1. Introduction to Personal Outcomes and Asset Based Approaches: The ability to have good conversations is at the heart of engaging with people around their personal outcomes.
March 2017
Ross Grieve
Lead External Training Consultant, Thistle Foundation
Alison Linyard , Personal Outcomes Programme Manager, Fife

2. Session Aims What do we mean by Personal Outcomes?
Techniques to support the outcomes conversations
Accessing Further Support

3. What do Humans need in order to experience wellbeing?

4. And at the heart of the approach are fundamental human needs
Feeling connected, part of , sense of belonging, accepted
Status, contribution , purpose
Love, friendship, companionship ( and alone time )
Wellbeing
Being respected, valued, treated with dignity
Peace, calmness
Safe
choice, having a say

5. Personal outcomes Frameworks
Quality of life
Process
Change
Feeling safe
Having things to do
Seeing people
Staying as well as you can
Living where you want/as you want
Dealing with stigma/
discrimination
Listened to
Having a say
Treated with respect
Being responded to
Reliability
Improved confidence/morale
Improved skills
Improved mobility
Reduced symptoms
Maintenance outcomes, Whole Life, working across agency boundaries in partnership with person, family and local communities.
Process relates to the experiences people have seeking, obtaining, and using services and can have a significant influence on the extent other outcomes are achieve.
Change relates to improvements or maintaining in PEM functioning
Relationships between outcomes are important and complex.
Supported accommodation feeling safe
Mental Health phone number to call
LD Not listened to affecting confidence and therefore quality of life
So high level enough to capture the issues most important to people. Not prescriptive list but only a guide an aide memoire, not to be used as checklist. A framework only like GIRFEC and SHANNARI

6. Personal outcomes and asset based approaches
A Personal Outcomes Approach is all about connecting to the person on the basis of ‘what matters to them’ as opposed to ‘what's the matter with them’.
Then using what matters to help them:
identify what they hope to get from your support
make informed decisions about their care/ treatment
make life changes which supports self management
It is an asset based approach as it asks important questions about hope and expectation, coping and resilience, person’s own knowledge, what the person is already doing that is helping them move towards where they want to be and using that information to make decisions and plan support/ treatment .

7. Our Questions: how might personal outcomes and asset based approaches:
Enhance care experience
Enhance staff experience
Support co-production
Support early discharge
Enhance discharge planning
Prevent hospital readmission
Support prevention/ anticipatory care, recovery and support for self management

8. Why do so many people value being able
To “tell their story” ( without interruption, fear of judgement, being diagnosed, solved and fixed)
To talk about “what matters”, not just “ what’s the matter”
To explore their resilience ( how they coping, managing, what they are already doing to deal with their life situation)
To talk about hope ( what they hope to get from working with you )

9. Who do you see?

10. Choose the person you want to work with.....
the person who has strengths, skills, resources, capacities and hopes… (despite overwhelming evidence to the contrary)

11. What does a Personal Outcome focused conversation look like?
Hopes ?
What else ?
Instead of ?
What difference ?
Description (who will notice? How will you know?)
Outcomes
Prompt questions
Person’s story
Resilience/ ability to
- Get through difficulty
Cope/ managing better
Keep going
(stay/ get more mobile)
- Manage/ reduce symptoms
- Progress toward outcomes
Listening to problems
Acknowledge
Coping
Exceptions
Strengths

12. Prompt questions/ agenda setting

13. ACES
Acknowledge
Coping
Exceptions
Strengths

14. What does a Personal Outcome focused conversation look like?
Hopes ?
What else ?
Instead of ?
What difference ?
Description (who will notice? How will you know?)
Outcomes
Prompt questions
Person’s story
Resilience/ ability to
- Get through difficulty
Cope/ managing better
Keep going
(stay/ get more mobile)
- Manage/ reduce symptoms
- Progress toward outcomes
Listening to problems
Acknowledge
Coping
Exceptions
Strengths

15. Micro skills Hopes ? Instead of ? What else ? What difference ?
Description (who will notice? How will you know?)

16. Cultivating Hope and Expectancy
Develop a repertoire of questions and prompts which help people focus on what they want. Many people typically respond with “I don’t know” and need support to think, using a range of questions:
What are you hoping for?
What are you wanting to get from our support/ work together?
How will you know our support is making a difference to you?
What is your wife/ son (another person) hoping you’ll get from....?
What matters to you? What’s important to you?
What do want to be different in your life?

