Ep 37 - Writing Great Goals in Nature-Based Therapy
Laura: Welcome to Therapy in the Great Outdoors, the podcast where we explore the business and practice of nature based pediatric therapy of all kinds. If you're an outdoor loving pediatric practitioner in the fields of occupational, physical, or speech therapy, social work, or mental health, this podcast will help you start and grow a successful nature based practice or program.
I am the ever honest, always 100 percent real. You'll hear it all on this podcast. Dr. Laura. I'm a pediatric OT with over 20 years of experience, and I run a thriving nature based practice with profitable locations in two different states and multi six figures in revenue. I also host the free online community at therapyinthegreatoutdoors.
com to help you pursue your nature based therapy dreams too. Are you ready to take action on those dreams? Let's jump in. Hello! Hello. Welcome back to another episode of therapy in the great outdoors. If this is your first time listening. Welcome. Today, we are going to talk about goal setting. So a few weeks ago, I put a shout out on Instagram to ask people to ask me anything and I would cover it on the podcast. And Samantha Willis reached out. She's a pediatric OT in an outpatient setting. Who's really interested in outdoor therapy. And she said, I'm curious about what goals look like in the outdoor setting and some examples of interventions on how you target them. She said she's a fairly new listener to the podcast, so thank you, Samantha. First of all, for submitting a question and today I want to focus mostly on the goal setting piece. I think there are. A bazillion different interventions that you could do with children in the outdoors. And that's going to depend on your profession, right? So as an OT, you are going to do things a little bit differently than someone who's a PT or speech therapist or social worker. So that's a bigger topic that I think would take longer to discuss. So on this episode, I want to talk about what goals look like in the outdoor setting. Spoiler alert. They're not much different than in the indoor setting. So there's not a secret here to writing special goals because we're outdoors with kids. I, but I do want to share some principles and some things to help you think. About how it might be a little different in the outdoors, but also some just general principles of writing. Really good goals. To help our families see good outcomes in our services. So the first thing that I want to say is that you are your profession first. You are not a quote nature based therapist. First, you are an OT or a PT or a speech therapist or social worker, a mental health counselor. You are your profession first. And so your assessment process is necessary in order for you to write good goals. Okay. So you must be going through some type of assessment process in order to get at the root of what's really going on with a child. I think assessment is so important and I think. The unfortunate thing is that often in our world, at least here in the us, We often have limited time to do our assessment. And we all know as therapists that, that assessment, every session, essentially is assessment, right? We're always looking and always piecing together the puzzle of who this little person is before us, in our sessions. Assessment is important and doing a thorough assessment is important to really get at the root of what's going on with a child in their life. So making sure that you are using. Good tools for assessment and they don't necessarily have to be standardized, but they should be something that really gets at the complexity of our lives as humans. So that may be an interview with the family to really understand the child's needs. And that may be standardized assessments of varying degrees in order to get out the root of what's going on with the child. So make sure that you keep in mind that you are your profession first. The second thing is in the Contigo approach online course, which is my nature based therapy approach. It stands for connection and transformation and the great outdoors. So in Contigo, we teach the coast method of goal writing. So this is a method that is commonly taught. I don't know if it's commonly taught in OT school. Actually, it was taught in my OT program and it's the way to write a really good goal. In any therapy profession, I think, but I will give you the frame here. And then talk to you about how we add a little bit to it in our, in my nature based practice. So coast is C O a S T. It's a method from Gateley and Borcherding, Sherry. was actually. My professor in OT school back in, I graduated in 2000 from OT school. That was many years ago. And she was my professor at university of Missouri way back when, but she still, this recent edition of the book that she wrote with Gateley is from 2012. So it's almost a little over 10 years old. I don't, I actually haven't looked lately to see if it's been updated, but. But basically the frame of coast stands for client occupation or task. So it doesn't have to, you don't have to use occupation if you're not in the field of occupational therapy. I promise this goal writing method will still work. Client occupation assists level is the a, the S stands for specific