Introduction to Personal Outcomes and the Talking Points Approach Dr Ailsa Cook
[email protected]
What do we mean by outcomes? The impact or end result of service(s) on a person’s life The user or carer is involved in identifying desired outcomes = setting goals in partnership with services
Which outcomes? • Research with service users and carers identified most important outcomes across Community Care – University of York (1995-2005) – University of Glasgow (2004-2006) – JIT / VOCAL / East Renfrewshire (2006-2007)
• Two outcomes frameworks underpin Scottish Government Community Care Outcomes Approach
Outcomes: service user Quality of life
Process
Change
Feeling safe Having things to do Seeing people Staying well Living as you / where want
Listened to Having a say Treated with respect Responded to Reliability
Improved confidence Improved skills Improved mobility Reduced symptoms
Outcomes: people living in a care home Quality of life
Process
Feeling safe and secure Treated as an individual Seeing people Valued and respected Having things to do Listened to Live in a nice place Having a say Live life as I want and Support to live well/ where I want plan for end of life Stay as well as I can Family and friends involved Belong to a community Trust staff and rely on them to respond Privacy is respected
Change Improved skills Improved confidence and morale Improved mobility Improved health / reduced symptoms Settled into home
Outcomes: Carer QoL cared for person
QoL carer
Managing the caring role
Process
Quality of life for the cared for person
Maintaining health and wellbeing A life of their own Positive relationship with cared for person Freedom from financial hardship
Choices in caring Feeling informed/ skilled/ equipped Satisfaction in caring Partnership with services
Valued/respected and expertise recognised Having a say Flexible and responsive Positive relationship with practitioners Accessible, available and free at point of need
Standards of Care for Dementia in Scotland
Knowledge and Skills Framework QoL Outcome Indicators
Talking Outcomes
I have the right to a Diagnosis
People with Dementia have access to a timely and accurate diagnosis of Dementia
Not explicitly covered
I have the right to be regarded as a unique individual and to be treated with dignity and respect I have the right to access a range of treatment and supports I have the right to end of life care that respects my wishes
People with Dementia feel empowered and enabled to exercise rights and choice, maintain their identity and to be treated with dignity and equity People with Dementia maintain their best level of physical, mental, social and emotional wellbeing
Process outcomes Change outcomes, plus Stay as well as can
People with Dementia have access to individuals, groups and organisations that can support their spiritual or personal beliefs and reflect their cultural wishes People with Dementia have access to quality services and can continue to participate in community life and valued activities People with Dementia feel safe and secure and are able to be as independent as possible People with Dementia are able to maintain valued relationships and networks, and have the opportunity to develop new ones both personal and professional
Live as you want, have a say, seeing people, dealing with stigma, discrimination. Having things to do, seeing people Feeling safe
People with Dementia, and their family, friends and carers, have access to the information, education and support that enhances the wellbeing of the person with dementia and those that support them.
Carers outcomes: managing the caring role
I have the right to be as independent as possible and be included in my community
I have the right to have carers who are well supported and educated about dementia
Points
Development of the Approach • Build on previous research at Universities of Glasgow and York • Work with JIT since 2006 • Workshops with 7 partnerships 2006 • Pilot work with 10 early implementer Partnerships 2007 – 2008 • Outcomes embedded in CCOF and NMIS • Name changed from UDSET – Talking Points late 2008
Talking Points: Personal Outcomes Approach • Embeds focus on outcomes in day to day practice through: – Identification of outcomes important to service users / carers at assessment – Negotiating outcomes focussed care and support plans – Determining whether outcomes achieved at review, why/why not and what more can be done
• Conversations about outcomes semi-structured and tailored to individual • Information on outcomes recorded at every stage through short narratives and tick boxes
Exchange Model of Assessment 1
EXCHANGE INFORMATION - Identify desired outcomes 2 User’s view Carer’s view NEGOTIATE 3 AGREE OUTCOMES
Assessor’s view
4 RECORD OUTCOMES
Agency’s view
‘EXCHANGE MODEL’ OF ASSESSMENT
Talking Points: Personal Outcomes Approach • Information recorded at assessment, support plan and review used to ensure experiences of service users and carers included in: – Service improvement – what is working well, for whom and why? – Planning – what are the key issues facing client groups / communities? How do services need to change to address these? – Performance management – are we delivering good outcomes for service users and carers in this service / partnership? – Commissioning and contract management – which providers deliver the best outcomes?
Dimensions of change implementing an outcomes approach CULTURE Performance
SYSTEMS
Improvement
PRACTICE
Progress in implementation • Almost all partnerships and approx 40 providers using Talking Points approach – From whole systems implementation to focussed / early pilots e.g. intermediate care
• Consensus on principles and philosophy underpinning approach • Considerable shared learning on effective implementation • Increasing alignment across policy areas, nb scrutiny bodies, reshaping care, LTC, dementia strategy, SDS • Support for implementation via JIT website and COP • Continued development work nb commissioning, communication, engagement with health, pilot in care homes
Is it making a difference? • Lots of evidence that service users and carers feel more listened to and empowered • Growing numbers of individuals whose lives have been transformed • Staff doing their job the way they want • Organisations working and thinking differently • Supports personalisation, re-ablement, community capacity building • People realise getting the views of service users and carers – Essential – Possible
Implementation with people with dementia • Semi-structured nature of approach inclusive to people with dementia • Communication tools such as Talking Mats have been used to support work • Successful implementation with providers and assessment and review teams (including in care homes) • Non specialist staff required additional support to include people with dementia in approach – Lack of confidence and experience at engaging with people with dementia – Time for relationship building and more exploratory approach to capturing info needs to be protected
Talking Mats
Support for implementation • Material and resources posted on JIT website (http://www.jitscotland.org.uk/action-
areas/user-and-carer-involvement/)
– NB digital stories – Communication Skills (communication difficulties and outcomes focussed conversations) – Using Outcomes Data – Care Home Pilot and Framework (coming soon)
• Community Care Outcomes Community of Practice http://www.communities.idea.gov.uk/welcome.do
