GBOs are a way of evaluating progress towards a goal in clinical work with children, young people, and their families and carers. GBOs compare 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.
GBOs are not a model of therapy, nor do they try to promote any one particular therapeutic modality above another. GBOs can be used with any intervention and any therapeutic modality. GBOs are simply a way of deciding at the beginning of an intervention where you want to head for, and to track progress along the way, or at the end to see how far along your agreed track you have managed to get. They are also a powerful tool to facilitate shared decision making and more personalised care in children and young people’s mental health and wellbeing services. 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.
GBOs are certainly not making any claims to be the ‘silver bullet’ of outcome measures, they are one way of getting useful information about progress in an intervention. They are best used as part of a battery of outcome measures, in conjunction with sound clinical feedback and judgement, to get the best picture of how well an intervention has gone. They 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.
(Law, D., & Jacob, J. (2015). Goals and Goal Based Outcomes (GBOs): Some useful information. Third Edition. London, UK: CAMHS Press)
Goals are idiographic outcome measures with a suggested reliable change index of 2.45. Please see see 'Edbrooke-Childs et al., 2015' for more information.
The GBO measure 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 intervention, session by session or at least frequently. The current CORC protocols around collecting GBOs are:
Set the goals over the first three sessions of the intervention/assessment
- Some clients come with very clear ideas of the goals they want to achieve – other 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 client 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 one (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 client now feels they are (this is the time two (T2) rating)
Scoring and interpretation
Progress toward individual goals is periodically rated by the child on a scale from 0 (no progress) to 5 (goal has been reached). The outcome is the amount of movement along the scale from the start to the end of the intervention.
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.
Working remotely with GBOs
The GBO 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.
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.
For guidance on implementing GBO in practice, including setting appropriate goals, and using goals with different groups of children and families see the references below.
A site with training videos and updates along with blogs from people who have direct experience using this tool.
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.
- 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.
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.
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.
- Law, D., & Jacob, J. (2015). Goals and Goal Based Outcomes (GBOs): Some useful information. Third Edition. London, UK: CAMHS Press.
- Bradley, J., Murphy, S., Fugard, A., Nolas, S., & Law., D. (2013) What kind of goals to children and young people set themselves? Child and Family Clinical Psychology Review No.1.