DeepDyve requires Javascript to function. Please enable Javascript on your browser to continue.
Feasibility, reliability and validity of a modified approach to goal attainment scaling to measure goal outcomes following cognitive remediation in a residential substance use disorder rehabilitation setting Feasibility, reliability and validity of a modified approach to goal attainment scaling to...
Berry, Jamie; Marceau, Ely M.; Lunn, Jo
2023-12-31 00:00:00
AUSTRALIAN JOURNAL OF PSYCHOLOGY 2023, VOL. 75, NO. 1, 2170652 https://doi.org/10.1080/00049530.2023.2170652 Feasibility, reliability and validity of a modified approach to goal attainment scaling to measure goal outcomes following cognitive remediation in a residential substance use disorder rehabilitation setting a,b c c,d Jamie Berry , Ely M. Marceau and Jo Lunn a b Department of Psychology, Macquarie University, Sydney, NSW, Australia; Advanced Neuropsychological Treatment Services, Strathfield South, NSW, Australia; School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia; We Help Ourselves (WHOs), Lilyfield, NSW, Australia ABSTRACT ARTICLE HISTORY Received 17 April 2022 Objective: Although person-centred outcome measures have been recommended to evaluate Accepted 24 October 2022 cognitive rehabilitation interventions, few validated measures have been developed for this purpose. The current study examined aspects of feasibility, reliability and validity of a modified KEYWORDS version of goal attainment scaling that uses a goal menu, calculator and control goals. Goal attainment scaling; Method: Participants were N=25 female residents of a substance use disorder therapeutic GAS; goal setting; substance community who were allocated to a four-week cognitive remediation (n=13) or treatment as use disorder; cognitive usual (n=12) control group in a controlled sequential groups trial. Modified goal attainment remediation scaling was used to set goals. Limited efficacy and efficiency, quality appraisal criteria, and convergent and discriminant validity of target and control goals were used to examine feasibility, reliability and content validity, and construct validity, respectively. Results: Target goals were achieved at a higher rate than control goals for the Intervention, but not Control, group, with a medium effect size (r = 0.5). The approach was efficient and 44% of reliability and 75% of content validity criteria were met. Target goals correlated more strongly than control goals with the Behavior Rating Inventory of Executive Function - Adult version. Conclusions: The modified approach to goal attainment scaling demonstrated aspects of feasibility, reliability and validity. KEY POINTS What is already known about this topic: (1) Cognitive remediation is a promising intervention for people with substance use disorder. (2) Goal attainment scaling captures individualised person-centred goals. (3) There is much variability in the quality and application of goal attainment scaling. What this topic adds: (1) Modified goal attainment scaling is feasible in substance use disorder treatment research. (2) Modified goal attainment scaling meets several reliability and validity criteria. (3) Modified goal attainment scaling can be used to generate an effect size using nonpara- metric techniques. Introduction whether person-centred goals are achieved post- Decades of research has focused on the question of intervention. whether and how cognitive functioning may be A recent systematic review concluded that although improved following acquired brain injury (Cicerone cognitive remediation is a promising approach for et al., 2000, 2005, 2011, 2019; Ponsford et al., 2014; improving cognition and treatment outcomes for peo- Tate et al., 2014; Togher et al., 2014; Velikonja et al., ple with substance use disorders, there was consider- 2014), and more recently substance use disorder able heterogeneity in the types of interventions, (Nardo et al., 2022). Although this research has com- participant characteristics and outcome measures monly focused on changes in scores on cognitive tests (Nardo et al., 2022). The outcome measures in the or standardised questionnaires following a course of reviewed studies could be classified as being either intervention, much less attention has been paid to performance-based (i.e., cognitive tests) or inventory- CONTACT Jamie Berry jamie.berry@mq.edu.au Supplemental data for this article can be accessed at https://doi.org/10.1080/00049530.2023.2170652. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 2 J. BERRY ET AL. based (i.e., questionnaires). None of the studies utilised subgoals; and breaking down subgoals into five GAS goal setting approaches to evaluate whether the inter- levels. A comprehensive critique of the GAS methodol- ventions resulted in individual goal attainment per- ogy adopted in that study was subsequently under- taining to everyday functioning (i.e., ecological goals) taken by two of the authors, and recommendations despite multiple systematic reviews of evidence-based were made to address GAS methodology limitations, cognitive rehabilitation for acquired brain injury including: having only one variable per GAS scale; emphasising the importance of developing and utilis- considering all possible outcomes; defining all five ing measures of everyday real-world functioning GAS levels; ensuring that all five GAS levels are (Cicerone et al., 2000, 2005, 2011, 2019). mutually exclusive; ensuring that all goals are mutually exclusive; and ensuring there are no gaps between GAS levels (Grant & Ponsford, 2014). The length of Goal attainment scaling time taken to set and scale the goals was also proble- matic, with 2–4 hours required to set and scale three Goal Attainment Scaling (GAS) was developed more goals (Grant & Ponsford, 2014; Grant et al., 2012). than half a century ago to measure unique and individualised goal outcomes for clients of outpati- ent mental health services (Kiresuk & Sherman, The current study 1968). Individualised goals that are difficult to cap- ture using standardised measures are set and each The current research aimed to address many of the goal is scaled so that a range of post-intervention quality appraisal criteria of Krasny-Pacini et al. (2016) goal outcomes are represented across five levels. and the practical GAS scale construction difficulties The levels are assigned scores of −2 (representing noted by Grant and Ponsford (2014) by applying a much worse than expected outcome), −1 (repre- a novel modified version of GAS in evaluating indivi- senting a worse than expected outcome), 0 (repre- dualised goal outcomes following cognitive remedia- senting the expected outcome), +1 (representing tion offered to residents of an SUD treatment program. a better than expected outcome) and+2 (represent- Marceau et al. (2017) previously showed that a 12- ing a much better than expected outcome). session cognitive remediation program resulted in Typically, the post-intervention GAS outcome scores improvements in inhibition (Stroop test; Golden & are entered into a formula and a T-score is calcu- Freshwater, 2002) and self-reported impulsivity lated, which summarises the outcomes for an indi- (Barratt Impulsiveness Scale; Patton et al., 1995), self- vidual across all their goals (Kiresuk & Sherman, control (Brief Self-Control Scale; Maloney et al., 2012) 1968). and executive functions (Behavior Rating Inventory of In their proposed criteria for evaluating GAS scales Executive Function – Adult version – BRIEF-A; Roth as outcome measures in rehabilitation research, et