Abstract
The aim of this research was to improve the quality of the goal attainment scales (GAS) developed for clients with developmental disabilities. This research focused on providing feedback to therapists based on generally accepted criteria for GAS. These findings will be useful in training and providing guidance for therapists in writing GAS for their clients.
Primary Author and Speaker: Maureen Russell
Additional Authors and Speakers: Garret Candelaria, Brooke Addario
This longitudinal retrospective study evaluated the quality and consistency of the Goal Attainment Scales (GAS) written by Occupational Therapists (OT), Physical Therapists (PT) and Speech Therapists (ST) at Northland Rural Therapy Associates (NRTA) in Flagstaff, Arizona for clients funded by the Division of Developmental Disabilities (DDD). The GAS is used across a variety of rehabilitation and practice settings and are sensitive to incremental changes.
Therapists at NRTA are required to report the progress of clients funded by DDD through quarterly progress notes and the GAS was implemented as a means of reporting this progress. A previous study that evaluated the progress of these clients based on the GAS suggested that there was a need for additional training of therapists in order to develop GAS that were consistent and of a higher quality. It was hypothesized that the quality of GAS will improve when practitioners are provided feedback on the key elements of the GAS. To be included in this study, therapists were required to be employed by NRTA, be licensed in the state of Arizona, and be serving clients who were enrolled in the DDD. Therapists participating in this project also needed to anticipate provision of services to clients funded by DDD at least until March 30th, 2018.
Two outcomes from quarterly reports using GAS and written by participating therapist were randomly chosen to be evaluated by OTD students involved in the research. A template was created to evaluate and score GAS scales from 0-8 based on their fulfillment of 8 criteria including equidistance between levels of progress, measurability of goal outcomes, unidimensionality, and clarity of context. Two GAS from each therapist’s quarterly progress notes were scored from the quarter beginning October 1, 2017 and ending December 31, 2017. Written feedback was given to therapists regarding the 8 criteria that were evaluated. Therapists provided written feedback through an online survey to the student researchers regarding the usefulness of the feedback that they received. The same outcomes were then reevaluated in the quarter begining January 1, 2018 and ending March 31, 2018.
There were a total of 22 therapists that participated in this study with the following distribution of therapists: 6 (27%) Occupational Therapy, 6 (27%) Physical Therapy, and 10 (46%) Speech Language Therapy. A total of 44 GAS goals were evaluated for the 1-2018 quarterly with the following distribution: 12 (27%) Occupational Therapy goals, 12 (27%) Physical Therapy goals, and 20 (46%) Speech Language Therapy goals. A total of 41 GAS goals were evaluated for the 4-2018 quarterly with the following distribution: 12 (29%) Occupational Therapy goals, 12 (29%) Physical Therapy goals, and 17 (42%) Speech Language Therapy goals. Over the two quarters there was a mean change in score of 0.56. Of the 8 criteria areas evaluated the criteria that had the most frequent errors was the reporting of the start and end dates. Of the therapists that responded to the survey, 93% stated that the feedback they received was “helpful” or “very helpful”. Additionally, 93% stated that they were “likely” or “very likely” to incorporate this feedback into their quarterlies in the future.
Impact statement: The Goal Attainment Scale (GAS) has the potential to assist OTs, PTs, and SLPs in measuring small changes in progress for clients with diverse diagnoses and needs. The knowledge that has been gained through this research will be valuable in developing training for therapists and evaluating the use of the GAS in clinical practice. This research will provide support for programming and policy change that can directly benefit related service professionals and the clients that they serve.
Krasny-Pacini, A., Evans, J., Sohlberg, M. M., & Chevignard, M. (2016). Proposed criteria for appraising goal attainment scales used as outcome measures in rehabilitation research. Archives of physical medicine and rehabilitation, 97(1), 157-170.
Mailloux, Z., May-Benson, T. A., Summers, C. A., Miller, L. J., Brett-Green, B., Burke, J. P., ... & Schaaf, R. C. (2007). Goal attainment scaling as a measure of meaningful outcomes for children with sensory integration disorders. American Journal of Occupational Therapy, 61(2), 254-259.