Client involvement in goal setting and its relationship to therapeutic outcome

Abstract

PROBLEMGoal attainment scaling was introduced to mental health programs for the purpose of treatment evaluation(a). It also has been suggested that goal attainment scaling should be incorporated in the clinical record for the purpose of treatment planning@). Finally, it has been suggested that if the client and therapist conjointly establish goals and specify outcome levels, then goal attainment scaling becomes a form of therapeutic contract (*). The present study explores the relationship between patient involvement in goal setting and various measures of treatment outcome, among which are goal attainment scores as rated by therapists and clients, client satisfaction, community adjustment in the goal-specific areas of functioning, global community adjustment, and length of stay in hospital. METHODClients in the present sample were selected randomly from all admissions to a 100-bed unit in a psychiatric hospital. This unit recently had adopted an experimental program that included a computerized goal-oriented record system (6). The 72 clients selected included 38 males and 34 females. The average stay for these clients was 30 days, which is the same for all admissions to the unit during the same period.A5 part of the experimental ward program, all acfmissions were assigned randomly to a physician and a therapist. The latter was usually a nurse or ward attendant whose primary responsibility was to design and record a program for the individual client. The responsibility of the therapist included setting treatment goals, describing possible treatment outcomes, and evaluating progress. Therapists were encouraged to involve the client in the goal setting process, but client participation remained voluntary.Each of the 72 clients selected for the present study was interviewed individually at admission, discharge, and 3 months after discharge. All interviews were conducted by hospital volunteers under the supervision of the senior investigator. The choice of location of the interview was left up to the client. Information collected during the admission interview was not relevant to the present study. Information collected at discharge included assessment of goal attainment by the client for each of the goals recorded by his therapist. Clients then were asked to assess the degree of involvement that they had in setting the goals, i.e., was actively involved in setting the goals (N = 15), was not actively involved in setting the goals, but had been informed (N = 21), had no knowledge of the goals that were set (N = 23). A fourth group consisted of those clients for whom no goals were set during their hospital stay (N = 13). Clients also were asked to complete a 24-item true-false questionnaire that measured client satisfaction ( 6 ) . From this questionnaire, a global client satisfaction score was computed for each client.Follow-up interviews were arranged to collect infprmation relevant to other studies, but their primary purpose was to have the client assem h a own level of community functioning. This assessment was ba...

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