Lesson 2 - Reviewing Progress and Treatment Goals
1. Introduction
Mental health care should be purposeful, collaborative and responsive to change. It is not enough simply to arrange a series of appointments and assume that continued attendance means that treatment is working. Practitioners need to review regularly whether the person is moving towards the outcomes that matter to them, whether the current intervention remains appropriate and whether their needs or risks have changed.
Reviewing progress is broader than asking whether symptoms have improved. A person may continue to experience anxiety, low mood or emotional dysregulation while making meaningful progress in other areas. They may be attending school more consistently, leaving the house more often, communicating their needs more clearly, managing disagreements more safely or reconnecting with activities and relationships that matter to them.
Equally, an apparent reduction in symptoms does not always mean that the person is functioning or coping better. They may be avoiding difficult situations, masking distress or relying heavily on family members to manage everyday demands. A good review therefore considers symptoms, functioning, wellbeing, relationships, strengths, safety and the person’s own experience of change.
The case worker has an important role in this process. Case workers may notice gradual changes that are less apparent during occasional medical reviews. They can help people identify progress, explore barriers, clarify goals and communicate relevant information to the wider multidisciplinary team. However, case workers must remain within their competence. They should not independently change treatment plans, interpret complex clinical deterioration or make decisions that require a qualified senior clinician.
This lesson builds upon earlier learning about recovery-focused care, the biopsychosocial model, rapport, active listening, asking effective questions and working within the multidisciplinary team. It explains how to conduct a structured review that remains person-centred rather than becoming a checklist exercise.
2. Learning Outcomes
By the end of this lesson, learners should be able to:
Explain why progress and treatment goals should be reviewed regularly.
distinguish between symptoms, functioning, wellbeing, safety and personally meaningful recovery outcomes.
Work collaboratively with a person to develop clear, realistic and measurable goals.
Conduct a structured review of progress while recognising strengths, barriers and unintended consequences.
Record and communicate review findings clearly, objectively and respectfully.
Recognise when limited progress, deterioration or increased risk must be escalated to a senior clinician.
3. The Lecture
What Is a Treatment Goal?
A treatment goal describes an outcome that the person and clinical team hope to work towards. It should identify what meaningful improvement would look like in the person’s everyday life.
Treatment goals are not limited to symptom reduction. They may relate to:
emotional wellbeing;
coping with distress;
daily routines;
relationships;
education or employment;
independence;
physical health;
medication adherence;
engagement with treatment;
participation in valued activities;
reduced risk;
confidence and self-understanding;
communication and self-advocacy.
For example, “reduce anxiety” identifies an important area but does not yet describe what improvement would mean in practical terms. A more useful goal might be:
“Over the next four weeks, I would like to attend my first two lessons on at least three school days each week, using the agreed support plan when I feel overwhelmed.”
This goal connects the emotional difficulty to an observable and personally meaningful outcome. It also provides a basis for reviewing what helped, what remained difficult and whether the plan should be continued or adapted.
Goals Should Belong to the Person
Goals are most effective when they reflect the priorities of the person receiving care. A goal should not be imposed simply because a practitioner or family member thinks it is important.
This does not mean that professionals should ignore safety, safeguarding responsibilities or essential treatment needs. It means that, wherever possible, these concerns should be discussed openly and incorporated into a collaborative plan.
A young person may want to return to school, while their parent may be most concerned about sleep and the clinical team may be worried about self-harm. All three perspectives are relevant. The review should acknowledge each concern and establish which goals require immediate attention.
A useful question is:
“If things were a little better in a month’s time, what would you notice yourself doing differently?”
This can be easier to answer than, “What are your treatment goals?” It encourages the person to describe change in everyday language.
Other helpful questions include:
What is most important to you at the moment?
What would make the biggest positive difference to your day?
What are you hoping will change through these appointments?
What would other people notice if things were improving?
Is there anything you would like to manage more independently?
What feels realistic before our next review?
What would be a small first sign that we were moving in the right direction?
Shared Decision-Making
Shared decision-making involves the practitioner and the person working together to reach decisions about care. The practitioner contributes clinical knowledge, while the person contributes their values, preferences, lived experience and understanding of their own circumstances.
Where appropriate, parents, carers or other supporters may also contribute. However, the person’s own voice should not become lost, particularly when family members have strong views.
