The use of goals based outcomes allows a child or young person and their families to choose the measure of change most important to them, but how can they be used to further improve mental health treatment for children and young people? Northumberland, Tyne and Wear NHS Foundation Trust have told us about one of their success stories.
A female patient (13yrs old) had been referred to their service following a number of attempts to self-harm. The community CYPS service was attended by both her and her parents (who were separated) to discuss the support available through the service and expectations following referral.The patient and parents were seen separately and asked to identify goals they wished to achieve mwhilst in the service and indicators for when that goal had been achieved. They then came together to share their goals and discuss a way forward.
|Parents’ goal||They wanted their daughter to be happy|
|Indicator of achievement||She would stop self-harming|
|Patient’s goal||She wanted her parents to stop using her as a way to communicate with each other about their difficult relationship|
|Indicator of achievement||They would talk to each other and not to her about the other person|
By sharing their goals, both the patient and her parents could have a conversation about the nature of their difficulty. It allowed the young person to see that her parents cared about her happiness and were worried about her. It also allowed the parents to see what impact their relationship difficulties were having on their daughter. An agreement was made that the parents would talk directly to each other and they discussed with their daughter how this would happen.
The young person did not require any further therapy or interventions and a potentially lengthy therapeutic process was avoided. A school nurse was identified who the young person identified as someone she could confide in and was offered the opportunity to ‘drop in’ if things began to change. It turns out that the implementation of a goal can be a great tool to facilitate conversations that may not have happened otherwise, as well as providing a shared understanding of what is going on for the child or young person. It also highlights that having different goals does not hinder the progress of treatment, but brings people together in a more collaborative approach.
Further information about goals based outcomes can be found in ‘Goals and goals based outcomes (GBOs): some useul information’ Law and Jacob (2015)
Many thanks to Suzanne Barton from Northumberland, Tyne and Wear NHS Foundation Trust.