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Goal Attainment Scaling (GAS)

>www.dpw.state.pa.us >www.dhs.pa.gov 2

• You will have an introductory understanding of what GAS is and you will have an understanding of what resources to use to develop the chart.

• You will not become proficient at developing GAS charts until you gain practical experience.

As a result of this training


• What is GAS? History, GAS Pilot, SSB

• Steps for GAS Implementation Identifying and Prioritizing Skills and Needs Determining Stage of Learning Writing Goals and Objectives Developing GAS chart Implementing and Reporting Progress

Agenda


What is GAS?

• Individualized approach for establishing and measuring the attainment of goals/objectives for people with varying levels of disability and support needs

• A set of unique goals/objectives and range of criteria are established

• A standardized approach to measuring and reporting outcomes


History of GAS

• Developed in 1968 to evaluate mental health programs

• Since then, GAS has been used in education, nursing, rehabilitation, medicine, corrections and social work fields

King, McDougall, Tucker, et., al (1999)GAS in therapy setting for functional skills for children with disabilities in a school setting.


Merits & Benefits of GAS

• Criterion NOT Norm referenced

• Uses quantitative measures

• Encourages data‐based instructional decisions

• Measures individual goals

• Allows for group analysis


• Fall 2014‐ BAS gathered data to review goals, objectives, and Quarterly Summary Reports

• December 2014‐ January 2015‐ Identified 10 participants and trained SCs and providers on GAS model

• Ongoing Technical Assistance from Clinical was provided• Round Table Discussions held to gather feedback on the model

for statewide implementation• Data was collected and monitored for one year to track progress• GAS Report written to summarize findings and plan for

implementation across all providers

GAS Pilot with AAW Providers


Outcomes: What Did We Learn

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

No: No QSR No: Inconclusive Yes: Informative Data

Percen

tage

Are there sufficient data to inform support and progress reporting?

No Model GAS Model

40%

40%

20%

How helpful has reporting GAS chart data in QSRs been to better understand participant progress?Very Unhelpful Unhelpful NeutralHelpful Very Helpful


Starting July 2016, SSB Providers were trained in GAS chart and are currently implementing.

Effective July 1, 2017, ALL providers who develop goals and objectives (and report on progress) will

implement GAS.


STEPS FOR GAS IMPLEMENTATION

12


IDENTIFYING AND PRIORITIZING SKILLS AND NEEDS

13


• Functional• Meaningful• Assessed Need• Consider naturalistic situations• Realistic‐ given the amount of support, balance outside of

service delivery• Long‐term outcome‐ can benchmark be addressed now?• Recommend no more than 3‐5 goals/objectives per service

Prioritizing Skills and Needs


Examples


Case Study: SallySally is a 27‐year‐old female who is receiving ResHabservices. She has assigned chores in the home, and ResHabstaff has been working with her to explore chores that she can complete on her own and establish a routine as she has a long‐term goal of living independently. Staff provides her with constant direct verbal prompts to assist her in cleaning dishes after meals, making her bed, and doing laundry as she is having difficulty learning the steps. She has a history of withdrawing from others and gets distracted easily, however she currently enjoys coloring and listening to music with housemates in the ResHab home. She enjoys volunteering at the local library and taking walks through the neighborhood. On weekends she visits with nearby family and attends a family dinner on Saturdays.


Given the information shared about Sally, what skill should be the highest priority for Res Hab to address?

1) Obtaining employment 2) Increasing safety skills 3) Establishing a routine of household chores4) Increasing community activities with family


ANSWER:Given the information shared about Sally, what skill should be the highest priority for Res Hab to address?

1) Obtaining employment 2) Increasing safety skills

3) Establishing a routine of household chores4) Increasing community activities with family


Jason is a 28 year‐old gentleman who resides with his parents. Jason has a serious hoarding habit and has few skills in the area of independent living (e.g., cooking, household care, laundry), but he would like to move out into his own apartment sometime soon.

He really likes his job, of 3 years, as a computer tech at Data Source Co. and has always received good evaluations. Although it is reported that he engages in some obsessive behaviors (clicking his pen, straightening up others work space), he is well regarded and known to be thorough and an efficient worker. Recently, the company has re‐organized and this has impacted and changed some of Jason’s work assignments and duties. He has begun to yell and slam things around the office and at his desk. His boss has said that his position is at risk if he continues to exhibit these behaviors.

Jason has a strong interest in baseball sports statistics and will talk at great lengths about this topic with co‐workers and people he knows from community settings he frequents (firehouse, church). He will sometimes even get angry (raise his voice, change his tone of voice) when others try to talk or add something to the conversation.

Case Study‐ Jason


Given the information shared about Jason, what skill should be the highest priority for BSS to address?