Shared decision-making requires more than offering a choice between two predetermined options. It involves:
explaining the available options;
discussing likely benefits and possible disadvantages;
considering the person’s preferences and circumstances;
checking understanding;
allowing time for questions;
agreeing what will happen next;
reviewing the decision when circumstances change.
A person may choose a different priority from the one a practitioner expected. Provided that the choice is safe and informed, this should be respected. Goals are more likely to motivate meaningful action when they reflect what matters to the person.
Understanding Progress
Progress is not always linear. People may improve for several weeks and then experience a setback. Symptoms may vary with stress, sleep, physical health, relationships, hormonal changes, school demands, employment pressures or significant life events.
A temporary deterioration does not necessarily mean that treatment has failed. It may provide useful information about triggers, protective factors and the support the person needs during more difficult periods.
Progress should be considered across several areas.
Symptoms
This includes changes in experiences such as:
low mood;
anxiety;
panic attacks;
intrusive thoughts;
compulsive behaviours;
emotional dysregulation;
inattention;
impulsivity;
sleep disturbance;
unusual experiences;
appetite changes.
Symptom rating scales can sometimes support review, but they should not replace a clinical conversation. A score may show change without explaining why it occurred or what it means to the person.
Functioning
Functioning describes how the person is managing everyday life. This may include:
personal care;
preparing meals;
managing medication;
attending education or employment;
completing daily tasks;
maintaining relationships;
leaving the house;
travelling independently;
managing money;
participating in enjoyable activities.
Functioning can improve even when some symptoms remain. Conversely, symptoms may appear less prominent because the person has withdrawn from situations that previously exposed their difficulties.
Wellbeing and Quality of Life
A person may report increased hope, confidence, self-understanding or enjoyment before there is a substantial reduction in symptoms. These changes are clinically meaningful.
Questions might include:
Have there been any moments you have enjoyed since we last met?
Do you feel any more hopeful about the future?
Have you noticed any change in your confidence?
Are you doing anything that gives you a sense of purpose or achievement?
Do you feel better able to understand or communicate your needs?
Safety
Every review should remain attentive to safety. The depth of the risk review will depend on the person’s history, current presentation and the purpose of the appointment.
Relevant areas may include:
thoughts of suicide or self-harm;
recent self-harm;
harm to other people;
aggression or loss of control;
impulsive or high-risk behaviour;
exploitation or abuse;
substance use;
self-neglect;
significant deterioration in mental state;
reduced ability to care for dependants;
safeguarding concerns;
access to potentially harmful means.
A previous absence of risk does not guarantee that risk remains absent. Changes in mood, circumstances, relationships or treatment may alter the clinical picture.
Strengths and Protective Factors
Reviews should not focus only on problems. Recognising strengths helps the person understand what is supporting their progress and how these resources can be used again.
Protective factors may include:
supportive relationships;
willingness to seek help;
engagement with treatment;
future plans;
personal values;
problem-solving skills;
faith or community;
caring responsibilities;
meaningful interests;
established coping strategies;
a safe living environment.
The question is not simply, “What went wrong?” It is also, “What helped things go better?”
Establishing a Baseline
It is difficult to review change unless there is some understanding of the starting point. A baseline describes the person’s situation before an intervention or agreed period of work begins.
The baseline does not need to involve a formal rating scale. It may include simple, observable information such as:
attending school once each week;
experiencing four panic attacks each week;
sleeping from approximately 3 am until midday;
leaving the house only with a family member;
arguing with family members most evenings;
not currently participating in any enjoyable activities.
Baseline information should be specific enough to support comparison later. “Sleep is poor” is less useful than, “It usually takes around three hours to fall asleep, and she wakes two or three times most nights.”
A baseline should not be presented as a permanent description of the person. It is a snapshot of their circumstances at a particular time.
Developing Clear and Achievable Goals
A useful goal is clear enough for everyone to understand and flexible enough to account for the realities of mental health recovery.
The commonly used SMART framework suggests that goals should be:
specific;
measurable;
achievable;
relevant;
time-limited.
This framework can be helpful, but it should not be applied rigidly. Some meaningful goals cannot be reduced easily to numbers. The purpose is to create clarity, not to make the person feel examined or judged.
Consider the broad goal:
“I want to feel more confident.”
This can be explored collaboratively:
“Over the next month, I would like to contribute at least once during my weekly group and record how manageable this felt afterwards.”
