Understanding outcome-based support

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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