The GBO tool is a way of evaluating progress towards goals in clinical work with children, young people, and their families and carers. The GBO compares how far a child or young person feels they have moved towards reaching a goal that they have set for themselves at the beginning of an intervention, on a scale between 0 and 10.
The GBO is not a model of therapy, nor does this approach to outcomes measurement try to promote any one particular therapeutic modality above another. The GBO tool can be used with any intervention and any therapeutic modality. The GBO tool is simply a way of deciding at the beginning of an intervention where you want to head to, and to track progress along the way, or at the end to see how far along your agreed track you have managed to get. It is also a powerful tool to facilitate shared decision making and more personalised care in children and young people’s mental health and wellbeing settings. It is true that some therapeutic modalities have goals and the monitoring of goals is already built into the intervention themselves: e.g., Cognitive Behavioural Therapy (CBT), Cognitive Analytic Therapy (CAT) and solution focused therapies. Hopefully, any therapeutic process starts with a joint understanding of what the goals of the intervention are (the destination) before the therapy (the vehicle to get you there) begins.
The GBO is certainly not making any claims to be the ‘silver bullet’ of outcome measures, it is one way of getting useful information about progress in an intervention. The GBO is best used as part of a range of outcome measures, in conjunction with sound clinical feedback and judgement, to get the best picture of how well an intervention has gone. Goals, and progress, can be shared with the young person, to use in supervision, for your own reflective practice, or as evidence of good work for service managers and commissioners.
(Adapted from: Law, D., & Jacob, J. (2015). Goals and Goal Based Outcomes (GBOs): Some useful information. Third Edition. London, UK: CAMHS Press)
The GBO tool can be used with individuals of any age. It can capture the perspective of children and young people, their families, teachers and professionals in mental and physical health settings.
Practitioners are encouraged to use the GBO tool throughout interventions, session by session or at least frequently. The current CORC protocols around completing the GBO tool is:
Set the goals over the first three sessions of the intervention/assessment
- Some young people come with very clear ideas of the goals they want to achieve – others take a little longer to decide. It may not take three sessions to agree goals with clients but all goals, to be measures for outcomes, should be fixed in the first three sessions.
Record up to three goals
- More goals may be set with the young person but the top three of the hierarchy of goals should be recorded for the CORC outcomes data. Give each goal an identity number (from one to three)
Once a goal is agreed, record how close the client feels they are to reaching the goal (this is the time 1 (T1) rating)
- Record the rating on a scale from zero to ten where ‘zero’ means the goal is not met in any way, ‘ten’ means the goal is met completely and a rating of ‘five’ means they are half way to reaching the goal.
At the end of the intervention record again how close to reaching the goal the young person now feels they are (this is the time 2 (T2) rating)
This series of videos has been developed by the Children's Wellbeing Practitioner (CWP) Programme in conjunction with the Anna Freud National Centre for Children and Families and the London and South East CYP-IAPT Learning Collaborative. The videos show examples of ways that practitioners and young people might work together to set and review collaborative goals. These videos are intended to provide examples of good practice and areas that could be improved; with the intention that they will facilitate discussions around goal setting.
Working remotely with the GBO tool
The GBO tool is ideal for online therapy – it is simple to rate and easy to facilitate a discussion online or over the phone, without the need for a complex IT system. To help with using the GBO in online work we have developed an editable PDF version that allows you or your client to rate the GBO electronically and share results. The interactive PDF versions rating sheets can be downloaded and used for free here.
Scoring and interpretation
Progress toward individual goals is periodically in collaboration with the young person on the scale from 0 (no progress) to 10 (goal has been reached). The outcome is the amount of movement along the scale from the start to the end of the intervention.
Because the GBO tool is an idiographic outcome measure, the approach to testing psychometric properties needs to be considered a bit differently. There are specific considerations of the GBO, and other goals tools, that mean that some researchers argue that traditional psychometric testing doesn't apply. The nested nature of goals - at the person level and then at the service level - is also another consideration not relevant for standardised measures; recently, researchers have explored data from the GB
|Internal consistency||The degree to which similar items within a scale correlate with each other||There are mixed views on whether internal consistency of goal measures is relevant, given that the goals set may be focussed on the different areas of change. However, Edbrooke-Childs et al., (2015) found evidence of good internal consistency for parent rated goals.|
|Test-retest reliability||Degree to which the same respondents have the same score after a period of time when goals shouldn't have changed.||Acceptable stability over a 6 to 24 week period has been found (Duncan et al., 2002).|
|Concurrent validity||Correlation of the measure with others measuring the same concept.||
Parent and young person reported goals have been found to be significantly moderately correlated with measures of functioning and satisfaction (Edbrooke-Childs et al., 2015; Wolpert et al., 2012).
Using multilevel analyses techniques, moderate convergent validity has been found with measures of wellbeing, self-esteem and depression (Duncan et al., 2022).
|Discriminant validity||Lack of correlation with opposite concepts.||No significant correlations have been found between parent or young person reported GBO and other measures of symptoms (see: Edbrooke-Childs et al.,2015; Wolpert et al., 2012; Krause et al., 2021). This suggests that goals may capture areas of change not explored by these symptom measures (see also Jacob et al., 2017).|
The suggested 'meaningful change' level for GBO, based on the principles of the reliable change index, is 2.45. Please see 'Edbrooke-Childs et al., 2015' for more information.
