Background: Working with goals is a critical yet often overlooked aspect of youth mental health and addictions care, with the potential to strengthen therapeutic relationships, support shared decision-making, and improve outcomes. Despite its importance, there is no cohesive, equity-centered guidance for working with youth on their goals. This review critically examines existing practice principles for working with youth aged 10–25 on goals within mental health and addictions services, with a particular focus on how equity, diversity, and inclusion are, or are not, embedded in these recommended approaches.

Methods: A narrative review methodology was employed to synthesize insights from both academic literature and clinical guidebooks published between 2003 and 2023. Searches were conducted across PubMed, EMBASE, Cochrane Library, Web of Science, and supplemented with general web searches to capture diverse perspectives from research and practice. Fifty-three publications were selected and analyzed using thematic and content analysis via MAXQDA software.

Results: Four key themes were identified: (1) semi-structured and strategic approaches to goal-setting, including the use of routine outcome measures and progress monitoring; (2) youth- and family-centered engagement strategies; (3) conceptual framing of goals within therapeutic processes; and (4) a nascent but growing emphasis on embedding EDI and cultural safety into goal-oriented practices.

Conclusion: Findings underscore the importance of moving beyond standardized, clinician-driven approaches to more inclusive, collaborative, and youth-informed goal practices.