Life Stage Outcome Planning in West Lothian

A Logic Modelling Approach

Logic Modelling in West Lothian

• Logic modelling is a tool used in the development of monitoring and evaluation plans to help to identify the person centred short-, medium- and long-term outcomes that are delivered by the key activities of a programme or strategy (Health Scotland).

• Logic Modelling work in West Lothian was initiated by the Health Improvement team in the CHCP to help plan more effective interventions to tackle health and social inequalities across the whole of West Lothian.

• We used expertise from consultants at Blake Stevenson with support from NHS Health Scotland. The aim of the model was to:

Stages in Logic Modelling – The Theory!• Identify the intended long-term person centered outcomes &

strategic aims (including targets). • Identify the main actions & group under strategic aims. • Identify what underlying assumptions are being made regarding

the delivery of activities. • Identify the short-term and medium-term outcomes that might

be expected to arise from each group of actions; agree timescale by which these are likely to be observed.

• Check whether short-, medium- and long-term outcomes are logically linked and are plausible, testable and do-able.

• Identify the external factors that will influence the outcomes identified and in what ways/directions these are likely to impact.

• Develop a framework for outcomes to guide data collection.

Logic Modelling & Life Stage Planning

Stage 1 Identify the life stage & prioritise based on evidence of need

‘Life’ diagram

Stage 2 Develop outcomes Logic modelling

Stage 3 Implement activities RE:AIM

Stage 4 Monitor Indicator sets on Covalent (PMS)

Outcomes for people - not services

West Lothian is planning outcomes on a Life Stage basis as follows (boundaries overlap):

• Early years

• School aged children

• Young people in transition (14-25)

• Adults of working age

• Older adults

Stage 1 – Identifying evidence of need

Existing national indicators

Professional knowledge base

Locally commissioned research

National/ international research

Community engagement

Priority groups of people

‘Badged’ lifestyle behaviours

Inequalities‘Unbadged’ life circumstances

Lifestyle

Life Circumstances

Life Chances

Life Stages

Stage 1 - Prioritising people

Stage 1 - Life circumstances

Where you live and workHousingQuality of local environment – lighting, paths, green spacesEnvironmental hazardsEmployment/Job quality/Job security/Job mobility/hours of work/incomeChild careTransport

How safe you are/feelCommunity safetyRoad safetyViolenceAbuseAccidental injuryProperty crime

Family circumstancesFamily culture/value system/learned behaviours

StatusSocio-economic statusMarital/partnership status

Access to recreationParksSports centresSwimming poolsLibrariesClubs/Theatre/Dance

What you achieveEducational achievementTraining opportunities

Community WellbeingSense of ‘community’Community ‘identity’Connection with others

Access to health carePrimary careAcute careSpecialist care

Life chances & Lifestyles – behavioursGenderAgeEthnicitySexual orientationFaithDisability: •physical disability, •learning disability, •learning difficulties, •visual impairment, •hearing impairment, •mental health

• Diet• Alcohol consumption• Smoking• Drug misuse• Physical activity• Self-harming/suicidal behaviours• Criminal behaviour• Anti-social behaviour

Stage 1 - People in context

Families with children aged 0-5 years

• Substance misuse• Physical activity• Diet

Young (single) mums

Lifestyle

Life Circumstances

Life Chances

Life Stages

Stage 1 - Populated chart

• Employment/skills • Poverty• Family circumstances• Access to services

Stage 2 - Outcome planning

Resources/ inputs

Activities

Outputs Short term outcomes

Medium term

outcomes

Long term

outcomes

Your planned work Your intended results

Performance Management

National indicators and local indicators at datazone level

Plausible = it is reasonable to expect that outputs will lead to short term outcomes, short term outcomes will lead to medium term outcomes and so on

Doable = you have the sufficient resources to enable you to achieve the outcomes

Stage 2 - Outcomes for early years

Health Warning! More work to be done on indicators….

The Outcome Planning Process

• Agreeing with users & partners which activities lead to short, medium & long term outcomes has taken longer than expected.

• It’s not perfect, but we’re agreed that thinking through the outcome logic together will help to improve the reach and engage with the most disadvantaged and most vulnerable in our community.

• Unravelling the threads of activities, outputs & outcomes has been more difficult than anticipated.

Stage 2 – The gap….

Evaluation – Adapted Re-AimR Increase Reach

E Increase Effectiveness

A Increase Adoption

I Increase Implementation

M Increase Maintenance

Stage 3 - Effective interventionsIdentification Do we know who and where the most vulnerable people are?

Are we agreed with other professional colleagues on this?

Reach and Engagement

Is our service reaching and engaging the most disadvantaged and most vulnerable in our community? If not, what can we do to ensure it does?

Service Activity What are we doing in order to make a difference? How do we know it’s the right service? Are we doing it intensively enough and over a long enough time period? How do we know it is making a difference?

Performance Measures and Indicators

How are we measuring progress? Are we all using the same measures?

Awareness and Referral

Do we know what other services are doing or could be doing for the most vulnerable? Do they know what we are doing? Are there effective referral processes, information sharing processes and pathways in place?

Doing it differently

What would we do differently if we could in order to achieve the outcomes? How could more flexibility in target setting and resource allocation help us better achieve the outcomes we have set?

Progress to-dateIdentification Life diagrams were agreed by Community Planning Partnership in March

2009

Reach and Engagement

Service Activity

Performance Measures and Indicators

A range of indicators is in the process of being identified, (those in SOA plus others). Indicators will be grouped in sets to enable more realistic picture of outcomes. - Issues identified with effectiveness of existing data / indicators.

Awareness and Referral

The CPP is now more aware of the range of activities; further work to be done on Customer Journey mapping through services.

Doing it differently

Decisions now to be made regarding investment/redesign.(New programme manager to be appointed to oversee service integration)

Research gathered by Life Stage Working Groups on what works, has led to the categorisation of activities which are required to ensure services reach target populations and provide sufficient positive impact to deliver outcomes as existing (green), requiring redesign (amber), or new (pink). A larger scale mapping exercise is now being planned.

Stage 4 – Monitoring

• We will need to consolidate & monitor indicator sets and performance measures across groups / services to ensure consistency.

• Constantly review/update our models• Use CPP structure to report progress• Regularly review joint working arrangements• This is a WORK IN PROGRESS!

Information Sharing• Outcome charts are recorded using ‘Doview’

software.

• Information is being shared between partners via the Communities of Practice websites at:www.communities.idea.gov.uk/welcome.do

• Data are being shared via a Local Information system on Wlinfo.