Understanding Outcomes Todor Proykov, research in practice for adults 2 nd 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 ( 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 _________________________________________________________ ‘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, Outcomes valued by users Health and emotional well-beingMaintaining Independence Quality of lifeKeeping clean and comfortable Making a positive contributionEnjoying a clean and orderly environment Exercising choice and controlBeing safe Freedom from discrimination and harassment Sustaining social contact and company Economic well-beingKeeping active and alert Personal dignity and respectLiving healthier and longer lives Maintaining an adequate income Having opportunities to contribute to family and community Feeling valued

User Defined Outcomes, DH Miller E and Cook A, University of Glasgow Quality of LifeProcessChange 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 2006 Miller E and Cook A, University of Glasgow Quality of life of carer Coping with CaringProcess 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 Study First phase findings ( ) 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 Outcomes Sawyer 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: - Social Policy Research Unit, University of York Publications 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), 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), 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,