GAS_Presentation_for_AHEAD_Conference_2012_6-1-12

Report
Opportunities for Postsecondary Success Project
Center for Community Partnerships
Department of Occupational Therapy
Colorado State University
Goal Attainment Scaling
AHEAD 2012 Conference
7/11/12
Cathy Schelly, M.Ed., OTR
Assistant Professor
Director, Center for Community Partnerships
Patti Davies, PhD., OTR
Professor
Research Director
Opportunities for Postsecondary
Success (OPS)

Implementation site:
Center for Community Partnerships (CCP)

OPS Students:
◦ CSU & Front Range Community College students
with Asperger’s/ASD, TBI, ID
◦ Transitioning youth with ID from local school district
(partnership with Project Search)
◦ Young adults with ID seeking community employment
Establishing measurable goals with
participants: Goal Attainment Scaling
Goal Attainment Scaling


Goal attainment scaling (GAS): an
individualized approach for measuring
the achievement of goals (King et al.,
1999).
Originally developed to assess adults in
a community mental health setting, but
has since been applied to numerous
practice areas, including education,
health, and social work (MacKay,
Somerville, & Lundie, 1996).
Original goal attainment scaling
method

The original GAS scale uses a 5-point scale,
ranging from -2 to +2, with zero representing the
expected level of performance after intervention.
Levels
Kiresuk, Smith, & Cardillo
(1994)
-2
Much less than expected outcome
-1
Somewhat less than expected
outcome
0
Projected level of performance
+1
Somewhat more than expected
outcome
+2
Much more than expected
outcome
Alternative methods
Levels
King et al. (1999)
-2
Baseline
-1
Less than expected
0
Expected level
+1
Greater than expected
+2
Much greater than expected
Levels
Steenbeek et al. (2007)
+2
A lot more
+1
A little more
0
As expected
-1
Partially achieved
-2
Same as baseline
-3
Worse
Levels
1
No change
2
Small improvement
3
Interest in goal
4
Takes some action towards
goal
5
Maintains new behavior
6
Committed to achieving
goal
7
Achieves goal
OPS Scale
Numerical Level of Goal Attainment
I lost ground.
0
Where I am right now. (Baseline)
1
I’m getting close to my goal.
2
I reached my goal!
3
I did even better than expected!
4
Descriptive Level of Goal Attainment
OPS Goal Attainment Scaling
GOAL: Implement effective study strategies.
Numerical Level of Goal Attainment
Descriptive Level of Goal Attainment
I lost ground.
Not willing or interested in
discussing/considering effective study
strategies.
0
Where I am right now.
1
Willing to discuss/consider potential
effective study strategies but not
implementing any strategies.
I’m getting close to my goal.
2
Implementing effective study
strategies with most difficult course,
with cueing and reminders.
I reached my goal!
Implementing effective study strategies
with all courses, with cueing and reminders.
3
I did even better than expected!
4
Independently implementing effective study
strategies with all courses.
Applying GAS in practice
1.
2.
3.
4.
5.
6.
7.
Identify the overall objective.
Identify the specific problem area(s) that the
individual wants/needs to address.
Identify the behaviors or events that will
indicate improvement in each area.
Determine the methodology to collect the
desired information.
Identify outcomes for scaling.
Determine the individual’s current status
(baseline).
Determine how progress will be documented.
What is the overall goal?

Setting your expected level of outcome
or the desired goal:
◦ For example, you and the student may agree
that developing self-advocacy skills is the
overall program goal.
◦ Document the student’s current status
(baseline).
◦ Establish incremental changes in behavior
from baseline to depict improvements or
‘losing ground’ as student pursues goal.
What are the specific problem areas?
Prioritize areas of
concern and
formulate SMART
goals.
 Prioritized goals
are given a weight,
which is used to
convert the scale
score into a
standard score.