17. Toward Desired Outcomes. Instead of ? ( pages 63,64)
Many people know what they don’t want but may not know what they want.
Why is it important to work toward something desired rather than wat from something undesired?
Try it out ( worksheet p63 and co-coaching exercise p124)
Evoking Calmness - try this…………

18. What else?
This question recognises the wholeness of people’s lives - most people have many interconnected issues / difficulties and hopes for change which cover a wide range of life domains

19. What else?
Discovering a range of hopes allows for the possibility of getting change started somewhere…. anywhere….which then impacts across the system

20. What else ?
Useful technique to work with unrealisable hopes

21. What difference Increases motivation to act.
This question helps people explore the “ripple effect” - how small changes can have large effects

22. What difference
From output to outcome. Some people want things which are actually the “means to the end” to achieving outcomes which are important to them
Unrealisable Hopes. Another technique where the practitioner can agree on the outcome (the end) then negotiate the means by which the outcome is reached

23. Description
Described in rich, detail of day to day living, the outcomes are experienced by both the person and practitioner as realisable. It is also likely that some aspects of this future description are already being experienced at times.
Helping people describe the detail of what they want increases motivation to act and be involved.
This rich description becomes “well formed” - the practitioner supports the person to also describe their future through the eyes of others and brings others’ perspectives into the description, allowing practitioner and person to address possible conflicts of interest between family members and carer’s hopes, practitioner’s attentiveness to duty of care and safety issues, and their responsibilities to their agency (see exchange model).
This detail also helps support workers to NOT assume they know what people want and can plan support which fits much more closely with what people specifically want.

24. Unrealisable hopes Moving towards ( for more aspirational hopes)
Signposting ( hopes are not within your remit)
Go with it ( person self corrects)
Means to an end questioning ( then negotiate more realistic means)
Refer to an authoritative other
Embed into a range of other hopes
Ask “how likely is this to happen?”
Finally…. confront directly if its your role to do so

25. Engagement Planning Review Preparing people to work collaboratively
Agreeing purpose of meeting, roles and responsibilities
Meeting the person (not the problem/ diagnosis),
Understanding what’s important to people
Negotiating and agreeing realisable outcomes
Planning
Detailed description.
Well formed outcomes
Competency based assessment
(Clinical) reasoning and shared decision making to plan input
Determine indicators of progress
Seeking feedback
Review
Reviewing progress
Learning from setbacks (creating contingency and crisis plans)
Determine next signs (indicators) of progress
Negotiating endings

26. Conversational Framework
ENGAGEMENT
PLANNING negotiating and agreeing plan to achieve outcome
competency based assessment
clinical reasoning identifying whether professional input is required
what is my duty to act ? ,
what is the risk of acting?
what is the risk of not?
What is the appropriate level of input (*)?

27. (*)Levels of Input reassurance, compliments, skillful disclosure,
shared decision making,
suggestions, advice,
education,
signposting,
referral
intervention,
formal risk assessment, escalation

28. What keeps you well?
10 - as well as you can be , given your life situations
0 – opposite
X - where we all are just now
How come you are an x and not lower? (what are you doing to keep you as well as you are keeping just now?)
What else, what else?

29. What’s the difference between
Next steps
Next signs
What do you need to do to
How will you know when

30. S – start again (or next Signs of change)
EARS
E - elicit
A – amplify
R – resource
S – start again (or next Signs of change)

31. When things are worse What was better after we last met?
How did you maintain?
What happened? (strengths/ resilience based listening)
How did you stop things being worse?
How did you turn it around so quickly?
What have you already been doing to get back on track?
What will the next signs of getting back on track be ?