condition or setting. And the T stands for time. So C O A s T client occupation assist level specific condition or setting and time. In my practice, we add one more thing to coast and that is a goal area. Which is a category to explicitly state the underlying skill area that the goal is addressing. So I'll give you an example here. So the format of your goal would look like the child will. Do some observable thing. With. Certain assist level. On a certain number of opportunities by a certain date. And then we add to the end, demonstrating improved. Whatever that goal area is. So a really simple example would be the child will initiate climbing a familiar tree with minimal assistance on 75% of opportunities by December 15th, 2023, demonstrating improved motor planning. And self-confidence. So by adding that last part to the goal, we're telling the family what we are working on, we're reminding ourselves as therapist. What are the key goal areas that we are working on with this child? So that every time you look at the goal, you remember, oh, the reason I wrote this goal originally was to improve motor planning and self-confidence. Because this school could be written for a number of reasons, right? This goal could be written like for a child to initiate climbing a familiar tree. Maybe they have trouble with. Initiation, maybe we're doing an executive function goal. I don't know. There could be a lot of different areas that you could write this goal for. And when you write the goal, adding those goal areas at the end, I think is a really key. A visual trigger for you as a therapist that every time you're documenting on that goal, it's reinforcing in your mind what you are supposed to be focusing on and working with that child. So another thing to mention here is that in my practice, we mostly do group therapy. But even for our individual kids, we really try to focus on one goal at a time. The purpose of focusing on one goal at a time really allows you as the therapist and the family to stay laser focused on that goal. When we try to do too much, we don't do anything. The having one goal per child is especially important when you're in a group setting, because that allows you to really focus on. One goal per child, so that you're not completely overwhelmed and forgetting to work on things during groups, because when you have a group, there's a lot of dynamics going on in that group. There's a lot of complexity and it's really hard to have a group of four to five kids and have each kid working on multiple goals to be able to plan anything in treatment that would address all of those goals is might even be impossible.
Maybe not, it makes it really complex for you as a therapist to, to keep everything in mind and to really make improvements and in a specific area. So the step-by-step goal writing process is. On intake paperwork. I want you to ask families what their top developmental concern is that the very most important thing, and really make them specify that. Ask them to tell you what is of most concern to them right now. And that is going to help, what to work on in therapy with the child. Families want outcomes when they come to our services and the only way that you are going to give them the outcome that they are wanting from your services is to use their exact language and to ask them and to really stay laser focused again. On what that outcome is that they want. Then you're going to step two is to do your assessments and interpret the data. What are the assessments saying about why this developmental concern the parent has or the concern the parent has? Might be happening. So what our assessments saying about why the concern may be happening. Then step three is to draft a goal using that coast format. You'd propose them to the family, the way we do it in my practice, as we propose them to the family over email or phone. And we make sure to explain why we wrote these specific goals. And then step four is to adjust. The goal based on family feedback and you track progress on the goal every week after every session, you need to be tracking progress on that goal. This is what we do in my practice. This is not the only way to do it, but it works very well. I have scaled my business to multiple six figures in revenue with a larger team now. And this is how we do it in my practice. And it seems to work well. We have repeat clients, people report that they are happy with their outcomes. So wanted to share that with you all here. This is actually Part of what we teach inside the Contigo approach online course, and in the course. I, I hesitate. I'm trying to, I'm trying to start referring to it more as just Contigo because. Calling it a course is not doing it justice to. What all is included when you join the Contigo program. I don't know what to call it. You all like it's when you join the course, when you enroll in the course. You get loads of resources and templates and things to use in your practice with children. And one of the things inside of Contigo. See, I did it. I just called it Contigo. I didn't say course there. One of the things you get is a nature-based therapy goal bank. So we have last time I counted, I think there were 66 goals. So we have them all broken up and two different. Categories.
