer, it points us in the right direction.

Subscribe - Subscribe to our website now to get access to our free downloads of Gray-Space paper and Occupational Profile for school-based assessments.

Freebies!

Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs.

Have any questions or comments about the podcast? Email Jayson at Jayson@otschoolhouse.com

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Episode Transcript

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Amazing Narrator   

Hello and welcome to the OT schoolhouse podcast. Your source for the latest school based occupational therapy tips, interviews and research now to get the conversation started, here are your hosts, Jayson and Abby. Class is officially in session. 

Jayson Davies   

Hey there, everyone, and welcome back to the OT school house podcast episode number three. Thank you all for being here today. Guess who's back with a brand new rap. And I don't mean rap as a new case, some old school Eminem there, but Abby is back and she's laughing her butt off right now.  

Abby Parana   

Surprise.  

Jayson Davies   

Yep, I rap not. 

Abby Parana   

I loved it. Do that every episode, every episode, we're gonna have a vote. If you like it on Facebook, just comment in your comment section, and Jayson will rap every episode. 

Jayson Davies   

I'm gonna have to get up to date on my rapping skills. All right. Well, anyways, today is episode number three, and we are talking about smart goals. I'm sure many of you have already talked about or know about smart goals, but we're gonna change it up just slightly for you, and we'll tell you about that in a second. First, want to say thank you to everybody. We are recording this the day that the episode number two actually went live, and you all have been listening to it so much and well, Abby and I cannot be more happy and excited, and that's why we're recording today. You're pumped. 

Abby Parana   

I'm super pumped, because I thought the majority of the listens would be family members of mine, which any family members that did listen. I'm eternally grateful. 

Jayson Davies   

But for all of those that didn't we.  

Abby Parana   

But all of those who are unrelated to me and listened on top of it, I'm also super excited about it, because I do think it's pretty cool. Yeah, so thank you to family and non family members that have listened to our podcast so far. We hope to keep bringing you good stuff.  

Jayson Davies   

Yeah, and you guys have already been giving us some great feedback, so we appreciate it. So yeah, the first episode, we talked about assessments and trying to put together an assessment that could be well defended by yourself in an IEP. And in our second episode, we talked to Tricia Gomez, the Global Director of rhythm works integrative dance, both very good episodes, and recommend that you have a listen if you haven't already, also, if you're enjoying this podcast already. I know we've already been a little silly today, go ahead and hit that subscribe button so that you can hear when all of the podcasts come out. So that's gonna be it for our intro. I think let's you ready to head into the SMART goals. Abby, oh yeah, let's do this. All right. Go ahead and tell them our little extra thing for smart goals.  

Abby Parana   

Okay, so we've decided to add an E and create smart e goals for all you smarty pants OTs out there, but ultimately that E is to make it educationally relevant. Smart S stands for Specific. M is measurable. A is actionable, and using action words in your goals, R means that it's going to be realistic and relevant, and t is time limited. So when we're talking about E, we also want to add that there's an educational component. And whenever we do education, we do it in the least restrictive environment. So I guess that E could be both education and environment.  

Jayson Davies   

What do you know? Alrighty, well, let's dive into smart goals a little bit. You gave the brief synopsis of it, but what does it mean for smart goals to be specific?  

Abby Parana   

So when we're looking at a specific goal, we need to make sure that it is functional, and that when we are being specific, we are looking at something that is measurable. So if we're looking at a child's grasp of their pencil, or something like that, we need to be extremely specific, that it is the grasp that we're looking at or that when we're looking at their self regulation skills, what is it that is specifically we causing them to become dysregulated? That specific part helps us be able to lead to the M in smart goals? 

