Topic 9: Goal Attainment Scaling

1. Topic 9: Goal Attainment Scaling Introductory Scenario What is Goal Attainment Scaling? Illustration of Goal Attainment Scaling Goal Attainment Scaling and Program Evaluation Variations of Goal Attainment Scaling Problems with Goal Attainment Scaling

2. Introductory Scenario A graduated student had taken a position in the rural part of the state The executive director requested that the graduate design a process by which a community mental health agency with numerous employees in several counties could begin to evaluate services Few resources were available and implementation was needed in two weeks Goal attainment scaling though not necessarily the best choice could be implemented quickly and was recommended

3. What is Goal Attainment Scaling? Goal attainment scaling (GAS) involves the quantifying of individualized goals set with clients during assessment and treatment using a 5 point normative scale. Clients outcome levels are converted into standard scores. The GAS approach allows comparison of success levels across a program or agency even when there is NOT a single intervention aimed at clients with a similar set of problems.

4. What is Goal Attainment Scaling? Goal Attainment Scaling requires the following: 1. Identification of Problem Areas and Defining Goals 2. Scaling Each Goal form -2 to +2 (See Figure 7.3)

5. Illustration of Goal Attainment Scaling A 26 year old client comes to see you about being unhappy with herself due to obesity and residing with her parents These 2 problems are operationalized by creating a scale from most unfavorable outcome (-2), to less than expected outcome (-1), to expected outcome (0), to more than expected outcome (+1) and to most favorable outcome (+2). (See Figure 7.2)

6. Goal Attainment Scaling and Program Evaluation: Composite scores across clients To use GAS as a program evaluation tool, staff need to be trained to write relevant, realistic and measureable goals. Then composite or summary scores can be computed across clients Deriving an average scale score for each client involves adding up the outcome scores for each goal, and dividing this value, by the number of goals or scales i.e. If the expected outcome (0) is obtained for 2 client goals, then by adding the two zero�s and diving by the number of goals(2), an average of (0) is produced indicating that the expected goal was obtained

7. Goal Attainment Scaling and Program Evaluation: Converting scores to standard scores

8. Variations of Goal Attainment Scaling Alternatively, a continuous scale can be derived based on a continuum of 100 points. A 100 value would be awarded when the hoped for outcome is achieved A value of 80 or 60 , etc. would be assigned depending on the percentage of the goal achieved (see Figure 7.4)

9. Problems with Goal Attainment Scaling GAS permits too much selectivity in the choice of goals selected Different treatment providers may opt to emphasize different goals with clients having similar problems Therapists might encourage clients to set goals that are easily obtained to look good for supervisors or evaluators Clients ability to achieve certain goals may be overestimated or under estimated A T- score of 50 could also actually arise form offsetting successes and failures for some clients

10. Problems with Goal Attainment Scaling On the plus side: GAS has therapeutic utility in increasing client self-awareness GAS has been reported in the literature to have high interrater reliability, adequate content validity, and high correlations with a standardized outcome measure Program managers however find that it provides little useful information about the program itself