“Steps in Intervention

Planning and How to write

an Intervention Goal”
B y : M s . S h arma i ne S h ane W.
Po nd o c, M AO T, O T R P
 INTRODUCTION
• Intervention planning is a crucial step in
occupational therapy that bridges assessment and
implementation.
• It involves using clinical reasoning to create a
structured plan that addresses the client's needs
and promotes their well-being
 THE ROLE OF OCCUPATIONAL
THERAPISTS IN INTERVENTION

Holistic Client- Interdisciplinary

Approach Centered Collaboration
PURPOSE OF INTERVENTION
PLANNING

Structured Approach

Efficiency

Outcome-Oriented
 INTERVENTION PLANNING IN
PSYCHIATRY
Our scientific and clinical understanding of
mental disorders is not yet sufficiently well
developed for us to be certain of the real cause
of the person’s problems, and because of this, it
is hard to identify the best solution.
INTERVENTION PLANNING IN
PSYCHIATRY
INTERVENTION PLANNING IN PSYCHIATRY

DREW IS A 19-YEAR-OLD COLLEGE FRESHMAN, LIVING AT HOME WITH HIS PARENTS WHILE ATTENDING
SCHOOL. DURING THANKSGIVING WEEKEND, HIS PARENTS FOUND HIS ROOM EMPTY ONE MORNING AND
DREW COULD NOT BE REACHED ON HIS CELL PHONE; AFTER 24 HOURS, HIS PARENTS NOTIFIED THE
POLICE.

HE WAS FOUND 2 DAYS LATER WANDERING ON THE STREET, WEARING ONLY HIS UNDERWEAR. HE HAD
NOT EATEN SINCE HE LEFT HOME. HIS PARENTS REPORTED THAT HE HAD BEEN GROWING MORE
ISOLATED OVER THE PAST 18 MONTHS, STAYING IN HIS ROOM FOR DAYS AT A TIME AND REFUSING TO
COME DOWNSTAIRS EVEN FOR MEALS.

HE HAD BEEN A GOOD STUDENT, EARNING AS AND BS IN HIS COURSES FOR THE FIRST 3 YEARS OF HIGH SCHOOL,
BUT HIS GRADES FELL TO CS AND DS IN HIS SENIOR YEAR. HE SAYS HE NEEDS TO BE LEFT ALONE BECAUSE VOICES
TELL HIM THAT HE “RUINS OTHER PEOPLE’S LIVES.” DREW’S DIAGNOSIS IS SCHIZOPHRENI
 THINKING QUESTIONS

• WHAT EXACTLY DO WE KNOW ABOUT DREW?

• WHAT CAN WE DO TO HELP HIM? WHERE SHOULD WE BEGIN?
 THINKING QUESTIONS

• WHAT EXACTLY DO WE KNOW ABOUT DREW?

• WHAT CAN WE DO TO HELP HIM? WHERE SHOULD WE BEGIN?
• IN THE MEANTIME, HOWEVER, HOW ARE WE TO HELP DREW?
• . BUT WHICH ONE SHALL WE WORK ON FIRST, AND WHY? ONCE THE GOALS ARE
CHOSEN, HOW SHALL WE ADDRESS THEM?
 CLINICAL REASONING

• is a complex cognitive and affective process—The therapist must come to understand how
the person’s life looks from the inside.
• In her Eleanor Clarke Slagle lecture in 1983, Rogers (24) identified three crucial
• questions on which the therapist should focus (Box 14.1)
 FIRST QUESTION: WHAT IS THE PATIENT’S STATUS? WHAT IS THE PATIENT’S
OCCUPATIONAL ROLE STATUS? WHAT PROBLEMS DOES HE OR SHE HAVE?
WHAT STRENGTHS DOES HE OR SHE POSSESS? WHAT IS HE OR SHE MOTIVATED TO TRY?

The therapist must consider the person’s engagement in occupation, his or her performance
skills and performance patterns, the contexts in which the occupations occur, and any pertinent
client factors that may be obstacles or supports.
 SECOND QUESTION, WHAT ARE THE AVAILABLE OPTIONS?

The therapist must search his or her memory for knowledge and experience that relates in any
way to the patient’s problem.

What supports are available? How might they help or hinder the person’s ability to function?

- Ultimately, the therapist generates an internal list of interventions that might address this patient’s
goals and needs.
 THIRD QUESTION, WHAT OUGHT TO BE DONE?,

focuses on the ethical aspects of the

occupational therapy process.

As Rogers states: “Simply because a goal appears

technically feasible for the patient does not mean that it should be set as a goal.”

The patient has a right to choose.

