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Beyond SMART Goals: A Better Way to Write Pediatric Therapy Goals

June 6 medical necessity in assessment dosage goal writingMost therapists are taught to use SMART goals – Specific, Measurable, Achievable, Relevant, and Time-bound as a foundational approach to documenting progress. But what if this framework, while structured, actually limits us when working with complex pediatric needs?

Jennifer Lawson, OT and educator with nearly 30 years in pediatric care, argues that there may be a framework that is more useful than the SMART goal concept. Her mission: help therapists write goals that are clinically sound, easy to track, and meaningful to families.

Lawson has observed that when therapists attempt to implement the SMART goal concept, the result is often overly clinical language that fails to connect with the day-to-day lives of children and families. Goals often end up overly complicated, unclear as to what is being measured, and confusing when it comes to defining and reporting “progress.”

A New Framework: The 3-Part Goal Structure

Lawson’s alternative approach incorporates:

    1. Participation-Based Outcome
      This defines the “why” behind the goal.
    2. Meaningful, Measurable Activity
      This clarifies the observable skill.
    3. Body Structure or Function
      This includes the clinical need.

This approach aligns closely with the World Health Organization’s ICF-CY model, which encourages functional outcomes tied to real participation, not just skill mastery (WHO, 2007).

Why Participation Matters

Therapists often default to starting with deficits: what the child can’t do. But Lawson teaches us to flip the script.
Start instead with:

Leaf bullet orange 1 1What the child enjoys
Leaf bullet orange 1 1What the family finds meaningful
Leaf bullet orange 1 1Daily routines that bring connection

Research supports this. Family-centered goals lead to improved engagement and treatment adherence (King et al., 2004; Rosenbaum et al., 2007). They also help therapists prioritize pivotal skills that, when mastered, unlock other abilities.

Line break 4

Takeaway: Write With Clarity, Purpose, and Connection

The 3-part structure makes it easier to:

Leaf bullet blue 1 5Track and document progress clearly
Leaf bullet blue 1 5Collaborate with other professionals
Leaf bullet blue 1 5Empower families to carry over strategies at home

Want to see this process in action?

Jennifer’s course offers concrete examples, multiple resources, and documentation strategies therapists can use right away.

References

  • World Health Organization. (2007). International Classification of Functioning, Disability and Health – Children and Youth Version (ICF-CY).
  • King, G., et al. (2004). The relationship between parents’ and service providers’ perceptions of family-centered care. Child: Care, Health and Development, 30(2), 167–183.
  • Rosenbaum, P., King, S., Law, M., et al. (2007). Family-centred service: A conceptual framework and research review. Physical & Occupational Therapy in Pediatrics, 24(1-2), 5–23.

 

 

 

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