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
1
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: [email protected]
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