The accessible Goal Based Outcomes (aGBO) Project

The Accessible GBO Project is an ongoing collaboration to improve the accessibility of working with goals and the GBO Tool.

The project is hosted by the Goals-in-Therapy website.

The project is a collaboration between Ro Rossiter, Jeni McElwee, Mike Charles, Andy James, Lucy Bennett-Downes, and Duncan Law.

When referencing work from this project please cite as: Rossiter, R., McElwee, J., Charles. M., James. A., Bennett-Downes, L. & Law, D. (2024) ‘The accessible Goal Based Outcomes (aGBO) project’ www.Goals-in-Therapy.com

Why is the accessible Goal Based Outcomes project important?

Supporting others requires establishing rapport and trust which means understanding developmental levels and communication, strengths, interests, hopes and needs.

Groupings or labels such as diagnoses or ‘protected characteristics’ that may be attached to a child or young person, their family or carers tells us little about their personal lives, likes/dislikes, talents and needs.

Factors affecting how we function include neurodiversity (e.g. autism, ADHD, additional learning needs), developmental experiences (e.g. Adverse Childhood Experiences, abuse, trauma), current life events, neurological conditions (e.g. epilepsy, brain injury, dementia), sensory issues or impairments, mental and physical health conditions, effects of medication and the ability/disability of environments and services to meet our needs.

Much neurodiversity is unrecognised or ‘misdiagnosed’ with higher rates of neurodiversity found with those excluded from school, Care Experienced people, and those within criminal justice system.

As practitioners and citizens, Equality, Diversity and Inclusion is all our responsibility. The Equality Act gives us all responsibility to promote equality and reduce inequalities across ‘protected characteristics’. This means not discriminating, and making reasonable adjustments, across age, ability/disability, gender, sex and sexual orientation, marital status, pregnancy and maternity, race (ethnic origin and nationality), religion and belief (including non-belief) and their intersectionalities.

So, Accessible Goal Planning is important for all of us and the people we support.

Origins of the aGBO Project?

The Accessible Goals Based Outcomes Project grew from learning in the ‘hearing the voice/feedback and measuring change and outcomes project’  see Feedback and outcome measures for children and young people with learning disabilities (corc.uk.net).  

Recommendations5 from that project were to:

  •         Set goals that are meaningful                              

  •         Actively seek feedback in a variety of ways for involvement in goal setting and review

  •          Choose and use outcome measures and methods with clear purpose

Goal Based Outcomes (GBO) were recommended as a universal outcome measure to use across all abilities/disabilities. The project found GBO are very useful with children and young people with learning disabilities, their families/carers and others in their network as they are easy to use, flexible and personal. GBO’s can be used in and across mental health and wellbeing services, education and participation in other areas.

Aims of the aGBO project

The Accessible Goals Based Outcomes Project aims to

  • Supplement the existing GBO guidance to further increase the accessibility of working with goals.

  • Give additional tips and examples of some practical, visual, concrete resources, materials and methods used by children, young people, and adults with a broad range of additional needs, their families, carers and support networks in setting goals and reviewing outcomes. These additional needs may include developmental disabilities, learning disabilities, neurodiversity, SEND (Special Educational Needs and Disability) and/or ALN (Additional Learning Needs). across different types of goals, ages and other diversity issues

  • Link with, and contribute to wider practice in working with goals, to increase awareness of, ideas for and confidence in using accessible Goals Based Outcomes with a diverse range of abilities, communication styles and ages.

The project materials aim to be brief and practical, and both show and signpost some helpful tips, visual examples and resources.

Top tips for making working with goals more accessible 

For shaping and setting, rating and reviewing goals, the context needs to be set up to listen and support communication. Where people need extra support to engage, understand or communicate, use the model below, considering Environment, Sender and Receiver.

 

Sender:

It is important that you take time to get to know the person you are supporting and to understand how they understand and communicate. This will help set the scene for your work with them. Working with people who know the person well can help to make sure that the goals are person centred. Identify 'observable indicators' which show how the person is feeling.

Scan the QR code for examples

Environment:

When planning your session there are some important things to consider. Consider the external environment and the person’s internal environment and how these might impact communication. Consider the sensory needs of the person you are supporting, is the room too noisy, too bright, too cluttered? Can you reduce the number of people needed in the room? Do they need someone they trust to be present or near? Can the session be carried out in a more familiar setting? It can help to use the environment as a cue, e.g. if the goal is to learn how to make a cup of tea, can you do the session in the kitchen? Consider the person’s mood. Strong feelings, for example: worry, sadness, anger and experience of trauma, affect people’s abilities to listen, think and communicate.

