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

BackgroundThe 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.MethodsWe 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.ResultsReach 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.ConclusionsThe 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.