Introduction

The goal-based outcomes (GBO) tool is a simple and effective method to measure progress and outcomes of an intervention.  It grew out of work with children, young people and their families in mental health and emotional well-being settings but can be used in any setting, that is change-focused and goal-oriented – including adult and physical health contexts.

The tool tracks what is arguably the most important thing to measure in any intervention: “Is this helping you make progress towards the things that you really want help with?”

The term ‘young person’ is used throughout this document. It is used as shorthand to refer to any young person: ‘child’, ‘youth’, ‘parent/carer’, ‘adult’, who may come into contact with your service.

This guidance is adapted and updated from Law and Jacob (2015) and Law (2018).

When referencing this document please cite as:  Duncan Law (2019) ‘The goal-based outcome (GBO) tool: guidance notes’ 

This Guidance is soon to be published in hard copy in early 2019.  Please follow http://www.goals-in-therapy.com to keep up to date with publication details.

Guidance Notes

1.   Primary purpose

  • The goal-based outcomes (GBO) tool is a tool to help facilitate collaborative goal-oriented conversations & to help track progress towards goalsand facilitate further collaborative goal-oriented conversations.

2.   The goal-based outcome (GBO) tool

  • The GBO tool is a simple and effective method to measure progressand outcomes of an intervention.
  • It can be used in any settingthat is change-focused and goal-oriented.
  • It can be used to track progress session-by-session, or just as an outcome tool
  • The GBO is a tool that measures the changes most important to the personyou are working with.
  • The tool was devised in children and youth mental health services in the UK but has been used successfully internationally and across adult and physical health settings

3.   Shaping and setting goals

  • Goals should be agreed collaborativelybetween the therapist, counsellor, clinician or practitioner, working with the young person or family and the person asking for help.
  • Once a goal has been set it is possible touse any suitable (preferably evidence based) interventionto reach it.
  • Thefirststep is to identify potential goalsand then shape these into agreed goals for the intervention
  • At the point where you feel the young person/family have told you enough initial information it can be helpful to start to introduce goalsby saying something along the lines of:

“That has been really useful to help me understand a little about what has brought you here today; next it might be helpful for us to think together about what your hopes for the future might be”

  • What comes out of the following discussion can begin to be shaped into goals:

“So, from what you have told me so far, what would you say your main goals are from coming to this service? If we were to work together in a very helpful way, when we agree to stop meeting, what things would you hope to be different in the future from how things are now?”

  • Once a goal has been agreed it is useful to write it downin a sentence that summarises it – ideally using the young person’s own language
  • Helpful goals tend to be future-focused, positively framed and realistic
  • Helpful goals could focus on:
    • Change goals– goals that focus on something someone wants to be different or change in their lives – most therapy goals are ‘change goals’
    • Learning goals–getting ideas that might help with the issues even if these might not lead to (immediate) change
    • Exploration or understanding goals– these might be goals that focus on the young person wanting to understand themselves better, or to explore who they are. These may lead to change but this is not the primary focus of the work
  • Make sure the goal is safe for the young person and others
  • Set up to three goals
  • You can write the agreed goals on the GBO ‘goals record sheet’

4.   Rating goals

  • Once a goal has been set the next step is to get the initial (time 1 or baseline) rating for the goal.You may want to say something like:

“Ok, now we have agreed the goals you want to work on, it would be helpful to get an idea of where you are now with each of the goals. This will help us get an idea of where we are starting from, and what you have already managed to achieve, and it can help us keep track of howfar you have moved on, at a later date”.

  • You maywantto specify at this point how oftenyou would expectto review progress towards the goal – every session, at review, at the end of the intervention, etc.
  • You can invite the young person to rate their goalsby saying something like:

“Taking your first goal: on a scale from zero to ten, where ten means that you have fully reached your goal, and zero means you haven’t even begun to make progress towards it, and a score of five is exactly half way between the two, today what rating would you give your current progress towards this goal?”

  • It can help to make the scale visualby showing the young person the GBO rating sheet with the numbers on, or by drawing a line on paper or a white board
  • Younger children might prefer a visual metaphor such as a ladder with the numbers 0 – 10 on the rungs
  • It is important to have the ending of therapy in mind at the first rating of goals. Make sure the young person understands that you do not expect goals to reach ten-out-of-ten, but you intend the work to help them move at least a little way along the scale
  • Write the agreed ratings on the GBO goal rating sheet

5.   If goals change

  • Goals can changeduring the course of an intervention and the work should change focus accordingly, if this is helpful
  • Use your clinical judgement,in conversation with the young person, before a decision to change focus is agreed
  • Consider how clinically helpful it really is, if goals change regularly throughout an intervention
  • It can be helpful to discuss potential changes in goals with a supervisor or a colleague
  • Depending on the type of intervention you are working on with a young person, you may want to formally reset the goals and start rating the new goals
  • Use your judgement as to whether it is helpful to continue rating the original goals

6.   Session-by-session monitoring of goals

  • Goals can be rated every sessionusing the GBO to track progress throughout an intervention
  • Use your judgement, in conversation with the young person, about when in a session the right time to rate goals might be – usually this would be in the first half of an appointment
  • It might be helpful to introduced rating of goals each sessionby saying:

“OK, let’s have a look at where you feel you are at, with the goals we agreed on at the start of the work together. Let’s look at goal one first, which was to… (insert goal summary sentence) – on a scale from zero to ten…etc…, today how would you rate your progress on that goal?”

  • Once the rating has been obtained it may be helpful to compare it to last week’srating and discuss as appropriate
  • Keep a record of progress by writing the ratings on the GBO goal progress chart
  • By connecting the ratings on the GBO goal progress chart you can create a simple run chart that can be shared with the young person and/or in supervision
  • Tracking and discussing progress regularly allows the therapist and young person to monitor progress together
  • When using the GBO session-by-session, the intention should be to rate goals every time you meet with the young person. However, there may be times when it is not possible, or when it does not feel clinically helpful to rate goals in a session – use your clinical judgement, in conversation with the young person, to decide whether to skip rating for a session
  • Sharing the information in sessions can lead to helpful discussions about what, and who is helping the young person to reach a goal and how this progress can be maintained. Conversely it can flag if there appears to be no progress, or if things appear to be moving away from a goal. This can lead to helpful discussions about what or who else might help.

7.   Lack of progress towards goals

  • If there is a lack of progress towards goals it can be helpful to revisit the goals themselves:
    • Are the goals set at the start of therapy still relevant to the young person?
    • Has the context around the young person changedand affectedtheir goals?
    • Are the goals too ambitious?
    • Are they focusedenough?
    • Does the young person understand how the therapy might help them reach their goals?

8.   Psychometric properties

  • The GBO is an ‘ideographic’measure, this means that as everyone’s goals are different and unique to them, so what is measured using the GBO is unique or particular to that person
  • The GBO scoring is ‘ipsative’meaning that changes in ratings are compared to the initial ratings by the person. You are comparing the ratings with themselves, rather than to some external ‘objective’ change score
  • The tool has good ‘face validity’, in that it makes sense to people using it, that it is measuring progress to their goals
  • Changes in GBO ratings have been shown to correlate well with symptom change measures using other tools such as the SDQ (see Wolpert et al 2012)
  • The GBO has a suggested reliable change index (RCI) of 2.45. (Edbrooke-Childs et al. 2015) 

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