Bre Robison and I recently presented a course for GPI on goals that we wanted to talk about. We know so many of you have goal writing requirements at your work to support ongoing treatment for your caseload. We wanted to share some of the themes of that course and maybe shift our thinking a bit. 

Most therapists tell us, “We write goals for insurance companies”.  OR “We write goals for our agencies”. OR “We write goals to meet designated standards”. But can we also remind ourselves that goals can helps us have a conversation with parents about where we are and what might  be the goal or direction we might be going in, and, then how to incorporate parent goals into therapy?  Can our goal writing help us build rapport with families? 

Goal writing reflects our own philosophy.

You know that in the Get Permission Approach our strategies are based on sensitive principles of responsive feeding where we focus on child and parent success, mealtime enjoyment, relationship, connection and internal motivation and safety. We focus on finding ways to help parent and child feel regulated at the meal and to reduce the pressure that has snuck its way into so many mealtimes and therapy sessions. We try to turn demands and requirements into offers and opportunities. Our goals should reflect this language.

This feels like a demand

I hate steak and Kidney pie.  I really hate it.  I hate the smell.  I hate the texture and the look.  When my Scottish Grandmother came to visit, she and my mother celebrated by making their favorite, steak and kidney pie. Fortunately, they learned that the kids would much rather have hot dogs on those days, but still, I could smell that awful stuff from the bus stop!  Now imagine that someone wrote this goal for me (or insert your disgust food and imagine the goal is for you.) 

Goal:  Marsha will eat four bites of Steak and Kidney Pie without refusal behaviors including pushing away, gagging or vomiting 3 out or 4 presentations in the clinic within three months. 

This goal does have all the important parts. But,there is a lot to unpack here. It certainly feels like a DEMAND, not an offer to me.  Why steak and kidney pie? (I can easily spend the rest of my life never ever, ever eating steak and kidney pie.)  There are lots of foods out there.  Why THAT food?   If you pushed me to eat steak and kidney pie, I would probably gag.  And if, perchance I happened not to gag the first taste then with your second , third or fourth demand I can easily see a vomit response. And why 3 out of 4? Is that every day? On my?!! And why in the clinic and not my home where I feel safe? And three months?  Do you mean I must smell, lick, kiss, touch, taste steak and kidney pie more than one day, or more than one times in multiple days? So many of the children we see have different ways of processing the sensory properties of foods, so we must find a way to help them learn about foods that interest them, not foods where the starting point is so uncomfortable.

Goals for Parents

Feeding is a parent and child skill. Feeding is a relationship. Think about this.  If ANYTHING about eating or mealtimes is going to change, the grown up must change SOMETHING.  Families come to see us so we can help them figure out how to change the process of eating or the mealtimes for their child.  But if they continue do the same things that have not been working, nothing will change.  If the change needs to come from the parent in how they present the foods, or how they welcome children into the mealtime, how they reduce the pressure, how they offer the foods, what foods they offer and so on, it is the PARENT that is doing things.  Why don’t we work with the parent on PARENT GOALS?

Here is a sample first part of a parent goal: The Parent will provide the opportunity for their child to interact/ explore foods… Opportunity is an important component here. We know children learn with opportunity and when given the opportunity to interact with a new food, the child can learn about is sensory properties and determine if it feels like a food that might be of interest to them. The goal could also be written in similar terms for the child.  The child will be given the opportunity to explore and interact with new foods…  Again, this is not a demand, it is an offer, an opportunity.  

To relate these goals to the big picture direction for each child we add an  “IN ORDER TO”.

IN ORDER TO completes the goal.

The Parent will provide the opportunity for their child to interact/ explore foods…IN ORDER TO find new food to enjoy.

OR IN ORDER TO find foods to expand his diet

OR IN ORDER TO increase his comfort with food interaction .

If you want to dive deeper into responsive goal writing, consider our In our interactive over three hour goals course.   We consider parent  goals and child goals, responsive language without demands that allows the child to make progress at her own pace and IN ORDER TO phrases to relate each goal to the big picture of each child’s growth and eating journey.

We go over LOTS of ways to write all kinds of eating, mealtime and food related goals and spend lots of time thinking about how to document each of these goals carefully in the progress notes sections that clarifies progress for those insurance companies, agencies, for you and especially parents. 

Rethinking Goals Through A Gentler Responsive Lens with Marsha Dunn Klein, OTR/L, M. Ed., FAOTA and Bre Robison, OTR/L, MS 

I co-authored the first book on pediatric feeding and yet today, I am busier than ever reading, taking continuing education classes, finding new research, and listening to podcasts. I also find myself following new Instagram and Facebook accounts and having conversations with those who have lived experiences. 

Sometimes the new learning compliments and expands my beliefs about feeding and sometimes these voices challenge me to rethink what I have “always done.” This learning has enabled me to pivot and go in new, more sensitive, more effective directions in my work with children and families.

I was around in the beginning of the pediatric feeding movement in the US. Suzanne Evans Morris and I co-authored Pre-feeding Skills in 1986,. by the research she had done on the development of oral motor skills in children. Our knowledge has grown and expanded as we have learned more about oral motor skills and swallowing. As a profession, we have learned more about the medical influences on feeding because we KNOW children who do not feel well often cannot, or do not want to eat. We continue to learn from gastroenterologists, pulmonologists, otolaryngologists, pediatricians, dentists, allergists, geneticists and others. We learn more and more about sensory processing and mealtime learning and, as a profession, have tried many different ways to support children and families.

Today, our field of pediatric feeding is expanding at a rapid pace. 

There is so much more to learn about new feeding research, family-centered care, newer medical and genetic influences on feeding, neurodiversity and neurodiversity- affirming care,  trauma and trauma-  informed care, neuroscience, attachment, relationship and connection, PFD (Pediatric Feeding Disorder), ARFID (Avoidant Restrictive Food Intake Disorder) , sensory processing and regulation, interoception, and multidisciplinary collaboration.  It is an exciting time to be interested in pediatric feeding.

Let us celebrate learning and have the courage to adapt our strategies as we learn more!