The second version does not claim that confidence will be fully resolved within a month. It identifies a small behaviour through which confidence can be developed and reviewed.
Goals should generally be:
written in language the person understands;
connected to something meaningful;
realistic in the person’s current circumstances;
broken into manageable steps;
accompanied by an agreed timescale;
reviewed rather than treated as fixed;
supported by a clear plan.
Breaking Goals into Smaller Steps
A goal may be important but currently feel overwhelming. Breaking it into smaller stages can reduce avoidance and create opportunities for success.
For example, the long-term goal may be to use public transport independently. Initial steps might include:
Looking at the route online with a support worker.
Walking to the bus stop without travelling.
Travelling for one stop with a trusted person.
Travelling the full route with support.
Travelling independently while remaining able to contact someone if needed.
The steps should be developed with the person rather than prescribed to them. What appears small to a practitioner may feel substantial to someone experiencing severe anxiety, low motivation, sensory overload or executive functioning difficulties.
Making Goals Neuro-affirmative and Accessible
Neurodivergent people should not be expected to suppress harmless traits or appear more neurotypical simply to demonstrate progress. Goals should focus on wellbeing, autonomy, access, communication and reduced distress.
For example, “maintain eye contact during conversations” is unlikely to be an appropriate treatment goal. Eye contact may be uncomfortable, distracting or unnecessary for effective communication.
A more appropriate goal might be:
“Develop a reliable way to show when I need more processing time during appointments.”
Similarly, the aim should not automatically be to eliminate stimming, intense interests or a need for routine. The practitioner should explore whether a behaviour is harmful, distressing or interfering with something the person values before treating it as a problem.
Goals may need to account for:
sensory needs;
communication preferences;
variable energy and capacity;
executive functioning;
the need for predictability;
different ways of expressing emotion;
demand sensitivity;
reasonable adjustments;
recovery time after demanding activities.
Progress might involve the environment becoming more accessible, rather than the person becoming better at tolerating an unsuitable environment.
Preparing for a Progress Review
A useful review begins before the appointment. The practitioner should understand:
the purpose of the review;
the goals previously agreed;
the intervention or support being provided;
any relevant outcome measures;
the current risk and safety plan;
actions allocated at the previous appointment;
information received from other professionals;
the limits of the case worker’s role.
The practitioner should avoid entering the appointment with a predetermined conclusion. Previous records provide context, but the current conversation remains essential.
Where possible, the person should know in advance what the review will cover. This can reduce anxiety and enable them to prepare. Some people may benefit from receiving questions beforehand, bringing written notes or using visual prompts.
Structuring the Review Conversation
A progress review should have enough structure to ensure that important matters are covered while remaining flexible and person-centred.
Begin with the Person’s Priorities
Start by asking how the person has been and whether anything important has happened since the previous contact.
For example:
“Before we look at the goals we agreed last time, is there anything particularly important that you would like us to discuss today?”
This gives the person an opportunity to raise new concerns that may change the focus of the review.
Review What Has Changed
Explore improvement, deterioration and areas that have remained unchanged.
Useful questions include:
What has been better since we last met?
What has been more difficult?
What changes have you noticed?
Have other people noticed any changes?
Which days or situations have gone particularly well?
Were there times when the problem was less intense?
What do you think made the difference?
Avoid relying solely on general questions such as, “Has everything been okay?” People may answer “yes” even when they have experienced significant difficulties.
Revisit Each Agreed Goal
Review what the person hoped to achieve, what action was planned and what actually happened.
The purpose is not to mark the goal as a pass or failure. Instead, explore:
whether the goal still matters;
what progress has occurred;
what helped;
what got in the way;
whether the goal was realistic;
whether additional support or adjustments are needed;
whether the goal should continue, change or be completed.
Review the Intervention
Ask about the person’s experience of the support or treatment itself.
This might include:
whether appointments feel helpful;
whether suggested strategies are practical;
whether the person understands the plan;
whether medication is being taken as prescribed;
possible side effects or concerns;
barriers to attendance or engagement;
whether cultural, financial, sensory or practical needs are being met;
whether the person feels heard and involved.
Case workers should gather and communicate medication information but must not independently advise the person to start, stop or change prescribed medication unless this falls within their professional authority and competence.
Review Risk and Protective Factors
Risk should be explored directly and calmly when clinically indicated. Asking about suicide or self-harm does not introduce the idea into someone’s mind. Clear questions can make it easier for a person to disclose distress.