 THREE REASONING TRACKS,

• Procedural Reasoning: Focuses on the disability and intervention options (e.g.,

diagnosis, long-term implications, and potential interventions).
• Interactive Reasoning: Centers on understanding and relating to the patient as an
individual, emphasizing communication and acceptance of the patient’s needs and
concerns.
• Conditional Reasoning: Involves considering the larger context and imagining different
scenarios, including potential changes and future possibilities.
 CREATING AND SHARING A VISION

• Use narrative reasoning to build a story that engages and motivates the patient (e.g., linking
tasks to a meaningful life story).
• Foster hope by connecting present tasks to a positive future vision.
 PRAGMATIC REASOINING

:
• Focuses on practical aspects of therapy, problem-solving, and efficient strategies (e.g., using
sticky notes for reminders).
STEPS IN INTERVENTION PLANNING

1. Review the results of the

evaluation and discuss

2. Identify problems and causes

STEPS IN INTERVENTION PLANNING

3. Identify strengths and assess the

person’s readiness and motivation

4. Collaborate with the client to set

goals
STEPS IN INTERVENTION PLANNING

5. Identify intervention principles

using the practice model.

6. Select methods appropriate to the

practice model.
 STEPS IN INTERVENTION PLANNING
1. Review the results of the
evaluation and discuss

• Approach the process with an open mind but have a clear idea of the information you need.
• Use the occupational profile and analysis of occupational performance to guide planning.
• Determine the client’s strengths, barriers, personal goals, and select appropriate outcomes and methods.

• Outcomes and priorities identified by both the client and therapist are fundamental to planning.

• Evaluate the client's potential for benefit from intervention based on prognosis and history.
• Prognosis refers to predicting recovery and the ability to resume normal life, which can be challenging to estimate.
 STEPS IN INTERVENTION PLANNING
1. Review the results of the
evaluation and discuss

• In short-term settings, focus on evaluation and transition to the next level of care rather than long-term planning.
• Analyze the evaluation to understand the client’s problems, strengths, readiness, and motivation for change.

• Integrate information from various sources to understand both the causes of the client’s problems and the problems themselves.
 STEPS IN INTERVENTION PLANNING

Example: a patient may have very poor hygiene—as evidenced by greasy

hair, stained teeth, and body odor—for a variety of reasons: He or she may
never have developed good hygiene skills, he or she may have gotten out of
the habit of using those skills, or his or her usual environment may make it
difficult to perform hygiene and grooming tasks (e.g., because of
homelessness).
 IDENTIFYING CLIENT NEEDS AND
PRIORITIES

Client Collaboration: Engaging clients in

discussions to understand their goals and
priorities.
Client Goals: Aligning intervention strategies with
what the client deems most important for their
well-being and functionality
IDENTIFYING CLIENT NEEDS AND
PRIORITIES

• strengths must be considered even though the main

focus of our energies appears to be on finding
solutions to the client’s problems
• the skills and habits the client has developed and
maintained and the client’s resolve to work hard and
succeed can only be strengthened by our recognition
and support.
 IDENTIFYING CLIENT NEEDS AND
PRIORITIES

• Questions sometimes arise about a client’s motivation

for change.
• The person who fails to work toward goals that the
therapist considers appropriate and necessary may
be labeled as unmotivated
• In inpatient settings with acutely ill persons, it is not
always possible to obtain the patient’s cooperation
and participation in planning intervention.
• In acute care settings, the staff may develop an
intervention plan on behalf of the patient, sometimes
in consultation with members of the patient’s family
IMPORTANCE OF DOCUMENTATION
• Distinct Value of OT
• Ethical and Fiscal Responsibility
• Marketing and Research
• EBP
 GOALS IN INTERVENTION PLANS

• Short-Term Goals (STGs): considers the length of time available for

treatment as well as the client’s sense of time and ability to visualize
the future; short-term goals are those that can be accomplished in a
few weeks or less.
• Long-Term Goals (LTGs): Also known as discharge goals, these are the
ultimate outcomes the client aims to achieve by the end of therapy.
 GOALS IN INTERVENTION PLANS

• Goals should be organized in order of priority. Priority means the

importance or urgency of the goal.
• In many cases, especially with persons who have severe and persistent
mental illness, it is possible to come up with a list of 5 or 6 long-term goals
and 20 or more STGs
 GOALS IN INTERVENTION PLANS

• An overall plan that describes the long-term goals of the client’s

program should be established.
• Although it may take months or years to reach these long-term goals,
having a clear final aim helps unify the smaller goals.
 GOALS IN INTERVENTION PLANS

• Problem-Specific: For each identified problem, there should be at

least one corresponding LTG. Multiple LTGs may be needed depending
on the complexity of the issues.
• Outcome-Focused: LTGs represent what the client hopes to
accomplish, and they are crucial for measuring overall success and
planning for discharge from therapy services.
SETTING GOALS AND OBJECTIVES

SMART Goals

Involving clients in goal-setting to

ensure the goals are meaningful and
tmotivating for them.

