Outcomes Based Assessment

Tuesday 2nd J anuary 2008, Exeter

Understanding Outcomes

Todor Proykov, research in practice for adults

2nd December 2009, Exeter

Definitions

• Resource (input) – provision to achieve outcome (staff, care, equipment, funding)

• Activity (measure) – how the outcome is achieved(assessment interviews, home visits)

• Output – end point produced by activity(number of people supported to stay at home)

• Outcome – impact/result of services on a person or population(reduced risk of harm)

• Goal – ultimate achievement; not measurable compared to Outcome(minimising the risk of harm)

Outcomes Quiz(resource, activity, output, outcome or goal?)

Adapted from Clegg & Associates’ Logic Model Game (http://www.cleggassociates.com)

• 240 hours of domiciliary services per month • 30 senior practitioners• Increased accessibility to care services • Individualised assistance in developing living skills • Increased ability of clients to perform daily living tasks • Initial assessment and quarterly follow-up assessments • Maintain older people independence in their own homes for as

long as possible • Referrals to Meals on Wheels • Maintained/improved physical, social, and emotional functioning • National Lottery funding • Domestic/chore service • Home alarm system

Glendinning C, Clarke S, Hare P, Kotchetkova I, Maddison J and Newbronner L (2006) Outcomes-focused services for older people. SCIE

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‘Outcomes’ refer to the impacts or end results of services on a person’s life.

Outcomes-focused services therefore aim to achieve the aspirations, goals and priorities identified by service users – in contrast to services whose content and/or forms of delivery are standardised or are determined solely by those who deliver them.

Outcomes are by definition individualised, as they depend on the priorities and aspirations of individual people.

The Outcomes Framework(Social Policy Research Unit, University of York, 2000)

• Maintenance of quality of life – maintaining acceptable levels of personal comfort and safety, social contact, meaningful activity, participation in normally accepted social roles, control over daily life and routines, etc.

• Change – improving confidence, accessibility to services or of the environment, reducing risk, improving means of communication, regaining self-care skills, etc.

• Process – whether people feel treated as individuals, valued and respected, whether services fit well with other sources of assistance or with users’ preferences; the working relationship

Outcomes in Health and Social Care for Adults

Our Health, Our Care, Our Say DoH 2006

SPRU, 1996-2004Outcomes valued by users

Health and emotional well-being Maintaining Independence

Quality of life Keeping clean and comfortable

Making a positive contribution Enjoying a clean and orderly environment

Exercising choice and control Being safe

Freedom from discrimination and harassment

Sustaining social contact and company

Economic well-being Keeping active and alert

Personal dignity and respect Living healthier and longer lives

Maintaining an adequate income

Having opportunities to contribute to family and community

Feeling valued

User Defined Outcomes, DH 2004-06Miller E and Cook A, University of Glasgow

Quality of Life Process Change

• Feeling safe

• Having things to do

• Seeing People

• Staying well

• Living life as you want

• Living where you want

• Dealing with stigma

• Listened to

• Choice

• Treated as an individual

• Reliability

• Responsiveness

• Improved confidence and

skills

• Improved mobility

• Reduced symptoms

Carer Defined Outcomes, JIT 2006Miller E and Cook A, University of Glasgow

Quality of lifeof carer

Coping with Caring Process

• Health and wellbeing

• A life of their own

• Positive relationship with person cared for

• Freedom from financial Hardship

• Choices in caring including limits

• Feeling informed/skilled/equipped

• Satisfaction in caring

• Partnership with services

• Valued/respected

• Having a say in services

• Responsive to changing needs

• Meaningful relationship with practitioners

• Accessible and available and free at the point of Need

Shaping Out Lives Outcomes StudyFirst phase findings (1996-1998)

• Value of outcomes: users saw it as essential that users’ views were primary in this process and that the evaluation included the subjective perspectives of individual users.

 • Difficulty identifying outcomes: where services were poor and not being provided at

an adequate level, users found it difficult to determine the outcome of the service. • Outcomes for users of direct payments: people in receipt of direct payments had very

clear ideas about the outcomes that they had from the support that they arranged.  • Negative outcomes: being associated with services that did not meet the wishes of

the user  • Outcomes and process: the process of getting a service and the way in which it is

delivered can have a major impact on a user’s experience of a service. Such experiences have an impact on the outcome of the service and are not detached from the outcome in users’ perceptions.

 • A holistic approach: service users want to look at their lives and their needs as a

whole.

Hierarchy of OutcomesSawyer L (2005) An outcome-based approach to domiciliary care.

Journal of Integrated Care, 13(3)

Regaining independence and control

• Make a simple meal• Dress and undress without help• Wash or shower on his own• Organise his own shopping needs• etc.

• The History of the Outcomes Debate

• Problem Areas– Outcomes and personalisation– Conflicting outcomes– Process outcomes– Negatively defined outcomes– Culture change

Not everything that can be counted counts, and not everything that counts can be

counted

Albert Einstein

References and Resources - research in practice for adults’ resource pack:

http://www.ripfa.org.uk/publications/videos/outcomes/Resource%20Pack.pdf

- Social Policy Research Unit, University of York Publications

http://php.york.ac.uk/inst/spru/pubs/main.php

Glendinning C, Clarke S, Hare P, Kotchetkova I, Maddison J and Newbronner L (2006) Outcomes-focused services for older people. SCIE

Glendinning C, Clarke S, Hare P, Maddison J and Newbronner L (2008) Progress and problems in developing outcomes-focused social care services for older people in England. Health and Social Care in the Community, 16(1), 54-63

Qureshi H (1999) Outcomes of social care for adults: attitudes towards collecting outcome information in practice. Health and Social Care in the Community, 7(4), 257-265

Sawyer L (2005) An outcome-based approach to domiciliary care. Journal of Integrated Care, 13(3)

Smith P (1996) Measuring Outcome in the Public Sector. Oxford: Taylor & Francis.

Stanhope V and Solomon P (2008) Getting to the heart of recovery: Methods for studying recovery and their implications for evidence-based practice. British Journal of Social Work, 38, 885-899