al., 2005) compared to a treatment as usual control Krasny-Pacini et al. (2016) reviewed the major criti- condition in a female-only therapeutic community. By cisms that GAS methodology has attracted, being: way of extending these findings, a purpose of the unknown clinimetric qualities due to the idiosyncratic current study was to examine whether modified GAS nature of GAS (Steenbeek et al., 2007); subjective scor- was also sensitive to the intervention, hence demon- ing; risk of choosing goals that are clinically irrelevant strating convergent validity. or too easy or challenging to achieve (Ruble et al., Setting both control and target goals allows each 2012); the ordinal nature of the scales with a lack of individual to act as their own control, and hence allows equidistance between GAS levels (Tennant, 2007; for the calculation of an effect of target to control goal Turner-Stokes et al., 2010); and inappropriate use of attainment for each individual. Whilst this approach T-scores with subjective values (MacKay et al., 1996; was adopted in an evaluation of physical therapy out- Malec, 1999; Schlosser, 2004). comes for individuals with severely limited physical Grant et al. (2012) found that Goal Management and cognitive abilities (Brown et al., 1998), the effect Training (Levine et al., 2011) resulted in sustained size was inappropriate as it utilised GAS T-scores rather improvements on a range of daily activities among than non-parametric methods. We addressed this lim- individuals with severe traumatic brain injury using itation by applying non-parametric analyses in the GAS. However, they noted several practical limitations present study. of using GAS, including: identifying appropriate goals The general hypotheses were that the modified for each participant; breaking down large goals into approach would be feasible according to two of AUSTRALIAN JOURNAL OF PSYCHOLOGY 3 Bowen et al’.s (2009) feasibility criteria: i) limited be able to find things quickly and easily), initiative (e.g., efficacy (i.e., that calculation of an effect size of to do things right away), persistence (e.g., to see things target to control goals was possible) and ii) practi- through to completion), flexibility (e.g., to respond cality (i.e., that the approach would be efficient). It better to change) and memory/attention (e.g., to con- was also predicted that the approach would centrate better whilst ______). demonstrate reliability and validity according to the Krasny-Pacini et al. (2016) quality criteria and Maximum realistic level and current functioning that construct validity would be demonstrated in questions relation to a standardised self-report inventory of For each of the 20 goal menu items, a maximum rea- executive functioning. listic level (MRL) and current functioning (CF) question The specific hypotheses were that: i) participants example was provided to guide the examiner when in the intervention group would attain their target setting goals with the participant (see Supplement 2). goals at a higher rate than their control goals, whereas those in the control group would have equal target and control goal attainment; ii) goal Procedure selection and scaling would be more efficient than Ethics approval to conduct this study was granted by that described in Grant and Ponsford (2014); iii) the the University of Wollongong and Illawarra and majority of the Krasny-Pacini et al. (2016) GAS qual- Shoalhaven Local Health District Health and Medical ity appraisal criteria for reliability and content valid- Human Research Ethics Committee (approval number ity would be met, and iv) there would be a stronger HE15/206). correlation between the BRIEF-A (Roth et al., 2005) and target goals than control goals. Study design The study was a controlled sequential groups trial, with Method recruitment commencing in July 2015. After providing consent to participate in the research, participants were Participants assigned to either a treatment as usual (Control) or Participants were N = 25 residents of a female-only resi- treatment as usual plus cognitive remediation dential SUD therapeutic community in Sydney, (Intervention) group. All residents of the service at the Australia. Inclusion criteria for the study were: (i) diag- time of recruitment were invited to participate in the nosis of SUD (a condition of entry into the rehabilitation trial, and the participation rate was 96%. The facility, which was confirmed using the Mini- Intervention group was recruited first followed by the International Neuropsychiatric Interview – MINI-Plus; Control group, following a washout period when all Sheehan et al., 1998), (ii) a minimum abstinence period Intervention participants had exited the program. of 7 days (with confirmation of detoxification), (iii) Participants in the Intervention group attended a total absence of any self-reported neurological, infectious, of 12 × two-hour group sessions across 4 weeks (three or other disease affecting the central nervous system sessions per week). Each two-hour session comprised except for traumatic brain injury due to the high pre- a strategy training component (1 hour) and compu- valence of traumatic brain injury in residential SUD terised cognitive training component (1 hour). All ses- rehabilitation facilities (Marceau et al., 2016), (iv) sions were facilitated by the first author (JB) and co- English as a first language and (v) GAS data available facilitated by the second author (EMM) who was also at four-month post-intervention follow-up. A condition involved in pre- and post-intervention testing. of staying at the residential facility was that participants remained abstinent from substances of misuse. Intervention Strategy training. The group-based cognitive reme- diation intervention was developed with a strong Materials emphasis on the remediation of executive functions Goal menu and self-regulation in view of the finding that A goal menu comprising 20 everyday self-control and executive functioning is particularly impaired in an executive functioning behaviours was developed (see SUD treatment population (Fernández-Serrano et al., Supplement 1). Items reflected healthy daily habits 2010; Valls-Serrano et al., 2016). Details regarding (e.g., to eat healthier food), impulse control (e.g., to the elements and structure of the program are control my temper or emotions), organisation (e.g., to found in Marceau et al. (2017). The facilitators 4 J. BERRY ET AL. followed a manual to ensure treatment consistency. Modified goal attainment scaling Participants were required to select any goal of Table 1 outlines instructions for the modified GAS goal their choosing in order to apply a mental contrast- setting, scaling and assessment processes as well as ing with implementation intentions exercise in a hypothetical example. This approach was based on modules eight and nine. Intervention group partici- use of an online calculator that automatically calcu- pants were provided with their target GAS goals to lated the GAS ranges based on the participants’ cur- use for this exercise if they wished. rent level of functioning and their maximum realistic level of functioning for the chosen goal behaviour, adopted from Clark et al. (2021). Computerised cognitive training. The strategy- based training comprised the first hour of each session. In the second hour, following a short Analysis break, participants played specific Lumosity games (Lumosity, 2021) on iPads in a group set- Hypothesis 1: limited efficacy ting. They were instructed to use and practice the Two target