1. © Triangle Consulting 2011 1 T The Outcomes Star Hotspot for SIAA Conference Berlin, November 2012 Joy MacKeith

2. The Outcomes Star™ Empowers service users and supports them in making changes Promotes a consistent, holistic, assets based approach to key-work Provides meaningful outcomes information

3. Tailored versions for different groups Recovery Star (mental health) Life Star (Learning Disabilities) Work Star Older Person’s Star Youth Star Empowerment Star (domestic violence) Teen Star Well-being Star (long-term health conditions) Spectrum Star (Autistic spectrum) Family StarCommunity Star Shooting Star (schools) Homelessness Star Alcohol Star Music Therapy Star Drug and Alcohol Star

4. More in the pipeline Carers Star Carers Star Children’s Star Children’s Star Recovery Star (secure settings) Recovery Star (secure settings) And in discussion….. ADHD Star ADHD Star Offenders Star Offenders Star Early Intervention Star Early Intervention Star

5. Widely recognised in the UK Department of Health mental health White Paper ‘New Horizons’ features the Recovery Star. DoH has funded the use of the mental health version of the Star in five of the ten strategic health authorities in England and the new Well-being Star National membership bodies Homeless Link, Mental Health Providers Forum and Alcohol Concern publish and promote the version for their sector Local Authorities including Camden, Kirklees, Westminster and Derbyshire are writing the Outcomes Star into their contracts Chartered Institute of Housing is featuring the Homelessness Star in its new qualification for key-workers in homelessness services Big Lottery funded the development of the Outcomes Star website Service providers are using it in USA, Australia, Italy, Denmark as well as UK 5 © Triangle Consulting 2010

6. Used around the world Collaborators offering Stars in the following countries Australia New Zealand Canada Ireland France Italy Holland Denmark

7. A visual tool

8. An objective tool

9. Detailed descriptions of each scale point

10. Built on a model of change 9-10 Effective parenting7-8 Finding what works5-6 Trying3-4 Aware 1-2 Stuck

11. Discuss each area in turn

12. Then plot on Star for overview

13. Repeat at later point to see change

14. Notes provide more detailed information

15. And links directly to action planning

16. Integrated within case-work Open discussion of each area Agree where client is on their journey in that area Plot on the star and take an overview Decide where to focus and develop action plan Triangle Consulting Social Enterprise 2012

17. Outcomes info at four levels 17 © Triangle Consulting 2010 National outcomes Commissioner/ organisation outcomes Service outcomes Individual outcomes

18. Service outcomes © Triangle Consulting 2009

19. Service outcomes (detail) © Triangle Consulting 2009

20. Service outcomes as Star © Triangle Consulting 2009

21. Service outcomes (detail) © Triangle Consulting 2009

22. Compare services © Triangle Consulting 2009

23. Compare services (detail) © Triangle Consulting 2009

24. Benchmark externally © Triangle Consulting 2009

25. Benchmark externally (detail) © Triangle Consulting 2009

26. Advanced Service Report © Triangle Consulting 2009

27. Advanced Service Report © Triangle Consulting 2009

28. Data is easy to interpret 28 © Triangle Consulting 2010 ScoreInterpretation Mean score on entry to the service = 3.5 entering the service at the ‘Aware’ stage Will attend appointments but need high level of encouragement, supervision and monitoring Mean score on exit = 6Leaving the service at the ‘Trying’ stage. Clients are trying to do things differently but still need a lot of support

29. St Mungos learning from Star data 73% of clients benefit (11% staying stable & 62% progressing) Best outcomes among a minority group with specialist workers (86% made progress) – demonstrating that this approach works Women did not progress in the hostels – need to rethink provision for women or avoid hostels? Outcomes reduce after 12 months, especially without progression and activities in a hostel – need for move-on accommodation 29 © Triangle Consulting 2010

30. Resources to support each version User guide for workers and service users Organisation guide to aid implementation Star On-lineTraining

31. Star online - Flexible use Can be used on its own or linked via API to an existing system Works on Ipad and Iphone Can complete Stars on paper and enter info online afterwards if preferred Can be purchased as part of a package (eg Substance Views) 31 © Triangle Consulting 2011

32. Service users like it © Triangle Consulting 2009 32 “I felt fully involved; it was clear and easy to understand and focused on me as a whole person, not just as a problem. It felt like a conversation; felt like the first time someone had really listened to me...”

