RS510 Chap.8 Performance Factors and Goal Attainment Scaling
Performance Factors and Goal Attainment Scaling
What moves a score
The practical session lists factors that affect cognitive performance: mood, medication, concentration, comprehension, motivation including possible secondary gain, physical problems, intoxication, psychiatric and pre-existing neurological conditions, testing outside the first language, cultural bias and prior familiarity with the test.
A report should name any that were present.
Measuring functional change
Impairment scores cannot show functional progress, such as better task performance once a compensatory strategy is used. Goal attainment scaling can: it rates progress toward an individual goal on five levels from minus two to plus two, built through eight steps from an overall objective to a baseline and evaluation date.
Its strengths are individualisation, sensitivity and motivation; its weaknesses are inconsistent implementation, training demands, subjectivity, time and difficulty making levels equidistant.
Using the scale well
A good scale starts from one broad objective, breaks it into specific problem areas, and names an indicator that someone other than the therapist could observe.
The expected level should be realistic within a fixed time, the other four levels should change only one variable, and the baseline should land on a defined level so that change can be read directly. Setting the goal with the person is part of the method's value, since the session lists motivation and shared decision-making among its advantages, but the rating is more trustworthy when someone independent makes it.
What this chapter covers
- 01
Person, history and test factors that affect performance
- 02
Secondary gain and consistency of effort
- 03
Impairment scores versus functional outcomes
- 04
Advantages and disadvantages of goal attainment scaling
- 05
The eight steps for implementing a scale
- 06
SMART goals and scoring from minus two to plus two
- 07
Checking levels for overlaps and gaps
Worked example · free
Repair a goal attainment scale with a gap
- 2Identify the gap.
- 2Explain why the baseline exposes it.
- 2Rewrite the levels.
Key terms
- Secondary Gain
- A benefit, such as compensation, that may follow from a finding of impairment and can affect a person's motivation during testing.
- Expected Level
- The zero level of a goal attainment scale, defined as a successful and realistic outcome within a set time.
- SMART Goal
- A goal that is specific, measurable, attainable, relevant and bounded in time, as each goal inside a goal attainment scale should be.
Performance Factors and Goal Attainment Scaling FAQ
Why are cognitive test scores not enough to evaluate a programme?
They measure impairment in a domain. A programme that teaches a compensatory strategy may improve a person's daily task performance without changing that impairment, so the score stays flat while life improves. The practical session presents goal attainment scaling as the measure of actual performance in functional tasks.
What are the weaknesses of goal attainment scaling?
It is implemented inconsistently, which affects reliability and validity; it needs training and experience; it is open to bias unless goal setting and rating are done independently; it takes time to build good scales; and it is hard to make levels equidistant or to scale complex or abstract goals.
Which factors should I check before interpreting a low score?
The person's mood, medication, concentration, comprehension and motivation, physical problems such as pain or sensory loss, intoxication, psychiatric or earlier neurological conditions, whether the test was in their first language, possible cultural bias and whether they already knew the test. Any one can lower a score without the deficit you are looking for.
How are goal attainment levels defined?
The expected outcome within the set time is level zero. Somewhat better than expected is plus one and the most favourable outcome plus two; somewhat less than expected is minus one and the least favourable minus two. Goals are expected to be SMART, that is specific, measurable, attainable, relevant and bounded in time, and each level must be distinct and measurable.
Assessment move
Build one goal attainment scale for your own client before you read further. Then hand it to a classmate and ask them to score three invented results; any disagreement between you shows a level that is not yet observable.
