What kinds of goals do children and young people set for themselves in therapy? Developing a goals framework using CORC data

Agreement on goals is thought to be central in successfully building a good therapeutic alliance which in turn improves outcomes. The qualitative idiosyncratic nature of goals set by children and young people in therapy has been relatively unexplored. We investigated service users’ account of the goals they set for them- selves in UK child and adolescent mental health services (CAMHS) using data collated by CAMHS Out- comes Research Consortium (CORC) members. Six services supplied their goals data for analysis: NHS targeted, specialist, and highly specialist services; a modality specific professional body; and a therapeutic community. Service users were 80 children and young people who had visited the services between 2007 and 2011. Emerging themes arising from key aspects of 241 goals from the participants (as agreed with and recorded by the clinician) were analysed using thematic analysis. The resulting taxonomy of goals consisted of three overarching themes and 25 lower level categories. Inter-rater reliability between two researchers was substantial for major themes (Cohen’s kappas from 0.78 to 0.88 and statistically significantly above 0.6) and 14 of the 25 subthemes had substantial agreement. The top five goals mainly concerned personal growth, functioning, and coping with specific symptoms and problems. We discuss these results and differences with a large analysis done in the USA on the inverse ‘top problems’.