Hybrid Type II Randomized Controlled Trial of the Goal-Based Outcomes Tool in a Child and Youth Outpatient Mental Healthcare Clinic

Abstract

Background

The Goal-Based Outcomes (GBO) tool tracks patient goals. Its implementation and effectiveness, especially in child and youth mental healthcare (CYMH) clinics using the Choice and Partnership Approach (CAPA) framework has been understudied.

Methods

We used a Hybrid Type II randomized controlled trial (RCT) and the Reach Evaluation Adoption Implementation Maintenance (RE-AIM) framework; 152 caregiver-patient (aged 5 to 17 years) dyads were randomized to GBO + treatment as usual (TAU) or TAU. Effectiveness outcomes included the Strengths and Difficulties Questionnaire (SDQ) and Children’s Global Assessment Scale (CGAS) pre-post treatment scores, which measured effectiveness using bivariate, ANCOVA (intention-to-treat), and Reliable Change Index analyses. Post-treatment Evaluation of Services Questionnaire (ESQ) measured care experience. Implementation outcomes included patient flow assessed using the total number of appointments across partnerships and the core partnership number of appointments, a fully recorded session, and the cost to ensure data collection for what was essentially a measurement-based care paradigm. Content of goals and patient/clinician qualitative reports were subjected to thematic analyses.

Results

Reach was high in patient and clinician populations. Effectiveness data did not show a group effect. Goal progress exceeded SDQ changes; goal themes were different from SDQ constructs. Adoption was high, as was implementation. All participants had positive experiences with GBO. Clinic function was not negatively affected by the GBO tool.

Conclusions

The GBO tool was implemented successfully into a CAPA-based CYMH clinic, but group effectiveness was mixed. However, the GBO tool identified unique treatment targets, suggesting potential to enhance tailored, precision CYMH.

Plain Language Summary

Why was the Study Done?

The Goal-Based Outcomes (GBO) tool helps young people and their families set personal goals and track their progress during mental health treatment. It could be especially useful in personalized child and youth mental health care. But until now, no studies have tested how well it works in regular clinical settings.

What did the Researchers do?

This study looked at how well the GBO tool could be used and how effective it was in a real-world child mental health clinic that follows the Choice and Partnership Approach (CAPA). Researchers ran a randomized controlled trial (RCT), which means participants were randomly put into two groups: one receiving usual care with the GBO tool (GBO + TAU), and the other received usual care only (TAU).

What did the Researchers Find?

A total of 152 child-caregiver pairs took part, split evenly between the two groups. Both groups showed improvement over time, but there were no major differences between them in standard mental health scores. However, patients made more noticeable progress on the personal goals they set using the GBO tool. The goals identified were different from what standard questionnaires measured. Families and clinicians liked the tool, and most clinicians said they would keep using it.

What do the Findings Mean?

The GBO tool was easy to use in a real clinic without disrupting care. Families and clinicians found it helpful. It helped identify personal goals that are not captured by standard mental health tools and may help clinicians create more personalized treatment plans.