Got GAS? A Primer on Goal

Attainment Scaling

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Background (NIMH Grant)

Used Goal Attainment Scaling (GAS) as one of clinical field trail outcome measures

Study was conducted at the Department of Psychiatry, Hennepin County General Hospital

Focus of the research study was effectiveness of outpatient mental health services and application of Goal Attainment Scaling.

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Reasons for Inclusion

The CARF Transforming Outcomes Institute: Exams various measurement options Includes measuring from birth to death References promising measurement

tools and applications

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Reasons for Inclusion

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

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

intense, and long term care programs

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Introducing… GAS!

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

and Robert Sherman, Drs. Aaron Smith and Joseph Cardillio, and many others from the extensive literature.

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Introducing… GAS!

This session provides another option: Samples from worldwide GAS

applications included in Resources Forty+ years later, GAS work

continues to add value to measurement field

A sampling of resource citations included with Resource files

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Definitive Sourcebook

Goal Attainment Scaling: Applications, Theory, and Measurement

Thomas J. Kiresuk (Editor)

Aaron Smith (Editor) Joseph E. Cardillo

(Editor)

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GAS Methodology

Method of scoring individual goal achievement during intervention: Each patient has own outcome

measure Scored to allow statistical analysis

Traditional standardized measures: Include standard set of items Each rated uniformly

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GAS Criteria

Tasks individually identified to suit patients

Levels individually set around current and expected levels of performance with intervention

How is GAS rated? Criteria for outcomes determined with

individual before intervention begins

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GAS Goal Orientation

The Goal Attainment Follow-up Guide give everyone realistic expectation of person-centered achievements

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

scale (goal) area Expected level of outcome is scored

as 0

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GAS Scoring

More than expected outcomes scored as: +1 (somewhat more than expected) +2 (much more than expected)

Worse than expected outcomes scored as: -1 (somewhat less than expected) -2 (much less than expected)

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GAS Score Analysis

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

individual Anticipated difficulty

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

goals and weights12

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Goal Attainment Score Calculation

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

weights, wi = 1)

xi = the numerical value achieved ( between –2 and + 2)

r = the expected correlation of the goal scales

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For practical purposes r is usually taken as 0.3.  

In effect, therefore the composite GAS (the sum of the attainment levels x the relative weights for each goal) is transformed into a standardised measure with a mean of 50 and standard deviation of 10. 

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Mathematically challenged

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

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1 2 3 4 5 6-12 19-11 22-10 20 24

-9 23 27-8 21 26 29-7 25 29 32-6 23 28 32 35-5 27 32 35 37-4 25 32 35 38 40-3 31 36 39 41 42-2 30 38 41 43 44 45-1 40 44 45 46 47 470 50 50 50 50 50 501 60 56 55 54 53 532 70 62 59 57 56 553 69 64 61 59 584 75 68 65 62 605 73 68 65 636 77 72 68 657 75 71 688 79 74 719 77 73

10 80 7611 7812 81

Total raw score(sum of scale scores)

Number of Scales in Followup Guide

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GAS Tools

Weighting tools: Calculation tables are presented in

the reference materials and in Goal Attainment Scaling: Applications, Theory, and Measurement

There are a number of GAS spreadsheet calculators on Internet

A score conversion table for programs using unweighted scales is included in this presentation.

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Scale 1 Scale 2 Scale 3 Scale 4 Scale 5

-2Much less

than expected

-1Somewhat less than expected

0Expected level of

outcome

+1Somewhat more than expected

+2Much more

than expected

Goal Attainment Follow-Up Guide

Level of Attainment

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Special Features of GAS

Specifically measures those symptoms, behaviors, feelings, skills, or achievements that intervention is designed to change

Person-centered Organizes and focuses treatment on

goals Clarifies person-specific treatment

aims

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GAS Utility

It has been argued that GAS Improves clarity of treatment objectives

for both therapists and patients Establishes realistic patient and therapist

expectations Increases client participation and

engagement Increases motivation for improvement

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Scale (Goal) Area Selection

Step 1: select scale areas Identify areas where behaviors should

be minimized or where behaviors should be developed or increased

Most often 3 to 5 goals

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Expected Outcomes

Identify the expected level of outcome (with intervention):

What is reasonably expected from treatment?

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

of goal attainment with intervention) This level indicates treatment success

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Creating “SMART” Goals

Goals should be realistic: Not too easily accomplished Not too difficult to achieve

Goals should be specific: Measurable, Not vague

Goals should be valid: Independent observers agree on

whether outcome was reached Do not have to be quantified

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Scale 1 Scale 2 Scale 3 Scale 4 Scale 5

-2Much less

than expected

-1Somewhat less than expected

0Expected level of

outcome

+1Somewhat more than expected

+2Much more

than expected

Goal Attainment Follow-Up Guide

Level of Attainment

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Some Examples

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Scale 1 Scale 2 Scale 3 Scale 4 Scale 5

EmploymentProtective

OrderHousing Clothing Day Care

-2Much less

than expected

No applications obtained.

Protective order denied.

No housing; no progress toward

housing.

No progress toward obtaining

clothes.No day care.

