Module 4: Patient-Centered Treatment Plan

SMART Goals Transcript With Time

0:00 — what is a smart goal

0:01 — how do i write one

0:03 — do all of the goals on my treatment plan

0:05 — need to be smart goals

0:07 — these are exactly the questions we are

0:09 — tackling in today's video

0:11 — and we're even going to write a goal

0:13 — together so you can see how it works

0:15 — hi i'm dr melissa mccaffrey founder of

0:17 — the free private practice paperwork

0:19 — crash course and today we are talking

0:22 — about smart goals

0:23 — first let's dive into what the heck is a

0:26 — smart goal anyway

0:28 — a smart goal is a specific way of

0:30 — writing a goal that makes the goal

0:32 — really observable

0:34 — easy to understand and easy to track

0:37 — smart is an acronym and it stands for

0:40 — specific

0:41 — measurable

0:43 — attainable or achievable

0:46 — realistic and time-bound

0:49 — now at this point you might be saying uh

0:51 — melissa that sounds complicated

0:53 — and do i really need to write all of my

0:55 — client goals as smart goals

0:58 — as is often the case in documentation

1:00 — the answer that question is

1:02 — maybe

1:03 — so if you work with medicare or medicaid

1:07 — yes

1:08 — all of your goals should be smart goals

1:10 — 100 of the time

1:12 — if you work with private insurance or if

1:15 — you give clients a super bill and their

1:17 — insurance might actually review your

1:19 — files at some point

1:20 — then it's a good guideline to have you

1:23 — don't have to worry

1:24 — so much about sticking to the specific

1:27 — formula i'm going to teach you

1:29 — but it's a helpful guideline and trust

1:31 — me it's going to be pretty easy once you

1:33 — learn this formula anyway

1:35 — if your clients are 100

1:38 — private pay then you can take it or

1:40 — leave it as far as smart goals go but

1:42 — you still want to follow a lot of the

1:43 — same principles of making the goal

1:46 — really observable easy for anyone to

1:49 — understand and easy to track this helps

1:52 — both you and your clients with knowing

1:55 — whether or not therapy is working

1:57 — let's go step by step together and write

2:00 — a smart goal

2:01 — first we have specific so specific is

2:04 — talking about the type of behavior for

2:06 — example maybe we want to create a goal

2:08 — to reduce depressive symptoms

2:11 — so you might think well

2:13 — depression or depressive symptoms are

2:15 — specific enough but they are not because

2:17 — how do we measure depression

2:20 — and any good therapist and actually most

2:22 — people know that depression looks

2:24 — different in different people

2:26 — so we want to be specific about what

2:28 — depression or depressive symptoms look

2:30 — like in this specific person

2:32 — and if you checked out our last video

2:35 — where we talked about the only two goals

2:37 — you need for every treatment plan

2:39 — you'll see that we're going to go with

2:41 — the symptoms goal right now so if you

2:43 — haven't checked that video out go do

2:44 — that now we'll put a card here so it's

2:46 — easy to link to

2:48 — okay so the easiest way to get specific

2:51 — is to

2:52 — use our symptoms so depressive symptoms

2:55 — anxiety symptoms we're going to stick

2:56 — with depression for this video client

2:58 — will reduce depressive symptoms and then

3:01 — use parentheses

3:02 — so your parentheses are going to

3:04 — describe what depression looks like for

3:07 — this particular client

3:09 — so for example client will reduce

3:11 — depressive symptoms parentheses

3:14 — depressed mood insomnia

3:17 — low concentration low motivation etc so

3:21 — you don't have to list out every single

3:23 — criteria but a good sample of what

3:25 — depression looks like for this person

3:28 — another example would look like client

3:29 — will reduce depressed symptoms

3:31 — parentheses depressed mood passive

3:34 — suicidal ideation feelings of guilt

3:37 — and hypersomnia

3:40 — so there we have two very different sets

3:42 — of depressive symptoms but they both

3:43 — meet the criteria

3:45 — and you're able to see specifically how

3:47 — depression is impacting this person

3:50 — next is measurable so this is literally

3:53 — assigning a number to the symptoms or

3:56 — whatever it is that your goal is about

3:58 — so that you can track it

4:00 — for a symptoms goal we want to know how

4:03 — often these things happen for a client

4:06 — and yes it is a little weird you're

4:08 — probably not going to ask someone

4:10 — how many times a day do you experience a

4:12 — depressed mood or lack of motivation and

4:15 — it can be difficult for people to track

4:17 — and put into a number but we're still

4:19 — going to do it

4:21 — and we're going to make it easy and it's

4:23 — actually going to be helpful clinically

4:25 — so the easiest way to do this is to ask

4:27 — your client

4:28 — and give them some help with figuring

4:31 — out that time frame

4:32 — and it's okay at times like this to tell

4:35 — your clients something like i know this

4:37 — sounds a little weird or i know this is

4:40 — kind of difficult to put into numbers

4:42 — but this is how insurance wants to see

4:44 — this goal written or this is how it will

4:47 — make things easier for us to track so

