8. Goal setting and care planning
Each Choice should start by helping the young person and family define their goals. This will form the basis of the Care Plan. There should be frequent Care Plan reviews considering young person and family’s preferences and choices. This can involve goal based outcome sheet /written Care Plans.
What do they want?
Being clear with young people and families about what they want help with and monitoring progress is key in CAPA. Sometimes this can feel very difficult - families and children can have many problems and there is always more that can be done! It can also be hard to define accurately. As children grow and develop, and families move through their life cycle, new problems emerge. Some mental health problems are recurrent or persistent so the work may never be ‘done’. In these circumstances our interventions may involve a burst of intense contact during crises followed by infrequent ‘booster’ contact.
We need to be clear with families about how we can help and how we cannot. And help them engage effectively with other agencies that can complement what we do.
Achievable Goals
It is worth spending some time working out goals that are achievable and measurable. Doing this improves therapeutic and task alliance and the effectiveness of the experience for the young person and family. Read Chapter 4 in Details and Green, 2006; Ulrich et al, 2007 for more information. Goals need to include how the family is going to manage the issues themselves. What resources have they got? Can extended family help?
How will the family know when things have improved? Sometimes this is straightforward e.g. return of normal body weight and menstruation in anorexia nervosa; return to school regularly in school phobia. For others it will be a reduction in frequency and severity of behaviours e.g. aggressive outbursts or cutting.
Writing down goals and plans helps with focus and continues to strengthen the task alliance. You may choose to do this as a structured Care Plan or letter. It needs to include a written description of the main issues, interventions, goals and which professionals and agencies are involved. Decide on review dates and stick to them. Go through what has changed since the last review.
Outcome measures such as those recommended by the CAMHS Outcomes Research Consortium (CORC) can also help both you and the family review how things are going. CORC has a set of goal focused outcome measure that can be used. Clinical Global Assessment Scale (CGAS), Strengths and Difficulties Questionnaire and the Experience of Service Questionnaire (ESQ) add further evidence of how things are changing and their experience.
What happens if you don’t set goals and use Care Plans?
Work becomes unfocussed, young people and families and clinicians are not clear about what they are both working towards. Things drift. Young people and their families may be seen for longer than needed. Flow through the whole system for all families is impeded.