So inside of the nature-based therapy goal bank, we have goals broken up written in this format already for you. Broken up into categories of balance ball skills, core strength. Praxis. So ideation, motor planning and execution. Strength, flexibility, perseverance, and grit, problem solving. Self-advocacy self-awareness attention and following directions, impulse control. Self-regulation tactile sensory processing cooperative play group participation, imaginative play, joining play perspective, taking self-expression and communication. Self-monitoring and turn-taking so we have a lot of categories in there of goals that are already written in the format for you. That you could just take straight from the bank and plug into whatever your need is for the child that you're seeing, and the reason that I provided this goal bank for people in Contigo is because it is much easier. For the human brain to select something than to generate something. So one of the things I really try to do in my programs is to give you all. Time saving. Resources so that you do not have to go through the. Arduous brain power of trying to come up with. Things. And one of those things is goals. So I think this is some of the hardest work we do as therapists is really thinking through all that data. Like I said, doing your assessment, thinking through that data and then needing to. Generate a goal specific for that child. And so in Contigo, we've tried to make it really easy for you to do the assessment. But then if you know that the concern of the, your assessment is starting to say gosh, this child really just lacks self-confidence or they really have a hard time participating in groups or whatever it may be.
You can go directly to the goal bank and search for that section. And find a few goals. And even if you don't use the exact goal, it actually will help you to get the ball rolling, to write a really good goal for that child. That's measurable. That's easy to track. That's another thing like. Writing measurable goals makes it very easy to track data on the goals. And we have kept that in mind with all of the goals that we have written and provided inside of Contigo. Okay. So th that is the format and the process for writing the goals now. Should I touch on intervention? We're about 14 minutes in, I think I can touch on intervention a little bit. Okay. I didn't mean this to be a whole A whole commercial for Contigo, but I have to say. One of the other things we offer inside of Contigo is it's called the tip grid. And it stands for therapy, intervention, planning grid. So it's a format that teaches you how to think through. Your assessment results. Planning your intervention and then the activities that you're going to do in your session. So the I'm not going to go through the whole form here, but the basics of it are that you need to find those goal areas, and write your goals. And then you're going to write out what those goal areas are and specifically force yourself to think about. What are evidence-based ways to work on this specific skill? Okay. When you. When you approach it, a child who has a specific goal that you are going to be working on, you should always be asking yourself, do I know the current evidence? To address this specific need for this child.
So a good example of this. If you have been in practice for a while, you will remember this, you will know this. Back in the day we used to tell autistic kids. We also used to say children with autism. And I know now that the language is switching to autistic children. We used to tell autistic children to have quiet hands. And this is now seen in our profession. This is now seen as masking, like forcing a child to look quote unquote normal. Okay. And that, that can be really distressing. to people on the autism spectrum. And so now we know that we would never write a goal for a child to have quiet hands that would just not be considered best practice. Based on what we know from autistic people who have told us how that made them feel. So that's an example of how, if you have outdated information you may be using strategies in practice or doing things in practice that are not. Based on current evidence. So what I would encourage you to do is think about what, now sometimes it's going to be easy. Sometimes, that current evidence says to use X, Y, Z approach, or to do X, Y, Z thing for whatever goal you're working on with the child. But I would really encourage you to really ask yourself, do I know the evidence? Do I know what evidence is out there? What does evidence say about how to, for example, work on social skills with children? So if you feel like you're not sure, or you feel like you, maybe haven't done a dive into the evidence lately, do a quick Google search or. Get on Instagram and look up things. There are so many therapists on Instagram sharing, really interesting things. Now, can we say they're all evidence-based I'm not sure. But maybe that wasn't the best advice to give, get on Instagram, to look for evidence for therapy approaches but sometimes you can get really great information there from experts, really, who are putting out some really good stuff. Look around and find the evidence. And then you are going to plan your activities for therapy based on that. Evidence. Okay. So one of the things, again, that is inside of the Contigo course there, I said it again inside of Contigo. See, I'm not going to say course anymore. Y'all not going to say course is a whole, the kind of process that I walk people through. When I talk about intervention planning, using the Contigo approach is to. Look at what the evidence says, about how to address these things with children. One of the things we put in the manual for Contigo is a list of evidence-based methods essentially to use in order to address motor skills and mental health. And. Social skills and sensory processing with children. Because those are the four areas that I originally created Contigo to address. And inside of that manual. I did some of the synthesizing work right. To say okay, what is the current evidence saying? And I'm due to, so I wrote the original manual in 2019, I think the current one, and there is a 20, 21 version. And I'm going to be updating it pretty significantly next year. So what I consider.