See also Sales et al., (2022) for a synthesis of idiographic patient reported outcome measures, including goal based measures, and the associated psychometric properties.
If you are planning to use this measure for the delivery and improvement of health and/or social care, it is licensed under creative commons (CC) and therefore free to use, unless it is adapted, in which case please use this contact form and reference the original measure. You can also incorporate this measure into electronic systems, which can be obtained from NHS Digital. Please note that licenses obtained via this route may be restricted to particular territory (e.g. England, UK). If planning to use the measure outside of England, you may wish to contact NHS Digital to clarify the geographical scope of the licence.
For guidance on implementing the GBO tool in practice, including setting appropriate goals, and using goals with different groups of children and families - see the references below in addition to the guidance from the developer.
A site with training videos and updates along with blogs from people who have direct experience using this tool.
Law, D. (2022). Working with goals and trauma in youth mental health. International journal of environmental research and public health, 19(17), 11048. https://doi.org/10.3390/ijerph191711048
Banwell, E., Salhi, L., Hanley, T., & Facey‐Campbell, N. (2022). The use of goal‐based outcome measures in digital therapy with adults: What goals are set, and are they achieved?. Counselling and Psychotherapy Research. https://doi.org/10.1002/capr.12584
Duncan, C., Cooper, M., & Saxon, D. (2022). 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. Journal of Clinical Psychology. https://doi.org/10.1002/jclp.23422
Jacob, J., Edbrooke-Childs, J., Flannery, H., Segal, T. Y., & Law, D. (2022). Goal-based measurement in paediatric settings: implications for practice. Archives of Disease in Childhood. http://dx.doi.org/10.1136/archdischild-2021-322761
Krause, K. R., Edbrooke-Childs, J., Singleton, R., & Wolpert, M. (2022). Are we comparing apples with oranges? Assessing improvement across symptoms, functioning, and goal progress for adolescent anxiety and depression. Child Psychiatry & Human Development, 53(4), 737-753. https://doi.org/10.1007/s10578-021-01149-y
O'Reilly, A., McKenna, N., & Fitzgerald, A. (2022). Measuring goal progress using the goal‐based outcome measure in Jigsaw–A primary care youth mental health service. Child and Adolescent Mental Health. https://doi.org/10.1111/camh.12489
Jacob, J., Edbrooke‐Childs, J., Costa da Silva, L., & Law, D. (2021). Notes from the youth mental health field: Using movement towards goals as a potential indicator of service change and quality improvement. Journal of Clinical Psychology. https://doi.org/10.1002/jclp.23195
Jacob, J., Costa da Silva, L., Sefi, A., & Edbrooke‐Childs, J. (2021). Online counselling and goal achievement: Exploring meaningful change and the types of goals progressed by young people. Counselling and Psychotherapy Research, 21(3), 502-513. https://doi.org/10.1002/capr.12363
Jacob, J. (2019). Moving toward a better understanding of idiographic outcome measurement: A commentary on Lloyd, Duncan, and Cooper (2019). Clinical Psychology: Science and Practice, 26(3), Article e12287. https://doi.org/10.1111/cpsp.12287
Lloyd, C. E. M., Duncan, C., & Cooper, M. (2019). Goal measures for psychotherapy: A systematic review of self‐report, idiographic instruments. Clinical Psychology: Science and Practice, 26(3), Article e12281. https://doi.org/10.1111/cpsp.12281
Jacob, J., Edbrooke-Childs, J., Lloyd, C., Hayes, D., Whelan, I., Wolpert, M. & Law, D. (2018) Measuring outcomes using goals. In: Cooper., M. & Law, D. (eds) Working with goals in psychotherapy and counselling.
Cooper, M. & Law, D. (Eds.) (2018): Working with Goals in Psychotherapy and Counselling, UK: Oxford University Press.
Jacob, J., De Francesco, D., Deighton, J., Law, D., Wolpert, M., & Edbrooke-Childs, J. (2017). Goal formulation and tracking in child mental health settings: when is it more likely and is it associated with satisfaction with care?. European child & adolescent psychiatry, 1-12. https://doi.org/10.1007/s00787-016-0938-y
Jacob, J., Edbrooke-Childs, J., Holley, S., Law, D. & Wolpert, M. (2015). Horses for Courses? A qualitative exploration of goals formulated in mental health settings by young people, parents and clinicians. Clinical Child Psychology and Psychiatry, 21 (2), 208-223. https://doi.org/10.1177/13591045155774
Jacob, J., Edbrooke-Childs, J., Law, D., & Wolpert, M. (2015). Measuring what matters to patients: Using goal content to inform measure choice and development. Clinical Child Psychology and Psychiatry, 2 (2) 170-186. https://doi.org/10.1177/1359104515615
Edbrooke‐Childs, J., Jacob, J., Law, D., Deighton, J., & Wolpert, M. (2015). Interpreting standardized and idiographic outcome measures in CAMHS: what does change mean and how does it relate to functioning and experience?. Child and Adolescent Mental Health. 20(3), 142-148. https://doi.org/10.1111/camh.12107
Bradley, J., Murphy, S., Fugard, A. J., Nolas, S. M., & Law, D. (2013). What kind of goals do children and young people set for themselves in therapy? Developing a goals framework using CORC data. Child and Family Clinical Psychology Review, 1(1), 8-18.