1. Outcomes – Gaye Powell

3. * “... a predicted measure of change that demonstrates a valid and significant therapeutic impact following an agreed intervention.” (Perigo and Callaghan, 2011.3) * “… intervention benefits in ‘real world’ conditions, particularly functional change” (Olswang, 1998)

4. * “ results or visible effects of interventions…. part of the quality cycle….. the impact of interventions….identify the effectiveness of practices….” (Enderby, John & Petheram, 2006) * “Outcomes, by and large, remain the ultimate validators of the effectiveness and quality of medical care.” (Donabedian 1980)

5. * improved use of existing function * reduction of communication anxiety and avoidance * improvement in interaction and effective social communication * increased awareness of others about communication * improved communication environment * greater opportunities for communication

6. * measures of process * assessments of need or impairment * diagnostic

7. * A process that enables comparison of inputs, processes or outputs between providers * Benchmarks are used as the [best] standard by which you measure your performance * Analysis of outcome data can identify conditions under which programs do well and do poorly * Need consistency between inputs, outputs, and outcomes. Inconsistent outputs = unreliable outcomes

8. “ Benchmarking is the practice of being humble enough to admit that someone else is better at something and wise enough to try and learn how to match and even surpass them at it.” (Benchmarking Clearinghouse, p. 20).

9. Structure ProcessOutcome Staff grades, costs of assessment tools, quality of accommodation No. of interventions provided; no of patients seen Changes in patients communication, wellbeing

10. ContextMechanismOutcome People and participants, resources available The theory and mechanism of how an intervention works Impact on patients

11. Parents * Communication as the fundamental underpinning skill * Independence * Social inclusion * Other people’s behaviou r Children * Fun and laughter * Friendships * Feeling supported * Emotions * Communication * Other people’s behaviour

12. Wide variation in levels of ‘outcomes’ Results of intervention Most written as ‘goals’ or ‘targets’ Wide range and number of outcomes across and within themes (from 34 to 8) Wide variation in levels of ‘outcomes’ Results of intervention Most written as ‘goals’ or ‘targets’ Wide range and number of outcomes across and within themes (from 34 to 8)

13. * Emotional wellbeing * Social interaction * Independence * Participation and inclusion * Academic achievement But where is the evidence?

14. “… decision making on hunches instead of data.” (Deming, 1982)

15. Assurance for: * parents and children - best possible, consistent standards of practice and outcomes (NHS, 2013) * commissioners - services which provide best possible outcomes * research - robust evidence base to evaluate effects and costs of different interventions * the wider public - profession provides assured high standards evidence based, low in variability, best practice and predictable outcomes.

18. * “… maximizing value for patients [service users]: that is, achieving the best outcomes at the lowest cost.” (p51) * changes from within the professions because ultimately, value will be determined by how therapy is practiced * Outcomes: evidenced, collected, and reported publicly in order that best practices are adopted and outcomes improved

19. * Tier 1. Health status achieved or retained functional level achieved, activities, and participation. * Tier 2. Process of recovery nature of intervention, waiting times, time in treatment. * Tier 3. Sustainability of health status ongoing progress, functioning, participation and well-being

20. * of value of SLT to commissioners (16.8%) and the power they hold! * to improve practice and outcomes (34.4%) * to support research (18.9%) * to secure future service provision for patients (17.8%) * to motivate patients (16%) and staff (16.3%) * to increase understanding of other professionals of the value of SLT (15%)

21. * Significant risks for our profession if we do not collect and share robust outcome data (100% ) * 1st step - agree critical domains for key clinical specialities (92%) * The profession should adopt a ready made system whilst we develop a consensus system (38% - ready made system; 58% want this whilst consensus system developed) * Most popular outcomes measure: TOMs (22%) (N Survey)

22. Principles: * An opt-in process * No tool is perfect but aim for continual refinement Signs of success: * Consensus about what should be measured and how * Outcome data being used to support service delivery and quality assurance * SLT services well positioned to provide evidence to commissioners and government

23. 1. Building on-going consensus 2. Developing a package of education & training 3. Agreeing the recommendation of a tool for the short term 4. Agreeing what needs to be measured at a clinician, service, national level 5. Capture major areas of emerging policy in Education, Health, Social Care, Justice, Public Health government agendas

24. 6. Building or signposting to existing useful resources 7. Building partnerships, collaborations with existing projects and partners 8. Identifying potential funding streams 9. Identifying effective means for collecting and analysing data across professional communities 10. Developing guidelines for measuring outcomes and using the tool

25. Steering group Action group Reference group email: gemma.lotha@rcslt.org Hubs email: hubs@rcslt.org CENs and specialist advisers email: gemma.lotha@rcslt.org