1) Hoarding behavior at home 2) Repetitive habits of pen clicking, straightening others’ work space at work3) Yelling and slamming things when asked to complete a new task at work4) Raising his voice, getting angry when others attempt to add or say something during a conversation at home and/or work


ANSWER:Given the information shared about Jason, what skill should be the highest priority for BSS to address?

1) Hoarding behavior at home 2) Repetitive habits of pen clicking, straightening others’ work space at work3) Yelling and slamming things when asked to complete a new task at work4) Raising his voice, getting angry when others attempt to add or say something during a conversation at home and/or work


Case Study: LouisLouis is a 22‐year‐old male who is receiving Supported Employment: Intensive Job Coaching services. He enjoys his job but has a lot of social anxiety. Because of this, he doesn’t socialize while at work (with co‐workers or customers) and avoids addressing issues with supervisor. He has a clothes pin that he likes to carry around with him, that he plays with when he is anxious. He has a tendency to dive into his work but often forgets what all of his tasks are for the day and doesn’t always complete the ones he does, thoroughly. He fully relies on his parents to get him to and from work.


1) Learning public transportation 2) Completing list of tasks thoroughly3) Greeting customers 4) Talking with co‐workers

Given the information shared about Louis, what skill should be the highest priority for Supported Employment to address?


1) Learning public transportation

2) Completing list of tasks thoroughly3) Greeting customers 4) Talking with co‐workers

ANSWER:Given the information shared about Louis, what skill

should be the highest priority for Supported Employment to address?


IDENTIFY THE STAGE OF LEARNING


• “Can’t Do, Won’t Do”• GOAL: performing the skill or behavior with improved

accuracy, significant prompts or supports often required• Example: Shawn’s parents have always attended to Shawn’s needs

without expecting Shawn to participate because “it is just easier that way.” However, Shawn wants to eventually live on his own and, upon observation, it is noted that Shawn does not know how to prepare simple meals and has all his meals prepared and brought to his room.

Stage of Learning: Skill Acquisition


• “Can Do, But Not Quickly/Easily” or “Can Do, But Still Prompt Dependent”

• GOAL: increasing the speed of responding, performing the skill smoothly

• Example: It was observed that Shawn can complete all the steps. He requires prompts but the latency between prompts has decreased. If left to follow a recipe independently, Shawn will either stare at the recipe and not do anything without someone telling him what to do or will just start getting random ingredients out and become confused and start self talking until redirected.

Stage of Learning: Skill Fluency


• “Can’t Continue Long‐Term Use Of” or “Can Only Complete Skill One Way”

• GOAL: retaining and using the skill or behavior consistently and outside of the instructional universe

• Example: In school, Shawn learned how to follow a recipe and prepare a simple meal to full independence. He has only remembered how to make macaroni and cheese and will make it when his mom is home, but when he is dad is home, he seems to be unable to remember the steps to preparing the meal.

Stage of Learning: Skill Maintenance/Generalization


• Ask yourself and the team (including participant): How does the participant perform this skill/behavior right now? How do YOU perform this skill? How often? Have they ever done the skill? Do they engage in other skills/behaviors when prompted to

begin? Do they rely on others to begin or finish the skill? Does the participant know when they have completed the skill? If the participant does not learn how to do this skill, what would

happen? Is it realistic for the participant to learn this skill independently or

will some support always be needed?

How Do You Determine the Stage of Learning?


• Move from skill acquisition to fluency to generalization Decreasing the number of prompts per step or overall Fading the type of prompts from most‐intrusive to least‐

intrusive with the ultimate goal of independence Ensuring the participant can complete a certain step(s) for a

certain amount of time before moving on Consider the use of different materials, across different

people, in different settings, different times of day, etc… May start in one stage of learning at beginning of plan year

and then move toward another stage as learning progresses

Suggestions when considering stage of learning


Examples


Sally requires constant direct verbal prompts from staff to complete most tasks around the house and does not yet have a set routine. It will be important for her to acquire these skills when planning for independent living.

What stage of learning should the focus of the GAS chart begin?1) Skill Acquisition2) Skill Fluency3) Skill Maintenance/Generalization


ANSWER:Sally requires constant direct verbal prompts from staff to complete most tasks around the house and does not yet have a set routine. It will be important for her to acquire these skills when planning for independent living.

What stage of learning should the focus of the GAS chart begin?

1) Skill Acquisition2) Skill Fluency3) Skill Maintenance/Generalization


Jason needs reminders and redirection to stop yelling and banging objects around in the office as he does not have any other coping skills.



ANSWER:Jason needs reminders and redirection to stop yelling and banging objects around in the office as he does not have any other coping skills.

