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peech
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athology
A
ustralia
Work– l i f e balance : preserv i ng your soul
evaluation with DB took 30 minutes, which is equivalent to a
regular therapy session in this setting. Scoring the outcomes
using the scale provided took 15 minutes and calculating the
summary score took 10 minutes.
Discussion
The prediction that the client would reach the “expected level
of outcome”, specified as 0 on the scale, was reached or ex
ceeded for three of the four goals set, with the fourth goal
reaching an outcome “much less than expected”. The aim of
this project was to evaluate the outcomes of PROMPT therapy
in one subject, using GAS. GAS allowed the measurement of
change in the client, in relation to the specified goals. It can be
seen from the follow-up ratings that the client made progress
toward three of the set goals. The t-score is 0.25 “points”
below the mean, indicating overall improvement; however,
one must be cautious in interpreting this score. First, one
cannot disregard the fact that extraneous variables were not
controlled, and therefore change cannot be attributed
confidently to the therapy provided. Second, despite research
in support of the construct validity of GAS, one must question
whether the improvement shown is a measure of the
therapist’s ability to set realistic goals. This second point
raises the issue of interpreting the scores provided by GAS.
It could be said that by making goals small and achievable
enough, progress is more likely. Thus, GAS could be a
measure of how skilled the professional is at setting goals.
However, it is important not to lose sight of the fact that it is a
measure of whether progress is being made with a particular
client, regardless of the size of the steps. Long-term goals as
well as short-term goals could be set and evaluated within
different timeframes, to gauge overall improvement. The
extent of the progress made should not detract from the fact
that it is progress and improvement towards the specific
individualised goals set. GAS has been used effectively to
evaluate programs (Malec, 1999), and the nature of the data
provided has been shown to be useful in team discussions
(Malec, 1999), for example, in making changes to goals, ex
pected outcomes or methods employed to reach particular
goals. Kiresuk and Sherman (1968) recommend sharing the
role of goal-setting across a team as a means of reducing bias
in goal-setting.
It should also be noted that DB missed two therapy sessions
in the period set for GAS, which potentially alters “expected”
outcomes. A further drawback to this study is the fact that
formal assessment was not carried out alongside the GAS
procedure. This would have enabled both a comparison
between outcome measures and an opportunity to evaluate
GAS outcomes. Future studies should include such an
assessment component for comparison.
In this small-scale project, it was found that GAS presented
as a feasible outcome measure to implement in the clinic in
terms of time. Setting the “scale” with possible outcomes took
only 5–10 minutes longer than the usual process of goal-
setting employed in the clinic. The review session was equiva
lent in length to a regular review session conducted in the
clinic, and time taken to collate notes from the review and
rate the client’s performance on the scale provided was
equivalent to the usual time taken to collate data from a
review session with a similar client. Calculating the summary
score was also a relatively quick procedure given that tables
were provided. This could be compared to the time taken to
look up a standard score in a test manual. Overall, it can be
seen that GAS does not require significant additional time as
compared to regular clinical procedures, and could therefore
verbal) and making appropriate eye contact. He has attended
regular therapy using the PROMPT technique over a period
of one and a half years. The GAS procedure was introduced
in the latter months of this period of therapy.
Procedure
Four therapy goals were selected based on assessment results
(primarily the PROMPT System Analysis Observation). It was
planned to review these goals after a period of 10 weeks.
Possible outcomes for each goal were defined on a 5-point
scale as can be seen in table 1.
DB attended 4 half-hour therapy sessions, conducted by a
PROMPT trained therapist, over 10 weeks. In the eleventh
week a second PROMPT trained therapist conducted a review
session to evaluate the goals set, using the 5-point scale.
Individual therapy was conducted in a private speech
pathology clinic with the client’s mother present.
The primary therapist read chapters 1 and 3 of Kiresuk,
Smith and Cardillo (1994) as a guideline for the use of GAS.
The second therapist (follow-up rater) was informed of GAS
follow-up procedures through informal discussion as Kiresuk
et al. (1994) recommend that all parties involved in rating be
familiar with GAS procedures.
GAS scores were calculated based on the follow-up
clinician’s ratings. A t-score was obtained from the Summary
Score Conversion Key (Kiresuk et al., 1994, p. 275).
Table 2 Core word lists – selected in conjunction with
DB’s parent
Word list for
Word list for
Sound/word list
goal 2
goal 3
for goal 4
Tiana
shoe
/n/
driving
blue
/t/
jumping
moo
/d/
hiding
moon
/s/
climbing
book
knee
spoon
ta (thank you)
(final consonant
tea
deletion and cluster
two
reduction acceptable) da (dad)
do
see
In the interest of exploring the feasibility of using GAS in a
clinical setting, the duration of setting and scaling goals,
follow-up evaluation of goals, scoring outcomes and
calculating the summary score were timed. This was
compared to the time usually taken to set goals for clients in
this particular clinical setting.
Results
For goal 1 DB reached a level “somewhat more than expected”
(+1). He was able to produce three numbers without surface
PROMPTs. For goals 2 and 3 DB reached the expected level of
outcome (0). He required a parameter PROMPT for 60–70% of
target words from the goal 2 word list and he was able to
produce 70% of target words from the goal 3 word list with a
verbal cue for lip rounding. The follow-up rater noted that for
goal 3 DB produced 50% of the target words without cues or
PROMPT.
The sum of DB’s scaled scores was equal to –1, the average
scale score was –0.25 and his T-score was 46.37.
It was found that setting goals and scales post-assessment
took 20 minutes, while the time usually taken to set goals
post-assessment ranged from 10 to 15 minutes. Follow-up