ACQ Vol 10 No 2 2008

Work– l i f e balance : preserv i ng your soul

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

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

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