Goal Attainment Scaling in Fieldwork: Client Competencies and Student Achievement

SIGNIFICANCE: The drive for accountability and outcome data has been a central focus of both the clinical and academic settings. In the academic setting, measurement of student learning is a critical component of the accreditation process. In the clinical setting, initiatives such as Pay for Performance programs have been implemented by both Medicare and private insurers to reward improvements in health care through measurement, transparency, and accountability.

INNOVATION: Goal Attainment Scaling (GAS) has been used increasingly in other fields but is still minimally used in occupational therapy, despite increasing research to support its efficacy.

RESEARCH QUESTION: The Western Michigan University (WMU) occupational therapy clinics provide a variety of clinical services to members of the community in need of subsidized and specialized care. Although these programs have been well-regarded in the professional and local community, there has been no formal program evaluation to validate the efficacy of both student learning and client outcomes. This study was implemented to assess the acquisition of students’ clinical competencies and client progress.

BACKGROUND: GAS, developed by Kiresuk and Sherman in 1968 for practitioners in mental health, is a method for measuring individual and program goal achievement. GAS provides a framework for identifying specific, measurable, and objective goals using a 5-point scale ranging from +2 to −2 to reflect the full range of possible outcomes for each identified goal. GAS allows for a comparison of scores among multiple subjects with different goals, making it useful for program evaluation as well.

METHOD: A pretest–posttest, quasi-experimental design was used to measure changes in goal attainment among Level I fieldwork students and their assigned clients. The occupational therapy teaching clinics, all faculty-supervised Level I fieldwork sites, are a unique feature of the occupational therapy program. All 10 clinics were included in the study—4 clinics in the Fall 2013 semester and 10 clinics in the Spring 2013 semester. Five of the clinics were on campus, whereas the other five clinics were based in the community. Students scaled two goals for each client (Fall 2013, N = 22; Spring 2014, N = 46). All students completing either Level IA or Level IB fieldwork were included in the study (Fall 2013, N = 46; Spring 2014, N = 63).

A paired t test and a repeated measure analysis of variance (ANOVA) were conducted. Due to the nonnormality distribution of students’ goal scales, however, a Wilcoxon signed rank sum test was used to confirm the results.

RESULTS: Two raw data sets were obtained in both semesters; t test results indicate that the mean score of final levels for student goal attainment is statistically significantly higher than the mean of baseline levels (t = 15.42, p < .0001). Likewise, client goal attainment is also statistically significantly higher at posttest for Goal 1 (t = 9.21, p < .0001) and for Goal 2 (t = 10.01, p < .0001).

CONCLUSIONS: Use of GAS has been shown to be a feasible method for measuring both student learning and client outcomes in a variety of occupational therapy teaching clinics. The GAS findings reveal that students experienced significant improvements in clinical competencies during their Level I fieldwork placement and that their assigned clients also experienced statistically significant functional improvements, achieving expected or better than expected levels of goal attainment. Moreover, findings also support the use of GAS as an outcome measure that can be used with a diverse client population, allowing each student to utilize individualized measurement instruments for each client rather than implementing a “one size fits all” evaluation tool.