Jayson Davies   

Yeah, I agree. Because I think sometimes we try to measure too much in a goal we try to measure, like some of us will just say handwriting in general. Devon, they can write their name, but you know, as OTs, we all know that there are so many things that go into handwriting, and sometimes we need to break it down a little bit to make it more specific. So maybe we're just looking at if they're able to size their letters correctly. So that's kind of what I think of when I think specific, or if it is like you're talking about sensory integration or sensory processing, looking at the one behavior that will be the result of in increased or improved sensory skills.  

Abby Parana   

If that's where establishing those baselines. So when you're looking at establishing a goal for a kid, you want to actually measure that goal before the IEP meeting, even if they're doing it zero out of three opportunities with 0% accuracy. You want to be very specific and what that baseline is in order to establish that goal. So, and just like you were saying, getting into the nitty gritty of those baselines will help you be more specific when you write the goal. 

Jayson Davies   

Definitely. So then that's s, I know we kind of said measurable in there a few times, but this one is measurable, and it is similar measurable means that it's a behavior that you can see, right? You can't measure something that you can't see. If you can't take data on it, then it's probably not the best goal to be measuring, and you want to write that at all. 

Abby Parana   

So when we're looking at measurable, you want to consider the service level in that part of your goal. So if you're recommending whatever your measurement is, you should be recommending that level of services. So if you are providing a two time a month 30 minute collaboration for the student, you should be measuring that goal two times a month. And when you do that, you should be specifically documenting the specifics of that goal twice a month. And so when you write a goal, for instance, I was making the mistake of saying, like, oh, four out of five opportunities observed. But that's for like, a goal that I'm going to work on with a kid every day, in which case the teacher would be measuring it. If I am measuring a goal specifically as an OT. I would be writing it as Oh, the child will do it in four out of four opportunities over a two month period with 80% accuracy. If it were like a handwriting legibility goal, because that would allow me to observe it the two times a month and I'm in there and adequately monitor that progress. Does that make sense? Definitely. So we're going to move on to the letter A in smart goals, and that stands for actionable words or action, I guess, oriented. That's a good word goals. So some folks will write goals that are, oh, they'll do it with minimal assistance, or they'll do it with, I don't know, a level well. In our district, they'll say level one prompt, which is a whole system that I have trouble with. But I choose to only write goals that are independently achieved, because I feel that as an OT when I'm trying to establish the just right challenge, I think that a goal, an annual goal, should be able to be independently achieved by the child. If it isn't able to be independently achieved by the child, it's probably too difficult for them, and you would want to dial it back a little bit, because we want the child to develop the new skill in order to access their educational environment. What do you think? 

Jayson Davies   

Yeah, we want them to be able to do it in the classroom by themselves, without needing the OT by their side or an aid by their side, or even the teacher by their by their side, so they should be able to do whatever we're trying to get them to do independently. And yeah, that may be that may mean sometimes we have to lower our expectations slightly, but that's still progress that they made, and they made it to a point where now you can build upon whatever progress they made. 

Abby Parana   

Exactly, and I think that this is particularly relevant when you're working with kids in special day classes for children who have moderate to severe disabilities. And the reason I say that is because oftentimes we're ourselves as therapists, but also I think the aides and teachers were likely to prompt them through things. And I don't think that's I don't think prompting is a I think prompting is a great way to teach a skill, but it shouldn't be a goal of the skill or like, if I look at cutting skills, I'm not going to have a child cut out a circle with moderate prompts from an adult in the classroom, or, well, you know, tactile prompts with an adult in the classroom, if they're not holding the scissors with a thumb up position, I would dial that goal all the bit way back that the child would independently position the scissors with a thumb up position in their dominant hand in order to cut, you know, or participate in a cutting activity in the class, whether that's they snip the edge of a paper on their own or whatever, I don't care that the end result is that. Are accurate, my end result is only that they held the scissors correctly, because that's the independent skill they need to be able to achieve. Sorry, just hit my mic. 

