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Goal Attainment Scaling

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Transcript of Goal Attainment Scaling

Projected level of performance
(Kiresuk, Smith, & Cardillo, 1994)
Projected Performance Expected by the End of the Measurement
Period (Mailloux et al., 2007)
Baseline (King et al., 1999)
Regression from current level (Miller et al., 2007)
Current level of performance (Miller et al., 2007)
Somewhat less than expected
(Kiresuk, Smith, & Cardillo, 1994; Mailloux et al., 2007)
Chapter 2: Goal Attainment Scale Design

Developed by Kiresuk and Sherman (1968)
Emerged for use in adult mental health
Way to increase a client's participation in identifying their own targets for therapy
Strongly emerged in pediatrics with King et al. (1998),
Miller et al., (2007), Mailloux et al., (2007)

Learning Objectives:

1. Learner will be able to
when a standardized tool versus an individualized tool should be used in measurement.
(Bloom's Taxonomy Level IV: Analysis)

2. Learner will be able to correctly recall the performance levels of a Goal Attainment Scale and their numeric value.
(Bloom's Taxonomy Level II: Comprehension)

3. Learner will correctly
a child's performance with a Goal Attainment Scale and a provided case study scenario.
(Bloom's Taxonomy Level VI: Assessment)

Much Greater Than Expected
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Greater Than Expected
Expected Performance
Less Than Expected
Much Less Than Expected
Expect More Than Expected:
Goal Attainment Scaling
in Pediatric Clinical Practice
Teresa L. Fair-Field, OTR/L
Relatively universal use
Provides normative data
Degree of impairment
Baseline prior to tx phase
Justification for reimbursement
Chapter 1
Identifying need and communicating urgency
limitations of existing tools
improving family engagement
Chapter 2
Goal Attainment Scale design
Chapter 3
Building a Goal Attainment Scale
Implementation in practice
Clinical case study
Assessment of Learning

Much more than expected outcome
(Kiresuk, Smith, & Cardillo, 1994; Mailloux et al., 2007)
Somewhat more than expected
(Kiresuk, Smith, & Cardillo, 1994; Mailloux et al., 2007)
"(Standardized tools) are based
on hierarchical sensory-motor
development and the underlying
construct that childhood development
has a predictable rate and sequence"
(McLaren & Rodger, 2003, p. 217).
Yet how many of the children in our service
have developmental trajectories that follow a
predictable rate and sequence?
Protracted administration
Generally performed in non-native, out of context settings
Do not factor
of movement or performance
Medical/impairment model
Poor gauge of functional
Within Normal Limits
Below Average (-1 s.d.)
Well Below Average (-2 s.d.)
Tasks may lack relevance
"Child will dribble a tennis ball with alternating hands x6 dribbles to demonstrate increased bilateral motor coordination necessary for successful participation in activities of daily living."
Inadequate sensitivity
Results may indicate lack of progress, or even regression.
Typical performance has not remained static
Though the child may be demonstrating gains in
age equivalency relative to actual age, he/she is being compared against a moving target relative to typical peers.
A Goal Attainment Scale Is...
a five point performance scale
marking performance from -2, -1, 0, +1, +2

Chapter 3: How to Build a GAS

Researchers agree about the essential components:
records review
parent meeting using semi-structured interview
3-5 scaled goals (functional, relevant, desirable)
GAS rater/ interviewer should not be the same person as that treating the child

(King et al., 1998; McLaren & Rodger, 2003; Mailloux et al., 2007)
Now let's take a look at an example of a parent interview to develop a Goal Attainment Scale.
Rubric Development
Now let's look at rubrics.
Rubrics are designed for the assessment of an individual against a fixed standard in which the performance at each interval is described in specific, observable terms.
Rubrics are positioned on a grid with fixed descriptions assigned to each interval. There are not set parameters for the number of intervals, nor for their headings, but following a model which should be familiar, headings may include:
Poor/Fair/Good/Superior (4 levels) or
Very Poor/Poor/Fair/Good/Excellent/Superior (6 levels)
In boxes below these headings, are performance descriptions which specifically indicate the parameters for obtaining that score.
Rubric levels can have numeric scoring attached which yield an overall score.

Chapter 1: Communicating Urgency
Implementation in Practice
Establishing clinic priority
Shift in clinical work flow
Education of the team
Family interview with the intention to set goals
Coordination with electronic health record
Child is a 8 y.o. boy "Jason"
Enjoys computer games and outdoor play
No formal diagnosis
Fine motor coordination challenges
Poor handwriting
Parents would like Jason to tie his shoes.
Jason picks up laces and attempts to cross but does not tie the shoe before becoming frustrated and stopping. He requires hand over hand or (usually) full assist to tie, and is constantly walking around with untied laces. Jason ends up getting mad and so an adult ties both shoes.
Shoe Tying Description
-2 Much Less than Expected Outcome:

Jason refuses to wear lace up shoes, or elopes the activity.

-1 Less than Expected Outcome
(Current Performance)
Jason attempts to to tie his shoes when prompted, but unable to complete without hands-on support. Adult ends up tying one or both shoes.

0 Expected Performance
Jason is able to complete the cross and the overhand knot, but requires help to complete the bow knot. He stays with the activity and asks for help appropriately.

+1 More than Expected Performance

Jason is able to tie his shoes with cueing assistance but no hands-on support. He may not be able to tie mid-activity if they come undone, or requires increased time to tie. He is able to complete one or both shoes by himself.

+2 Much More than Expected Performance

Jason is able to tie both shoes independently whenever needed (after donning, or mid-activity if the shoe has come untied) in a reasonable time allowance.

Jason's Goal Attainment Scale: Shoe Tying
Review of Objectives
Quiz Instructions:
Please click on the following link:
and enter this "room" number: XVK7FUEMR
Thank you for learning with me!

King, G., Tucker, M. A., Alambets, P., Gritzan, J., McDougall, J., Ogilvie, A., . . . Malloy-Miller, T. (1998). The evaluation of functional school-based therapy services for children with special needs: A feasibility study. Physical & Occupational Therapy in Pediatrics, 18, 1-27.

McLaren, C., & Rodger, S. (2003). Goal attainment scaling: Clinical implications for paediatric occupational therapy practice. Australian Journal of Occupational Therapy, 50, 216-224.

Mailloux, Z., May-Benson, T. A., Summers, C. A., Miller, L. J., Brett-Green, B., Burke, J. P., . . . Schoen, S. A. (2007). Goal attainment scaling as a measure of meaningful outcomes for children with sensory integration disorders. American Journal of Occupational Therapy, 61, 254-259.

Miller, L. J., Coll, J. R., & Schoen, S. A. (2007). A randomized controlled pilot study of the effectiveness of occupational therapy for children with sensory modulation disorder. American Journal of Occupational Therapy, 61, 228-238.

Western Michigan University Occupational Therapy Department (Producer). (2015, June 12, 2016). Gas demo: Scaling clinical goals. Retrieved from
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