Something that I can offer to our nature-based therapy community is to two. To do that, look at the evidence and give you the summary list. Of ways to work on these things. In order to in order to know that you're working in alignment with evidence, because that's the whole thing about Contigo. I really am big on the idea that nature-based practice is an expertise. It is not something. That you can just go do and be really good at right away. You really do need to treat this as. An area in which you need to develop expertise in order to be really effective at doing your job. Now don't hear me say that you shouldn't just take your work outdoors and try it. Of course. I'm like I've said that on other podcasts, my entire work is, the work I do is to support. Therapists taking their workout doors with children. So of course we all need to get started. And we're not going to know what we're doing when we get started, but I do. Want us to elevate. The practice of nature-based work in order to be a true expertise, a true area that you become an expert in. And it's not something that just anybody can go out and do. I do think we're going to start to see. Nature-based therapy be more and more embraced by mainstream kind of medical models eventually. Fingers crossed. So I think it's something that we need to build expertise in and we need to make sure that we're doing evidence-based practice.
Oh, one last thing I forgot to mention about goal writing in nature based work is that it may depend also on.
Who the payer of your services? If you are a private pay practice and parents are paying you directly, you're free to work on whatever you want to work on in your practice. You could even write a goal that the child will. Enjoy being outdoors more, or that the child, parents will report the child self-initiated playing outside, or parents will report that the child enjoys being outside with their family more. There's so many goals that you could write that are. Not medical model based. But if you are working with a payer like Medicaid or insurance or, government health systems, often, I would assume in other countries, even outside of the us, then your goals are going to have to be in alignment with what a medical model would be. Okay. So you're not going to write about nature inside your goal. You're going to have to write a goal that is going to be considered. Medical model goal for that insurance payer. And I do not take insurance in my practice, so I don't write these kinds of goals, but the method that I shared that coast method is a method that you can use to write a really rock solid goal for an insurance company. If they require you to submit your goals and. Documentation, which I'm assuming they do for reimbursement. But you just wouldn't be able to write a goal for a child to like, experience joy or like the kind of things that you can write goals for in measurable ways, the kind of things you can write goals for. In a nature-based practice setting, you might not be able to write those if you are having an insurance payer or a medical model of payment. So there's a lot more freedom in a private pay model.
As far as treatment planning, once you get a good goal written. And you understand the evidence for how to work on that goal. Then you can develop the activities that you want to do in your nature-based session. So incorporating the child's interests and making things novel are key. Parts of the Contigo approach specifically, but also in general, I think we really. Want to have children bought into the process. So incorporating the child's interests and. Thinking about things that children don't often get to do in daily life. So I like to do things like fire and knives and things that kids don't normally get to play with. I think that's what makes nature-based therapy really fun and interesting is that. There's this sense of adventure and excitement and kind of risk that goes on. So the more that you can incorporate things into play in your nature-based sessions, that kids might not be able to do in other settings. I think we'll make the activity very novel. Novelty is a huge part of the Contigo approach and the more that we can incorporate novelty into our sessions, I think the more buy-in we get from children. Those are just a couple of activities that could work on almost any goal that a child would have. I can, I could think of ways to incorporate. Using that activity in order to address the goal. But.
The variety of activities that you can do outdoors with children are just endless. So that may be like, A whole other episode or multiple episodes.
But I'll let this episode be mostly about goal writing. So if you have questions or if you disagree with me, I'd love to hear. So send me a message in the therapy, in the great outdoors community. And if you're not already in the community, go on over and join us therapy in the great outdoors.com. It's free.
It doesn't cost anything, and you can connect with me there. That's it for this week and I will see you guys next time. Bye.
Thanks for joining me today for therapy in the great outdoors. If you want valuable advice, as you start or grow your nature based pediatric practice, get my free ebook, the nature based practice roadmap. It is a guide to help you focus and avoid. Mistakes as you start or grow your outdoor work with children in it.
I share the four stages of nature-based practice, what you need to focus on and common mistakes to avoid in each stage. Plus a checklist of specific action steps for you to take at each stage in the process. Get it at Therapy in the great outdoors.com/. roadmap. So until next time, get outside, connect, reflect, and enjoy therapy in the great outdoors.