What are SMART goals?
 Specific= a specific goal has a much
greater chance of being achieved. It is
the who, what, where, when, which,
and why of the goal.
 Measurable=establish concrete
criteria for measuring progress.
 Attainable=help client’ set goals
that are meaningful to them and that
they want to achieve.
 Relevant=a goal must represent an
objective toward which you are both
willing and able to work.
 Time-specific=a goal should be
grounded within a time-frame.
Tips for scaling goals…
Select the expected level of performance.
 Identify the least favorable outcome and
the most favorable outcome.
 Identify the intermediate levels of
performance.
 Set SMART goals.
 Develop scale with equally interval levels.

Important considerations
Where is my client’s current level of
performance (baseline)?
 When/how often should I follow-up to
determine and document client’s change
in status?

What behaviors and events will
indicate improvement?
Create a scale that will be useful for
measuring changes in performance.
 For the student working on self-advocacy
skills, this may involve creating a scale based
on the number of times the student attends
his/her professor’s office hours.
 For student who is wanting to make friends in
the residence hall (RH), this may involve
creating a scale based on the number of RH
activities he participates in.

GAS Goal: Recognize and address issues that result
in lack of persistence spring semester.
Numerical Level of Goal Attainment
Descriptive Level of Goal Attainment
I lost ground.
Withdraws from all courses spring
semester with no warning, no support.
0
Where I am right now. (Baseline)
1
Planning on withdrawing from challenging
courses spring semester – seeking support
but unwilling to discuss issues that are
causing urge to withdraw.
I’m getting close to my goal.
2
Willing to discuss issues that cause
the urge to withdraw from challenging
courses.
I reached my goal!
Recognizes and begins addressing issues
that are causing urge to withdraw from
challenging courses.
3
I did even better than expected!
4
Proactively addresses issues that cause urge
to withdraw from challenging courses and
persists with all courses.
GAS Goal: Implement study strategies.
Numerical Level of Goal Attainment
Descriptive Level of Goal Attainment
I lost ground.
Not willing to develop study strategies.
0
Where I am right now. (Baseline)
1
Not participating in Academic Advancement
Center (AAC) to learn study strategies and
not using any study strategies, but willing to
consider development of strategies.
I’m getting close to my goal.
2
Attending AAC study strategy
sessions to learn about and develop
study strategies.
I reached my goal!
Fully implementing study strategies with
OPS support during study sessions.
3
I did even better than expected!
4
Independently implementing study
strategies.
GAS Goal: Self-advocacy for learning accommodation needs.
Numerical Level of Goal Attainment
Descriptive Level of Goal Attainment
I lost ground.
Not willing to speak with professor.
0
Where I am right now. (Baseline)
1
States a willingness to speak with professor
regarding accommodation needs, but afraid
to follow through.
I’m getting close to my goal.
2
Made list of learning accommodation
needs in preparation for meeting with
with professor(s).
I reached my goal!
With mentor assistance, set up
appointment(s) with professor and kept
appointment(s), advocating for learning
accommodation needs and with mentor
attending meeting(s).
3
I did even better than expected!
4
Independently set up appointment(s) with
professors and kept appointments,
advocating for learning accommodation
needs with behind the scenes
encouragement from mentor.
GAS Goal: Completes new tasks when assigned
jobs are finished.
Numerical Level of Goal Attainment
Descriptive Level of Goal Attainment
I lost ground.
Leaves work area when assigned jobs are
finished.
0
Where I am right now. (Baseline)
1
Sits down and stops working when assigned
jobs are finished, even when additional tasks
are not completed.
I’m getting close to my goal.
2
Asks job coach what to do next when
assigned jobs are finished and works
on additional tasks as directed.
I reached my goal!
Asks supervisor and/or natural support staff
if there are additional tasks to be done and
then works on these tasks as directed.
3
I did even better than expected!
4
Recognizes additional tasks after assigned
jobs are finished and independently
completes these tasks.
Process we use







Develop relationship with student.
Connect student with mentor.
Gather information re: needs, wants of student,
and areas where there are challenges (assessment
process).
Develop semester goal with student – review
with team to ensure that goal is SMART.
Enter goal into GAS database.
Begin goal attainment activities, documenting
incremental changes.
At end of semester, regroup and establish new
goal(s) for next semester.
CCP Assessment Process

