Implementing an outcomes assessment protocol in an independent practice setting: Using reflection-in-action

Anne Kimball Pike (2000)

A Goal Attainment Scaling/Global Assessment of Functioning (GAS/GAF) outcomes assessment instrument (Clement, 1998) was used to plan and evaluate treatment for 21 patients having managed care subscriptions in my independent psychotherapy practice. Nineteen patients completed treatment using this protocol. Eighty-six percent of these patients attained all of the articulated and scaled goals. Two methods were employed. Method 1 is the GAS/GAF outcomes assessment protocol. Method 2 (Reflection-in-Action) tracks and describes factors influencing role-induction into a collaborative process. Conclusions from across case generalizations highlight the utility of effective problem-setting on goal development and goal attainment. Calculations of the Treatment Effect Score (ES) were problematic due to overestimation of the score derived by averaging averages of scores. ES is calculable for single goals over time, but an overall ES is not calculable through the technique used in this study. Reflection-in-action, a qualitative research technique, was used to track instrument reactivity. Within case data is summarized and generalizations across cases are summarized in matrix form. Instrument reactivity is defined on two continuums. High-low reactivity describes the level of influence the GAS/GAF protocol exerted on the developing therapist-patient collaborative relationship through phases of treatment. Positive-negative describes the level of influence the GAS/GAF had on structuring and evaluating problems, goals and goal attainment. Instrument reactivity was charted as high-positive 7/21, low-positive 6/21, high-negative 4/21 completing treatment using GAS/GAF. Negative reactivity was present in 2/21 who terminated within four sessions, and 2/21 who refused to conclude the rating scale at the first mid-session evaluation.