What stage of learning should the focus of the GAS chart begin?

1) Skill Acquisition2) Skill Fluency3) Skill Maintenance/Generalization


Louis knows how to complete his tasks while at work. However, sometimes he forgets certain steps or does not complete them thoroughly. In order to ensure he retains his position, he will need to strengthen this skill.



ANSWER:Louis knows how to complete his tasks while at work. However, sometimes he forgets certain steps or does not complete them thoroughly. In order to ensure he retains his position, he will need to strengthen this skill.

What stage of learning should the focus of the GAS chart begin?1) Skill Acquisition

2) Skill Fluency3) Skill Maintenance/Generalization


GAS IS ONLY AS GOOD AS THE GOALS & OBJECTIVES WRITTEN


• 1 skill, 1 goal, 1 objective• All providers should use the correct format when writing

goals and objectives

Goals and Objectives‐ BAS Expectations


Examples


What is wrong with Sally’s goal/objective? Select all that apply.

Goal Phrase: Routine of household choresGoal Statement: Sally will complete a routine of household chores (e.g. making bed, laundry, doing dishes, vacuuming) following a task analysisAnnual Objective:

Condition: After waking up and getting ready for the day,Behavior: Sally will complete a routine of household chores (e.g. making bed, laundry, doing dishes, vacuuming) following a task analysis, completing 11/13 steps independently.Criteria: completing 11/13 steps independently, two times per week for one consecutive month.


ANSWER:What is wrong with Sally’s goal/objective? Select all that apply.

Goal Phrase: Routine of household chores Goal Statement: Sally will complete a routine of household chores (e.g. making bed, laundry, doing dishes, vacuuming) following a task analysisAnnual Objective:

Condition: After waking up and getting ready for the day,Behavior: Sally will complete a routine of household chores (e.g. making bed, laundry, doing dishes, vacuuming) following a task analysis, completing 11/13 steps independently.Criteria: completing 11/13 steps independently, two times per week for one consecutive month.


What is wrong with Jason’s goal/objective? Select all that apply.

Goal Phrase: Coping Skills (Behavior)Goal Statement: Jason will utilize coping skills including deep breathing, counting to 10 or requesting a break Annual Objective:

Condition: When task assignments change at work Behavior: Jason will utilize coping skills Criteria: 4 out of 5 times a week


ANSWER:What is wrong with Jason’s goal/objective? Select all

that apply.Goal Phrase: Coping Skills (Behavior)Goal Statement: Jason will utilize coping skills including deep breathing, counting to 10 or requesting a break Annual Objective:

Condition: When task assignments change at work Behavior: Jason will utilize coping skills Criteria: 4 out of 5 times a week


What is wrong with Louis’ goal/objective? Select all that apply.

Goal Phrase: Employment/EducationGoal Statement: Louis will talk with Supervisor to obtain task list for the day, ask any questions as needed, and complete assigned tasks thoroughly 4/5 times a weekAnnual Objective:

Condition: Louis will obtain task list for the dayBehavior: Louis will obtain task list for the day, ask any questions as needed, and complete assigned tasks thoroughlyCriteria: 4/5 times a week for 12 consecutive weeks, independently


ANSWER:What is wrong with Louis’ goal/objective? Select all

that apply.Goal Phrase: (Employment/Education)Goal Statement: Louis will talk with Supervisor to obtain task list for the day, ask any questions as needed, and complete assigned tasks thoroughly 4/5 times a weekAnnual Objective:

Condition: Louis will obtain task list for the dayBehavior: Louis will obtain task list for the day, ask any questions as needed, and complete assigned tasks thoroughlyCriteria: 4/5 times a week for 12 consecutive weeks, independently


COMPLETING THE GAS CHART

49

GAS Chart

Example- Sally

Example‐ Jason

Example‐ Louis


GAS template and new features


Let’s Walk Through This, Step‐by‐Step


Step 1‐Demographics

Level of Attainment Quarter 1Dates:

Quarter 2Dates:

Quarter 3Dates:

Quarter 4Dates:

Much less than expected

‐2

Somewhat less than expected

‐1

Expected level of outcome

0

Somewhat more than expected

+1

Much more than expected

+2

Level of Attainment per quarter

Comments

Instructional Decision

Step 2: Enter dates for each quarter.

2


Examples

Not Completed Correctly (assuming PED is 7/14/16)

Completed Correctly (assuming PED is 7/14/16)


Quarter 2Dates:

Quarter 3Dates:

Quarter 4Dates:


‐2Baseline goes here


‐1


0Annual criteria

component of the objectivegoes here


+1


+2


Comments


Steps 3 & 4: Enter Baseline and Annual CriteriaBaseline should align with info in SBP chart. Annual should indicate the realistic expected outcome at the end of the plan year.