If risk has increased, the practitioner should follow the service’s escalation and emergency procedures. The review should not continue as though this were an ordinary goal-setting discussion.
Agree the Next Steps
The review should conclude with a shared understanding of:
what progress has been made;
which goals remain relevant;
whether any goals need to change;
what the person will do;
what the practitioner or team will do;
what support is available;
when progress will be reviewed again;
what should happen if the person deteriorates before then.
The practitioner should check understanding rather than assume that the plan is clear.
Recognising Meaningful Change
A person’s progress may be overlooked when attention is focused only on whether the final goal has been achieved.
Suppose someone’s goal is to return to college. They have not yet attended a lesson, but they have responded to an email from their tutor, visited the campus and agreed a phased return plan. The overall goal has not been reached, but meaningful progress has occurred.
Progress may include:
increased understanding of triggers;
recognising distress earlier;
asking for help sooner;
using a coping strategy before reaching crisis;
recovering more quickly after setbacks;
communicating needs more clearly;
tolerating a small amount of uncertainty;
attending appointments more consistently;
becoming more involved in decisions;
accepting appropriate support;
attempting a difficult task even when the outcome was imperfect.
The practitioner should validate genuine effort without offering false reassurance. It is possible to acknowledge progress while remaining honest about ongoing difficulties.
When There Has Been Limited Progress
Limited progress should prompt curiosity rather than blame.
The practitioner should consider several possible explanations.
The Goal May Not Be Personally Meaningful
A goal developed mainly by professionals or relatives may not motivate the person. The practitioner should ask whether the goal still reflects what the person wants.
The Goal May Be Too Large
The first step may need to be smaller. “Return to full-time school” may be unrealistic when the young person is currently unable to approach the school building.
Practical Barriers May Be Present
Barriers may include:
transport;
finances;
caring responsibilities;
unstable housing;
lack of privacy;
appointment times;
digital exclusion;
language needs;
poor communication between services;
absence of reasonable adjustments.
The Formulation May Be Incomplete
A strategy aimed at anxiety may be ineffective if the main difficulty is sensory overload, trauma, depression, bullying, substance use or an emerging physical health condition.
Case workers should not independently reformulate complex presentations. They should identify the concern and request senior clinical review.
The Intervention May Not Be Acceptable or Effective
The person may dislike the approach, experience side effects, misunderstand its purpose or feel that it does not address their priorities. This information should be taken seriously.
The Person’s Circumstances May Have Changed
Bereavement, family conflict, examinations, employment problems, illness or safeguarding concerns can affect the person’s capacity to work towards goals.
Shame or Fear May Be Affecting Disclosure
A person may say that they “did not try” when they were frightened, overwhelmed or unsure what to do. A non-judgemental conversation may reveal the actual barrier.
Reviewing Goals After a Setback
Setbacks are common and should be treated as information rather than proof of failure.
A helpful review might explore:
What happened before the setback?
What thoughts, feelings, physical sensations or environmental pressures were present?
What did the person do in response?
What helped, even slightly?
Was support available and accessible?
What could be changed next time?
Does the safety or treatment plan need review?
Avoid language such as “non-compliant”, “failed to engage” or “refused” without explaining the context. More precise documentation might state:
“He did not attend the two planned sessions. He described feeling increasingly anxious as the appointment approached and was unsure how to cancel or request a telephone appointment.”
This records what happened while also identifying a potentially modifiable barrier.
Balancing Different Perspectives
The person, their family and the clinical team may have different views about progress.
For example, a young person may feel that they are coping better because they have fewer arguments at home. Their parent may feel that little has improved because school attendance remains low. Their teacher may report better engagement during the lessons they attend.
The practitioner should not automatically decide that one account is correct and the others are wrong. Differences may reflect:
behaviour varying between settings;
different expectations;
different observation periods;
masking;
family stress;
different definitions of improvement;
information not yet shared.
The case worker can summarise these perspectives neutrally and help identify areas of agreement. If disagreements affect treatment, consent, safety or safeguarding, senior clinical advice should be sought.
Using Outcome Measures
Outcome measures are questionnaires or scales used to record symptoms, functioning, wellbeing, risk or progress towards goals. They can provide a consistent way to monitor change over time.
They may help to:
establish a baseline;
identify areas requiring further assessment;
track patterns;
support treatment discussions;
evaluate whether an intervention appears helpful;
communicate change within the multidisciplinary team.
