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Understanding outcome based support planning
The impact of Outcomes on Support Planning
Getting support planning right
Brokerage
Resources not just services
Commissioning investing not funding
The market
Aims of support planning how do we get it right?
Is the means by which information is presented to release funding (DH) but its a whole lot more than that as well
Sets out how to achieve the desired outcomes
What the outcomes are and what the barriers (needs) are
Who will be involved and what do they will do
Evidence that DH guidance (personalisation toolkit etc) will work well for the most able and most keen to manage things themselves but what about least able?
Some have little idea about what might be possible
In some cases family or friends may be too protective
Some have no capacity to plan support
Some just dont want the hassle of doing it all themselves
Support planning getting it right
Should focus on bringing about best possible levels of independence, health and well being but must also reflect each persons own priorities
Will providing assistance solve the problem? How can we be sure that assistance doesnt skew the persons own wishes?
How can we achieve the right balance of power between service user and the council?
How can we ensure that even the least able can gain choice and control?
In time, will everyone want to do it for themselves??
An outcomes approach can help:
All about the impact that interventions have on a persons quality of life.
Concerned with bringing about support, which is flexible and responsive
About the person being in control, whether support is via mainstream services or unique to them but within a framework in which there is shared agreement about the aims
Ensures the outcomes are the right ones for that person
These should apply to every service user, however they get funding and whether they control it themselves or not so long as outcomes thinking permeates all our processes, and way of working
Personalisation
Universal Services
Applies to everyone, including those who wont qualify for public funding
Demands universal access to such services as transport, leisure, housing, education
Early Intervention and prevention
Choice and Control
Social Capital
Community, family and friends networks etc.
An outcome-based approach
Conventional
Assessor considers needs in consultation with user
Assessor identifies tasks to be completed on each visit
Assessor specifies time of arrival and time of departure
Monitoring consists of verifying visits and checking tasks completed
Success is related to efficiency in carrying out visits and tasks according to specification
Outcome-based
Service user identifies desired outcomes (priorities) in discussion with assessor
Assessor considers needs and determines time budget and eligibility. Possibly agrees some tasks with user, but user can change these as he/she wishes
Provider agrees service plan with user, including times/ days of visits, and tasks focusing on how best to achieve outcomes. User and provider can agree changes in visit days, times and tasks
Allocated time can be used flexibly over a given period
Monitoring will include verifying visits and recording tasks
Success is judged on whether or not outcomes are achieved
Department of Health guidance
Provide a range of information
Undertake, or assist with, support planning
Guidance on choice of support resources
Negotiation, mediation
Facilitation
Provide or access technical skills/information
Advocacy
Who provides brokerage?
Brokers must:
Understand the concept and practice of outcomes working, focusing on what is most important to the person
Understand local market
Have wide knowledge of local and national resources, including benefits etc.
Know where to access specialised advice
Have ability to think out of the box
How to make best use of budget i.e. not just buying paid support
Be able to design, or assist in designing and costing, support which supports the person in relation to his desired lifestyle, needs and chosen outcomes
Have excellent communication skills, including how to help those with communication difficulties
Have stories (examples) of how others have used budget
Understand issues around capacity to consent
Resources
Support resources not just services
Family and friends
Community resources to which we should all have access
Volunteers or voluntary sector organisations
Range of specific social care services
In-house provision
Voluntary or private providers commissioned or purchased individually
Individually sourced Personal Assistants
Making the change
Involve providers as you develop your ideas get wide-scale commitment and provide training
Really get to know your local providers what area do they cover, what is their capacity, who are the middle managers, how open are they to change?
Be clear about what you want and expect, but be open to negotiation what are the problems they foresee in changing what they do and how they do it? How can you help them?
There are advantages to them as well staff turnover improves with outcomes working, the potential for learning new skills, and taking more initiative
Relationships with service users will also improve as providers are able to respond more flexibly and as the service user has control over what is done and what is not done
Measuring outcomes
Service outcomes
numbers of people able to continue living at home
Individual outcomes
physical or emotional (confidence, engagement etc.)
Individual outcomes simple recording or more complex tools e.g. depression index, quality of life measure
Hard and Soft outcomes
Hard
Observable functional improvements
Reduction in recidivism or substance abuse
Young care leavers have improved academic qualifications
Carers are able to continue at work
Soft
Improved quality of life
Reduction in depression
Carers have reduced stress levels
People feeling more confident
Older people feeling valued
Well-being
Tools for measuring outcomes
Scales based on Activities of Daily Living (ADLs) focus on dependency, for example, bathing, dressing, continence etc.
Instrumental ADLs include core activities of independent living eg preparing meals, doing housework, managing finances, remembering to take medication etc.
Outcomes for Quality of Life
For Services
Feeling safe
Having things to do
Seeing people
Staying as well as you can be
Living where you want and as you want
Dealing with stigma/discrimination (mental health)
FOR CARERS
Quality of life for the cared-for person
Maintaining health and well-being
A life of his/her own
Positive relationship with the person cared for
Freedom from financial hardship
