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New research allows us to be increasingly confident that measuring goal progress is a robust way of assessing change

The Goal Based Outcomes tool (GBO) is widely used to track children and young people’s mental health and wellbeing goals. It was developed in 2011 by Dr Duncan Law, and since then, there has been a huge uptake in its use. This is in part due to the growing appreciation that aims for mental health recovery can differ from person to person, and in part due to increased awareness that goal-based outcomes tools are adaptable for a range of practices, and complement standardised outcome measures, such as the RCADS (1). In our own research, and in that of our colleagues, we have found that goal-based outcome measures may tap into areas of outcome for children and young people that are additional to the symptoms captured by standardised symptom-based measures (2–4). Research suggests that young people most commonly set goals related to coping mechanisms, personal growth, improving self-expressing emotions, self-confidence and self-acceptance and managing interpersonal difficulties (5–7). 

The GBO itself is a tool that helps support goal setting and tracking: young people collaboratively agree up to three goals to work on with their practitioner (and family/carers as relevant) and track progress towards the goals on a scale of zero to ten. You can download copies of the GBO, available in several languages, and the user guide the Goals in Therapy website.  

We, and other researchers, have been exploring the use of the GBO and one of the ways we do this is through exploring the psychometric properties. Back in 2015 (8), we found promising results based on the parent-reported GBO data in the CORC data set, including finding that for an individual parent/carer, their goals tended to be closely aligned, and good alignment between the GBO and well established measures of functioning and service satisfaction. This suggested that the (up to three) goals parents set and rated were fairly consistent between themselves, and that the goals set were more likely to be about functioning than symptoms (symptoms as captured using the SDQ).  

Thinking about the GBO (and other goals tools), has come along over time. Because the GBO tool is an idiographic outcome measure, meaning that the content of it is bespoke to the individual completing it, the approach to testing psychometric properties needs to be a bit different. Some researchers argue that traditional psychometric testing, such as exploring how aligned the items are with each other, isn’t the best approach for these tools. If we want to use goal data for service evaluation, we should also take account of the individual goals data for a person and then the average at the service level – a consideration that we don’t have to bear in mind for standardised measures. Recently, researchers from the British Association for Counselling and Psychotherapy, and the universities of Roehampton and Sheffield have explored self-reported GBO data from secondary school pupils using multilevel analysis to take this into consideration (9). 

What does a recent study tell us?  

In this research, Charlie Duncan and colleagues (9) looked at child-rated goals and found that the GBO tool was much more sensitive to individual change than standardised measures, such as the Young Person’s CORE (YP-CORE) (10). This supports previous research which suggests that GBO may pick up on change not captured by other outcome measures (2–4). The researchers also covered new ground in In addition, it is important to know that people are consistent in the way they rate goals at different time periods, e.g., at the start and end of an intervention. The researchers found that scores on the GBO tool could be considered stable over between 6 and 24 weeks, which has not been explored in any previous research on the GBO.  

Duncan and colleagues also found that the child-rated GBO data was most correlated with measures of general wellbeing, self-esteem and depression (WEMWBS and the depression subscale of the RCADS), and least correlated with the SDQ subscales. This supports previous findings focused on parent-reported goals (8,11) and suggests that goals are less likely to be aligned with the areas of outcome captured on the SDQ subscales (emotional, prosocial, hyperactivity, peer and behaviour difficulties). 

Here at CORC we did some work to find out what amount of change in a GBO score would be a “meaningful change”.  We based this on the information we hold about parent-reported GBOs in the CORC dataset and, using the principles of the reliable change index, determined that movement of 3 points or more on the GBO scale constitutes change that would be considered over and above that which is due to chance alone (8). Duncan and colleagues also found a change of at least 3 points is needed to be considered meaningful change for the self-reported GBO data from their school sample. It is helpful for these criteria to be recalculated on different samples – this is a key finding for the continued use of the GBO, as the meaningful change criterion was only available for parent-reported goal data previously. 

What does this mean for practice? 

There are new findings in this latest research, which are encouraging for the continued use of the GBO tool to track individual outcomes and to also track service level outcomes too. It is important that we stay curious about measures; always considering which measures are most appropriate for use with each individual young person. We know that this can sometimes be a balancing act!  