However, outcome measures have limitations. Scores can be influenced by the person’s interpretation of questions, current circumstances, literacy, language, masking and who completes the measure.
A reduced score does not automatically mean that the person has recovered. An increased score does not always mean that treatment is failing. Scores should be interpreted alongside the person’s account, clinical observations, functioning, contextual information and risk.
Case workers should only administer and score measures they have been trained and authorised to use. Interpretation that requires clinical expertise should be completed or supervised by an appropriately qualified practitioner.
Goal Attainment Scaling
Goal attainment scaling is one approach to recording progress towards an individualised goal. It involves describing different possible outcomes, from considerably less progress than expected to considerably more progress than expected.
A simplified clinical version might identify:
the starting position;
less progress than hoped;
expected progress;
more progress than expected.
For example, if the goal concerns leaving the house:
Starting position: does not currently leave the house.
Initial progress: stands outside the front door with support.
Expected progress: completes a ten-minute walk with support twice a week.
Greater progress: completes the walk independently or more frequently.
This approach can make gradual change more visible. However, levels must be agreed carefully, remain realistic and not create pressure to perform. Formal goal attainment scaling may require specific training and should only be used in accordance with service procedures.
Reviewing Medication-Related Goals
Case workers may contribute valuable observations about medication, particularly where they have regular contact with the person. Relevant areas may include:
whether the medication is being taken;
perceived benefits;
possible side effects;
difficulties obtaining or remembering medication;
the person’s concerns or preferences;
changes in sleep, appetite, mood or behaviour;
physical observations requested by the prescribing team.
The aim should not simply be to determine whether symptoms have “gone”. Medication goals may relate to improved concentration, reduced distress, safer behaviour or increased ability to participate in education, work or therapy.
Any concern about severe side effects, significant physical symptoms, marked mental-state change, suspected toxicity, medication misuse or increased risk should be escalated promptly. The case worker must not independently recommend dose changes unless professionally authorised to do so.
Reviewing Progress in Children and Young People
When working with children and young people, information may come from the young person, parents or carers, school and other professionals. Each perspective can add useful information, but the young person should remain involved in a way that reflects their developmental level and communication needs.
The practitioner should consider:
what the young person thinks is important;
whether they understand the goals;
how they prefer to communicate;
whether part of the appointment should take place independently;
what information can be shared and with whom;
parental responsibility and consent;
whether school expectations are realistic;
whether apparent improvement reflects masking or increased support;
whether family stress is influencing progress.
Goals should not focus solely on making a child easier for adults to manage. They should support the child’s wellbeing, development, participation, safety and autonomy.
Documentation
The clinical record should allow another practitioner to understand what was reviewed, what changed and what was agreed.
A useful record includes:
the person’s current priorities;
relevant changes in symptoms and functioning;
progress towards each goal;
strengths and protective factors;
barriers to progress;
adherence, benefits and concerns relating to treatment;
relevant risk information;
the person’s views;
the views of others where relevant;
the agreed plan;
actions allocated to named people;
the timescale for follow-up;
any escalation or senior advice obtained.
Documentation should be factual, respectful and proportionate. Avoid judgemental language or unsupported conclusions.
Instead of:
“She was unmotivated and failed to follow the plan.”
Consider:
“She did not complete the agreed daily walks. She described feeling exhausted after work and said that the original goal felt unmanageable. The goal was revised to a ten-minute walk on one non-working day each week.”
This version records the outcome, explores the barrier and explains the revised plan.
When to Escalate
A case worker should seek advice or escalate when:
suicide or self-harm risk has emerged or increased;
there is a risk of harm to another person;
there are safeguarding concerns;
there is a significant or rapid deterioration in mental state;
symptoms suggest possible psychosis, mania or severe depression;
the person appears intoxicated, severely withdrawn, confused or unable to care for themselves;
medication side effects or physical symptoms cause concern;
the person reports stopping medication or changing the dose without prescriber input;
treatment does not appear effective and requires clinical reconsideration;
the person’s presentation falls outside the case worker’s competence;
there is uncertainty about consent, confidentiality or information-sharing;
disagreement between those involved is interfering with safe care;
the person repeatedly disengages and their welfare cannot be established;
the care or safety plan is no longer adequate.
If risk is immediate, the practitioner should follow emergency procedures rather than wait for routine supervision.
