These are some examples of planning frameworks. Use your own local resource libraries and professional networks to identify formal and informal frameworks that may be available for you to try.
The goal pyramid
The goal pyramid is a simple representation of the rehabilitation planning process. It can be used to facilitate:
- the person’s contribution to plan development
- consideration of barriers
- contribution of others
- criteria for assessing outcomes.
SMARTAAR goal framework
Use of the SMART goal writing format continues to be quite common across the rehabilitation context. This approach has been extended (with AAR) to provide a framework for planning which includes action planning, evaluation and reporting cycles.1
Specific | The goal statement includes:
|
|---|---|
Measurable | Quantify the goal. How well or how much? How many times? How will you know when the desired result has been achieved? |
Achievable | The goal is at least a clear stepping-stone to achieving the main goal. The effort expected of the patient, family and clinicians is reasonable. |
Relevant | The desired result needs to be relevant to the person and is related to achieving the main goal. |
Time | The anticipated timeframe for the step or goal to be achieved. |
Action plans | The actions of the patient, their significant others and the clinicians and how they will help the person work towards their goal. Treatments of impairments at body structure and function levels may be incorporated into the action plans. |
Achievement | Considers the outcome of these efforts. The measures of the goals and actions, and may be at participation, activity or body function levels. Consider patient reported measures (e.g. PROMIS-29 profile) and broad clinician measures (e.g. Mayo-Portland Adaptability Inventory, and goal attainment scaling). Includes analysis of why goals and actions may not be achieved. Guides next steps and future planning. |
Reporting | People receiving rehabilitation services, service providers and any funders need to know that the services and effort are of benefit to the person. Formal reporting against goals helps to communicate outcomes and value to all stakeholders. It guides and justifies next steps and supports requests for further funding. |
Goal setting and action planning framework
The goal setting and action planning (G-AP) framework is a theory-based framework to guide goal setting practice following stroke.2 The G-AP framework describes goal negotiation, goal setting, action planning, coping planning, action, appraisal and feedback.
The key constructs in the G-AP framework have been identified through an examination of social cognition theory, goal theory, health action process approach and self-regulation theory.
The G-AP framework website has tools and online training resources.
G-AP key constructs
Self-efficacy beliefs (or confidence) – If people are confident they can do something, they are more likely to do it.
Outcomes expectancies – If people think that doing something will result in a good outcome for them, they are more likely to do it.
Goal specificity and difficulty – Specific, difficult goals lead to better performance than vague, “do your best” goals.
Assigned or self-set – It doesn’t really matter if the goals are assigned or self-set, as long as the person buys-in to the goal and feels motivated to work towards it.
Learning and performance goals – Performance-based goals can enhance outcomes. But if the goal is complex, it may be necessary to break it down into learning goals. This provides the person with the baseline skills and knowledge to then work towards the more complex outcome.
G-AP stages
Goal negotiation – Consider current situation and identify main problems to be addressed.
Goal setting – Refine problems into specific and challenging rehabilitation goals agreed by health professional and person.
Action planning – Bridge the gap between a good intention and the behaviours the person needs to execute to achieve the outcome.
Coping planning – Identify barriers to actions and negotiate how to manage or overcome these barriers.
Appraisal, feedback and goal-performance discrepancy – Reflect on:
- how we went in achieving that goal
- how we went in meeting the actions needed in order to achieve the outcome
- what we can do differently to enhance the desired outcome.
References
- Badge H, Weekes M, Jones B, et al. Goal training workbooks 2012-2013. Sydney: NSW Agency for Clinical Innovation; 2012.
- Scobbie L, McLean D, Dixon D, et al. Implementing a framework for goal setting in community based stroke rehabilitation: A process evaluation. BMC Health Serv Res. 2013;13:190. DOI: 10.1186/1472-6963-13-190