4:50 — acknowledge if you feel awkward doing it

4:52 — or if the process feels awkward or like

4:54 — it's not quite capturing everything

4:56 — most people will be understanding as

4:59 — long as you acknowledge the awkwardness

5:01 — of the process

5:02 — the easiest way to get people to give

5:05 — you some numbers as far as how often

5:07 — things occur for them is to break down

5:08 — their day so

5:10 — about how often do you think these

5:13 — thoughts or have these feelings or

5:15 — notice these feelings in the morning so

5:17 — between the time that you wake up until

5:19 — you go to work or before you go to

5:22 — school or between the time you get and

5:24 — then literally break it down between the

5:26 — time you get to work and before you have

5:28 — your first lunch break or between the

5:30 — time you get to work and leave leave

5:32 — from work

5:33 — and then you just keep continuing

5:34 — through the day break it down based on

5:37 — whatever your client's schedule is and

5:39 — what makes the most sense for them

5:41 — now i know it seems kind of silly but

5:44 — this is another one of those things that

5:45 — can actually turn into a really valuable

5:47 — clinical discussion because sometimes

5:50 — people are surprised by how often or how

5:52 — little they're experiencing a symptom

5:54 — that they were previously telling you

5:56 — about

5:56 — especially with kids this is really

5:59 — helpful to do with the parents

6:01 — involvement because it helps parents

6:03 — later on down the line when they might

6:05 — be thinking he's still having a tantrum

6:08 — every day

6:09 — but if you were able to identify that a

6:11 — child had a tantrum

6:13 — three times a day and now it's only once

6:15 — a day you're able to highlight the

6:17 — progress they're making over time

6:19 — and one last tip about measurement the m

6:21 — part of our smart goal

6:23 — stick with times

6:25 — avoid percentages percentages just get

6:29 — really confusing and no one understands

6:30 — what you're tracking and it's too

6:32 — ambiguous whereas times per day are a

6:35 — lot easier to track regardless of what

6:37 — it is stick with times per day times per

6:40 — week or times per month and you're good

6:42 — to go so what does our goal look like so

6:44 — far well we have reduced depressive

6:46 — symptoms

6:47 — example

6:48 — depressed mood passive suicidal ideation

6:52 — hyperinsomnia and feelings of guilt

6:54 — from

6:55 — six times a day to two times a day so

6:58 — now this is a goal we can actually track

7:01 — and it's pretty specific to this client

7:04 — and why from six times a day to two

7:07 — times a day well that comes into the

7:09 — rest of our smart goal attainable and

7:13 — realistic we all know it's probably not

7:16 — realistic for our client to have zero

7:18 — depressive symptoms in a matter of a few

7:20 — months so this is a combination of

7:23 — creating a goal that is attainable and

7:26 — can show progress and be encouraging in

7:28 — that way for your client but still

7:31 — capture enough of what you need to cover

7:33 — over a longer period of time so you're

7:35 — not constantly having to redo all of

7:37 — your goals

7:38 — lastly we have time bound so now our

7:41 — goal is fully smart

7:42 — and time bound just means what's the

7:45 — time frame within this treatment plan or

7:48 — within which you'll be working on this

7:49 — particular goal

7:50 — this time frame can vary based on what

7:52 — contracts you might have sometimes

7:54 — medicare or medicaid want you to check

7:56 — in on the goals every three months not

7:58 — necessarily redo the whole treatment

8:00 — plan but a good rule of thumb is that

8:02 — your treatment plan is for a year and

8:05 — you probably want to check in on the

8:07 — goals after the first three months and

8:09 — at least within the first three to six

8:11 — months that's one of my guidelines

8:13 — because practically when you meet with

8:16 — people things often come up or change as

8:18 — you get to know your clients so the

8:21 — first three months you're still kind of

8:23 — in that process of getting to know them

8:24 — but between three to six months you have

8:26 — a good idea of what's impacting them and

8:28 — if there was something they didn't feel

8:29 — comfortable sharing with you then they

8:31 — might have brought that up by then and

8:33 — if you're just private pay and not

8:35 — really worried about insurance then i

8:37 — would recommend create some good broad

8:40 — goals that will apply over time and just

8:42 — check in on your treatment plans

8:43 — annually and no you don't usually need

8:46 — to actually write the time frame within

8:47 — the goal because it's kind of inherent

8:49 — in the treatment plan for however long

8:51 — you've set that up if you want more

8:53 — examples of smart goals and how they

8:56 — intertwine with your progress notes and

8:57 — your intake assessment and all the

8:59 — wonderful things that you need for

9:00 — medical necessity then check out my paid

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9:06 — your one stop shop as a therapist for

9:09 — everything you need related to

9:10 — documentation

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9:16 — writing