GOAL ATTAINMENT SCALING Steve Marson Ph.D. steve.marson@uncp.edu Dave Dran Ph.D. david.dran@uncp.edu Department of Social Work UNCP

GAS Goal Attainment Scaling

WHY GAS? Why are we doing this? Is this really necessary? Why this particular method? Is this another fad, someone’s pet idea? What other options are there?

Why GAS (2) What is it going to cost us in money, time? Is there going to be new help, or is this coming out of our hide? Who is for and against it?

Why Gas (3) How is it going to be carried out and enforced? What happens if I don’t go along with it? What good is it to me and the program? Is it really worth it?

A brief history of GAS Frustration of Mental Health Professionals SOAP vs GAS Research

Ten Commandments of GAS

Ten Commandments of GAS 1-2 Include at least three ordinal scales on a follow-up guide except in dire straits, and even then have at least two scales. Have at least three levels filled-in for each scale. One filled-in level should be the expected level, and there should be at least one filled-in level on each side and the expected level.

Ten Commandments of GAS 3-5 Include only one problem or variable on each scale. If any of the scales on a follow-up guide are weighted, all scales should be weighted. The client's behavior at intake may be equivalent to any of the five levels. Avoid terms like "better than when treatment began."

Ten Commandments of GAS 6-8 Avoid variables which are too general or vague to be accurately scored at a follow-up interview. The levels on a scale should not overlap each other. If the information needed for a scale's follow-up scoring is to be obtained from a source other than the client, the special source of information should be listed.

Ten Commandments of GAS 9-10 There should be no "expected" levels which are so high that there is no possible "better than expected" level. There should be no "expected" goals which are so low that there is no possible "less than expected" levels.  There should usually be a possible outcome for all levels of the scale even if some are left blank. Avoid having two blank levels adjacent to each other on a scale.

Identifying Goals Clinical Judgments

Goals Goals are different from interventions Interventions are what the client (or social worker) will do. Goals reflect the change in quality of life.

Intermediate goals Sometimes smaller goals are stepping stones to other goals Eg. Medication compliance for a diabetic on pills

Measuring goals In measuring we can ask How much (quantity) How long (duration) How often (frequency)

An example Ralph and Road Rage

Ralph: the problem The problem Ralph yells at other drivers on the road while driving home from work He is visibly upset His wife is concerned

Ralph: the intervention Ralph agrees to practice some relaxation exercises before the drive home

Ralph: the goal There can be different goals He decides on the following: To not yell at other drivers while driving home

Measuring Ralph's goal How many days does he arrive home during the workweek without yelling at another driver? Right now he is at zero days, meaning he yells at someone on the road every day on the way home from work

So far.. Identified a problem Given an intervention Identified a goal Measured the goal Now we scale the goal…

Handout

Scaling The “scaling” in Goal Attainment Scaling refers to stretching out the goal measurement from far better than expected to Far worse than expected

Scaling Goals Scaling indicates performance for the goal From much less than expected to much more than expected Somewhat more Somewhat less -2 -1 0 1 2 Expected Much less Much more

Example: Ralph and his road rage Measuring how many days in the work week he arrives home without yelling at someone on the highway.

Scaling the goal for Ralph Somewhat more Somewhat less -2 -1 0 1 2 Expected Much less Much more

Scaling Goals for Ralph How many days per week w/o yelling Four days Two days -2 -1 0 1 2 Three days zero to one day Five days

Example scaling for Ralph -2 (zero to 1 day w/o yelling) -1 (two days w/o yelling) 0 (three days w/0 yelling) 1 (four days w/o yelling) 2 (five days w/o yelling)

So far… Identified a goal Scaled a goal Now we Rate Weight Tally

Rating Ralph’s goal Please put a check mark in the first column…

Weighting of goals Some goals are more important than others

Weighting the goal In GAS we rate each goal on relative importance From 1 to 10 (10 being most important) Please fill in weight in box at top of column

Tally: Adding it all up For each goal Multiply the weight by the rating Add up the total This is the “composite score”

Summary of steps Identify the goal and “scale” the goal from -2 to 2 Rate the client performance on the scale Weight the goal importance Tally up weight X rating for all goals

Ex. With handout Ralph and his road rage

More goals for Ralph Not yelling at drivers Sleep better at night Spend more time out with his wife Job satisfaction self rating

Example: Ralph sleeping better at night Measuring how many nights in the work week he has seven or more hours of sleep.

Example scaling for Ralph sleeping 7 hours or more -2 (zero to 1 night per week) -1 (two nights per week) 0 (three nights per week) 1 (four nights per week) 2 (five nights per week)

Weighting the goal In GAS we rate each goal on relative importance From 1 to 10 (10 being most important) See box at top of sample form

More goals for Ralph Not yelling at drivers Sleep better at night Spend more time out with his wife Job satisfaction self rating

Example scaling for Ralph nights out with spouse -2 (zero to 1 night per week) -1 (two nights per week) 0 (three nights per week) 1 (four nights per week) 2 (five nights per week)

Weighting the goal In GAS we rate each goal on relative importance From 1 to 10 (10 being most important) See box at top of sample form

More goals for Ralph Not yelling at drivers Sleep better at night Spend more time out with his wife Job satisfaction self rating

Measuring another goal for Ralph Self rating of job satisfaction On a scale of one to ten (ten being high) how satisfied are you with your job?

Example scaling for Ralph self rating of job satisfaction Averaged per week -2 (one to two self rating) -1 (three to four self rating) 0 (five to six self rating 1 (seven to eight self rating) 2 (nine to ten self rating)

Weighting the goal In GAS we rate each goal on relative importance From 1 to 10 (10 being most important) See box at top of sample form

Adding it all up For each goal Multiply the weight by the rating Add up the total This is the “composite score”

See handout

Graphing results Imagine graphing the composite score over four sessions Graphing gives us a visual confirmation of the client’s progress

graph

Some fine points about measuring goals

Counting behaviors We can gather much information with a simple count how much (quantity) How long (duration) How often (rate) Example:

Rating behaviors We can also rate behaviors in various ways Asking the client to rate themselves Using standardized or “store bought” tests

Ex. Small groups