Occupational therapists views on GAS-light as an outcome measure in community adult mental health
| Date | 27 June 2024 |
| Pages | 272-287 |
| DOI | https://doi.org/10.1108/MHRJ-09-2023-0050 |
| Published date | 27 June 2024 |
| Author | Ashley Lister,Karen Morris |
Occupational therapists views on
GAS-light as an outcome measure in
community adult mental health
Ashley Lister and Karen Morris
Abstract
Purpose –The paper aims to gain understanding of perceived benefits andbarriers to GAS-light as an
occupational therapy outcome measure in community adult mental health. The study explored
occupational therapists’views on the client-centred nature of GAS-light and whether it is an applicable
outcome measurefor group intervention. It also aimed to understand how occupationaltherapists use of
GAS-lightinformed their practice and the wider multidisciplinaryteam perspective.
Design/methodology/approach –The study used a phenomenological design. This comprising of a
focus group of occupational therapists experienced in using the tool, followed by framework analysis.
Focus groupquestions were derived from literature.
Findings –Three main themes were identifiedto reflect experiences relating to the GAS-light tool as an
outcomemeasure; value in process, occupational narrativeand language and expertise.
Practical implications –The paper is indicativeof practical implications regarding theuse of the GAS-
light tool with community mental health clients and therapists, including the perceived value in the
process,the language used by the therapist andlevel of expertise.
Originality/value –This paper fulfils an identified need to contribute towards an evidence base for
occupationaltherapy and mental health.
Keywords Occupational therapy, Mental health, Outcome measure, GAS-light,Occupational narrative
Paper type Research paper
Introduction and background
Occupational therapy provides support to facilitate recovery and overcome barriers which
prevent peoplefrom doing occupations that are important to them;this supports an increase
in independence and satisfaction (South Tees Hospitals NHS Foundation Trust, 2023).
Occupational therapy is a dynamic process undertaken to enhance health and wellbeing
and is based onthe assumption that “doing”creates change (Pentlandet al.,2018).
Occupational therapy in mental health is concerned with the daily lives of those who
experience challenges. It achieves this through participation in meaningful activities.
Occupational therapists demonstrate specialist skills which are based on research
evidence and focus on what is valued by individuals (Ikiugu et al.,2017). For those
experiencing mental health difficulties, occupation can be disrupted across multiple
domains (Hammell, 2009). Engagement in occupations is more challenging when
symptoms impede participation, hence hindering recovery (De Vos and Leclair, 2019).
Occupational therapists work with clients in a variety of environments which are meaningful
and important to the individual and within their owncommunities. In a survey, 41% of
occupational therapists working in adult community mental health did not measure the
outcomes of their interventions (Birkenet al.,2017).
Ashley Lister is based at
the Department of Adult
Community Mental Health,
Tees Esk and Wear Valleys
NHS Foundation Trust,
Durham, UK.
Karen Morris is based at
the Department of Health,
Psychology and Social
Studies, University of
Cumbria, Carlisle, UK.
Received 6 September 2023
Revised 19 March 2024
13 May 2024
Accepted 16 May 2024
PAGE 272 jMENTAL HEALTH REVIEW JOURNAL jVOL. 29 NO. 32024, pp. 272-287,©Emerald Publishing Limited, ISSN 1361-9322DOI 10.1108/MHRJ-09-2023-0050
Outcome measures
Outcome measures allow us to assess and improve service quality and accountability
(Kampstra et al.,2018). Further to this, The Royal College of Occupational Therapists
(RCOT, 2020) have identified research priorities in relation to working with other
professionals to enhance outcomes for those who access services, the impact on everyday
lives, as well as ensuring client-centredness and inclusivityfor mental health clients, hence
robust outcome measures are vital in service delivery. There is little research on client or
therapist perceptions of the measures used in occupational therapy practice. Existing
measures may not be conducive to the client-centred paradigm of the profession,
particularly as client-centred goal setting is central to the process of enabling occupation
(Kessler et al., 2019).
In occupational therapy, outcomes are the consequences of intervention and are evaluated
in numerous ways, ranging from standardised tools to client evaluationand feedback
(Pentland et al., 2018). Outcome measures are commonly discussed in occupational
therapy services within mental health. There are an abundance of clinician reported
measures but lack of patient reported outcomemeasures which are truly client centred. It is
difficult to identify and use measures which capture effectiveness due to complexity of
intervention and subjectivity(Shankar et al.,2020).
Further to this, measuring the effectiveness of occupational therapy intervention is
complicated by the dynamic and multifaceted nature of an individual’s occupational
performance (Austin, 2008). Pentland et al. (2018) also suggested that consequences of
intervention may be considered transition points, which occur when a change is being
evaluated, measured, estimated or observed and not just at the end of treatment. Birken
et al. (2017) stated that routine use of outcome measures in occupational therapy practice
and strategies to implement them in mental health needs to be a priority. There is a gap in
this area, highlighting limited research on goal-setting and subsequent outcome measures,
in delivery of occupational therapyin mental health (Okita et al.,2024).
Goal attainment scaling
Goal attainment scaling (GAS),was developed for use in mental health treatment and dates
back to the 1960’s (Shankar et al.,2020). It is a method of standardised scoringwhich
considers the extent to which individual goals are achieved during an intervention to allow
statistical analysis (Turner-Stokes, 2015). GAS is sensitive to change in recovery goal
achievement for those with severe mental illness (Tabak et al., 2015). It is a collaborative
measure (Krasny-Pacini et al.,2013; promoting hope (Clarke et al.,2006), facilitating
operationalism and observation(Wade, 2009) and adds value by measuring the progress of
highly individualised goals (Lannin, 2003). That is goals which are identified by the client,
with the therapist. Setting goals with a person promotes behaviour change, through
increasing motivation (Wade,2009).
It is suggested that GAS may be used as a secondary measure in clinical trials as it
captures a unique aspect of the recovery process (Tabak et al.,2015). Due to the
responsive nature of GAS, it may not capture the full range of outcomes(Khan et al., 2008);
the level of achievement is pre-determined by the client and therapist. GAS has been
critiqued for the use of ordinal data and associated difficulties, such as lack of rigour with
statistical analysis (Krasny-Pacini et al.,2016). Shankar et al. (2020) demonstrated that
construct validity is not supported by current evidence and the various ways goals are
considered suggest clarity is needed. There is need for researchers to consider ways that
validation evidence can help verify the many claims that are made about this measure
(Shankar et al., 2020).
AstudybyTabak et al. (2015) found GAS to be reliable and sensitive to measure
achievement. This is dependent on the experience, training and the ability of the therapist to
VOL. 29 NO. 32024jMENTAL HEALTH REVIEW JOURNAL jPAGE 273
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