-1Somewhat less than expected

Applications obtained.

No progress toward

protective order.

Waiting list for temporary housing.

Vouchers provided; no

clothing.

Unsatisfactory day care (cost, location, etc.)

0Expected level of

outcome

Applications submitted.

Papers filed for protective order.

Temporary or transitional housing.

Some clothing obtained.

Satisfactory day care obtained.

+1Somewhat more than expected

Interviews set.Transitional

housing; list for permanent.

Most clothing needs met.

Satisfactory day care; list for assistance.

+2Much more

than expected

Full-time employment

obtained.

Protective order granted.

Permanent housing.

All clothing needs met.

Satisfactory day care w/ financial

assistance.

Goal Attainment Follow-Up Guide: Example 1

Level of Attainment

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Scale 1 Scale 2 Scale 3 Scale 4 Scale 5

Self-Esteem Fear Isolation Education Education

-2Much less

than expected

Generally negative regard (feel worthless).

Not afraid of partner 10% of

time.

Spends all time in room; no

social conversations.

No attempt to enroll in program.

Unsure about obtaining GED.

-1Somewhat less than expected

More negative features than

positive.

Not afraid of partner 25% of

time.

Leaves room occasionally; no social contact.

Interest in and plan for enrolling

in program.

Decision to pursue GED.

0Expected level of

outcome

Feels positive and negative features are about equal.

Not afraid of partner 50% of

time (self-report).

Leaves room; converses only if approached; does

not initiate contact.

Enrolled in program.

Attending GED classes.

+1Somewhat more than expected

More positive features than

negative.

Not afraid of partner 75% of

time.

Sometimes interacts; social outside room.

Attending classes; no

vocational goal.

Completed GED classes; has not obtained GED.

+2Much more

than expected

Generally positive regard

for self.

Not afraid of partner 95% of

time.

Participates in group or outside social activities.

Attending classes toward vocational goal.

Obtained GED.

Goal Attainment Follow-Up Guide: Example 2

Level of Attainment

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Scale 1 Scale 2 Scale 3 Scale 4 Scale 5

Dental Needs Medical Needs Special Foods Substance Use Assertiveness

-2Much less

than expected

Dental problems

unaddressed.

Medical problems

unaddressed.

Dietary needs unaddressed.

Uses substances on regular basis;

no attempts to abstain.

Able to express needs/opinions <=10% of time.

-1Somewhat less than expected

Plans to address immediate dental

problems.

Plans to address

immediate medical probs.

Efforts to address needs;

diet still inadequate.

Attempts to abstain; continued

substance use.

Able to express needs/opinions

25% of time.

0Expected level of

outcome

Immediate dental needs addressed.

Immediate medical needs

addressed.

Dietary needs satisfied.

Abstains from use; does not attend group

meetings.

Able to express needs/opinions

50% of time.

+1Somewhat more than expected

Progress toward resolution of all dental needs.

Progress toward resolution of all medical needs.

Dietary needs and occasional

preferences met.

Abstains from use; occasionally

attends group meetings.

Able to express needs/opinions

75% of time.

+2Much more

than expected

All dental needs resolved.

All medical needs resolved.

Dietary needs and preferences

met.

Complete abstinence;

attends support meetings daily.

Able to express needs/opinions >=90% of time.

Goal Attainment Follow-Up Guide: Example 3

Level of Attainment

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Pictures can work very effectively for many clients with cognitive issues

Particularly helpful in areas of gerontology and mental retardation

Excellent examples in:

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

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GAS For Clients Who Cannot Read

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Goal Attainment Follow-Up Guide for:

1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8

1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8

1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8

1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8

1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8

GAS Composite Scores1 = __ 2 = __ 3 = __ 4 = __ 5 = __ 6 = __ 7 = __ 8 = __

Friendships

Somewhat less than expected

+2Much

more than expected

0Expected level of

outcome

Depression

+1Somewhat more than expected

Level of Attainment

Much less than

expected-2

-1

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Select References

Stolee P, Rockwood K, Fox RA, Streiner DL. The use of goal attainment scaling in a geriatric care setting. Journal of the American Geriatrics Society. 1992;40(6):574-8.

Stolee P, Zaza C, Pedlar A, Myers AM. Clinical experience with Goal Attainment Scaling in geriatric care. Journal of Aging & Health. 1999;11(1):96-124.

Stolee P, Zaza C, Pedlar A, Myers AM. Clinical experience with Goal Attainment Scaling in geriatric care. Journal of Aging & Health. 1999;11(1):96-124.

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More Select References

Williams RC, Steig RL. Validity and therapeutic efficiency of individual goal attainment procedures in a chronic pain treatment centre. Clinical Journal of Pain 1987;2:219-228.

Rockwood K, Joyce B, Stolee P. Use of goal attainment scaling in measuring clinically important change in cognitive rehabilitation patients. Journal of Clinical Epidemiology. 1997;50(5):581-8.

Rushton PW, Miller WC. Goal attainment scaling in the rehabilitation of patients with lower-extremity amputations: a pilot study. Archives of Physical Medicine & Rehabilitation. 2002;83(6):771-5.