The use of the measures is what is key. The meaningful completion of measures and conversations about what the data shows is the most important thing. Where possible, it may be useful to balance out what the young person’s goals are, and to think about how to use standardised measures and goal-based outcome measures can be used in a complementary way. For example, if we know that goals tap into areas of change absent on the SDQ (12), and there is a service mandate to use the SDQ, you may want to consider the use of the GBO in addition to it.  

Next steps 

There are continued debates in the research domain about what goal-based outcome tools measure, how to analyse and interpret the data, and how they fit in with overarching service evaluation. The findings outlined here offer good grounding for their continued use. We, and I’m sure others, will continue to explore the data and keep you updated on how outcome measures hold up, what is and isn’t useful in practice, so you can get on with the important tasks of helping young people through outcome informed practice. We have recently looked into the use of the GBO tool, where it is most meaningful and least meaningful to young people. I’ll be talking about this research more at the upcoming Members’ Forum – sign up here. 

Check out our updated GBO page on the website, with links to the measure and the relevant available research, including practice focused papers, such as guidance for goal setting and tracking in paediatrics settings, and which young people who have experienced trauma.  

Thanks to Mick Cooper for his comments on this blog. 

Dr Jenna Jacob, October 2022 

 

References  

1. Chorpita, B. F., Yim, L. M., Moffitt, C. E., Umemoto L. A., & Francis SE. Assessment of symptoms of DSM-IV anxiety and depression in children: A Revised Child Anxiety and Depression Scale. Behav Res Ther. 2000;38(1):835–55.
2. Edbrooke-Childs J, Jacob J, Law D, Deighton J, Wolpert M. Interpreting standardized and idiographic outcome measures in CAMHS: What does change mean and how does it relate to functioning and experience? Child Adolesc Ment Health. 2015;20(3).
3. Krause KR, Edbrooke-Childs J, Singleton R, Wolpert M. Are We Comparing Apples with Oranges? Assessing Improvement Across Symptoms, Functioning, and Goal Progress for Adolescent Anxiety and Depression. Child Psychiatry Hum Dev [Internet]. 2021;(0123456789). Available from: https://doi.org/10.1007/s10578-021-01149-y
4. Jacob J, Edbrooke-Childs J, Law D, Wolpert M. Measuring what matters to patients: Using goal content to inform measure choice and development. Clin Child Psychol Psychiatry. 2017;22(2).
5. O’Reilly A, McKenna N, Fitzgerald A. Measuring goal progress using the goal-based outcome measure in Jigsaw – A primary care youth mental health service. Child Adolesc Ment Health. 2022;27(3):238–45.
6. Jacob J, Edbrooke-Childs J, Holley S, Law D, Wolpert M. Horses for courses? A qualitative exploration of goals formulated in mental health settings by young people, parents, and clinicians. Clin Child Psychol Psychiatry. 2015;21(2).
7. Rupani P, Cooper M, McArthur K, Pybis J, Cromarty K, Hill A, et al. The goals of young people in school-based counselling and their achievement of these goals. Couns Psychother Res. 2014;
8. Edbrooke-Childs, J., Jacob, J., Law, D., Deighton, J., & Wolpert M. Interpreting standardized and idiographic outcome measures in CAMHS: what does change mean and how does it relate to functioning and experience? Child Adolesc Ment Health. 2015;20(3):142–8.
9. Duncan C, Cooper M, Saxon D. Test–retest stability, convergent validity, and sensitivity to change for the Goal-Based Outcome tool for adolescents: Analysis of data from a randomized controlled trial. J Clin Psychol. 2022;(July):1–14.
10. Twigg, E., Barkham, M., Bewick, B.M.m Mulhern, B., Connell, J. & Cooper M. The Young Person’s CORE: Development of a brief outcome measure for young people. Couns Psychother Res. 2009;9(3):160–8.
11. Wolpert M, Ford T, Trustam E, Law D, Deighton J, Flannery H, et al. Patient-reported outcomes in child and adolescent mental health services (CAMHS): Use of idiographic and standardized measures. J Ment Heal. 2012;
12. Goodman R. Psychometric properties of the strengths and difficulties questionnaire. J Am Acad Child Adolesc Psychiatry. 2001;40(11):1337–45.