Jayson Davies   

And you know what? Maybe they do need help once they actually have the scissors in their hand. But that one step of them being able to get their scissors into their hand appropriately is a big skill, especially for some of those, those kids with more needs so and then you know what that gives you. Now you know exactly what your your goal is going to be for the next year. Now, they're going to be able to snip paper in a year, or they're going to be cut a five inch line in a year. So yeah, building upon previous years goals. All right, let's move on. 

Abby Parana   

Leads to relevant and realistic, the R and smart goals, man, we're just moving right through these. We are moving right through the actually, if you follow this, like logistical pattern, it really makes a lot of sense. When you're writing a goal for an IEP, you start to be like, Oh, each one kind of flows into the next. It's not like, Oh, I got the s done. I got the M done. It's not really a checklist. It's more of like a grade flowing. So. 

Jayson Davies   

And you did a good job at showing that in the blog post, so we'll definitely link to the blog post that you did to kind of and that has some examples of goals as well. So definitely that in the show notes. Again, the OT schoolhouse.com, forward slash, episode three. Now three. Episode Three. So three, yeah, okay, so relevant and realistic. It's like what Abby just said. You know, it's just making sure we're not giving a goal to a student that's just outlandish, and sometimes that's the best attribute an OT can provide to a teacher, because a lot of teachers try to make goals that are for the child to write their entire name, and yet they can't. They can't form a circle, a line, or in a vertical or horizontal line yet, and they're trying to work on S, A, M, A, N, T, H, A, to write Samantha. And so sometimes we just need to help bring that realistic value, that realistic projection for the student. 

Abby Parana   

Oh, yeah, absolutely. And that's where that collaboration on goals is really important, because as OTs, we help bring the child, the occupation and the environment together to create a just right challenge. And writing a relevant, realistic goal is super important to that, because if a goal is too difficult for a kid to achieve, they're going to get frustrated. You might actually see an increase in their behaviors, particularly when it comes to tabletop writing activities or anything relevant to that center or those types of activities, you're going to see the kid try and escape, and then before you know it, they're like, Do you have a strategy for this? Well, the goal is too difficult, maybe. So those are those relevant and realistic goals that it's got to be meaningful to the child, the child's got to understand what it is they need to do, and then you help them develop the skills to bridge that gap. That's that part of being relevant and realistic. 

Jayson Davies   

all right. And then the last one of the original, SMART goals is T for time limited. And well, Abby, you put this in a good way. So go ahead. 

Abby Parana   

Yeah, so when you're looking at it, you really want to look at in one year's time, what is it that that child would should be able to achieve? And that's where, when you're looking at those developmental stages or developmental milestones, or you're trying to understand the development of cutting skills, or the development of handwriting skills, you're trying to look for a one year advancement in that so, like we were just talking about with the cutting, if they're not able to hold with a thumb up pattern, you want them to be able to do that. But then the next year, oh, they can hold with a thumb up pattern and snip. What's the next step that they be able to stabilize the paper and cut with a forward fluid motion? So maybe you want to take them that one more year down the road. And so really looking at those time limited objectives as to what they can actually do in an annual, you know, within an annual IEP, because it's the worst when you write a goal that's too hard and you have to go in and be like, yeah, partially met, they can kind of do it or not met at all. But, I mean, be honest with yourself, you might have to just dial it back and just say, Hey. I was, you know, I was thinking that this is what they could do, but that's establishing the baseline, and following S, M, A, R, T, and we'll add the E component here at the end, but following that flow and that pattern will help you lead to writing a good, time sensitive or time limited goal that can be achieved within the year. So follow each one of those steps and you'll and you should be able to achieve it pretty easily. Okay. 

Jayson Davies   

Yeah, I want to interject real quick, a year is such a long time, and it's even harder because it's not really a year. It's only like nine and a half months, because you got Christmas break, summer break, spring break, you have all these breaks. So a year really isn't a year. So don't stress out about this one too much. Try to do the best you can, because this is very tricky. I mean, I can't project what I'm gonna have, I mean, for breakfast tomorrow morning. So looking to hear out true, that's tough, but do your best. 