33. And so do workers and managers © Triangle Consulting 2009 33 “The services are more client-focussed because the Star makes us think about the client and what is changing for each individual..... It has helped staff to start thinking creatively about how to get greater improvements as well.

34. Outcomes Stakeholders Service users need: Tools which empower them to make changes Workers need: tools which help them work effectively with stakeholders Managers need: tools which help them identify service strengths and weaknesses Commissioners need: tools which enable them to identify effective providers Researchers and policy makers need: tools which help establish which interventions are most effective 34

35. Validation Questions? 35

36. Service Users – lots of case study evidence © Triangle Consulting 2011 36 “I felt fully involved; it was clear and easy to understand and focused on me as a whole person, not just as a problem. It felt like a conversation; felt like the first time someone had really listened to me...”

37. A Mental Health Tribunal © Triangle Consulting 2011 37 The RMO spoke of the Recovery Star and how her team uses it tool with patients..... The sense of progressive momentum and optimism that seems to be possible with this tool is just so lovely to hear about, and such a privilege to see in action. This was a lad who could so easily have gone on to be crippled with such early psychotic distress, but instead seems to be facing an energised sense of his own capabilities

38. Workers 1) Burns, MacKeith and Graham (2008) Looked at 25 organisations that had been using the homelessness version of the Outcomes Star for two years or more All 25 organisations reported that key-work had improved as a result of using the Outcomes Star Key-work had become  more focused on service user change  more systematic and consistent  and covered a wider range of issues 2) Study carried out by the University of Newcastle and Hunter New England Mental Health, Australia on the Recovery Star found that clinicians viewed all Recovery Star domains as important for care planning © Triangle Consulting 2012 38

39. And lots of case study evidence too © Triangle Consulting 2011 39 “The services are more client-focussed because the Star makes us think about the client and what is changing for each individual..... It has helped staff to start thinking creatively about how to get greater improvements as well.

40. Outcomes data for Managers (from St Mungos research) 73% of clients benefit (11% staying stable & 62% progressing) Most progress seen in accommodation and substance misuse, least in living skills and mental health Only 46% of women make progress Best outcomes among a minority group with specialist workers – 86% Positive outcomes correlate with participation in activities in the project and outings 40 © Triangle Consulting 2011

41. Many commissioners are writing the Star into their contracts and are requiring reporting on Star data – in some cases as part of PbR contracts (in Supporting People) We recommend that Star data is collected alongside severity and risk data © Triangle Consulting 2012 41 Commissioners:

42. Policy-makers and Researchers Two studies carried out on the Recovery Star 1) Study carried out by Mental Health Providers Forum and St Andrews “Recovery Star: validating user recovery” published in 2012 in the Psychiatrist 2) Study carried out by Dr Helen Killaspy at University College Hospital, London, submitted for publication 42 © Triangle Consulting 2012

43. MHPF and St Andrews Study Based on 2 Star readings for 203 service users Normal distribution: Scores on 7 of 10 scales were normally distributed Internal consistency: high Item redundancy: low Responsiveness (ie the tool recorded change over time): Good Study indicated some refinement needed on Addictive behaviour, responsibilities and work scales 43 © Triangle Consulting 2012

44. UCL Study Based on Star readings with 172 services users and 120 staff from four inpatient and community services participated. Test:retest reliability Inter-rater reliability Convergent validity Worker views of usefulness and usabillity Service user views of usefulness and usability Some issues with suitability of some of the settings 44 © Triangle Consulting 2012

45. To find out more Visit www.outcomesstar.org.uk to find out more about the Outcomes Star and download and try out paper versions of the Star for freewww.outcomesstar.org.uk Visit www.staronline.org.uk and click on 30 day free trial to experiment with using the Star online yourselfwww.staronline.org.uk 45 © Triangle Consulting 2010