and two control goals were chosen for strategies they learnt about in the previous hour each participant using the approach described in of strategy training. After each of three 10–15-min Table 1. Notably, although the target goals were blocks of computerised training, the facilitator explicitly chosen by the participants, the control asked participants to share with the other group goals were set implicitly by asking the Maximum members the strategies they found useful whilst Realistic Level and Current Functioning questions completing the cognitive training exercises. pertaining to goal menu items that the examiner randomly selected. Follow-up GAS scores were subtracted from the consistent baseline score of Data collection −2 (outcome range 0–4). Although some studies All participants completed the GAS goal setting pro- have allowed for the pre-intervention GAS level to cess, together with a battery of cognitive tests and be −1, rather than −2 to account for the possibility questionnaires (Marceau et al., 2017) at baseline. Post- of deterioration, this limits the range of goal intervention measures were collected at an average attainment to four, rather than five levels. Ruble of 4.5 weeks (SD = 0.55) following baseline assess- et al. (2012) have argued that the use of ment, allowing a four-week period for the groups to a consistent −2 baseline is justifiable in popula- receive treatment. A third assessment (follow-up) tions that are not expected to deteriorate, and including a final GAS outcome measurement was maintaining the five-point GAS scale for clinical undertaken at an average of 21.2 weeks (SD = 4.14) purposes was supported in a review of GAS in post-baseline, which was used in the current study acquired brain injury rehabilitation (Ertzgaard because the post-intervention outcomes included et al., 2011). Applying a consistent −2 baseline a retrospective evaluation period that overlapped also ensures compliance with the recommendation with the active intervention or control phase. by Krasny-Pacini et al. (2016) for the pre- intervention score to be comparable between groups. Measures Wilcoxon Signed Rank tests were used to ana- lyse differences between target and control goals Behavior rating inventory of executive function – (within participants), whereby it was predicted adult version (BRIEF-A; Roth et al., 2005) that there would be a significant difference for The BRIEF-A is a 75-item self-report questionnaire the Intervention, but not the Control group. consisting of nine subscales. Participants are A power analysis revealed that a sample size of instructed to answer each question by selecting 10 was required to detect a population mean never, sometimes, or often, in relation to the fre- difference of 1 with a population standard devia- quency with which they have had problems with tion of 1, power of .8 and alpha of .05. The med- any of the listed behaviours in the previous month. ian scores across the two target goals and the two The Global Executive Composite (GEC) provides an control goals were used in the analyses. The for- overall summary score on a T-distribution, with mula for a Pearson r effect size based on Wilcoxon higher scores indicating more severe impairment. AUSTRALIAN JOURNAL OF PSYCHOLOGY 5 Table 1. Modified GAS instructions and a hypothetical example. Step Instructions Hypothetical example 1 Explanation State: “Over the course of this study, we are interested in E: “Over the course of this study, we are interested in knowing whether your memory, thinking and self- knowing whether your memory, thinking and self- regulation skills improve in day-to-day activities”. regulation skills improve in day-to-day activities”. 2 Goal selection Hand the Goal Menu to the participant and explain: “Choose E: “Choose two goals from this goal menu that you would two goals from this goal menu that you would like to like to work on” P: Chooses goal 15, To remember_____ work on” and specifies: “To remember to bring the things I need with me” (only one goal is exemplified here) 3a Goal specification State: “OK, so let’s make those goals really specific to you to E: “OK, so let’s make those goals really specific to you to make sure we are measuring real changes in your life” make sure we are measuring real changes in your life. and ask about specific real-world examples for each of What is an example of a situation where you need to the selected goals. remember to bring the things you need?” 3b Goal specification – Document the responses to questions in 3a for each “To bring a pen and notepad to group sessions” is documentation selected goal documented 4a Establishing Refer to Maximum Realistic Level and Current Functioning E: “In a typical week, how many group sessions do you maximum realistic Questions and ask the relevant MRL question for each attend?” P: “10” level selected goal 4b Maximum Document the responses to the questions in 4a “10” is documented as the MRL realistic level documentation 4c Establishing current Refer to Maximum Realistic Level and Current Functioning E: “How many times per week do you remember to bring functioning Questions and ask the relevant CF question for each your pen and notepad to groups?” P: “5” selected goal 4d Current functioning Document the responses to the questions in 4c “5” is documented as the CF documentation 5 Ensure five levels of Subtract 4d from 4b. If less than 4, double both 4d and 4b 10–5 = 5 (no need to double the values and denominator measurement until difference is > = 4. Each time 4b and 4d are doubled, because 5 > = 4) the measurement interval (denominator) should also be doubled. For example, “per week” doubled becomes “per fortnight” and “per fortnight” doubled becomes “per month” a b a 6a Calculation of the Enter MRL and CF values from steps 4b and 4d (if Enter the following values into the online calculator: MRL = c b GAS levels/scale difference is > = 4) or new values from step 5 (with 10, CF = 5 difference > = 4) into the calculator at gas2.com.au 6b Ensure goal Ensure the goal (“expected” outcome from the calculator The “expected” outcome of remembering to bring a pen achievability output) is achievable. If not, reconsider the MRL and and notepad to groups 8 times per week is achievable. modify accordingly by repeating steps 4 and 5 with a more realistic MRL 7a Orientation to the Show the participant the calculator output on an electronic +2 much better than expected 10 to 10 GAS scale device or print or transcribe onto paper +1 better than expected 9 to 9 0 expected 8 to 8 −1 less than expected 7 to 7 −2 much less than expected 4 to 6 7b Explanation of the Explain: “So, you’re currently [statement of behaviour] X out E: “So, you’re currently remembering to bring your pen and GAS scale of a possible Y times per [interval]. However, it can be notepad to groups sessions 5 out of a possible 10 times hard to motivate oneself to achieve something at the per week. However, it can be hard to motivate oneself to maximum realistic level when one is nowhere near that achieve something at the maximum realistic level when level currently. So, I suggest the target outcome be in one is nowhere near that level currently. So, I suggest the between where you are currently functioning and that target outcome be in between where you are currently maximum realistic outcome. I have made some functioning and that maximum realistic outcome. I have calculations to show you what I mean. You are currently made some calculations to show you what I mean. You [statement of behaviour] X times per [interval] and, as