Abby Parana   

Oh my gosh. And particularly with the kids that have. I was just thinking of a student I had that had a lot of behavioral concerns when I first assessed her and I wrote a goal for her to write her first name, she could write the whole alphabet and copy sentences by the time her annual rolled around, because once the behaviors were kind of handled and she got better at understanding her school routines and environment, her Visual motor integration, her ability to write that was like nothing for her, she could pick up on that real fast. So then my goal was not just met, it was exceeded. And in those cases, that's where that progress monitoring and make sure you know you keep tabs on it and hold an IEP before it gets to that point is probably a good idea. But lesson learned, and thanks bring me back. 

Jayson Davies   

All right. Letter E for Smart E goals. This is one that we kind of came up with earlier today, and we really liked it because SMART goals, they're great for all OTs, but smart E goals are great for school based OTs and anyone in the school based setting, you know, we are not we do not see children in schools for them to be receiving OT. They are there to get an education. We see them because they need ot in order to access their education. So everything we do should be related back to the education environment, the educational curriculum, the educational skills that they need. So that's why we added the E here. What do you think? 

Abby Parana   

Oh, absolutely, I think so many times it's easy to confuse the education model with a medical model, but I think adding the e to the goal and understanding that this goal is to be educationally relevant, and it should be within their educational environment, and that environment should always be least restrictive. So LRE so when we're designing things with our goals in mind. We need to keep in mind that the goal for the child is not to receive occupational therapy services at school. The goal is for them to participate in their education as least restrictively as they can. And so ot should always support that. 

Jayson Davies   

Yeah, and I, real quick, I want to combine the E for education and the S for specific, because you should put in your goal in what setting the child is going to meet their goal? Are they going to meet their goal in a one on one session with you? Hopefully, you know, there are some kids that do need that one on one, and they will meet that that goal one on one with you, but hopefully then the next year, you're working on implementing that goal to be met within the classroom setting. So that's where you got to be specific about in what setting the child is going to meet their goal. 

Abby Parana   

Oh, yeah, definitely. 

Jayson Davies   

All right, great. So I'm going to read those off real quick for you. Just as a refresher, we have s for specific, M for measurable, a for action, R for realistic and relevant, T for time limited, and our special E for educationally purposed or educationally relevant. 

Abby Parana   

And you could say educational environment, we got two E's.  

Jayson Davies   

Boom, smart E. All right, so. 

Abby Parana   

So once you've developed your smart e goal, you want to determine your service level. And I had a really I guess maybe it was like a poignant moment where our special maybe not poignant isn't the right word, but our special ed director was discussing an IEP where she kept trying to prompt one of the service providers to develop the level of service. And these were one of those moments where the parent wanted an increased level of service.  

Jayson Davies   

No, oh, IEP, they didn't want to. IEP, yeah. They just wanted the services to stay the same. Yeah, this service provider was trying to decrease services after the student had not met their previous goals and and then they were trying to propose less goals and less services. And so the parent was upset because. They said, Well, okay, I understand that you're saying he needs less time because you only have one goal. But why do you only have one goal? You had three goals last year. He didn't meet any of them. So why are you cutting back goals? The student needed more. And so that's where that came from. And the service provider, yeah, she had a difficult time coming up with why she was giving the service at the recommending the service at that level. So.  

Abby Parana   

Oh, that's right, okay.  

Jayson Davies   

and that's why we're putting these two things together on this one podcast, because your goals should be driving your recommendation of services. And so I wish you could see me right now. I'm doing all these hand gestures, but the goals drive the services. So those Smarty goals that you develop, like Abby was saying, should drive your service. In the sense of, how many times do you need to see this the student, and in what setting in order to help that student meet their goals? Yes, perfect. So we're gonna go a little deeper than that for you to develop that, but that's kind of the gist. So there's a few things that you have to look at. To look at when you're looking at service, you have to look at how many times you're going to see the student in a week or in a month period, and you have to know where you're going to see them. Are you going to pull them out, or are you going to see them in the classroom? You can also see them in a group or individually, or just working with a teacher to work with a student, also known as consult collaborative. So those are the kind of the the three main areas that you're looking at when you create a service. Does that make sense? Heavy about right? 

