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15.5 Case Example for Goal Attainment Scaling

Debra is a 28 year old former Reservist Army Corporal (Combat Medical Assistant). Her main role in the reserve force was medical records manager. She works full time as a paramedic and is highly skilled in administration.

Debra does not have a partner and has one child who is 7 years old. As a paramedic officer, Debra’s civilian role is physically and mentally demanding as she is required to undertake a range of activities varying from patient care and transport to emergency response and assistance.

Debra was medically discharged in December 2009 after which DVA accepted liability for an injury to her right knee. Debra has been transferred to an administrative role in her civilian workplace as her knee injury resolves. She is not able to work as a paramedic until pain, swelling and mobility issues are addressed.

Following the acceptance of liability by DVA, a needs assessment was undertaken which resulted in Debra being referred to a local rehabilitation provider and Occupational Therapist (OT).

The provider assessed Debra and ensured she completed a Life Satisfaction Indicators (LSI) form. The LSI aids the provider in identifying areas of the client’s life that they are less satisfied with. The assessment outlined her main symptoms as:

  • chronic pain and swelling, as a result of severe ligament and patella damage to her right knee;
  • severe mobility issues and minimal weight bearing capacity;
  • difficulties with accessing medical treatment to address knee injury and no clear treatment plan;
  • difficulties with managing pain caused by knee injury;
  • diagnosed depression – Debra is having difficulties in coping with her discharge from the reserve force, inability to fulfil her paramedic role and managing her household responsibilities and caring for her child.

The following Rehabilitation Plan was developed to address her needs:

  • a medical management Rehabilitation Plan to help her to manage her physical and mental health and treatment needs and coordinate her medical appointments;
  • a psychosocial Rehabilitation Plan including attendance at a pain management program;
  • provision of a walking aid and simple home modifications (ramps) through the Rehabilitation Appliances Program;
  • household services to assist with management of house cleaning and washing prior to surgery, and additional tasks for a period while recovering from surgery; and
  • attendant care services to assist with personal care needs post surgery.

Debra and the provider developed the following goals under a medical management and psychosocial Rehabilitation Plan.

Level of expected outcome

Goal 1: Access treatment for knee condition and be following recovery plan

Goal 2: Improve mood/mental health

Goal 3: Improve management of pain

Debra's goals developed under a medical management and psychosocial Rehabilitation Plan

Most favourable outcome (+2)

Knee replacement surgery has occurred within three months and knee is progressing better than expected so there is no pain or swelling three months post surgery as a result of following recovery plan

Has accessed treatment for depression and managing symptoms effectively 50% of the time within three months

Has participated in pain management program and is managing pain symptoms effectively 50% of the time within three months

More than expected outcome (+1)

Knee replacement surgery has occurred within three months and knee is progressing as expected so there is little pain or swelling three months post-surgery as a result of following recovery plan

Has accessed treatment for depression and managing symptoms effectively 25% of the time within three months

Has participated in pain management program and is managing pain symptoms effectively 25% of the time within three months

Expected outcome (0)

Knee replacement surgery has occurred within three months and there is a recovery plan in place

Has accessed treatment for depression and is learning strategies to manage symptoms within three months

Is participating in pain management program and is learning strategies to manage pain within three months

Less than expected outcome (-1)

Knee replacement surgery did not occur within three months, but has seen surgeon and date is set. There is an active management plan in place for managing injury while awaiting surgery

Is yet to access treatment for depression and there is no change in depression symptoms

Is yet to participate in pain management program and there is no change in ability to manage pain

Most unfavourable outcome (-2)

Knee replacement surgery did not occur within three months, has had no contact with surgeon or other health professional and no active management plan in place

Is yet to access treatment for depression and symptoms have worsened

Is yet to participate in pain management program and pain has worsened

 

At the Progress Report stage, Debra completed an additional LSI. The scores demonstrated improvement in wellbeing, employment, finances, mental and physical health and personal relationships. Debra is recovering well from knee surgery with less pain and greater mobility. Debra still requires household services but this will be reviewed as recovery continues. Her depression treatment and support is also progressing well and Debra is pleased to be able to return to her role as a paramedic officer. Debra also received workplace modifications, as recommended by the OT.

Level of expected outcome

Goal 1: Access treatment for knee condition and follow recovery plan - 1 Month Follow Up

Goal 2: Improve mood/mental health - 3 Month Follow Up

Goal 3: Improve management of pain - 3 Month Follow Up

Debra's scores at closure of plan

Most favourable outcome (+2)

   

More than expected outcome (+1)

 XX

Expected outcome (0)

X  

Less than expected outcome (-1)

   

Most unfavourable outcome (-2)

   

 

 

Rehabilitation Goals are what the client wants to achieve through their rehabilitation plan.  They will have a vocational, medical management or psychosocial focus.  An example for each is provided below.

  • Vocational goal – return to sustainable part-time work.
  • Medical Management goal – identify appropriate medical professionals in my local area and start accessing treatment regularly.
  • Psychosocial goal – to increase level of social activity and community participation.

A client may be working towards a mix of vocational, medical management and/or psychosocial goals concurrently, or may initially focus on achieving specific types of goals (e.g. medical management goals) before moving on to others. This will be determined by what is most appropriate for each client given their individual circumstances and needs.