Got GAS? A Primer on Goal Attainment Scaling

2 Background (NIMH Grant) Used Goal Attainment Scaling (GAS) as one of clinical field trail outcome measures Study was conducted at the Department of Psychiatry, Hennepin County General Hospital Focus of the research study was effectiveness of outpatient mental health services and application of Goal Attainment Scaling. 2

3 Reasons for Inclusion The CARF Transforming Outcomes Institute: Exams various measurement options Includes measuring from birth to death References promising measurement tools and applications 3

4 Reasons for Inclusion Observations over the years: Organizations need options and to find a good fit for their particular needs Challenges are especially true in smaller, intense, and long term care programs 4

5 Introducing… GAS! This session provides another option: Drawn from original GAS materials From work by: Drs. Thomas Kiresuk and Robert Sherman, Drs. Aaron Smith and Joseph Cardillio, and many others from the extensive literature. 5

6 Introducing… GAS! This session provides another option: Samples from worldwide GAS applications included in Resources Forty+ years later, GAS work continues to add value to measurement field A sampling of resource citations included with Resource files 6

7 Definitive Sourcebook Goal Attainment Scaling: Applications, Theory, and Measurement Thomas J. Kiresuk (Editor) Aaron Smith (Editor) Joseph E. Cardillo (Editor) 7

8 GAS Methodology Method of scoring individual goal achievement during intervention: Each patient has own outcome measure Scored to allow statistical analysis Traditional standardized measures: Include standard set of items Each rated uniformly 8

9 GAS Criteria Tasks individually identified to suit patients Levels individually set around current and expected levels of performance with intervention How is GAS rated? Criteria for outcomes determined with individual before intervention begins 9

10 GAS Goal Orientation The Goal Attainment Follow-up Guide give everyone realistic expectation of person-centered achievements Scales are rated on 5-point scale: Attainment degree captured for each scale (goal) area Expected level of outcome is scored as 0 10

11 GAS Scoring More than expected outcomes scored as: +1 (somewhat more than expected) +2 (much more than expected) Worse than expected outcomes scored as: -1 (somewhat less than expected) -2 (much less than expected) 11

12 GAS Score Analysis Goals can be weighted according to: Relative importance of goal to individual Anticipated difficulty Overall GAS scores: Calculated with T-score formula = 50 + (see formula) Computation based on compilation of goals and weights 12

13 Goal Attainment Score Calculation Overall GAS = 50 + Where: w i = the weight assigned to the ith goal (if equal weights, w i = 1) x i = the numerical value achieved ( between –2 and + 2) r = the expected correlation of the goal scales

14 For practical purposes r is usually taken as 0.3. In effect, therefore the composite GAS (the sum of the attainment levels x the relative weights for each goal) is transformed into a standardised measure with a mean of 50 and standard deviation of 10.

15 Mathematically challenged For equally weighed scales a conversion key has been developed (Baxter, 1972) to permits uses to simply look it up in a table!

16

17 GAS Tools Weighting tools: Calculation tables are presented in the reference materials and in Goal Attainment Scaling: Applications, Theory, and Measurement There are a number of GAS spreadsheet calculators on Internet A score conversion table for programs using unweighted scales is included in this presentation. 17

18

19 Special Features of GAS Specifically measures those symptoms, behaviors, feelings, skills, or achievements that intervention is designed to change Person-centered Organizes and focuses treatment on goals Clarifies person-specific treatment aims 19

20 GAS Utility It has been argued that GAS Improves clarity of treatment objectives for both therapists and patients Establishes realistic patient and therapist expectations Increases client participation and engagement Increases motivation for improvement 20

21 Scale (Goal) Area Selection Step 1: select scale areas Identify areas where behaviors should be minimized or where behaviors should be developed or increased Most often 3 to 5 goals 21

22 Expected Outcomes Identify the expected level of outcome (with intervention): What is reasonably expected from treatment? Is the goal relevant to treatment? Becomes middle level (probable level of goal attainment with intervention) This level indicates treatment success 22

23 Creating SMART Goals Goals should be realistic: Not too easily accomplished Not too difficult to achieve Goals should be specific: Measurable, Not vague Goals should be valid: Independent observers agree on whether outcome was reached Do not have to be quantified

24

25 Some Examples

26

27

28

29 Pictures can work very effectively for many clients with cognitive issues Particularly helpful in areas of gerontology and mental retardation Excellent examples in: Rating Scales in Mental Health by Sajatovic, M., and Ramirez, L.F. (2001 ). 29 GAS For Clients Who Cannot Read

30

31 Select References Stolee P, Rockwood K, Fox RA, Streiner DL. The use of goal attainment scaling in a geriatric care setting. Journal of the American Geriatrics Society. 1992;40(6): Stolee P, Zaza C, Pedlar A, Myers AM. Clinical experience with Goal Attainment Scaling in geriatric care. Journal of Aging & Health. 1999;11(1):

32 More Select References Williams RC, Steig RL. Validity and therapeutic efficiency of individual goal attainment procedures in a chronic pain treatment centre. Clinical Journal of Pain 1987;2: Rockwood K, Joyce B, Stolee P. Use of goal attainment scaling in measuring clinically important change in cognitive rehabilitation patients. Journal of Clinical Epidemiology. 1997;50(5): Rushton PW, Miller WC. Goal attainment scaling in the rehabilitation of patients with lower-extremity amputations: a pilot study. Archives of Physical Medicine & Rehabilitation. 2002;83(6):771-5.