Abby Parana   

OT, sounds amazing. Jayson, so yes, absolutely, because and, and that's the most important thing, because when we're looking at least restrictive environment, you don't want to be providing too many services or too little services for the child to be able to meet their goal, and so establishing that service level and really being able to defend because I notice in most points of contention, is that offer of free and appropriate public education that we make at The end of the IEP meeting, where you say, you know, you've developed this amazing goal, you've gone through the your assessment or the present levels of function, and you know and have established strengths and concerns, and you develop this goal, and you recommend two times a month for 30 minutes collaborative push in services for the child to meet that goal. Being able to establish why that is is super important, because the parent will only hear or the IEP team is not really just the parent, it's the whole team. I've had lots of people asked about that is going to hear, you're only going to see my kid twice a month for 30 minutes, and they're supposed to be able to, you know, improve in this area. Well, yes, but that's where that whole evidence based practice comes in, which is going to lead us to another topic. 

Jayson Davies   

Whole another topic, evidence based practice in episode number one. Gonna get the two into that today, but I can promise you there will be more episodes about that. So yeah, when it comes to developing your level of service, you just really got to take into account mostly how much occupational therapy, or, if you're a speech pathologist, how much speech or how much of your service does the student need in order to meet their goals? And so with that, it's again, like I was saying earlier, this is one of the toughest things to do. To look out a year in the future is a tough thing, and no one expects you to get it right on the nail. Sometimes students won't quite meet their goals. Sometimes they're they'll surpass their goal tremendously. And you know, we always want to see that, but do your best to to make sure that the goals and the recommended service levels kind of make sense. If you have three goals, you might need a little more than one time a month. And if you have one goal, you may not need once a week. Remember, this is individualized education, so trying to make it individualized to the goals. So all right, well, that just about wraps up what we got for you today. I hope that makes sense. We'll definitely tag some links into the show notes to help it make a little more sense and give you some examples of goals and services. So check that out for sure. Do you have any last things to say Abby? 

Abby Parana   

just go ahead and check out the blog post on this too. If you're having questions about it, you know you can always submit a question to us on our website or our email. Um. Check us out on Instagram and Facebook, where we have a lot of resources and information on these things, and just keep the conversation going. I love learning about how occupational therapists write goals. I develop these strategies by talking to Jayson a lot in the office, and Jayson talking to me a lot in the office and kind of commensuring, like, oh, that goal last year was not a good goal. I want to write a better one for this kid this year going forward. And so, you know, let's collaborate, let's share. Let's keep this going.  

Jayson Davies   

Yeah, yeah, and yeah, we'd love to keep it going. And we are very much enjoying doing this podcast thing. We're having a time of our lives, and we hope it's it's helpful. We're getting great feedback from you all, so we appreciate that. 

Abby Parana   

If you like what you've heard, or maybe you don't like what you've heard, and you want to give us your opinion on it, please leave us a review on iTunes, I mean, but if you liked it really, please leave us a review. 

Jayson Davies   

Yeah, it really helps. That would be fantastic. We're hoping to reach, we're hoping to get a community. It's not necessarily about us reaching as many OTs as possible. It's about all of us OTs getting together, whether it's on Facebook, this podcast, any website. So.  

Abby Parana   

Yeah, cool. Thanks for listening.  

Jayson Davies   

Bye, everyone. 

Amazing Narrator   

Thank you for listening to the OT schoolhouse podcast for more ways to help you and your students succeed right now, head on over to otsoolhouse.com Until next time class is dismissed

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