You can reach the finish line only if you can see it
Some may take it slow and steady while others may sprint, jog, walk or even crawl to make it to the finish line. What definitely matters is that you make it to the finish line so you can declare, “I did it.” There is immense satisfaction in that because you decided on a goal and accomplished what you set out to achieve. Goals are essential to make progress of any kind.
PT as a related service in IEP
First of the three main purposes of the IDEA Act is to ensure that all children with disabilities have available to them appropriate and free public education that emphasizes special education and related services designed to meet their unique needs and prepare them for further education, employment, and independent living. Related services are transportation and those developmental, corrective, and other supportive services required to help a child with a disability to benefit from special education.1 The main goal of Physical Therapy as a related service is to address the impairments in strength, balance, coordination, and mobility that affect the student’s functional task performance. The target for improving performance could be tasks in the classroom, the gym or any school related activity and that includes navigation and playtime. In addition to interviews, observation and evaluations, some therapists may consult the gym curriculum to help establish benchmarks when assessing motor abilities.
Choosing school-based PT Goals
The graduate school courses and clinical fieldwork experiences train us well to identify impairments and disabilities. In a school setting however, the skill lies in seeing how these are affecting the student’s performance and inclusion. Let us consider the case of Jane, a kindergartener who uses one or both handrails to access stairs within the school building. Jane looks down at her feet when stepping, and cannot carry her school-related items (artwork, lunch bag, or music folder) without losing her balance. Moreover, she is consistently slower than her peers. Jane’s functional limitation to independence is her need for external assistance and an aide and the physical therapist identifies inadequate strength, poor proprioception and lack of sufficient balance as Jane’s impairments. A school-based PT goal to navigate stairs safely and independently would therefore be appropriate for Jane’s IEP because being unable to reach her classroom safely and on time independently affects her learning experience.
Writing S.M.A.R.T school-based PT Goals
Just as an Early Intervention therapist makes family-friendly goals, it would behoove a school-based therapist to set functional academic goals for easy progress monitoring. Identifying the functional limitation is a swift way to overcome the next hurdle – constructing a goal. The aim could be to focus on either the desired task if many opportunities are available during the school day or the impairment to make headway towards the desired task. Each goal should be a skillfully crafted combination of a well-defined task that is objectively measureable in an academically relevant setting. A 2009 pilot study that included 249 physical therapy goals from the IEPs of 32 children found that generally, although the school-based goals centered on task performance, most goals (72%) were not context-specific, and very few goals (6%) addressed academic tasks. The majority of goals (84%) utilized measurement criteria, with the most commonly-used criterion being the level of independence (49%).2 Since most therapists recognize the importance of evidence-based practices, it is easy to believe that they would be more willing to train themselves to write better goals. S.M.A.R.T (Specific, Measurable, Achievable, Realistic/Relevant and Temporal) therapy goal is a clearly defined objective task that is not only directly related to the need but also sensitive and meaningful to the child. With that in mind, let us consider the acronym in detail.
Specific – The action verbiage will be the crux of your goal. What exactly will the student do? For example, ‘safely go up and down a flight of 12 steps.’ The goal must keep the student’s interests in mind. If Mary cannot dribble or shoot a basketball but also does not particularly like the game, she will certainly not be engaged to work on it. A different eye-hand coordination task, say a racquet sport or a beanbag corn-hole toss game may be more favorable since she enjoys the game and finds it challenging.
Measurable – Consider an objective element in order to monitor progress. Most therapists only see the student once a week so it might make more sense to choose the criteria of 80% of presented opportunities or 4 out of 5 random data collection dates in the fourth grading period. Take into account however that although therapists usually do periodic data collection that is not always true or possible. If the opportunity is available every day, a teacher may collect and report progress too. It is therefore also important to respect who else might be accessing the goals.
Achievable – Child-centered prognostic goals are sensitive to the student’s impairments for example a reciprocal step pattern without use of handrail. It is vital to indicate the adaptation, level of independence, supervision, assistance, prompts or redirection provided for that student to work towards being successful.
Relevant/Realistic – Goals must relate directly to the academic functional needs, e.g. independent and safe classroom transitions, peer play during recess or gym with easy opportunities for data collection. The goal should address the area of concern and directly reflect the reason that student was referred for a physical therapy service. Tandem walking across a balance beam with 100% success would not be a realistic goal for a student with special needs.
Temporal –Since all IEP goals are annual, each goal should therefore reflect that dimension as well. To be honest, it is quite difficult to write an annual goal. Many things could happen during a year, changes in classroom routine or the support personnel, growth spurts, orthoses, medication, a family situation, or a medical condition that might affect attendance and as a result alter the functional needs.
Let us now consider some sample goals –
Stair Goal – Jane will go up and down stairs independently using one handrail, 80% of the time during the school day. This goal looks quite well written but is not specific. Will Jane use reciprocal or non-reciprocal stepping pattern? It is also not realistic since data collection will be difficult if the goal does not mention the number of steps or flights if endurance is a factor. A SMARTer goal: During classroom transitions, Jane will independently go up and down one flight of stairs with non-reciprocal step pattern using the right handrail and carrying a folder in her left hand with verbal cues from teacher to keep pace on 80% of trials in the fourth quarter.
Navigation Goal – Donna will go between classroom and school bus safely, 75% of opportunities throughout the school day. This goal does not specify if the navigation involves levelled walking or if it also includes stairs, curb, ramp or the level of independence. A SMARTer goal: To navigate between classroom and school bus independently, Donna will safely access one flight of steps with preferred non-reciprocal pattern and a 100 feet long inclined ramp with her donned backpack on 75% of presented opportunities in the fourth quarter.
Setting up Benchmark Goals
Data collected at presented opportunities during and towards the end of each nine-week grading period denotes the progress towards the annual goal. Short-term benchmarks are the pit stops on the racetrack of annual goals. For example, Johnny currently consistently needs assistance in the form of tactile, visual and verbal cues to keep pace with peers when walking distances more than 25 feet from one classroom to the other on the same level of the building. Annual PT goal – During classroom transitions, Johnny will independently keep pace with peers for a 100 feet distance on 75% of presented opportunities. The short-term benchmarks:
Benchmark #1 – First grading period – During classroom transitions, Johnny will keep pace with peers for a 25 feet distance with only verbal or visual cues (no tactile cues) on 75% data collection dates.
Benchmark #2 – Second grading period – During classroom transitions, Johnny will keep pace with peers for 50 feet distance with only an initial verbal or visual cue on 75% data collection dates.
Benchmark #3 – Third grading period – During classroom transitions, Johnny will independently keep pace with peers for a 75 feet distance without any cues on 75% data collection dates.
S.M.A.R.T. goals intended to help with easy monitoring also make for productive therapies. It is critical that all IEP team members, including the parent and student, understand that success is a moving target and is truly a result of very hard, challenging work, part of which involves self-discovery. It is very much a self-paced process and a journey that begins with the first step taken towards establishing an IEP and then several goals in between to ensure progress. Ultimately, these SMART school-based goals are simply tools for therapists to help guide and propel the students closer to the finish line so they can proclaim, “I did it!”, and help one more student feel the immense satisfaction of victory.
- IDEA Statute Chapter 33 Subchapter 1 Section 1400 Short title; findings; purposes at https://sites.ed.gov/idea/statute-chapter-33/subchapter-I/1400
- McConlogue A, Quinn L. (2009). Analysis of physical therapy goals in a school-based setting: a pilot study. https://www.ncbi.nlm.nih.gov/pubmed/19401929