Functional, community-referenced
process
◦ Identify strengths, challenges, barriers in all
domains
◦ Identify support needs
◦ Formulate student/participant driven goal(s)
Challenges/Support Needs
Evaluation
Observed Indicator (actual behavior,
action or circumstance)
Fatigue (physical Student describes inability to stay focused and
and cognitive) awake in afternoon classes. Student complains
that fatigue is unrelenting, even after 8 hours of
sleep each night. Student states that mornings
are best for being alert and focused.
Confusion
(short-term
memory
challenges)
Student spends unusually long periods of time
studying for exams and completing assignments,
but complains of inability to remember content
even after reading numerous times.
Assessment process is ongoing
•
Assessment is the critical starting point that paves
the way to successful planning, educational
mentoring, and provision of necessary supports
that facilitate success.
•
Functional assessment continues after the student
is working towards goals to continually guide
planning, solve problems, improve academic
performance and, ultimately, persistence, retention
and graduation.
•
Same guidelines apply for students pursuing
employment/careers.
Canadian Occupational
Performance Measure (COPM)



Under consideration, to complement GAS.
Assesses individual’s perceived occupational
performance in life areas.
Process:
◦ Conduct semi-structured interview to identify
wants/needs of client.
◦ Based on wants/needs, create goals.
◦ Supplement interview information through direct
observation, environmental assessment, or
standardized tests.
Benefits of COPM
Measures client’s perceived progress in
goal attainment between pre-COPM,
intervention and post-COPM (designed as
outcome measure).
 Easy to administer ~20 minutes.
 Demonstrated reliability and validity.
 Similar to GAS, useful with a wide variety
of clients in many different settings.
 Can weight and prioritize goals (again,
consistent with GAS).

Audience Discussion

What type of assessment
process(es) are you using?
◦ What are the advantages of your
assessment process?
◦ What are the disadvantages, if any, of
your assessment process?

What population do you serve?
Practice session on writing goals
Review GAS worksheets.
 Develop goals as per worksheet, OR, for
student you are working with.

◦ Connect goals to domain areas.
◦ Develop SMART goals.

Discussion
◦ Actual goals that we established with our
students/participants
How will data be collected?
What
process will your group implement to
collect and analyze data?
How
will information be collected and who will
collect it?
 Role of the Transition Coordinator
 Role of the Mentee
 Role of the Mentor
Our GAS Research
Exciting results from pilot study fall 2011
and spring 2012
 Noted progress in following areas:

◦
◦
◦
◦
◦
◦
◦
Academics
Self-advocacy
Socialization
Persistence
Retention
Graduation
Employment
Preliminary Data

Participants - total 23
◦ 12 students at CSU
◦ 5 students at FRCC
◦ 6 students enrolled in Project Search

Number of goals written – total 43
◦ 15 in Fall semester 2011
◦ 28 in Spring semester 2012
Students enrolled in Project Search

6 students

Goals written for a 3 month internship

8 goals written
◦ 1.3 goals on average per student

83% of the students made steady improvement on
their goals during their internships

16% of the students displayed a decline in their GAS
score at the end of the internship

100% of students were hired after completing their
internships
Students in College (FRCC) and
University (CSU)

17 students

Goals written for a semester

35 goals written
◦ 1.8 goals on average per student

47% of the students made steady
improvement on their goals across the
semester

24% of the students displayed a decline in
their GAS score at the end of the semester
Changes in Goal Attainment Scores
Before and After Intervention
T Score
Mean
Standard
Deviation
Pre Intervention
38.12
2.23
Post Intervention
58.90
7.92
Changes in Goal Attainment Scores
Before and After Intervention
ANOVA
Statistic:
F(1,20) = 136.17, p < .0005
Effect Size:
 Partial η² = .87
Converting Goal Attainment Scales
Scores to T Scores

Sum the GAS score for the goal(s)
◦ If a participant only has one goal the sum will
be the score for that one goal.
◦ If a participant has more than one goal the
score for each goal will be added together.

