Transcript Personal outcomes approach

Introduction to Personal Outcomes
and the Talking Points Approach
Dr Ailsa Cook
[email protected]
What do we mean by outcomes?
The impact or end result of
service(s) on a person’s life
The user or carer is involved
in identifying desired
outcomes = setting goals in
partnership with services
Which outcomes?
• Research with service users and carers identified
most important outcomes across Community Care
– University of York (1995-2005)
– University of Glasgow (2004-2006)
– JIT / VOCAL / East Renfrewshire (2006-2007)
• Two outcomes frameworks underpin Scottish
Government Community Care Outcomes Approach
Outcomes: service user
Quality of life
Process
Change
Feeling safe
Having things to
do
Seeing people
Staying well
Living as you /
where want
Listened to
Having a say
Treated with
respect
Responded to
Reliability
Improved
confidence
Improved
skills
Improved
mobility
Reduced
symptoms
Outcomes: people living in a care
home
Quality of life
Process
Feeling safe and secure Treated as an individual
Seeing people
Valued and respected
Having things to do
Listened to
Live in a nice place
Having a say
Live life as I want and
Support to live well/
where I want
plan for end of life
Stay as well as I can
Family and friends
involved
Belong to a community
Trust staff and rely on
them to respond
Privacy is respected
Change
Improved skills
Improved confidence
and morale
Improved mobility
Improved health /
reduced symptoms
Settled into home
Outcomes: Carer
QoL cared for
person
QoL carer
Managing the
caring role
Process
Quality of life
for the cared
for person
Maintaining
health and wellbeing
A life of their
own
Positive
relationship with
cared for person
Freedom from
financial
hardship
Choices in caring
Feeling informed/
skilled/ equipped
Satisfaction in
caring
Partnership with
services
Valued/respected and
expertise recognised
Having a say
Flexible and
responsive
Positive relationship
with practitioners
Accessible, available
and free at point of
need
Standards of Care for Dementia
in Scotland
Knowledge and Skills Framework QoL Outcome Indicators
Talking
Outcomes

I have the right to a
Diagnosis
People with Dementia have access to a timely and
accurate diagnosis of Dementia
Not explicitly
covered

I have the right to be
regarded as a unique individual
and to be treated with dignity and
respect

I have the right to access a
range of treatment and supports

I have the right to end of
life care that respects my wishes
People with Dementia feel empowered and enabled to
exercise rights and choice, maintain their identity and to be
treated with dignity and equity
People with Dementia maintain their best level of physical,
mental, social and emotional wellbeing
Process outcomes
Change outcomes,
plus Stay as well as
can
People with Dementia have access to individuals, groups
and organisations that can support their spiritual or
personal beliefs and reflect their cultural wishes
People with Dementia have access to quality services and
can continue to participate in community life and valued
activities
People with Dementia feel safe and secure and are able to
be as independent as possible
People with Dementia are able to maintain valued
relationships and networks, and have the opportunity to
develop new ones both personal and professional
Live as you want,
have a say, seeing
people, dealing with
stigma,
discrimination.
Having things to do,
seeing people
Feeling safe
People with Dementia, and their family, friends and carers,
have access to the information, education and support that
enhances the wellbeing of the person with dementia and
those that support them.
Carers outcomes:
managing the caring
role

I have the right to be as
independent as possible and be
included in my community

I have the right to have
carers who are well supported and
educated about dementia
Points
Development of the Approach
• Build on previous research at Universities of
Glasgow and York
• Work with JIT since 2006
• Workshops with 7 partnerships 2006
• Pilot work with 10 early implementer
Partnerships 2007 – 2008
• Outcomes embedded in CCOF and NMIS
• Name changed from UDSET – Talking Points
late 2008
Talking Points: Personal Outcomes
Approach
• Embeds focus on outcomes in day to day practice
through:
– Identification of outcomes important to service users /
carers at assessment
– Negotiating outcomes focussed care and support plans
– Determining whether outcomes achieved at review,
why/why not and what more can be done
• Conversations about outcomes semi-structured and
tailored to individual
• Information on outcomes recorded at every stage
through short narratives and tick boxes
Exchange Model of Assessment
1
EXCHANGE INFORMATION
- Identify desired outcomes
2
User’s view
Carer’s view
NEGOTIATE
3
AGREE
OUTCOMES
Assessor’s view
4
RECORD
OUTCOMES
Agency’s view
‘EXCHANGE MODEL’ OF ASSESSMENT
Talking Points: Personal Outcomes
Approach
• Information recorded at assessment, support plan
and review used to ensure experiences of service
users and carers included in:
– Service improvement – what is working well, for whom
and why?
– Planning – what are the key issues facing client groups /
communities? How do services need to change to address
these?
– Performance management – are we delivering good
outcomes for service users and carers in this service /
partnership?
– Commissioning and contract management – which
providers deliver the best outcomes?
Dimensions of change implementing an
outcomes approach
CULTURE
Performance
SYSTEMS
Improvement
PRACTICE
Progress in implementation
• Almost all partnerships and approx 40 providers using Talking
Points approach
– From whole systems implementation to focussed / early pilots e.g.
intermediate care
• Consensus on principles and philosophy underpinning
approach
• Considerable shared learning on effective implementation
• Increasing alignment across policy areas, nb scrutiny bodies,
reshaping care, LTC, dementia strategy, SDS
• Support for implementation via JIT website and COP
• Continued development work nb commissioning,
communication, engagement with health, pilot in care homes
Is it making a difference?
• Lots of evidence that service users and carers feel more
listened to and empowered
• Growing numbers of individuals whose lives have been
transformed
• Staff doing their job the way they want
• Organisations working and thinking differently
• Supports personalisation, re-ablement, community capacity
building
• People realise getting the views of service users and carers
– Essential
– Possible
Implementation with people with
dementia
• Semi-structured nature of approach inclusive to
people with dementia
• Communication tools such as Talking Mats have been
used to support work
• Successful implementation with providers and
assessment and review teams (including in care
homes)
• Non specialist staff required additional support to
include people with dementia in approach
– Lack of confidence and experience at engaging with people
with dementia
– Time for relationship building and more exploratory
approach to capturing info needs to be protected
Talking Mats
Support for implementation
• Material and resources posted on JIT website
(http://www.jitscotland.org.uk/action-
areas/user-and-carer-involvement/)
– NB digital stories
– Communication Skills (communication difficulties and
outcomes focussed conversations)
– Using Outcomes Data
– Care Home Pilot and Framework (coming soon)
• Community Care Outcomes Community of Practice
http://www.communities.idea.gov.uk/welcome.do