we are currently bringing your pen and notepad to groups discussed, the maximum realistic level is Y times per sessions 5 times per week and, as we discussed, the [interval]. So, a realistic goal for you might be to maximum realistic level is 10 times per week. So, [statement of behaviour] Z times per [interval] (pointing a realistic goal for you might be to bring your pen and to the GAS = 0 or ‘expected’ range). At the end of the notepad to groups sessions 8 times per week (pointing to trial we will be able to see whether you have achieved the GAS = 0 or ‘expected’ range). At the end of the trial that goal, whether you made progress towards the goal we will be able to see whether you have achieved that but haven’t achieved it (pointing to the −1 GAS level), goal, whether you made progress towards the goal but c c achieved more than the goal (pointing to the+1 GAS haven’t achieved it (pointing to the −1 GAS level: level), made no progress at all (pointing to the −2 GAS bringing your pen and notepad 7 times per week), level) or achieved the maximum realistic level (point to achieved more than the goal (pointing to the+1 GAS the+2 GAS level)” level: bringing your pen and notepad 9 times per week), made no progress at all (pointing to the −2 GAS level: bringing your pen and notepad 4 to 6 times per week) or achieved the maximum realistic level (point to the+2 GAS level: bringing your pen and notepad 10 times per week)” (Continued) 6 J. BERRY ET AL. Table 1. (Continued). Step Instructions Hypothetical example 8 Documentation of Document the GAS scale in full, using the specified goal +2 I bring a pen and notepad to group sessions 10 times per c d the GAS scale for wording, ensuring a time-frame is stipulated. The SMART week target goals goal is represented by the expected outcome (GAS = 0) +1 I bring a pen and notepad to group sessions 9 times per statement. This step can be completed later to save time week during the goal setting process) 0 I bring a pen and notepad to group sessions 8 times per week -1 I bring a pen and notepad to group sessions 7 times per week -2 I bring a pen and notepad to group sessions 4 to 6 times per week 9a Establishing Control goals should be set implicitly, so complete this and Goal 6 on the Goal Menu is randomly chosen by the maximum following steps after some interference task so as to examiner, and the MRL question for that goal is asked, E: realistic level of dissociate the following questions from the goal setting “In a typical week, how often do you need to be control goal process. Randomly choose a non-selected goal on the punctual?” P: “7” (only one control goal is exemplified menu and ask the relevant MRL question for the chosen here) goal 9b Control goal Document the responses to the questions in 9a for each “7” is documented as the MRL maximum selected control goal realistic level documentation 9c Establishing current Refer to Maximum Realistic Level and Current Functioning E: “How many times per week are you currently punctual?” functioning of Questions and ask the relevant CF question for each P: “4” control goal selected control goal 9d Control goal current Document the responses to the questions in 9c for each “4” is documented as the CF functioning selected control goal documentation 9e Ensure five levels of Subtract 9d from 9b. If less than 4, double both 9d and 9b 7–4 = 3. Doubled: 14–8 = 6 (the measurement interval is measurement of until difference is > = 4). Each time 9b and 9d are doubled from “per week” to “per fortnight”) control goal doubled, the measurement interval (denominator) should also be doubled. For example, “per week” doubled becomes “per fortnight” and “per fortnight” doubled becomes “per month” a b a b 9f Calculation of the Enter MRL and CF values from steps 9b and 9d (if MRL = 14, CF = 8 (per fortnight) GAS levels/scale difference is > = 4) or new values from step 9e (with difference > = 4) into the calculator at gas2.com.au 9 g Ensure goal Ensure the goal (“expected” outcome from the calculator The “expected” outcome of being punctual 11 times per achievability output) is achievable. If not, reconsider the MRL and fortnight is achievable. modify accordingly by repeating steps 4 and 5 with a more realistic MRL 10 Documentation of Document the GAS scale in full. This step can be completed +2 I am punctual 14 times per fortnight the GAS scale for later to save time during the goal setting process +1 I am punctual 12 to 13 times per fortnight control goals 0 I am punctual 11 times per fortnight −1 I am punctual 10 times per fortnight −2 I am punctual 7 to 9 times per fortnight 11 Assessment of goal At the predetermined follow-up interval, ask about the E: “How often did you bring a pen and notepad to group attainment frequency of the target and control goals over the sessions in the past fortnight?”; “How often were you relevant time period punctual in the past fortnight?” MRL = maximum realistic level. CF = current functioning. GAS = goal attainment scaling. SMART = specific, measurable, achievable, relevant, time-based. Signed Rank tests (Fritz et al., 2012; Pallant, 2016), Hypothesis 3: reliability and content validity pffiffiffi r ¼ , was used to calculate the effect of treat- The current study was evaluated against the 17 GAS quality criteria proposed by Krasny-Pacini et al. (2016), ment versus control goals for statistically signifi - which includes items to evaluate i) reliability of scale cant differences. construction (four items), ii) reliability of scale rating (five items), iii) content validity (four items) and iv) Hypothesis 2: practicality other (four items) criteria. The focus was on whether Time taken to set and scale a goal was retrospectively most of the reliability and content validity criteria were estimated by the examiner to examine practicality, met. To evaluate equidistance of levels, one of the and specifically the efficiency of goal setting and reliability of scale construction criteria, intraclass scaling. AUSTRALIAN JOURNAL OF PSYCHOLOGY 7 correlations of the GAS level ranges were calculated for The final sample comprised n = 12 Control and n = each of the two target and control goals. To fulfil one 13 Intervention participants. The Control participants of the content validity criteria, the target and control set a total of 24 target and 23 control goals and the goals were classified according to their World Health Intervention participants set a total of 26 target and Organisation International Classification of Health and 23 control goals. However, n = 3 Intervention partici- pants and n = 1 Control participant had set only one Disability (ICF; WHO, 2002) domains. control goal, meaning that median values could not be calculated. Hence, the final analyses were con- Hypothesis 4: construct validity ducted on data from n = 11 Control and n = 10 Bivariate Spearman rank order correlations between Intervention participants. A missing values analysis BRIEF-A GEC scores and both target and control was conducted using Little’s MCAR test (Little, 1988), goal attainment was undertaken to examine con- revealing non-significant results, χ (1) = .899, p = .343, struct validity. It was predicted that there would indicating that the data were missing completely at be a higher correlation between BRIEF-A GEC and random. target goals (convergent validity) than between BRIEF-A GEC scores and control goals (discriminant validity). Hypothesis 1: limited efficacy Target goal attainment (Mdn = 4, 3–4) was greater Results than control goal attainment (Mdn = 2, 1.125–4; Z = 2.232, p = .026) for the Intervention group. The The characteristics of the sample are presented in effect of target versus control goals for the Table 2. 