Goal Attainment Scaling (GAS)

Goal Attainment Scaling (GAS) is used to help a person with cerebral palsy and their family develop personal goals for therapy, in collaboration with their health professional. GAS can be used by itself or in combination with other assessments.

Health professionals will use GAS to help people with cerebral palsy work out goals to work on during therapy or intervention. Setting personal goals can help focus the attention and energy of the client and their health care provider. This, in turn, may increase motivation levels and help someone achieve improvements in different areas of their life1. Importantly, a second GAS is completed after therapy or intervention to measure whether the goals have been achieved.
GAS can be used by people of any age, and with cerebral palsy of any severity to measure the outcomes for a wide range of interventions and services2. The health professional completes the assessment with the client, their parent or family member - or both people together.
The health professional works with the client and their family to identify goals that matter to them. Goals may be related to participating in life situations, such as going to youth groups or the movies. Goals may also be related to everyday activities such as improving handwriting, eating with a knife and fork, riding a bike or catching a ball. Health professionals play an important role in helping the person and family select goals that are realistic and achievable. After completing the therapy or intervention, the health professional will help the person and their family determine how well their goals were achieved.
Completing a GAS assessment usually takes between 20 and 40 minutes.

You can ask your health care provider about how the GAS will be included within your fees for ongoing assessment and intervention.

Check with your health care provider if you are eligible for funding to assist with the assessment and intervention fees. People with disability living in Australia may also be eligible for a health care rebate through Medicare or funding from the National Disability Insurance Scheme.

Training

While there is no specific manual or website providing training in using GAS, a number of resources are available to assist health professions in working with clients to develop reliable, valid and effective goals (see references 3 to 5 below3-5). Health professionals will need education, support and the opportunity to practice goal setting. Ideally the GAS goals that they set, when starting to use this assessment, should be peer reviewed to assist the health professional in developing reliable and valid goal scaling6.

Cost

There is no cost for using GAS. Developing GAS goals can be time consuming but, ultimately, may save time for the health professional, client and their family, as it is more likely that they will have a greater ability to remain focused during intervention1,2.

Method

GAS is a client-centred, criterion referenced measure. When using this assessment, the Canadian Occupational Performance Measure can be used in combination to help the client identify priorities, which are then written as GAS goals. Up to five of the most important goals are scaled on a five-point scale. Usually, the current level of ability for each goal is given a score of minus 2 (-2) and the ability level (or goal) that is desired or expected after intervention is given a score of zero. Progress toward, but not achieving the expected outcome is scaled -1 (less than expected outcome), and two levels of achievement which exceed the expected outcome are scaled as +1 (greater than expected) and +2 (much greater than expected). Occasionally 6- or 7- point scales are used2.

After therapy or intervention, the health professional, with the person and family, will work out how well each goal has been achieved. For each goal, a score will be generated according to the scale listed above. It will be clear if the person has achieved each goal (score = 0), progressed, but less well than expected (and scored -1) or has achieved the goal better (+1) or much better than expected (+2). These scores can be collated into totals which indicate the client’s average goal achievement.

Things to note

There is considerable debate around the best way to collate the scores from individual goals, but no recognised best-practice approach. A number of references below discuss this debate and provide suggestions2,3,7,8,9.

There is no standardised process for developing, scaling and scoring GAS – making it difficult to evaluate its psychometric properties. Both reliability and validity, however, are optimised when the health professional takes a collaborative approach with the client and their family to develop goals10.

The goals that are set should be articulated as observable behaviours and written in present tense language, using the SMART format4,11. SMART goals are Specific, Measurable, Achievable, Relevant/Realistic and have a specified Timeframe for achievement.

Psychometric properties reviewed

Validity – little work has been completed on the validity of GAS. Low to moderate correlations exist between GAS and standardised assessments, such as the Pediatric Evaluation of Disability Inventory (PEDI)7. This is expected, however, because PEDI contains a range of items, many of which may not be relevant to a person’s goals for therapy. GAS, on the other hand, contains a limited range of very specific items5.