Ending the Review
A good ending consolidates the discussion and reduces the possibility of misunderstanding.
The practitioner might say:
“We have discussed that you are now leaving the house twice a week, although travelling alone still feels too difficult. You would like to keep the same overall goal, but make the next step smaller. You will try one short journey with your sister, and I will speak with the senior clinician about the increase in panic symptoms. We will review this again in two weeks. Have I understood that correctly?”
The person should have an opportunity to correct the summary, ask questions and say whether the plan feels manageable.
Where appropriate, provide the agreed actions in writing. This can be particularly helpful when a person experiences anxiety, memory difficulties, attention difficulties or information-processing needs.
4. Clinical Perspective
Clinical Pearl: Ask About What Is Better
Mental health reviews can become heavily focused on continuing problems. Asking what has improved helps identify strengths, effective strategies and protective factors. It also gives a more balanced understanding of the person’s experience.
Clinical Pearl: Function May Be More Informative Than a General Mood Rating
A person may say that their mood is “fine” while remaining in bed for most of the day, withdrawing from relationships and neglecting personal care. Ask what daily life has actually looked like.
Clinical Pearl: Lack of Progress Is Clinical Information
When a goal has not been achieved, avoid assuming that the person lacks motivation. The goal may be unsuitable, the intervention may not be effective or an important barrier may have been missed.
Clinical Pearl: Review the Goal, Not Just the Person
Practitioners sometimes repeatedly ask why a person has not achieved a goal without considering whether the goal itself was realistic, accessible or genuinely collaborative.
Practical Tip: Use Concrete Examples
Questions about specific days and situations often produce more useful information than global questions.
Instead of asking, “Has your anxiety improved?”, try:
“Think about the last time you needed to leave the house. What happened from the point you started getting ready?”
Practical Tip: Compare Similar Situations
Progress is easier to judge when similar situations are compared. A school holiday week should not automatically be compared with an examination week without acknowledging the different demands.
Practical Tip: Notice the Cost of Apparent Progress
A person may be attending school or work but spending the rest of the day recovering, experiencing increased distress or becoming unable to manage basic tasks. Achievement should be considered alongside its emotional and physical cost.
Common Pitfall: Treating Attendance as the Main Outcome
Attending every appointment does not necessarily mean that the person is benefiting. Conversely, missed appointments do not necessarily mean that they do not want help. Explore engagement, understanding and barriers.
Common Pitfall: Changing Too Many Goals at Once
A long list can feel overwhelming and make it difficult to determine which intervention helped. Prioritise a small number of meaningful goals.
Common Pitfall: Using Goals as a Test of Compliance
Goals should support recovery, not become a way of rewarding obedience or criticising difficulty. The review is a collaborative learning process.
Common Pitfall: Over-Relying on Scores
Outcome measures can support clinical judgement but cannot replace it. Always explore what a score means in the context of the person’s life.
Common Pitfall: Ignoring Differences Between Accounts
Conflicting accounts should be explored respectfully. They may reveal variation between settings, masking, different expectations or changes in support.
Advice for Newly Qualified Practitioners
Do not feel that every review must result in a new strategy. Sometimes the most useful task is to understand why the current plan has not worked and take that information to supervision.
Be honest about the limits of your role. It is safer to say, “I need to discuss that with the senior clinician,” than to offer advice outside your competence.
Document changes in risk clearly and escalate them promptly. Do not assume that another professional will notice the same concern later.
Remember that small changes can be clinically important. For someone who has been severely withdrawn, replying to one message or sitting downstairs for ten minutes may represent meaningful progress.
Situations Requiring Particular Clinical Judgement
Additional care is needed when:
the person reports improvement but others describe significant deterioration;
the person’s goals conflict with immediate safety needs;
family goals differ substantially from the person’s goals;
apparent progress depends on excessive masking or unsustainable effort;
symptom scores improve while functioning worsens;
repeated non-attendance occurs in someone with known risk;
the person wants to end treatment despite continuing concerns;
medication appears beneficial but significant side effects are reported;
the person’s ability to understand or participate in decisions is uncertain.
These situations should be discussed with an appropriately qualified senior clinician.
5. Summary
Reviewing progress is an active clinical process, not an administrative exercise. It helps determine whether treatment remains relevant, safe, acceptable and effective.
Good reviews consider symptoms, functioning, wellbeing, safety, strengths and the person’s own definition of recovery. Progress may be gradual, uneven and visible in small changes rather than complete achievement of the final goal.