2:232 pffiffiffiffi Intervention group was = .5. There was no There were no significant differences between difference between target (Mdn = 2.5, 2–3) and the Control and Intervention groups for age, t(23) control (Mdn = 3, 1.5–4) goal attainment for the = −.343, p = .735, education, t(23) = .165, p = .87, Control group (Z = −.141, p = .888). estimated premorbid intellect, t(23) = .798, p = .433, primary substance of misuse, χ (5) = 6.804, p = .236, loss of consciousness following head Hypothesis 2: practicality injury, χ (1) = .427, p = .513, or hospitalisation fol- Average time to select and scale a goal was 10 min. lowing head injury, χ (1) = 1.924, p = .165. Table 2. Sample characteristics. Control (n=12) Intervention (n=13) Overall (n=25) Characteristic M SD M SD M SD Age 32.3 8.9 33.7 10.7 33 9.7 Education 11.8 1.6 11.7 2.5 11.8 2.1 TOPF 100.8 12.8 96.9 11.7 98.8 12.1 Years of regular use Alcohol 9.1 5.8 9.8 8.5 9.5 7.2 Amphetamines 6.8 6.4 6.9 5.9 6.8 6 Sedatives 3.8 5.8 2.8 5.6 3.3 5.6 Cannabis 8.1 8 8.1 7.1 8.1 7.4 Heroin 2 3.6 0 0 1 2.6 Cocaine 1.4 3.4 1.3 4.4 1.4 3.9 Primary substance of misuse % % % Methamphetamine 25 46.2 36 Alcohol 41.7 23.1 32 Sedatives 8.3 15.4 12 Other Amphetamines 0 15.4 8 Cannabis 16.7 0 8 Heroin 8.3 0 4 Loss of consciousness after head injury 66.7 53.8 60 Hospitalised after head injury 58.3 30.8 44 TOPF = Test of Premorbid Functioning (Pearson, 2009). includes methamphetamine. 8 J. BERRY ET AL. Table 3. Krasny-Pacini et al. (2016) criteria met in the current study. Criterion Domain Criterion met Comment Content validity Collaborative goal Yes The first step of the GAS process involved giving the participant a choice of the goals they wanted to work setting on. Relevance/ No Although selection of goals from the goal menu indicated relevance to the participant, an external judge importance was not asked to verify the relevance or clinical meaningfulness of the goals ICF classification of Yes Documented in Results section goal types Specificity Yes The 20 goals on the goal menu were related to the broad intervention target of improving executive functioning Reliability of scale construction Equidistance of levels No Equality of levels was not verified by an external judge Preintervention Yes All goals had their baseline set at the −2 GAS level. performance Attainability/ No Although an external judge did not verify the attainability/difficulty of the scales, the examiner and difficulty participant collaboratively appraised the attainability of the scale in step 6b of the method. An external judge would have reduced examiner bias Time-specificity Yes Time 3 (follow up) GAS data were defined as the outcomes. Reliability of scale rating Interrater reliability No Outcomes were based on participant self-report Precise description of Yes The calculator ensured all five GAS levels were clearly defined. all levels Measurability No Outcomes were based on participant self-report Unidimensionality Yes The goal menu, calculator and overall method ensured only one variable was included per goal, and this was additionally confirmed by an external judge (first author) Context of No Outcomes were based on participant self-report of their daily functioning measurement Other criteria Training Yes Training was provided to the examiner, who was given the opportunity to practice GAS scaling with corrective feedback prior to the trial Examiner bias No The examiner was involved in both setting/scaling of the goals and post-intervention scoring Statistical analysis Yes Non-parametric analyses were used to analyse the data and calculate an effect size Provision of a sample Yes Included three examples of full GAS scales scale GAS = Goal attainment scale. ICF = International Classification of Functioning, Disability and Health. Hypothesis 3: reliability and content validity Hypothesis 4: construct validity Table 3 shows that 10 of the 17 (59%) criteria proposed Spearman rank order correlation between BRIEF-A GEC by Krasny-Pacini et al. (2016) were met in the current and target goals was −.455 (n = 14, p = .102). Spearman study. Two of four (50%) reliability of scale construc- rank order correlation between BRIEF-A GEC and con- tion and two of five (40%) reliability of scale rating trol goals was −.199 (n = 12, p = .535). Figure 1 shows criteria were met. Three of four (75%) content validity BRIEF-A GEC (panel A) and Target minus Control goal criteria were met and three of four (75%) other criteria outcomes (panel B) across groups. were met. The intraclass correlation coefficients of the GAS level ranges, which were calculated based on an Discussion absolute agreement, 2-way mixed effects model, for target goal 1 was .987, 95% CI (.974, .994), for target The current study sought to examine the feasibility, goal 2 was .986, 95% CI (.97, .994), for control goal 1 reliability and validity of a modified approach to GAS in was 1, 95% CI (.999, 1), and for control goal 2 was .996, measuring goal attainment for residents of a drug and 95% CI (.993, .998), revealing excellent agreement. alcohol rehabilitation facility who were offered cogni- All 46 control goals and 43 of 50 (86%) target goals tive remediation. Consistent with the first hypothesis, belonged to the ICF Activities and Participation there was significantly greater target than control goal domain. Six (12%) target goals corresponded to the attainment for the Intervention, but not the Control Body Functions domain due to a lack of specificity of group, demonstrating limited efficacy. Furthermore, the goals and one goal was not clear enough to be consistent with the second hypothesis, the modified classified into an ICF domain. See Table 4 for examples GAS approach that made use of goal menus, an online of scaled GAS goals across three Activities and calculator and control goals saved time, with an aver- Participation ICF subdomains. age duration of 10 min to set and scale a goal. This is AUSTRALIAN JOURNAL OF PSYCHOLOGY 9 Table 4. Examples of GAS scale across three activities and participation ICF subdomains. GAS Learning and applying knowledge Level GAS Descriptor goal General tasks and demands goal Self care goal +2 Much better than To concentrate for 56 to 60 To wake up at 6:30am 6 to 7 times To practice mindful eating during 17 to 21 expected minutes in groups per week meals per week +1 Better than To concentrate for 52 to 55 To wake up at 6:30am 5 times per To practice mindful eating during 13 to 16 expected minutes in groups week meals per week 0 Expected To concentrate for 47 to 51 To wake up at 6:30am 3 to 4 times To practice mindful eating during 9 to 12 minutes in groups per week meals per week −1 Less than expected To concentrate for 43 to 46 To wake up at 6:30am 2 times per To practice mindful eating during 5 to 8 minutes in groups week meals per week −2 Much less than To concentrate for 38 to 42 To wake up at 6:30am 0 to 1 times To practice mindful eating during 0 to 4 expected minutes in groups per week meals per week GAS = Goal attainment scale. much quicker than has been reported with conven- of executive functioning, a primary outcome measure tional GAS (Grant & Ponsford, 2014; Grant et al., 2012). of the Marceau et al. (2017) study. Indirectly, this also These efficiency gains constitute evidence for practi- constitutes evidence of sensitivity or responsiveness of cality. Together, these findings support feasibility of modified GAS. the novel approach. Although