Beruflich Dokumente
Kultur Dokumente
Goal Subcategory
Attainment Level Score Written Communication Functional Fine Organizational Skills
Motor Skills
Baseline *2 Writes some letters in Cuts within a 1/4I wide Organizes desk (all notes
isolation (i,e,u,l,t) with boundary with verbal and books stacked neatly)
verbal and visual cueing cues to turn page with with physical assistance,
nonĆdominant hand at standby supervision,
corners scheduling, and a
checklist
Less than expected *1 Writes all letters of the Cuts within a 1/8I wide Organizes desk (all notes
outcome alphabet in isolation with boundary with verbal and books stacked neatly)
For personal use only.
verbal and visual cueing cues to turn page with with standby supervision,
nonĆdominant hand at scheduling, and a
corners checklist
Expected outcome O Writes all letters of the Cuts within a 1/16I wide Organizes desk (all notes
alphabet in isolation with boundary with verbal and books stacked neatly)
visual cueing cues to turn page with with standby supervision
nonĆdominant hand at and a checklist
corners
Greater than +1 Writes all letters of the Cuts within a 1/16I wide Organizes desk (all notes
expected outcome alphabet with grouping of boundary and and books stacked neatly)
2 to 3 letters with visual independently turns page with standby supervision
cueing with nonĆdominant hand
at corners
Much greater than +2 Writes all letters of the Cuts on a regular penĆ Organizes desk (all notes
expected outcome alphabet with grouping of width line and and books stacked neatly)
3 to 4 letters independently turns page independently (general
independently with nonĆdominant hand instructions from teacher)
at corners
Goal Subcategory
Baseline *2 Descends 6 stairs, Ambulates (with walker) Transfers self from walker
holding the handrail, from the resource room to to desk chair with verbal
utilizing a stepĆtoĆstep classroom in 8.5 minutes assistance and physical
pattern, with one hand with supervision and verbal assistance (other person
held cueing holding trunk and placing
feet on/off footrest with
weight supported)
For personal use only.
Less than expected *1 Descends 6 stairs, Ambulates (with walker) Transfers self from walker
outcome holding the handrail, from the resource room to to desk chair with verbal
utilizing a stepĆtoĆstep classroom in 6 to 8 minutes cueing and physical
pattern, with standby with supervision and verbal assistance (holding trunk
assistance cueing and placing feet on/off
footrest)
Expected outcome 0 Descends 6 stairs, Ambulates (with walker) Transfers self from walker
holding the handrail, from the resource room to to desk chair with verbal
utilizing a reciprocating classroom in 5 minutes or cueing and physical
pattern, with one hand less with supervision and assistance (placing feet
held verbal cueing on/off footrest)
Greater than +1 Descends 6 stairs, Ambulates (with walker) Transfers self from walker
expected outcome holding the handrail, from the resource room to to desk chair with verbal
utilizing a reciprocating classroom in 5 minutes or cueing and no physical
pattern, with standby less with supervision and no assistance
assistance verbal cueing
Much greater than +2 Descends 6 stairs, Ambulates (with walker) Transfers self from walker
expected outcome holding the handrail, from the resource room to to desk chair independently
utilizing a reciprocating classroom in 5 minutes or
pattern, independently less independently (no
supervision/verbal cueing)
Goal Subcategory
Attainment Level Score Speech Sound Production Speech Sound Production Speech Sound Production
of Blends in Final Word Position in Initial Word Position
Baseline *2 Produces ``l'' blends with Produces ``m'' sound in Produces ``f'' sound in
85% accuracy in final word position with initial word position in
structured phrases (i.e., 80% accuracy at the imitated phrases with
17 of 20 trials correct) spontaneous phrase level 85% accuracy (i.e., 17 of
(i.e., 8 of 10 trials 20 trials correct)
correct)
Less than expected *1 Produces ``l'' blends with Produces ``m'' sound in Produces ``f'' sound in
For personal use only.
outcome 85% accuracy in imitated final word position with initial word position in
phrases 80% accuracy at the imitated sentences with
imitated sentence level 85% accuracy
Expected outcome 0 Produces ``l'' blends with Produces ``m'' sound in Produces ``f'' sound in
85% accuracy in final word position with initial word position in
structured sentences 80% accuracy at the structured sentences with
structured sentence level 85% accuracy
Greater than +1 Produces ``l'' blends with Produces ``m'' sound in Produces ``f'' sound in
expected outcome 85% accuracy in final word position with initial word position in
spontaneous sentences 80% accuracy at the spontaneous sentences
spontaneous sentence with 85% accuracy
level
Much greater than +2 Produces ``l'' blends with Produces ``m'' sound in Produces ``f'' sound in
expected outcome 85% accuracy at the final word position with initial word position
spontaneous 80% accuracy at the when describing a picture
conversational level conversational level with 85% accuracy
collection and training and to ensure the technical quality of the GAS
scaling and rating procedures.