Receiver:

It is important that your approach to communication should be individualised to each person you support. Each person is likely to require a different style or approach in order for them to communicate as fully as possible. Use of visual and auditory cues and other communication tools to support the “conversation”. For example, you could use photos, PECS, Talking Mats, Signing, Objects of Reference, VOCA (Voice Output Communication Aid) or other AAC (Augmentative and Alternative Communication).

Other things to consider when making working with goals more accessible

Ask …..

  • What to focus on/measure? May be feelings, behaviours, thoughts, situations and might include ‘how many times?’, ‘for how long?’,’ how strong?’, ‘timing of response or delay?’; ‘where?’ and /or ‘with whom?’ (frequency, duration, intensity, latency, settings and people e.g. home/room, school, shops, family, football coach etc).

  • Is what’s being measured objective (e.g. time staying in bed, playing with sibling/parent, parent trying new activity, doing mindfulness, head banging, throwing toys) or subjective (e.g ratings of calmness, anxiety – might link with how does doing mindfulness make me feel or anger)?

  • How are you going to ask? E.g. Direct and/or structured assessment, observation, looking at reports, trying things out? See Stream 1 report5; link with EHCP’s (Education, Health and Care Plans)

  • Who are you asking, and why? How will I remember the importance of the process of collaboration in setting goals- building relationships, listening/looking; keeping an open, curious mind?

  • Where are we in the 3 R’s framework - Regulate, Relate, Reason. The 3 R’s model and sequence applies to parents, carers and other adults too.

 

 

  • How will I make sure I/we really listen, be interested and open-minded, check my and their understanding, clarify “What would it look like if it were better/worse?”, “What would be happening when …….?” into individualised, concrete, measurable, ‘performance’ words which focus on desired goals, rather than ‘problems’, and build on strengths.

  • How will I make sure I use individualised approaches with creativity and supports to fit cognitive/communicative needs e.g. simplified language/concepts, pictures, photos, symbols.

  • Useful tools/examples include: Sussex Behaviour Grids - Parents Priorities for Change9; Gore et al.’s, Personalized Goals using Talking Mats to ask about activities, their own behaviour, caregiver’s behaviour, and quality of life; McGill et al.’s use of Talking Mats and semi-structured interviews to support caregivers to develop goals; Bradshaw et al.’s, support for direct involvement of students with disabilities in functional assessment through use of Talking Mats®; use of Mosaic approach

  • People who know the young person well can give you important information about them including ‘observable indicators’ of how they show how they are feeling.  

Examples

Click here to download a free PDF with examples of working with accessible GBO’s across different needs, focus (bedtime, self-help, emotions), age and backgrounds

We hope to add adaptable templates in due course

Contact us.

We would love to hear from you about the aGBO project and we would really love it if you would share your own resources and templates to help make working with goals more accessible

use the form below to contact us

References and resources

 Simonoff E, Pickles A, Chadwick O, Wood N, Maney JA, Karia N, Iqbal H, Moore A (2006). The Croydon Assessment of Learning Study: prevalence and educational identification of mild mental retardation. Journal of Child Psychology and Psychiatry 47, 828–839.

 Kirby, A. (2021) Neurodiversity – a whole-child approach for youth justice. HM Inspectorate of Probation. Neurodiversity – a whole-child approach for youth justice (justiceinspectorates.gov.uk)

 Kirby, A. (2020) Children in Care-Consider intergenerational adversity. Children in Care-Consider intergenerational adversity. (linkedin.com)

 British Psychological Society Division of Clinical Psychology and Child Outcomes Research Collaboration (CORC) 2021 Gathering feedback and measuring outcomes and change with children and young people with Learning Disabilities (LD). Feedback and outcome measures for children and young people with learning disabilities (corc.uk.net) Last Accessed 22.01.24

 Rossiter, R. & Tait, N. (2021) Gathering feedback and measuring outcomes and change with Children and Young People with Learning Disabilities (CYP-LD), their families and networks: revised Guidance. British Psychological Society Division of Clinical Psychology/Child Outcomes Research Consortium, London. Pages 2-6  Special Measures Project (corc.uk.net) Last Accessed 22.01.24

 Law, D. 2019 Guidance notes for using the goal-based outcome (GBO) tool –GBO edition, GBO Tool - Guidance Notes (squarespace.com) Last Accessed 28.01.24

 Phillips, N. & Demjen, E. (2021). Measuring outcomes and change for children and young people with learning disabilities and their families: a clinical perspective. British Psychological Society Division of Clinical Psychology/Child Outcomes Research Consortium, London. Full Report Stream 1 Special Measures (corc.uk.net) Last Accessed 28.01.24