goal menus have been noted to facilitate Ten of the 17 (59%) criteria advanced by Krasny- quicker generation of GAS goals (Turner-Stokes, 2009), Pacini et al. (2016) were met in the current study. the use of goal menus has been criticised for being However, only four of the nine (44%) reliability criteria contrary to the person-centred individualised were met. The items of interrater reliability, measur- approach of GAS (Grant & Ponsford, 2014; Playford ability and context of measurement were failed et al., 2009). The benefits of a purely individualised because the outcomes were based on participant self- approach without goal menus needs to be weighed report. The criterion of equidistance of levels stipulates against the costs of the added burden and time it takes that the difficulty from one level to the next should be to set highly individualised goals without the structure verified by an external judge and that the levels should of a goal menu to facilitate this process. Use of the be roughly equal (Krasny-Pacini et al., 2016). The cur- calculator ensured unidimensionality, a consideration rent study employed a statistical comparison of the of the range of all possible outcomes, the generation ranges of the GAS levels across the two target and of ranges for all five GAS levels, and that there were no control goals, yielding exceptionally high levels of gaps or overshoots between the GAS levels, hence equivalence (>98%). However, because this was not addressing many of the recommendations made by verified by an external judge, this criterion was con- Grant and Ponsford (2014). sidered to have not been met. Future research may Use of control goals enabled the calculation of the elucidate whether a statistical comparison as effect of the intervention on target goals relative to employed in this study might be sufficient to meet control goals. The Pearson r effect size was .5, consid- this criterion. Although attainability/difficulty was con- ered to be a medium effect (Cohen, 1988), whereby sidered as part of the modified approach, this criterion there is a 67% overlap between the curves for the two was not met because it was not verified by an external conditions (Zakzanis, 2001). This is one of the first judge. studies to utilise non-parametric procedures to calcu- Three of the four (75%) content validity items were late an effect size for GAS as per the Krasny-Pacini et al. met. The only item that was not met was relevance/ (2016) guidelines. There is practical utility in calculating importance, due to non-verification by an external such an effect size relative to a control condition given judge. Three of the four (75%) other criteria were the criticism of GAS being too subjective to be used as met, with the examiner bias item not being met due an outcome measure in clinical trials (Tennant, 2007; to the examiner being involved in both the goal set- Turner-Stokes, 2011). Given the effect pertains to the ting and goal scoring phases. relative attainment of target compared with control The correlation between the BRIEF-A and target goals, with each participant acting as their own con- goal outcomes (convergent validity) was more than trol, the effect size is calculable even when there is no double that between the BRIEF-A and control goal control group. This approach therefore lends itself to outcomes (discriminant validity). Together, these find - clinical research involving single cases and pre-post ings provide evidence for construct validity of modi- group studies. It may also be used as an adjunct to fied GAS outcomes with an inventory-based measure controlled group studies, which do not always find an 10 J. BERRY ET AL. Figure 1. BRIEF-A GEC (panel A) and target minus control goal outcomes (panel B) across the control and intervention groups. Note: BRIEF-A GEC = Behaviour Rating Inventory of Executive Function – Adult version Global Executive Composite; T = Target; C = Control. effect across groups on a single GAS outcome measure “expected” and “better than expected” level on the (Herdman et al., 2018). GAS scale for the Intervention and Control groups, Control goal attainment for both groups was respectively. General non-specific factors associated high, which indicated goal achievement at the with being a client of residential rehabilitation may AUSTRALIAN JOURNAL OF PSYCHOLOGY 11 partly explain this result. It is also possible that compromise. Similarly, retrospective estimation, rather residential rehabilitation, particularly that offered in than prospective recording, of the time taken to set a therapeutic community, may directly target the and scale goals was used. There was insufficient power types of ecological goals that were on the goal to conduct ordinal regression, which could have exam- menu. The high attainment of target goals by the ined interaction effects between group and goal type Control group may also be explained on the basis to demonstrate within- and between-participant dif- of the therapeutic nature of goal setting whereby ferences in goal outcomes. Finally, as there were no the simple act of setting goals may itself result in male participants, generalisation of findings to male greater goal attainment, even when there is no residents of SUD rehabilitation is limited. explicit striving towards the goal (Evans, 2012; Sources of bias evident in the current study Herdman et al., 2018). Regardless, the inclusion of could be addressed in future research by asking control goals was able to control for any non- participants to rate the relevance and importance specific effects associated with the goal setting of goal attainment, having the clinical meaningful- process. ness and attainability of the goals rated by an The modified approach to goal setting adopted external judge, and having an independent rater in this study differs from traditional GAS in that measure post-intervention goal attainment. It is the “expected” outcome is calculated, rather than also recommended that data be collected prospec- predicted. In traditional GAS, the goal setter is tively by both the participants and informants and/ required to predict the goal outcome and then or have independent raters rate video recordings populate the other four levels of the GAS scale, of the behaviours relevant to the goal outcomes whereas modified GAS requires the values for cur- during contrived assessment tasks or in ecological rent level of functioning and maximum realistic settings. level of functioning to calculate the ranges for Another consideration for future research is to the five GAS levels. The current approach involved develop a repository of goals based on the ICF informing participants that it was better to set codes, with associated maximum realistic level and goals at an intermediate point between these current functioning questions and make this avail- two levels rather than to strive for a stretch goal, able to researchers and clinicians to facilitate like-by which accords with the finding that people invest -like comparisons across studies. This would also the highest level of effort in a task when it is allow for the tracking of goal type choice by various perceived to be moderately difficult rather than clinical populations, which could aid in the genera- when it is perceived as very easy or hard to tion of appropriate goal menus for use with parti- achieve (Locke & Latham, 2002). This difference cular clinical groups. in defining the “expected” outcome level arguably represents a fundamental difference in the inter- Conclusion pretation of the final GAS