34


• Need to know current level of performance (baseline) as aligned with criteria in the objective

• Quantitative! • Alignment with objective is also needed (e.g. if objective

talks about % completed, baseline should also talk about % completed)

Is the baseline realistic and entered correctly?


Examples

Completed Correctly (assuming objective criteria is “…100% of task analysis independently for one month)

Not Completed Correctly (assuming objective criteria is “…100% of task analysis independently for one month)


• Should match exactly with criteria from objective and entered into quarter 4, Level 0

• Quantitative!

Is the annual criteria from the objective realistic and entered correctly?


Examples

Not Completed Correctly (assuming objective criteria is “…100% of task analysis independently for one month)

Completed Correctly (assuming objective criteria is “…100% of task analysis independently for one month)


Quarter 2Dates:

Quarter 3Dates:

Quarter 4Dates:


‐2


‐1


0Expected Outcome at the end of Quarter 1

Expected Outcome at the end of Quarter 2

Expected Outcome at the end of Quarter 3


+1


+2


Comments


Step 5: Enter Expected Outcome for Each QuarterEnter the progress the participant should make at the end of each quarter.

5


• Keep similar format as baseline and annual• This is where the GAS gets tricky so it may be trial and error

as you work through filling out the rest of the chart (see next question for more guidance)

• Remember, the expected level is the GOAL of that quarter so it needs to be something the participant has a realistic chance of achieving!

Are the expected level of outcomes for score “0” in Quarters 1, 2 and 3 realistic and entered correctly?


Examples

Completed Correctly (assuming there are 10 steps on the TA)


Examples

Not Completed Correctly (assuming there are 10 steps on the TA)


Quarter 2Dates:

Quarter 3Dates:

Quarter 4Dates:


‐2


‐1


0


+1


+2


Comments


Steps 6, 7, &8: Fill in Additional Sections of GAS ChartEnter the criteria to indicate what it would look like for the participant to attain more or less progress for each quarter. Some information will be duplicated as noted below.

6a6b

6a 7a 8a

7a 8a

6b

7b

7b

8b

8b


Quarter 2Dates:

Quarter 3Dates:

Quarter 4Dates:


‐2


‐1


0


+1


+2


Comments


Steps 9 & 10: Fill in the Rest of the Chart

910a

10b


• Filling out the remainder of the chart may result in changes to the expected level of outcomes.

• Remember, sometimes having more than one variable in a cell helps (when there are less than 11 steps on the TA) and sometimes it makes things more complicated (because it becomes harder to reach a level)

Is the remainder of chart realistic and complete?


ExamplesCompleted Correctly (assuming there are 10 steps on the TA)


ExamplesNot Completed Correctly (assuming there are 10 steps on the TA)


ADDITIONAL TIPS FOR GAS CHART DEVELOPMENT

74


• Including baseline and annual criteria (from the objective), there are 14 unique increments of change that need to be captured in the GAS chart.

• Common concerns we hear:“I do not know how to break the criteria down enough to

fill out the entire chart.” or

“The task analysis only has 8 steps which is not enough to fill out the chart.”


• Every cell in the GAS chart is CRITERIA to determine progress for each quarter in a plan year

• Determining criteria begins with the objective and the baseline! Example:

• Objective: When it is dinnertime and the dinner alarm goes off, Shawn will prepare a meal from a recipe card following a task analysis, 8 out of 11 steps independently, with the rest of the steps requiring no more than a gesture prompt for one month.

• Baseline: Although he can perform each step on the task analysis, he requires model prompts and completes 0 steps independently.


• Use “no more than” or “less than” or “average” to account for multiple variables in a criteria

• If participant will acquire the skill before end of the plan year based upon your best guess (100% independence) or (as defined) prompts, identify which quarter that would occur and then start adding how long (e.g. for 4 weeks, 5 weeks…) The complete criteria is still needed for Quarter 4, Level 0,

which should always include “how long”


Submit completed GAS chart(s) to the SC so they can enter information into the ISP


IMPLEMENT AND REPORT PROGRESS


• If participant falls between 2 levels of attainment in a given quarter, then score in the lower level

• +2 in a quarter means anything above and beyond all the levels of attainment written for that quarter

• ‐2 in a quarter means anything below or less than all the levels of attainment written for that quarter

• Remember: In order for a participant to score at a certain level, ALL components must be met

Rules to Remember when Determining Level


• You should now have an introductory understanding of what GAS is and an understanding of what resources to use to develop the chart.

• You will not become proficient at developing GAS charts until you gain practical experience.

As a result of this training

goal attainment scaling (gas) - store & retrieve data anywhere€¦ · goal attainment scaling...

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