two outcomes paradigms 11th July 2012

Dr. Emma Miller, Glasgow School of Social Work

Overview Story of outcomes research followed by national outcomes

into practice project in Scotland (mainly Adult Care) Outcomes of health and social care partnership – Glasgow

University – worked with 3 service user research organisations (2004-6)

2 researchers worked with the Joint Improvement Team of the Scottish Government since 2006: Talking Points

Refocusing Adult care on what matters to people who use the services (personal outcomes) = implemented across Scotland

Challenging in a system rooted in 1990 Health and Social Care Act – care management, deficit and service led, managerialism, performance culture focused on inputs, throughput etc

Types of Outcome (Qureshi 2001)

Glasgow University research started by reviewing existing work by York University – Social Policy Research Unit (SPRU)

Maintaining quality of lifee.g. Achieving and maintaining acceptable levels of

safety, social contactTime limited change

e.g. Improving confidence and regaining skillsProcess outcomes - impact of service process

e.g. Service users feeling valued and respected, listened to

Outcomes defined by people using services (Petch et al 2007) (separate framework for carers)

Quality of life Process Change Feeling safeHaving things to doSeeing peopleAs well as can beLife as want (including where you live)

Listened toHaving a say Respect Responded to Reliability

Improved confidenceImproved skillsImproved mobilityReduced symptoms

Principles/Defining Outcome Focused Approach Understand outcomes as the

impact or end result of support and/or services on a person’s life:

However, crucially start by defining expectations and outcomes with the person

Focus on strengths and capacities more than deficits

Include consideration of the person’s role as well as supports and services

Consider mainstream opportunities not just formal services

Ensure that there is review of whether the plan is achieving the intended outcomes.....

AGREEOUTCOMES

User’s view Carer’s view

Assessor’s view Agency’s view

NEGOTIATE

RECORDOUTCOMES

‘EXCHANGE MODEL’ OF ASSESSMENT

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2

3

4

EXCHANGE INFORMATION

- Identify desired outcomes

Exchange Model of Assessment (Smale and Tuson 1993)

Talking Points (Cook and Miller 2012) Engagement, recording and use of information

Making the shift

FROM TOQ and A Conversation

Needs Led Identifying Potential

Coordinator Use of Self

Tick Boxes Analytical

Service Led Outcomes Led

Clienthood Citizenship

Progress and challenges TP activity in all 32 local authority areas in Scotland

– also many third sector provider agencies TP featuring strongly in policy in Scotland (4

government strategies in 2010) and Reshaping Care for Older People, associated with community capacity building (JIT)

Surrounding culture has a way to go, particularly with regard to performance management (Miller 2012)

Need to ensure better outcomes for staff too = Senses (Nolan et al 2006)

A whole systems approach: could go either way

Outcomes Focused Support/Supervision (Stirling Council Social Services 2011

Resources Lots of resources on JIT websitehttp://www.jitscotland.org.uk/action-areas/talking-points-user-and-carer-involvement/

Miller (2012) Individual outcomes: Getting back to what matters, Edinburgh: Dunedin

Contact: e.miller@strath.ac.uk