Treatment goals should be collaborative, meaningful, realistic and clear. When a goal is not achieved, practitioners should explore barriers and reconsider the goal or intervention rather than blaming the person.
Outcome measures may support review, but they must be interpreted alongside clinical information and lived experience. Scores alone do not determine whether someone is recovering.
Case workers can help identify change, reinforce strengths, clarify goals and communicate concerns. They must remain within their competence and escalate increased risk, significant deterioration, treatment concerns or uncertainty to a senior clinician.
A useful review should end with a shared and clearly documented plan: what will happen next, who will do it, when it will be reviewed and what the person should do if their wellbeing deteriorates.
6. Further Reading
NICE Guideline NG197: Shared decision making — guidance on involving people in decisions about their care and treatment.
NICE Guideline CG136: Service user experience in adult mental health services — recommendations on collaborative, respectful and person-centred mental health care.
NICE Guideline NG53: Transition between inpatient mental health settings and community or care home settings — includes principles relevant to collaborative planning, continuity and review.
Coulter, A. and Collins, A. Making Shared Decision-Making a Reality: No Decision About Me, Without Me. The King’s Fund, 2011.
Slade, M. Personal Recovery and Mental Illness: A Guide for Mental Health Professionals. Cambridge University Press, 2009.
Law, D. and Jacob, J. Goals and Goal Based Outcomes: Some Useful Information. CAMHS Press, 2015.
Kiresuk, T. J., Smith, A. and Cardillo, J. E. Goal Attainment Scaling: Applications, Theory, and Measurement. Lawrence Erlbaum Associates, 1994.
Goal Attainment Scaling in Rehabilitation: An Educational Review — a detailed review of how individualised goal attainment can be defined and measured.
7. Knowledge Check
Question 1
Which statement best describes the purpose of reviewing treatment goals?
A. To determine whether the person has complied with professional advice
B. To decide whether the person should remain in the service
C. To understand progress, barriers and whether the plan remains appropriate
D. To replace clinical discussion with a standard questionnaire
Correct answer: C
Explanation: A review should establish what has changed, what has helped, what barriers remain and whether the current goals and interventions are still meaningful, safe and appropriate.
Why the other answers are incorrect:
A is incorrect because goals should not be used as a test of obedience or compliance.
B is incorrect because service continuation may sometimes be considered, but it is not the main purpose of reviewing goals.
D is incorrect because questionnaires can support a review but should not replace a collaborative clinical conversation.
Question 2
Which is the clearest example of a person-centred treatment goal?
A. The practitioner wants the person to be more cooperative
B. The person will stop feeling anxious
C. The person will attend every available activity
D. The person would like to complete a ten-minute walk twice a week over the next month
Correct answer: D
Explanation: This goal reflects the person’s preference and identifies a specific, observable and time-limited action.
Why the other answers are incorrect:
A is incorrect because it reflects the practitioner’s judgement rather than the person’s desired outcome.
B is incorrect because it is broad, absolute and does not identify what meaningful change would look like.
C is incorrect because it may not be realistic, relevant or chosen by the person.
Question 3
A person’s anxiety questionnaire score has improved, but they have stopped leaving the house and are no longer attending college. What is the most appropriate response?
A. Conclude that treatment is working because the score improved
B. Explore the discrepancy between the score and the person’s functioning
C. Disregard the functional changes because they are not symptoms
D. Repeat the questionnaire until a consistent result is obtained
Correct answer: B
Explanation: Outcome measures must be interpreted alongside functioning, context and the person’s account. The reduced score may reflect avoidance rather than genuine recovery.
Why the other answers are incorrect:
A is incorrect because a score alone is insufficient to establish improvement.
C is incorrect because functioning is a central part of mental health assessment and review.
D is incorrect because repeating the measure does not address the important discrepancy.
Question 4
A person has not completed an agreed activity. What should the case worker do first?
A. Record that the person is non-compliant
B. Remove the person from the intervention
C. Explore what made the activity difficult
D. Make the goal more demanding to improve motivation
Correct answer: C
Explanation: A collaborative discussion may identify anxiety, practical barriers, misunderstanding, an unrealistic goal or a change in circumstances.
Why the other answers are incorrect:
A is incorrect because the term is judgemental and does not explain what happened.
B is incorrect because one uncompleted activity does not justify ending support.