Reliability – inter-rater and intra-rater reliability are well established for GAS8 but no work appears to have examined test-retest reliability.

Responsiveness – this is considered a strength – probably because GAS is focused on issues that are relevant to the client, are targeted by intervention and therefore most likely to respond to the intervention8.

NOTE: Assessments should have strong psychometric properties. These properties refer mainly to i) validity – whether the tool measures what it is meant to measure, ii) reliability – whether the results of the tool are stable under different conditions and, for tools which measure outcome iii) responsiveness – whether the test is responsive to change.

Date of literature searches: March 2016

  1. Tam, C., Teachman, G. & Wright, V. (2008). Paediatric application of individualised client-centred outcome measures: A literature review. British Journal of Occupational Therapy, 71(7), 286-296. See abstract
  2. Wallen, M., & Stewart, K. (2015). The GAS Approach: Scaling Tailored Goals. In Poulsen, A, Ziviani, J & Cuskelly, M. (Eds) Motivation and Goal Setting: Engaging Children and Parents. Jessica Kingsley Publishers: London. Book chapter not available online.
  3. Kiresuk, T.J., Smith, A. & Cardillo, J.E. (1994). Goal Attainment Scaling: Applications, Theory, and Measurement. New Jersey: Lawrence Erlbaum Associates. Book not available online.
  4. Bovend’Eerdt, T.J., Botell, R.E. & Wade, D.T. (2009). Writing SMART rehabilitation goals and achieving Goal Attainment Scaling: A practical guide. Clinical Rehabilitation, 23(4), 352-31. See abstract
  5. McDougall, J. & Wright, V. (2009). The ICF-CY and Goal Attainment Scaling: Benefits of their combined use for pediatric practice. Disability and Rehabilitation, 31(16), 1362-1372. See abstract
  6. King, G.A., McDougall, J., Palisano, R.J., Gritzan, J. & Tucker, M.A. (1999). Goal Attainment Scaling: Its use in evaluating pediatric therapy programs. Physical and Occupational Therapy in Pediatrics, 19(2), 31-52.
  7. Steenbeek, D., Gorter, J.W., Ketelaar, M., Galma, K. & Lindeman, E. (2011). Responsiveness of Goal Attainment Scaling in comparison to two standardised measures in outcome evaluation of children with cerebral palsy. Clinical Rehabilitation, 25(12), 1128-1139.
  8. Krasny-Pacini, A., Hiebel, J., Pauly, F., Godon, S. & Chevignard, M. (2013). Goal attainment scaling in rehabilitation: A literature-based update. Annals of Physical and Rehabilitation Medicine, 56(3), 212-230.
  9. Tennant, A. (2007). Goal Attainment Scaling: Current methodological challenges. Disability and Rehabilitation, 29(20-21), 1583-1588. See abstract
  10. Steenbeek, D., Ketelaar, M., Lindeman, E., Galama, K. & Gorter, J.W. (2010). Interrater reliability of Goal Attainment Scaling in rehabilitation of children with cerebral palsy. Archives of Physical Medicine and Rehabilitation, 91(3), 429-435.
  11. Steenbeek, D., Ketelaar, M., Galama, K. & Gorter, J.W. (2007). Goal Attainment Scaling in paediatric rehabilitation: A critical review of the literature. Developmental Medicine and Child Neurology, 49(7), 550-556.
Find out about CP Check-Up™

Cerebral Palsy Alliance offers a service called CP Check-Up™ which provides ongoing surveillance of the health and well-being of our clients aged 0-18 years.
The information on this page was developed using the best research evidence combined with the expertise of clinicians and people with cerebral palsy and their families. It is provided to help people with cerebral palsy, their families and caregivers, clinicians and service providers make decisions about suitable interventions. This information is intended to support, but not replace, information exchanged, and decisions made, between people with cerebral palsy, their families and health professionals.