score across these approaches. With traditional GAS, the outcome The present study addresses a gap in the neurop- represents both the goal setter’s goal attainment sychological intervention literature by describing prediction skills and progress towards goals, a novel process of measuring individualised, per- whereas modified GAS outcomes represent pro- son-centred goal outcomes to supplement the gress towards the nominated goals independent results of standardised performance- and inven- of the goal setter’s prediction skills. tory-based measures that are typically used as out- come measures in cognitive intervention evaluation studies (Cicerone et al., 2000, 2005, Limitations and future directions 2011, 2019). The present modified approach to A limitation of the current study was that the GAS met the Bowen et al. (2009) feasibility criteria Intervention group participants were provided with of limited efficacy (i.e., an effect size of target to their target goals during an exercise in the latter part control goals was calculated), and practicality (i.e., of the intervention, which likely inflated the effect size. efficiency of goal identification and scaling). Another limitation was the use of retrospective recall Although content and construct validity were to determine goal outcomes, which is particularly demonstrated, fewer than half of the reliability unreliable in a population characterised by cognitive criteria advanced by Krasny-Pacini et al. (2016) 12 J. BERRY ET AL. were met, requiring further refinement of and Physical Medicine and Rehabilitation, 86(8), 1681–1692. https://doi.org/10.1016/j.apmr.2005.03.024 research into this novel approach to GAS. Cicerone, K. D., Goldin, Y., Ganci, K., Rosenbaum, A., Wethe, J. V., Langenbahn, D. M., Malec, J. F., Bergquist, T. F., Kingsley, K., Nagele, D., Trexler, L., Fraas, M., Bogdanova, Y., & Harley, J. P. Acknowledgements (2019). Evidence-based cognitive rehabilitation: Systematic review of the literature from 2009 through 2014. Archives of The authors would like to acknowledge the residents and Physical Medicine and Rehabilitation, 100(8), 1515–1533. staff of We Help Ourselves (WHOS) New Beginnings. https://doi.org/10.1016/j.apmr.2019.02.011 Cicerone, K. D., Langenbahn, D. M., Braden, C., Malec, J. F., Kalmar, K., Fraas, M., Felicetti, T., Laatsch, L., Harley, J. P., Disclosure statement Bergquist, T., Azulay, J., Cantor, J., & Ashman, T. (2011). No potential conflict of interest was reported by the Evidence-based cognitive rehabilitation: Updated review author(s). of the literature from 2003 through 2008. Archives of Physical Medicine and Rehabilitation, 92(4), 519–530. https://doi.org/10.1016/j.apmr.2010.11.015 Funding Clark, M., Miller, A., Berry, J., & Cheng, K. (2021). Mental contrasting with implementation intentions increases The work was supported by the University of Wollongong study time for university students. The British Journal of Community Engagement Scheme [Faculty of Social Sciences: Educational Psychology, 91(3), 850–864. https://doi.org/10. Partnership Grant], including contribution by industry part- 1111/bjep.12396 ner, We Help Ourselves, and an Australian Government Cohen, J. (1988). Statistical power analysis for the behavioral Research Training Program Scholarship. sciences. Erlbaum Associates. Ertzgaard, P., Ward, A. B., Wissel, J., & Borg, J. (2011). Practical considerations for goal attainment scaling during rehabi- ORCID litation following acquired brain injury. Journal of Rehabilitation Medicine, 43(1), 8–14. https://doi.org/10. Jamie Berry http://orcid.org/0000-0001-6560-2457 2340/16501977-0664 Ely M. Marceau http://orcid.org/0000-0003-0209-9377 Evans, J. J. (2012). Goal setting during rehabilitation early and Jo Lunn http://orcid.org/0000-0002-4054-5641 late after acquired brain injury. Current Opinion in Neurology, 25(6), 651–655. https://doi.org/10.1097/WCO. 0b013e3283598f75 Data availability statement Fernández-Serrano, M. J., Pérez-García, M., Schmidt Río-Valle, J., & Verdejo-García, A. (2010). Neuropsychological conse- The data that support the findings of this study are available quences of alcohol and drug abuse on different components from the corresponding author upon reasonable request of executive functions. Journal of Psychopharmacology, 24(9), https://data.mendeley.com/datasets/3w3rb3stt2/1. 1317–1332. https://doi.org/10.1177/0269881109349841 Fritz, C. O., Morris, P. E., & Richler, J. J. (2012). Effect size estimates: Current use, calculations, and interpretation. References Journal of Experimental Psychology General, 141(1), 2–18. https://doi.org/10.1037/a0024338 Bowen, D. J., Kreuter, M., Spring, B., Cofta-Woerpel, L., Linnan, Golden, C., & Freshwater, S. M. (2002). Stroop color and word L., Weiner, D., Bakken, S., Kaplan, C. P., Squiers, L., Fabrizio, test adult version: A manual for clinical and experimental C., & Fernandez, M. (2009). How we design feasibility uses. Nova Southeastern University: Stoelting. studies. American Journal of Preventive Medicine, 36(5), Grant, M., & Ponsford, J. (2014). Goal attainment scaling in 452–457. https://doi.org/10.1016/j.amepre.2009.02.002 brain injury rehabilitation: Strengths, limitations and recom- Brown, D. A., Effgen, S. K., & Palisano, R. J. (1998). Performance mendations for future applications. Neuropsychological following ability-focused physical therapy intervention in Rehabilitation, 24(December), 661–677. https://doi.org/10. individuals with severely limited physical and cognitive 1080/09602011.2014.901228 abilities. Physical Therapy, 78(9), 934–947. https://doi.org/ Grant, M., Ponsford, J., & Bennett, P. C. (2012). The application 10.1093/ptj/78.9.934 of goal management training to aspects of financial man- Cicerone, K. D., Dahlberg, C., Kalmar, K., Langenbahn, D. M., agement in individuals with traumatic brain injury. Malec, J. F., Bergquist, T. F., Felicetti, T., Giacino, J. T., Neuropsychological Rehabilitation, 22(6), 1–22. https://doi. Harley, J. P., Harrington, D. E., Herzog, J., Kneipp, S., org/10.1080/09602011.2012.693455 Laatsch, L., & Morse, P. A. (2000). Evidence-based cognitive rehabilitation: Recommendations for clinical practice. Archives Herdman, K. A., Davidson, S., Au, A., Davidson, S., of Physical Medicine and Rehabilitation, 81(December), Vandermorris, S., Vandermorris, S., Davidson, S., Au, A., 1596–1615. https://doi.org/10.1053/apmr.2000.19240 Troyer, A. K., & Herdman, K. A. (2018). Comparable achieve- Cicerone, K. D., Dahlberg, C., Malec, J. F., Langenbahn, D. M., ment of client-identified, self- rated goals in intervention and Felicetti, T., Kneipp, S., Ellmo, W., Kalmar, K., Giacino, J. T., no-intervention groups: Reevaluating the use of goal attain- Harley, J. P., Laatsch, L., Morse, P. A., & Catanese, J. (2005). ment scaling as an outcome measure. Neuropsychological Evidence-based cognitive rehabilitation: Updated review Rehabilitation, 29(10), 1–11. https://doi.org/10.1080/ of the literature from 1998 through 2002. Archives of 09602011.2018.1432490 AUSTRALIAN JOURNAL OF PSYCHOLOGY 13 Kiresuk, T. J., & Sherman, R. E. (1968). Goal attainment scaling: Pearson Assessment. (2009) . Advanced clinical solutions for A general method for evaluating comprehensive commu- WAIS-IV and WMS-IV: Clinical and interpretive manual. NCS nity mental health programs. Community Mental Health Pearson Inc. Playford, E. D., Siegert, R., Levack, W., & Freeman, J. (2009). Areas Journal, 4(6), 443–453. https://doi.org/10.1007/BF01530764 of consensus and controversy about goal setting in rehabili- Krasny-Pacini, A., Evans, J., Sohlberg, M., & Chevignard, M. tation: A conference report. Clinical Rehabilitation, 23(4), (2016). Proposed criteria for appraising goal attainment 334–344. https://doi.org/10.1177/0269215509103506 scales used as outcome measures in rehabilitation Ponsford, J., Bayley, M., Wiseman-Hakes, C., Togher, L., research. Archives of Physical Medicine and Rehabilitation, Velikonja, D., McIntyre, A., Janzen, S., & Tate, R. (2014). 