D is incorrect because making the goal harder is unlikely to address the barrier.
Question 5
Which is the most neuro-affirmative goal for an autistic person who finds conversations difficult?
A. Maintain eye contact throughout every conversation
B. Stop using all repetitive movements in public
C. Develop a way to communicate when additional processing time is needed
D. Learn to hide signs of distress from other people
Correct answer: C
Explanation: This goal supports communication, autonomy and reasonable adjustment without requiring the person to suppress harmless autistic traits.
Why the other answers are incorrect:
A is incorrect because eye contact may be uncomfortable and is not required for meaningful communication.
B is incorrect because repetitive movements may support regulation and should not automatically be treated as a problem.
D is incorrect because encouraging masking may increase distress and conceal support needs.
Question 6
During a routine review, a person reports new thoughts of suicide and says that they have considered how they might act on them. What should the case worker do?
A. Complete the remaining treatment-goal questions before responding
B. Advise the person to reconsider their goals
C. Follow the service’s risk assessment and escalation procedures immediately
D. Wait until the next routine supervision session
Correct answer: C
Explanation: New suicidal thoughts accompanied by consideration of method require prompt assessment and escalation in accordance with service and emergency procedures.
Why the other answers are incorrect:
A is incorrect because immediate safety takes priority over the routine structure of the review.
B is incorrect because revising goals does not address the urgent risk.
D is incorrect because delaying escalation could place the person at further risk.
Question 7
A young person has not yet returned to school, but they have visited the building, met their pastoral worker and agreed a phased return plan. How should this be understood?
A. No progress has occurred because the final goal was not reached
B. Meaningful intermediate progress has occurred
C. The original goal should automatically be abandoned
D. The young person should be told to return full-time immediately
Correct answer: B
Explanation: The young person has completed several important steps towards the longer-term goal. Recognising intermediate progress can strengthen confidence and clarify the next step.
Why the other answers are incorrect:
A is incorrect because progress should not be judged only by whether the final outcome has been reached.
C is incorrect because the available information does not suggest that the overall goal is no longer relevant.
D is incorrect because an immediate full-time return may be unrealistic and undermine progress.
Question 8
Which clinical entry is the most appropriate?
A. “She was lazy and failed to engage.”
B. “She was clearly not interested in getting better.”
C. “She did not complete the agreed walks and described feeling exhausted after work; the goal was revised collaboratively.”
D. “She refused treatment and therefore no further discussion was required.”
Correct answer: C
Explanation: This entry is factual, respectful and specific. It records what occurred, identifies the reported barrier and explains the action taken.
Why the other answers are incorrect:
A is incorrect because “lazy” is a judgement rather than an objective clinical observation.
B is incorrect because it makes an unsupported assumption about motivation.
D is incorrect because declining one aspect of treatment does not remove the need to understand the person’s reasons, preferences or continuing needs.
Question 9
A person says that medication is helping their concentration but reports new episodes of chest discomfort. What should a case worker do?
A. Recommend reducing the dose
B. Reassure the person that this is an expected effect
C. Advise them to continue unchanged until the next routine review
D. Escalate the physical symptom promptly in accordance with the service’s medication-safety procedure
Correct answer: D
Explanation: New chest discomfort during medication treatment requires prompt clinical consideration. The case worker should follow the agreed escalation pathway and remain within their competence.
Why the other answers are incorrect:
A is incorrect because a case worker should not independently alter a prescribed dose unless authorised and professionally competent to do so.
B is incorrect because chest discomfort should not be dismissed without appropriate assessment.
C is incorrect because waiting for a routine review may be unsafe.
Question 10
A person has repeatedly missed appointments. They have previously disclosed self-harm and cannot currently be contacted. What is the most appropriate response?
A. Assume they no longer want support
B. Close the case automatically
C. Follow the service’s non-attendance, welfare and risk-escalation procedures
D. Wait until the person contacts the service again
Correct answer: C
Explanation: Previous self-harm and an inability to establish the person’s current welfare require proportionate action under the service’s procedures. Non-attendance can sometimes be an indicator of deterioration or increased vulnerability.
Why the other answers are incorrect:
A is incorrect because non-attendance may result from deterioration, anxiety, practical barriers or other difficulties.
B is incorrect because automatic closure without considering risk may be unsafe.
D is incorrect because passive waiting may not be appropriate where there are unresolved welfare concerns.