Convert the summed score to a T Score
◦ Formula in Kiresuk & Sherman (1968)
 More precision
◦ Tables in Kiresuk, Smith, & Cardillo (1994)
 Less precision
Advantages of Using T Scores

Helps to equate scores across
participants when they have different
number of goals.

Provides variability to pre-intervention
scores which is necessary for conducting
statistical analyses.
Goals can be Weighted

To reflect
◦ Relative value of each goal based on intervention
outcomes
◦ Relative importance of each goal based on
participants’ perspectives
◦ Relative to the difficulty of the goal


Weights do not need to sum to a particular
fixed total
Examples
◦ 1, 2, 3 or 2, 4, 6 or 10, 20, 30

Equal weighting of goals lose little
information
Goal Attainment Scaling as an
Intervention Tool

Weighting and selecting goals based on
client’s desires

Setting goals in collaboration with client

Using improvement on GAS scores as
motivation for the client to work hard

Can be used in combination with the COPM
◦ Determine goal areas
◦ Weight goals
Goal Attainment Scaling as an
Research Tool

The evaluation and establishment of goals
may be conducted by someone different
than the person providing the intervention.

Follow-up assessment on goals may be
conducted by someone other than the
person providing the intervention.

Consider comparing intervention programs
or using a control group.

Consider using other evaluation tools in
addition to GAS.
Goal: University Graduation
Success!
Goal: College Graduation
Success!
Advantages of using GAS with the
OPS project
Provides a quantitative measure of outcome.
Can be used to compare a student’s progress
over time.
 Can be used to compare performances across
clients in the same program but who have
different skills, challenges (Ottenbacher &
Cusick, 1989).
 Allows for a collaborative approach-working
with the student to set realistic goals.
 Provides flexibility for measuring diverse
outcomes (Brown, 2009).


Limitations of GAS
Scaling can be a time-consuming process.
 Biases can occur in goal setting, scaling, and
rating.
 Temptation to modify goals throughout the
course of intervention.
NOTE: Good goals are really hard to write!!

References








King, G.A., McDougal, J., Palisano, R.J., Gritzan, J., & Tucker, M.A. (1999). Goal attainment scaling: its use
in evaluating pediatric therapy programs. Physical and Occupational Therapy in Pediatrics, p. 31-52.
Kiresuk, T. & Sherman, R. (1968). Goal attainment scaling: A general method of evaluating
comprehensive mental health programs. Community Mental Health Journal, 4 (6), 443-453.
Kiresuk, T.J., Smith, A., & Cardillo, J.E. (1994). Goal Attainment Scaling: Application,Theory, &
Measurement. Hilldale, N.J.: Lawrence Erlbaum Associates.
Mailloux, Z., May-Benson, T.A., Summers, C.A., Miller, L.J., Brett-Green, B., Burke, J.P., et al. (2007).The
Issue Is-Goal Attainment Scaling as a measure of meaningful outcomes for children with sensory
integration disorders. American Journal of Occupational Therapy, 61, 254-259.
McKay, G., Somerville, W., & Lundie, J. (1996). Reflections on goal attainment scaling (GAS): cautionary
notes and proposals for development. Education Research, 38,2, 161-172.
Ottenbacher, K.J. & Cusick, A. (1990) Goal attainment scaling as a method of clinical service
evaluation. American Journal of Occupational Therapy, 44, 6, 519-525.
Steenbeek, D., Ketelaar, M., Galama, K., & Gorter, J.W. (2007). Goal attainment scaling in pediatric
rehabilitation: a critical review of the literature. Dev Med Child Neurol, 49, 550-556.
Turner-Stokes, L. & Williams, H. (2010). Goal attainment scaling: a direct comparison of alternative
rating methods. Journal of Clinical Rehabilitation, 24, 66-73.

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