GOAL%20ATTAINMENT%20SCALING

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GOAL ATTAINMENT SCALING

• Steve Marson Ph.D.
• steve.marson_at_uncp.edu
• Dave Dran Ph.D.
• david.dran_at_uncp.edu
• Department of Social Work
• UNCP

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GAS

• Goal Attainment Scaling

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WHY GAS?

• Why are we doing this?
• Is this really necessary?
• Why this particular method?
• Is this another fad, someones pet idea?
• What other options are there?

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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?

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Why Gas (3)

• How is it going to be carried out and enforced?
• What happens if I dont go along with it?
• What good is it to me and the program?
• Is it really worth it?

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A brief history of GAS

• Frustration of Mental Health Professionals
• SOAP vs GAS Research

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Ten Commandments of GAS
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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.

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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."

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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.

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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.

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Identifying Goals

• Clinical Judgments

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Goals

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

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Intermediate goals

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

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Measuring goals

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

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An example

• Ralph and Road Rage

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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

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Ralph the intervention

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

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Ralph the goal

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

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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

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So far..

• Identified a problem
• Given an intervention
• Identified a goal
• Measured the goal
• Now we scale the goal

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Handout
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Scaling

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

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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
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Example

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

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

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So far

• Identified a goal
• Scaled a goal
• Now we
• Rate
• Weight
• Tally

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Rating Ralphs goal

• Please put a check mark in the first column

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Weighting of goals

• Some goals are more important than others

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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

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Tally Adding it all up

• For each goal
• Multiply the weight by the rating
• Add up the total
• This is the composite score

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Summary of steps

1. Identify the goal and scale the goal from -2 to
   2
2. Rate the client performance on the scale
3. Weight the goal importance
4. Tally up weight X rating for all goals

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Ex. With handout

• Ralph and his road rage

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More goals for Ralph

• Not yelling at drivers
• Sleep better at night
• Spend more time out with his wife
• Job satisfaction self rating

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Example

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

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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)

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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

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More goals for Ralph

• Not yelling at drivers
• Sleep better at night
• Spend more time out with his wife
• Job satisfaction self rating

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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)

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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

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More goals for Ralph

• Not yelling at drivers
• Sleep better at night
• Spend more time out with his wife
• Job satisfaction self rating

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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?

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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)

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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

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Adding it all up

• For each goal
• Multiply the weight by the rating
• Add up the total
• This is the composite score

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See handout
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Graphing results

• Imagine graphing the composite score over four
  sessions
• Graphing gives us a visual confirmation of the
  clients progress

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graph
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Some fine points about measuring goals
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Counting behaviors

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

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Rating behaviors

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

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Ex. Small groups