97(1), 157–170. https://doi.org/10.1016/j.apmr.2015.08.424 INCOG recommendations for management of cognition Levine, B., Schweizer, T. A., O’connor, C., Turner, G., following traumatic brain injury, part II: Attention and infor- Gillingham, S., Stuss, D. T., Manly, T., & Robertson, I. H. mation processing speed. The Journal of Head Trauma (2011). Rehabilitation of executive functioning in patients Rehabilitation, 29(4), 321–337. https://doi.org/10.1097/HTR. with frontal lobe brain damage with goal management training. Frontiers in human neuroscience, 5(9), 1–9. https:// Roth, R., Isquith, P., & Gioia, G. (2005). Behavior Rating Inventory doi.org/10.3389/fnhum.2011.00009 of Executive Functioning - Adult version (BRIEF-A). PAR. Little, R. J. (1988). A test of missing completely at random for Ruble, L., McGrew, J. H., & Toland, M. D. (2012). Goal attain- multivariate data with missing values. Journal of the ment scaling as an outcome measure in randomized con- American Statistical Association, 83(404), 1198–1202. trolled trials of psychosocial interventions in autism. https://doi.org/10.1080/01621459.1988.10478722 Journal of Autism and Developmental Disorders, 42(9), Locke, E. A., & Latham, G. P. (2002). Building a practically 1974–1983. https://doi.org/10.1007/s10803-012-1446-7 useful theory of goal setting and task motivation. A Schlosser, R. W. (2004). Goal attainment scaling as a clinical 35-year odyssey. The American Psychologist, 57(9), measurement technique in communication disorders: 705–717. https://doi.org/10.1037/0003-066X.57.9.705 A critical review. Journal of Communication Disorders, 37 Lumosity. (2021). www.lumosity.com (3), 217–239. https://doi.org/10.1016/j.jcomdis.2003.09.003 MacKay, G., Somerville, W., & Lundie, J. (1996). Reflections on Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., goal attainment scaling (GAS): Cautionary notes and pro- Janavs, J., Weiller, E., Hergueta, T., Baker, R., & Dunbar, G. C. posals for development. Educational Research, 38(2), (1998). The Mini-International Neuropsychiatric Interview (M. 161–172. https://doi.org/10.1080/0013188960380204 I.N.I): The development and validation of a structured diag- Malec, J. F. (1999). Goal attainment scaling in rehabilitation. nostic psychiatric interview for DSM-IV and ICD-10. Journal Neuropsychological Rehabilitation, 9(March 15), 253–275. Clinica Psychiatry, 59(Suppl. 20), 22–33. https://doi.org/10.1080/096020199389365 Steenbeek, D., Ketelaar, M., Galama, K., & Gorter, J. W. (2007). Maloney, P. W., Grawitch, M. J., & Barber, L. K. (2012). The Goal attainment scaling in paediatric rehabilitation: multi-factor structure of the brief self-control scale: A critical review of the literature. Developmental Medicine Discriminant validity of restraint and impulsivity. Journal and Child Neurology, 49(7), 550–556. https://doi.org/10. of Research in Personality, 46(1), 111–115. https://doi.org/ 1111/j.1469-8749.2007.00550.x 10.1016/j.jrp.2011.10.001 Tate, R., Kennedy, M., Ponsford, J., Douglas, J., Velikonja, D., Marceau, E. M., Berry, J., Lunn, J., Kelly, P. J., & Solowij, N. Bayley, M., & Stergiou-Kita, M. (2014). INCOG recommen- (2017). Cognitive remediation improves executive func- dations for management of cognition following traumatic tions, self-regulation and quality of life in residents of brain injury, part III: Executive function and self-awareness. a substance use disorder therapeutic community. Drug The Journal of Head Trauma Rehabilitation, 29(4), 338–352. and alcohol dependence, 178(June), 150–158. https://doi. https://doi.org/10.1097/HTR.0000000000000068 org/10.1016/j.drugalcdep.2017.04.023 Tennant, A. (2007). Goal attainment scaling: Current methodo- Marceau, E. M., Lunn, J., Berry, J., Kelly, P. J., & Solowij, N. logical challenges. Disability and Rehabilitation, 29(20–21), (2016). The Montreal Cognitive Assessment (MoCA) is sen- 1583–1588. https://doi.org/10.1080/09638280701618828 sitive to head injury and cognitive impairment in Togher, L., Wiseman-Hakes, C., Douglas, J., Stergiou-Kita, M., a residential alcohol and other drug therapeutic Ponsford, J., Teasell, R., Bayley, M., & Turkstra, L. S. (2014). community. Journal of Substance Abuse Treatment, 66, INCOG recommendations for management of cognition 30–36. https://doi.org/10.1016/j.jsat.2016.03.002 following traumatic brain injury, part IV: Cognitive Nardo, T., Batchelor, J., Berry, J., Francis, H., Jafar, D., & communication. The Journal of Head Trauma Borchard, T. (2022). Cognitive Remediation as an Adjunct Rehabilitation, 29(4), 353–368. https://doi.org/10.1097/HTR. Treatment for Substance Use Disorders: A Systematic Review. Neuropsychology Review, 32(1), 161–191. https:// Turner-Stokes, L. (2009). Goal attainment scaling (GAS) in doi.org/10.1007/s11065-021-09506-3 rehabilitation: A practical guide. Clinical Rehabilitation, 23 Pallant, J. (2016). SPSS survival manual: A step by step guide to (4), 362–370. https://doi.org/10.1177/0269215508101742 data analysis using SPSS program (6th ed.). McGraw-Hill Turner-Stokes, L. (2011). Goal attainment scaling and its relation- Education. ship with standardized outcome measures: A commentary. Patton, J. H., Stanford, M. S., & Barratt, E. S. (1995). Factor Journal of Rehabilitation Medicine, 43(1), 70–72. https://doi. structure of the Barratt impulsiveness scale. Journal of org/10.2340/16501977-0656 Clinical Psychology, 51(6), 768–774. https://doi.org/10. Turner-Stokes, L., Baguley, I. J., De Graaff, S., Katrak, P., Davies, L., 1002/1097-4679(199511)51:6<768:AID-JCLP2270510607>3. McCrory, P., & Hughes, A. (2010). Goal attainment scaling in 0.CO;2-1 the evaluation of treatment of upper limb spasticity with 14 J. BERRY ET AL. botulinum toxin: A secondary analysis from a double-blind V: Memory. The Journal of Head Trauma Rehabilitation, 29 placebo-controlled randomized clinical trial. Journal of (4), 369–386. https://doi.org/10.1097/HTR. Rehabilitation Medicine, 42(1), 81–89. https://doi.org/10. 0000000000000069 2340/16501977-0474 WHO. (2002). Towards a common language for functioning, Valls-Serrano, C., Verdejo-García, A., & Caracuel, A. (2016). disability and health ICF (Vol. 1149). https://doi.org/WHO/ Planning deficits in polysubstance dependent users: EIP/GPE/CAS/01.3 Differential associations with severity of drug use and Zakzanis, K. K. (2001). Statistics to tell the truth, the whole intelligence. Drug and Alcohol Dependence, 162, 72–78. truth, and nothing but the truth. Formulae, illustrative https://doi.org/10.1016/j.drugalcdep.2016.02.027 numerical examples, and heuristic interpretation of effect Velikonja, D., Tate, R., Ponsford, J., Mcintyre, A., Janzen, S., & size analyses for neuropsychological researchers. Archives Bayley, M. (2014). INCOG recommendations for manage- of Clinical Neuropsychology, 16(7), 653–667. https://doi. ment of cognition following traumatic brain injury, part org/10.1093/arclin/16.7.653
http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png
Australian Journal of Psychology
Taylor & Francis
http://www.deepdyve.com/lp/taylor-francis/feasibility-reliability-and-validity-of-a-modified-approach-to-goal-SwlT0ujfON
