Introduction to Personal Outcomes and the Talking Points Approach

Dr Ailsa Cookailsa.cook@ed.ac.uk

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 userQuality of life Process Change

Feeling safeHaving things to

doSeeing peopleStaying 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 Change

Feeling safe and secure

Seeing peopleHaving things to doLive in a nice place

Live life as I want and where I want

Stay as well as I canBelong to a community

Treated as an individualValued and respected

Listened toHaving a say

Support to live well/ plan for end of lifeFamily and friends

involved Trust staff and rely on

them to respondPrivacy is respected

Improved skillsImproved confidence

and moraleImproved mobilityImproved health / reduced symptomsSettled 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 well-beingA life of their ownPositive relationship with cared for person Freedom from financial hardship

Choices in caringFeeling informed/ skilled/ equippedSatisfaction in caringPartnership with services

Valued/respected and expertise recognisedHaving a sayFlexible and responsivePositive relationship with practitionersAccessible, available and free at point of need

Standards of Care for Dementia in Scotland

Knowledge and Skills Framework QoL Outcome Indicators Talking Points Outcomes

I have the right to a Diagnosis

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

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

People with Dementia have access to a timely and accurate diagnosis of Dementia

People with Dementia feel empowered and enabled to exercise rights and choice, maintain their identity and to be treated with dignity and equityPeople with Dementia maintain their best level of physical, mental, social and emotional wellbeing

People with Dementia have access to individuals, groups and organisations that can support their spiritual or personal beliefs and reflect their cultural wishesPeople with Dementia have access to quality services and can continue to participate in community life and valued activitiesPeople with Dementia feel safe and secure and are able to be as independent as possiblePeople with Dementia are able to maintain valued relationships and networks, and have the opportunity to develop new ones both personal and professional

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.

Not explicitly covered

Process outcomesChange outcomes, plus Stay as well as can

Live as you want, have a say, seeing people, dealing with stigma, discrimination.Having things to do, seeing peopleFeeling safe

Carers outcomes: managing the caring role

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

AGREE OUTCOMES

User’s view Carer’s view

Assessor’s view Agency’s view

NEGOTIATE

RECORD OUTCOMES

‘EXCHANGE MODEL’ OF ASSESSMENT

1

2

3

4

EXCHANGE INFORMATION - Identify desired outcomes

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?

• Qualitative and quantitative data on individual outcomes gathered systematically and consistently

• Information used in a range of ways– Maximising outcomes for individuals– Service improvement / staff development– Planning, commissioning, performance management

• Staff training and feedback essential to data quality

Dimensions of change implementing an outcomes approach

CULTURE

PRACTICESYSTEMS

ImprovementPerformance

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