A Primer on GoalA Primer on GoalAttainment ScalingAttainment Scaling

James W. Baxter, PhD

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Background (NIMH Grant)Background (NIMH Grant)

n Used Goal Attainment Scaling (GAS) asone of clinical field trail outcome measures

n Study was conducted at the Department ofPsychiatry, Hennepin County GeneralHospital

n Focus of the research study waseffectiveness of outpatient mental healthservices and application of GoalAttainment Scaling.

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Reasons for InclusionReasons for Inclusion

n The CARF Transforming OutcomesInstitute:

l Exams various measurement optionsl Includes measuring from birth to deathl References promising measurement

tools and applications

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Reasons for InclusionReasons for Inclusion

n Observations over the years:l Organizations need options and to find a

good fit for their particular needsl Challenges are especially true in smaller,

intense, and long term care programs

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Introducing… GAS!Introducing… GAS!

This session provides another option:n Drawn from original GAS materialsn From work by: Drs. Thomas Kiresuk

and Robert Sherman, Drs. Aaron Smithand Joseph Cardillio, and many othersfrom the extensive literature.

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Introducing… GAS!Introducing… GAS!

n This session provides another option:l Samples from worldwide GAS

applications included in Resourcesl Forty+ years later, GAS work

continues to add value to measurement field

l A sampling of resource citationsincluded with Resource files

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Definitive SourcebookDefinitive Sourcebook

Goal Attainment Scaling:Applications, Theory,and Measurement

l Thomas J. Kiresuk(Editor)

l Aaron Smith (Editor)l Joseph E. Cardillo

(Editor)

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GAS MethodologyGAS Methodology

n Method of scoring individual goalachievement during intervention:

l Each patient has own outcomemeasure

l Scored to allow statistical analysisn Traditional standardized measures:

l Include standard set of itemsl Each rated uniformly

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GAS CriteriaGAS Criteria

n Tasks individually identified to suitpatients

n Levels individually set around currentand expected levels of performancewith intervention

n How is GAS rated?n Criteria for outcomes determined with

individual before intervention begins

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GAS Goal OrientationGAS Goal Orientation

n The Goal Attainment Follow-up Guidegive everyone realistic expectation ofperson-centered achievements

n Scales are rated on 5-point scale:l Attainment degree captured for each

scale (goal) areal Expected level of outcome is scored

as 0

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GAS ScoringGAS Scoring

n More than expected outcomes scoredas:

l +1 (somewhat more than expected)l +2 (much more than expected)

n Worse than expected outcomes scoredas:

l -1 (somewhat less than expected)l -2 (much less than expected)

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GAS Score AnalysisGAS Score Analysis

n Goals can be weighted according to:l Relative importance of goal to

individuall Anticipated difficulty

n Overall GAS scores:l Calculated with T-score formulal = 50 + (see formula)l Computation based on compilation of

goals and weights12

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Goal Attainment Goal Attainment ScoreScore Calculation Calculation

n  Overall GAS   =  50 +n  Where:n wi = the weight assigned to the ith goal (if equal

weights, w i = 1)n xi = the numerical value achieved ( between –2

and + 2)n r = the expected correlation of the goal scales

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n For practical purposes r is usuallytaken as 0.3.  

n In effect, therefore the composite GAS(the sum of the attainment levels x therelative weights for each goal) istransformed into a standardisedmeasure with a mean of 50 andstandard deviation of 10. 

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Mathematically challengedMathematically challenged

n For equally weighed scales aconversion key has been developed(Baxter, 1972) to permits uses tosimply look it up in a table!

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GAS ToolsGAS Tools

n Weighting tools:l Calculation tables are presented in

the reference materials and in GoalAttainment Scaling: Applications,Theory, and Measurement

l There are a number of GASspreadsheet calculators on Internet

n A score conversion table for programsusing unweighted scales is included inthis presentation.

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Special Features of GASSpecial Features of GAS

n Specifically measures those symptoms,behaviors, feelings, skills, orachievements that intervention isdesigned to change

n Person-centeredl Organizes and focuses treatment on

goalsl Clarifies person-specific treatment

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GAS UtilityGAS Utility

n It has been argued that GASl Improves clarity of treatment objectives

for both therapists and patientsl Establishes realistic patient and therapist

expectationsl Increases client participation and

engagementl Increases motivation for improvement

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Scale (Goal) Area SelectionScale (Goal) Area Selection

n Step 1: select scale areasn Identify areas where behaviors should

be minimized or where behaviors should be developedor increased

n Most often 3 to 5 goals

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Expected OutcomesExpected Outcomes

Identify the expected level of outcome(with intervention):

n What is reasonably expected fromtreatment?

n Is the goal relevant to treatment?n Becomes middle level (probable level

of goal attainment with intervention)n This level indicates treatment success

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Creating “SMART” GoalsCreating “SMART” Goals

n Goals should be realistic:l Not too easily accomplishedl Not too difficult to achieve

n Goals should be specific:l Measurable, Not vague

n Goals should be valid:l Independent observers agree on

whether outcome was reachedl Do not have to be quantified

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Some ExamplesSome Examples

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n Pictures can work very effectively for manyclients with cognitive issues

n Particularly helpful in areas of gerontology andmental retardation

n Excellent examples in:

Rating Scales in Mental Health by Sajatovic, M., and Ramirez, L.F. (2001 ).

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GAS For Clients Who CannotGAS For Clients Who CannotReadRead

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Select ReferencesSelect References

Stolee P, Rockwood K, Fox RA, Streiner DL. Theuse of goal attainment scaling in a geriatric caresetting. Journal of the American Geriatrics Society.1992;40(6):574-8.Stolee P, Zaza C, Pedlar A, Myers AM. Clinicalexperience with Goal Attainment Scaling in geriatriccare. Journal of Aging & Health. 1999;11(1):96-124.Stolee P, Zaza C, Pedlar A, Myers AM. Clinicalexperience with Goal Attainment Scaling in geriatriccare. Journal of Aging & Health. 1999;11(1):96-124.

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More Select ReferencesMore Select References

Williams RC, Steig RL. Validity and therapeuticefficiency of individual goal attainment procedures ina chronic pain treatment centre. Clinical Journal ofPain 1987;2:219-228.Rockwood K, Joyce B, Stolee P. Use of goalattainment scaling in measuring clinically importantchange in cognitive rehabilitation patients. Journalof Clinical Epidemiology. 1997;50(5):581-8.Rushton PW, Miller WC. Goal attainment scaling inthe rehabilitation of patients with lower-extremityamputations: a pilot study. Archives of PhysicalMedicine & Rehabilitation. 2002;83(6):771-5.