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Goal-Based Outcomes (GBO)

Introduction

The GBO is an effective and simple way of youth deciding at the beginning of an intervention what they want to work on, tracking progress along the way, as well as seeing how far they have managed to get at the end of an intervention. It is a brief tool used to measure progress (i.e., changes the youth has identified as most important to them) and outcomes of an intervention. It is a measure of what the young person wants to achieve, not the goals a service provider might wish to see the youth achieve. The GBO tool can be used with any intervention or therapeutic modality, and has been used successfully with youth and adults in mental and physical health settings. . It has good face validity (e.g., it makes sense to youth using it, as it is measuring goal progress). The GBO is what is known as an ideographic measure; Since youth’s goals are different and unique to them, what is measured with the GBO is particular to that youth.

Why are we asking youth to complete this form?

Youth may come to Youth Wellness Hubs Ontario (YWHO) with a solid notion of what they want help with, or they may not have specific change, learning, or self-understanding goals. If the youth is unsure of goals prior to the first clinical visit, they can be identified and explored collaboratively between the youth and service provider. Youth can then provide ratings of their goal progress. Addressing goal progress in session can lead to beneficial discussions about what/who is helping the youth reach their goal, as well as how progress can be maintained. It can also flag if there is a lack of progress, or if a goal may need to be modified, and what can assist in these regards. The GBO tool is important as it provides an opportunity for youth to have a voice in terms of where they want support, and then answers the question, “Is this intervention helping you make progress towards the things that you really want help with?” The GBO tool is also suitable for virtual services; It is simple to both rate and engage in a discussion about goals/ratings online or over the phone. Done well, writing down goals to track them leads to a clear articulation of the collaborative work to be done between the service provider and young person. 

Responding to youth asking why they are being asked to complete this tool:

This form is basically asking you to share the things that you really want help with. You can either fill in the goals on your own or, if it’s tricky to come up with specific goals, you can talk about it with a service provider and figure one/some out together. Then you can track how you’re progressing when you visit the hub. Of course, the expectation is not that goals reach 100% accomplishment. We just want to work with you to help move a little bit more toward whatever learning or change you’re interested in achieving. You and a service provider can monitor your progress together over time.

Clinical questionnaire:

At the hub, when youth are provided the questionnaire on an iPad (or possibly in hard copy form), they receive the following instructions:

In coming to this service, what are some of the problems you want help with or goals you want to get to? (List up to three goals)

How close are you to the goals you want to get to?

On a scale from zero to ten, please circle the number below that best describes how close you are to reaching your goal today. Remember a score of zero means no progress has been made towards a goal, a score of ten means a goal has been reached fully, and a score of five is exactly half way between the two

Your First Goal

Your Second Goal

Your Third Goal

Youth are asked to type/write in issues or goals they would like to work on, as well as their current progress rating in terms of addressing each of the issues/goals.

When do you respond to these questions?

Young people are asked to complete this questionnaire at their first clinical visit, and subsequent clinical visits more than seven days later (either 8-29 days later, or 30 or more days, depending on when they return). This questionnaire is not completed if youth visit the hub for service seven or fewer days after their last clinical visit.

What if youth don't understand the question?

If a young person requires assistance with an item due to developmental, cognitive, language, or other issues, try to provide these supports:

• Read all items aloud exactly as printed word for word, at an appropriate pace; 
• If there is some misunderstanding, repeat the item;
• Determine which word is confusing and define the word, but try not to reword the question (it may alter the meaning of the question, as well as the response); and
• Do not suggest answers.

In addition, for the GBO tool, hub staff can use the following to clarify,
“What would you say your main goals are from coming to this service?”
“What things would you hope to be different in the future, from how things are now?”

Scoring/Results:

Scoring of the GBO tool is ipsative, meaning that rating changes are compared to the youth’s initial ratings. More specifically, ratings are being compared with themselves, rather with some external change score.

How can I go over results with youth?

• Responses are recorded automatically on the YWHO Data Collection platform, although there is no scoring.
• Service providers are able to view youth’s goals and goal progress ratings from each visit, to determine what issues are most important to youth and what they have already managed to achieve, and compare current ratings to past ones and discuss as appropriate.
• If there is a consistent lack of progress toward goals, it may be helpful to revisit the goals with youth:
  • Are goals still relevant to youth?
  • Are goals too ambitious? Sufficiently focused?
  • Has the context around the youth changed and impacted their goals?
  • Is there an understanding of how the intervention might help youth reach their goals?

Youth’s goals represent their own voice as to what they are interested in working on, and can help inform the most appropriate intervention at any intensity level (low, medium, high).