The pros and cons of using GAS have been outlined in many ar-
ticles.1,6,8,13,15,16,18,19,23,26 A primary strength of GAS is its ability to
measure change in performance, whereas most standardized measures
are discriminative tools designed to measure post-intervention status
(based on norms for children without special needs) and have not been
validated as responsive to clinically significant change.6,16,19 Clinical
significance refers to the magnitude of an effect in real-world terms.27
GAS is criterion-referenced, rather than norm-referenced, making it
For personal use only.
One needs to ensure that the goal scales are reliable (i.e., that a
rating made by one therapist observing the child’s performance is
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How much clinical Therapists should have a minimum of 1 Involve only experienced
experience is necessary to set year of pediatric experience. therapists in goal setting and
appropriate goals? scaling.
How much instruction and Therapists should have approximately 7 See Table 5 for
training is necessary for hours of specific training in the use of recommended orientation
therapists? GAS. and training steps.
How can one ensure adequate The process of selecting goal areas should
goal selection? ensure that:
For personal use only.
How can one ensure adequate Each of the levels on the scale should: Each criterion can be
goal scaling (i.e., adequately assured through the use of
written goal levels on the 1. be written as clearly as possible, in three interĆconnected
fiveĆpoint scale)? concrete behavioral terms procedures and tools:
2. specify an observable behavior of the
child Therapist training
3. be written in the present tense
4. be achievable or realistically possible Peer review to ensure the
adequacy of the goal
The scale as a whole should: scales
1. have levels that reflect clinically
meaningful gradations of Use of a standard
improvement procedure and checklist
2. have approximately equal intervals to review the technical
between the goal attainment levels adequacy of written goal
(i.e., the change from +1 to + 2 should scales (see Figure 1)
be similar to that between *2 to *1, etc.)
3. specify a time period for achievement
4. reflect a single dimension of change
(as long as a goal remains meaningful),
keeping other variables constant
5. not reflect attainment that is
dependent on the therapist's physical
assistance (unless the assistance of
others is a written part of the goal)
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TABLE 4 (continued)
How can one ensure adequate 1. Ratings should be done by therapists Use independent raters.
goal rating? āĂnot involved in providing the intervention.
2. Reduce the ``performance demands" of
ĂāĂĂ the visiting independent rater.
How is the summary score Clients' individual outcome scores need to Ensure that you have
determined? be aggregated in some way, preferably thought of the data analysis
using TĆscores. stage and have access to a
statistical software package.
For personal use only.
S Orientation session
S Handout
S examples of goals
S specific guidelines
S list of common errors
Overly Generalized If the expected level (i.e., 0 level) of a scale The expected level of a scale
Goals is written in very general terms (e.g., ``walks should be written as clearly as
a greater distance in a set period with possible (e.g., ``walks with
assistance"), it will be difficult or platform walker 100 metres in six
impossible to create the remaining scale minutes with two hands on walker
points, therefore making the goal unmeasurable. to assist with steering").
Overly Technical A goal setter may use terms specific to Write goals in common terms,
Goals his/her profession in creating a scale that the especially if the goal rater is not of
goal rater is not familiar with. the same professional background
as the goal setter.
Multiple Variables A scale may include two or more variables Decide on one variable by which to
of Change of change. This could be problematic if the measure change in performance
For personal use only.
Unequal Scale A scale may be created where the amount of Aim for clinically equal intervals
Intervals clinical change is greater between, say, the between all levels of the scale.
+1 and +2 levels than the amount of change
between the *2 and*1 levels.
Clinically Irrelevant A scale may be created where one or more The amount of change between all
or Unrealistic Scale of the levels represents an amount of change scale levels needs to be clinically
Levels that would not be clinically relevant to the relevant and all levels should be
child (i.e., the amount of change is too small achievable for the child.
to matter) or the amount of change is
unrealistic for the child (i.e., the amount of
change is too great).
Using Different A GAS scale may be written with the *2 All scale levels should be phrased
Tenses (i.e., Past, level written in one tense and all other levels in the present tense, in order for
Present, Future) in another tense, which could be confusing evaluation to make sense at
When Writing Scale and bias the goal rater. different time points (i.e., ``walks . . .'').