 R’s Framework see Themes for hearing the ‘voice’ of young people with moderate, severe or multiple and profound learning disabilities. Page 7 Special Measures Project (corc.uk.net) Last Accessed 26.01.24. Image courtesy of Beacon House Therapeutic Services & Trauma Team, 2024,  www.beaconhouse.org.uk; draws on work of Bruce Perry.   Last Accessed 28.01.24

 Sussex Behaviour Grids Microsoft Word - v6 Behaviour Grids (corc.uk.net) Last Accessed 22.01.24

 Gore, N.J., McGill, P. & Hastings, R.P. (2021) Personalized Goals for Positive Behavioral Support: Engaging Directly with Children who have Intellectual and Developmental Disabilities. Journal of Child and Family Studies https://doi.org/10.1007/s10826-020-01867-2  Open access - https://rdcu.be/cc8ec  

 Talking Mats, see Talking Mats | Improving communication, improving lives for more information on use, impact and training. Last accessed 29.01.24

 Gore, N. J., McGill, P., & Hastings, R. P. (2019). Making it meaningful: caregiver goal selection in positive behavioral support. Journal of Child and Family Studies, 28, 1703–1712. https://doi.org/10.1007/s10826- 019-01398-5

 Bradshaw, J., Gore, N.J. & Darvell, C. 2018 Supporting the direct involvement of students with disabilities in functional assessment through use of Talking Mats®. Tizard Learning Disabilities Review; Vol. 23 No. 2, pp. 111-116.

 Use of Mosaic Approach – Taylor-Whiteway et al. Development of a range of tools to promote pupil voice in schools.Example 9, pages 41-43,  Special Measures Project (corc.uk.net)  Last Accessed 28.01.24

 Clark, A. 2005. Ways of seeing: using the Mosaic approach to listen to young children’s perspectives. 00-Miller_OU_Reader-4233-Prelims.indd (sagepub.com)  Last Accessed 28.01.24

 Observable indicators and observation framework for staff selection in Good practice examples from ‘Hearing the Voice’ of children and young people with moderate, severe or multiple and profound learning disabilities, Example 9,pages 34-38.  Special Measures Project (corc.uk.net)  Last Accessed 28.01.24

 BPS/CORC Feedback and outcomes measures for children and young people with learning disabilities. Feedback and outcome measures for children and young people with learning disabilities (corc.uk.net) Last accessed 01.02.2024

 Murphy, K. (2023). A guide to neurodiversity in the early years. Anna Freud Centre. A guide to neurodiversity in the early years | Anna Freud Last accessed 01.02.2024

 PAMIS  Your Art World | PAMIS  Last accessed 03.02.2024.

 PAMIS  I can if you can! | PAMIS Last accessed 03.02.2024

 PAMIS Digital passports PAMIS Digital Passports Leaflet - Digital Bit Bigger

PAMIS and Changing Places toilets collaboration World Toilet Day 2022 - Changing Places Toilets | PAMIS Last accessed 03.02.2024

PAMIS and Postural Care  a5-booklet-final.pdf (pamis.org.uk) and Launch of the new PAMIS 24 Hour Postural Care course Upcoming PAMIS Training for 2024 | PAMIS Last accessed 04.02.2024.

 Rossiter, R., Armstrong, H., Legg, G. & Woodrow, J. 2015 Delivering psychological services for children and young people with learning disabilities and their families. Paper 12, pages 153-164, (Page 161 for Woodland days and Rhythmix Music group) in What good looks like in psychological services for children, young people and their families: special edition of the child and family clinical psychology review. The British Psychological Society. Available from: https://www.researchgate.net/publication/283634680_What_good_looks_like_in_psychological_services_for_children_young_people_and_their_families_special_edition_of_the_child_and_family_clinical_psychology_review#fullTextFileContent Last accessed 01.02.2024.

 Leicester NHS If you listen you will hear us video https://www.youtube.com/watch?v=Hp4PW17U_h8  Last accessed 01.02.2024.

 Marchant et al. 2017 How young is too young paper re evidence of under 5’s in CJS: https://www.triangle.org.uk/files/2017-05/-how-young-is-too-young-ruth-marchant-2013.pdf   Last accessed 03.02.2024.

 Opening doors framework- showing how a listening adult may need to play an active, enabling role, and respond to what a child ‘does’ as well as what they ‘say’: https://triangle.org.uk/files/Documents%20(various)/2017-marchant-turner-opening-doors-ilovepdf-compressed-1-.pdf  Last accessed 03.02.2024.

Triangle:  Home (triangle.org.uk) Last accessed 03.02.2024.