Examples:
GENERAL GOALS OF PSYCHIATRIC
OCCUPATIONAL THERAPY

to help individuals engage in occupation, to

function as independently as possible within
the limits of their disabilities, in the contexts
of their choice
GENERAL GOALS OF OT IN
MENTAL HEALTH
 WRITING EFFECTIVE
INTERVENTION GOALS
Specific

Relevant
Measurable

Time-bound
Achievable
 WRITING EFFECTIVE
INTERVENTION GOALS
Relevant

Behavioral
understandable

Achievable
Measurable
 HOW TO WRITE AN
INTERVENTION GOAL
Goals should follow logically from problems that have
been identified by assessment and selected by the client
and staff as important.

Consider the following:

Mr. Peters has low self-esteem.
Ms. Danford has poor reality testing.
PROBLEM STATEMENTS

1. Ms. Flint exhibits poor hygiene as evidenced by greasy hair,

stained teeth, and body odor.
2. Mr. Mills reports no regular leisure interests except watching
television and drinking.
3. Ms. Woolworth has been fired from many jobs as a result of
arguments with supervisors.
 SAMPLE GOALS

1. Ms. Flint will wash her hair twice a week, bathe daily, and
brush her teeth twice every day.
2. Mr. Mills will attend the activity center two evenings a week
and will have dinner with a friend once a week. For 3 weeks,
3. Ms. Woolworth will not argue with the therapists and group
leaders in her activity programs.
MAKING GOALS MEASURABLE
AND TIME LIMITED
MAKING GOALS MEASURABLE
AND TIME LIMITED
MORE SAMPLE GOALS
MORE SAMPLE GOALS
MORE SAMPLE GOALS
MORE SAMPLE GOALS
INVOLVING CLIENTS IN SETTING
THEIR OWN GOALS
• goals may be written by the OT or the supervised OTA in
collaboration with the client and family
• must address functional outcomes related to occupational performance.
• should be relevant to the client’s needs and values and stated in terms
that the client can understand.
INVOLVING CLIENTS IN SETTING
THEIR OWN GOALS
• goals should contain some criterion against which success can be
measured, and they must indicate the behavior the person is to
demonstrate.
• They must include a time frame that is reasonable and that corresponds
to the reimbursement guidelines applicable to the
• situation.
• must be achievable—that is, realistic for this person at this time in his
or her life.
 SAMPLE
LTG: Client will be able to bathe given minimal verbal cues with no signs of
inattention within 2 months of OT sessions.
STG:
• Client will be able to identify shampoo and soap without signs of
inattention given moderate cues within 3 OT sessions.
• Client will be able to initiate going to the bathroom, without signs of
inattention given minimal cues within 3 OT sessions.
• Client will be able to use dipper without signs of inattention given
minimal cues within 3 OT sessions.
• Client will be able to wash hair shampooing without signs of inattention
given minimal cues within 3 OT sessions.
 SAMPLE
LTG: Client will be able to participate in chosen leisure activities given pain
management techniques, planning strategies, and conditioning exercises
within 2 months of OT sessions
STG:
• Client will be able to create a plan with 5 leisure activities she wants to
do each day from monday to friday for the next week given planning
strategies within 2 OT sessions
• Client will be able to organize leisure activities to plan what leisure
activity to do on each day for the next week given minimal verbal
prompts within 3 OT sessions
• Client will be able to participate in table top leisure activities given
conditioning exercises within 3 OT sessions
• Client will be able to participate in movement based leisure activities
with 2 out of 10 pain given pain management techniques within 8 OT
sessions
 SAMPLE
LTG Client will be able to establish routine skills needed for Home
Management Activities consistently and independently within 2 months of OT
sessions.
STGs
1. Client will be able to initiate in performing her morning household
chores routine consistently for at least 5 days given minimal verbal
prompts within 2 weeks of OT sessions.
2. Client will be able to accomplish her morning household chores routine
consistently for at least 5 days given minimal verbal prompts within 2
weeks of OT sessions.
3. Client will be able to initiate in performing her morning household
chores routine consistently for at least 5 days given minimal verbal
prompts within 2 weeks of OT sessions
4. Client will be able to accomplish her afternoon household chores
routine consistently for at least 5 days given minimal verbal prompts
within 2 weeks of OT sessions.
 SELECTING INTERVENTION
STRATEGIES

• Types of strategies
• Evidence-based practice
• Customization
 MONITORING AND ADJUSTING

• Progress Tracking: Regularly assessing the client’s progress

towards goals using objective measures and client feedback.
• Flexibility: Being prepared to adjust the intervention plan based
on ongoing assessments and client responses.
• Documentation: Keeping detailed records of progress, changes,
and any issues encountered during the intervention.
 ANY
QUESTION?
THANK
YOU