Levels
Redundant or A scale may be written where a child could Be careful not to create scale levels
Incomplete Scale be scored on two levels at the same time that are redundant or incomplete.
Levels (e.g., the +1 level has walking distances Careful wording (e.g., +1 would be
specified between ``40 and 50 metres'' and the ``more than 40 metres and up to 50
+2 level specifies distances between ``50 and metres" and +2 would be ``more than
metres"). If a child walks exactly 50 metres, 50 metres and up to 60 metres")
both the +1 and the +2 level would be or specific instructions to the
correct. On the other hand, a gap could be rater (e.g., if a child obtains a
present in the scale where a child could not midway point between two levels,
be scored on any level (e.g., the +1 score the child at the lower level)
specifies walking distances between ``40 and will be of benefit.
50 metres" and the +2 specifies distance
between ``60 and 70 metres"; if a child
walks 55 metres, neither the +1 nor the +2
level is correct).
Blank Scale Levels It may be difficult to write the more extreme Be careful to set goals where it is
levels of a scale, tempting the goal setter to possible to complete all scale
leave these levels blank. If a child happens to levels.
achieve an upper or lower extreme, it would
be impossible to rate the child's performance.
King et al. 45
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factor or as the variable that changes over time. The key idea is that
goal attainment levels should reflect change in the child’s behavior,
not unacknowledged variations in the therapist’s physical assistance. It
is permissible to write goals where the physical assistance of someone
else is explicitly stated as the variable that changes over time, so that
the goal scale shows meaningful changes in the level of assistance the
child requires to perform a task. An example of the gradations that
could be included in a scale focusing on changes in level of assistance
is: physical and verbal assistance required (*2), verbal assistance
with checklist required (*1), checklist and verbal cueing or prompt-
ing required (0), verbal cueing/prompting required (+1), and com-
pletely independent (+2).
According to strict research methodology,8 the therapist who sets
the levels of goal attainment should not be the same therapist who
provides the treatment. This is a difficult criterion to meet since, in
actual clinical practice, the treating therapist is involved in goal set-
ting, often in conjunction with the client.10,11,23 This is defensible
when one involves an independent rating therapist and a trainer/study
coordinator in the review of the goal attainment levels (who follows a
standard procedure with set criteria). In our experience, even highly
experienced therapists have some difficulty identifying the baseline
and expected levels of the goals. Assistance and review by others is
useful, appreciated, and necessary. Figure 1 provides a checklist that
can be used in the review of written goals by a trainer and independent
rating therapist.
How Can One Ensure Adequate Goal Rating? Cardillo30 addresses
the selection of raters and the decision about the timing of the goal
rating session, but provides little information on how to conduct the
46 PHYSICAL & OCCUPATIONAL THERAPY IN PEDIATRICS
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Name of Participant:
actual goal rating session. Our experiences have led to some recom-
mendations. First, it is important to consider the child’s view of the
rating situation. When children are aware that a new person is coming
to watch a session, they may be very motivated to perform well for
this visiting person. The treating therapist can reduce the ‘‘hype’’
regarding the rater’s visit by informing the child in advance of the visit
and assuring the child that his/her regular performance is what is
called for. The rating therapist should minimize the effect of his/her
presence by sitting quietly in the back of the room and making notes
discreetly.
King et al. 47
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(10 WiXi)
T = 50 + p
(1 * r) Wi 2 + r (Wi 2)
represents the score for each goal. The r represents the expected over-
all intercorrelation among outcome scores. The formula for computing
the T-score assumes a relatively low correlation among goals of .30.
Kiresuk and Sherman5 found this correlation useful because it yields a
standard deviation of 10 units. Cardillo and Smith4 strongly recom-
mend against the use of differential weighing of GAS goals. The use
of this formula may appear time-consuming and difficult, but the need
for manual computation is rare. If goals are not weighted and the
suggested intercorrelation of .30 is used, tables are available that allow
the quick and easy conversion of outcome scores into T-scores for
clients with up to eight scored scales (see Kiresuk et al.6).
For personal use only.
some aspect internal to the child. On the other hand, when the variable
being changed deals with the level of physical or verbal assistance pro-
vided, or levels of equipment support, then the variable of change corre-
sponds to the factor of critical importance in the therapist’s view. Under
these conditions, the written goal levels provide a window on the thera-
pist’s view of the factors limiting the child’s goal achievement.
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