The Outcomes Star

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The Outcomes Star Hotspot for SIAA Conference Berlin, November 2012

Joy MacKeith © Triangle Consulting 2011

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The Outcomes Star™

Provides meaningful outcomes information

Empowers service users and supports them in making changes

Promotes a consistent, holistic, assets based approach to key-work

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 Star

Community Star

Shooting Star (schools)

Homelessness Star

Alcohol Star

Music Therapy Star

Drug and Alcohol Star

More in the pipeline  Carers Star  Children’s Star  Recovery Star (secure settings)

And in discussion…..  ADHD Star  Offenders Star  Early Intervention Star

Widely recognised in the UK 5

 Department of Health mental health White Paper ‘New Horizons’

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   

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

© Triangle Consulting 2010

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

A visual tool

An objective tool

Detailed descriptions of each scale point

Built on a model of change

9-10

Effective parenting

7-8

Finding what works

5-6

Trying

3-4

Aware

1-2

Stuck

Discuss each area in turn

Then plot on Star for overview

Repeat at later point to see change

Notes provide more detailed information

And links directly to action planning

Integrated within case-work

Open discussion of each area

Agree where client is on their journey in that area

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Plot on the star and take an overview

Decide where to focus and develop action plan

Outcomes info at four levels 17

National outcomes Commissioner/ organisation outcomes Service outcomes

Individual outcomes

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Service outcomes

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Service outcomes (detail)

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Service outcomes as Star

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Service outcomes (detail)

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Compare services

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Compare services (detail)

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Benchmark externally

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Benchmark externally (detail)

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Advanced Service Report

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Advanced Service Report

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Data is easy to interpret 28

Score

Interpretation

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 = 6

Leaving the service at the ‘Trying’ stage. Clients are trying to do things differently but still need a lot of support

© Triangle Consulting 2010

St Mungos learning from Star data 29

 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 © Triangle Consulting 2010

Resources to support each version

User guide for workers and service users

Organisation guide to aid implementation

Star On-line

Training

Star online - Flexible use 31

 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) © Triangle Consulting 2011

Service users like it 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...”

© Triangle Consulting 2009

And so do workers and managers 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.

© Triangle Consulting 2009

Outcomes Stakeholders 34

 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

Validation Questions? 35

Service Users – lots of case study evidence 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...”

© Triangle Consulting 2011

A Mental Health Tribunal 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

© Triangle Consulting 2011

Workers 38

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

And lots of case study evidence too 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.

© Triangle Consulting 2011

Outcomes data for Managers (from St Mungos research) 40

 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 © Triangle Consulting 2011

Commissioners: 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

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Policy-makers and Researchers 42

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

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MHPF and St Andrews Study 43

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

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UCL Study 44

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 © Triangle Consulting 2012

To find out more 45

 Visit www.outcomesstar.org.uk to find out more

about the Outcomes Star and download and try out paper versions of the Star for free  Visit www.staronline.org.uk and click on 30 day

free trial to experiment with using the Star online yourself

© Triangle Consulting 2010