London region outcome training
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Transcript of London region outcome training
Stroke helpline Website0845 3033 100 www.stroke.org.uk
Goals and Outcomes
The Stroke Association’s Life After Stroke Services
Stroke helpline Website0845 3033 100 www.stroke.org.uk
What are Goals and Outcomes all about?
• Support Coordinators work in an ‘outcome oriented’ way
• Establish processes for capturing outcomes
• Provide the information that commissioners are asking for
Stroke helpline Website0845 3033 100 www.stroke.org.uk
1: Support Coordinators to work in an ‘outcome oriented’ way
1. Are we sure that what we do is what the service user wants us to do?
2. Does something useful result from what we do?
Stroke helpline Website0845 3033 100 www.stroke.org.uk
2: Introduce processes to linking Goals with Outcomes
• Unmet Needs & Goals
• Informal discussions with service users
• Recorded in casenotes
• Outcomes & Impact
• Casenotes
• Impact surveys
Hard to extract information
Stroke helpline Website0845 3033 100 www.stroke.org.uk
2: Introduce processes to linking Goals with Outcomes
• Unmet Needs & Goals
• Unmet needs recorded
• Goals formally identified
• Illustrating a pathway for the service user
• Outcomes & Impact
• Outcomes captured in CRM
• Linked to client cases
Stroke helpline Website0845 3033 100 www.stroke.org.uk
3: Provide a better picture to commissioners about what we do
• Commissioners are demanding information about ‘outcomes’ rather than ‘outputs’ or ‘inputs’
• Hundreds of potential outcomes are mapped onto 7 ‘impact’ categories
• Drawn from ‘our health our care our say’
• Widely accepted by commissioners
Stroke helpline Website0845 3033 100 www.stroke.org.uk
Linking Goals and Outcomes
Unmet needsGetting to know service user. Finding out what is important to them
Impact Reporting Matching ‘outcomes’ to ‘impact’ so that they can be reported on CRM & to Commissioners
Outcome
Stroke helpline Website0845 3033 100 www.stroke.org.uk
What we’re going to be talking about:
2: Goals 3: Action
4: Outcomes5: Impact Reporting
1: Needs Assessment
6: Case Studies
Stroke helpline Website0845 3033 100 www.stroke.org.uk
1: Needs Assessment
2: Goals 3: Action
4: Outcomes5: Impact Reporting
1: Needs Assessment
6: Case Studies
Stroke helpline Website0845 3033 100 www.stroke.org.uk
Needs assessment
• Opportunity to get a ‘global’ picture of what the service user’s unmet needs are
• Could use the Initial Assessment form• Covers:
– Daily Living– Communication– Social, home and financial– Lifestyle and health education– Carer’s issue
1: Needs Assessment
Stroke helpline Website0845 3033 100 www.stroke.org.uk
1: Needs Assessment
Stroke helpline Website0845 3033 100 www.stroke.org.uk
2: Goals
2: Goals 3: Action
4: Outcomes5: Impact Reporting
1: Needs Assessment
6: Case Studies
Stroke helpline Website0845 3033 100 www.stroke.org.uk
Are we doing what they want us to do?
• How do we know that what we’re doing is useful for the service user? – Because our services are stroke services?– (when you’ve got a hammer. . . )– Because we develop a plan with the service user– You to sit down with your service user and
identify what is important for them– Does this get the focus it deserves?
• Central to a Person Centred Service• Art Group example
2: Goals
Stroke helpline Website0845 3033 100 www.stroke.org.uk
Aside: Person Centred Planning
• A collection of tools and approaches built up around the field of Learning Disability that can be used to plan with a person - not for them .
• Used to help the person think about what is important in their lives now and also to think about what would make a good future.
• Planning should build the person's circle of support and involve all the people who are important in that person's life.
2: Goals
Stroke helpline Website0845 3033 100 www.stroke.org.uk
Easy goals to identify
• I want to feel like someone cares
• I want to talk with someone who understands and who’s got time to listen
• I want to understand
• I want to know what has happened to me and my family by talking with someone who knows what I’ve been through
• I want to know what to expect
• I want to talk with someone about what’s going to happen next
2: Goals
Stroke helpline Website0845 3033 100 www.stroke.org.uk
Turning conversation into goals: what might be the barriers?
• The language of goals can be confronting and ‘alien’
• However, people do express wishes for the future once a relationship has been established
• Goals have to be theirs, not ours
• Employ the principles of ‘person centred planning’
• Keeping it achievable
2: Goals
Stroke helpline Website0845 3033 100 www.stroke.org.uk
Dealing with un-achievable goals
• “I want to go back to how I was”• “I want to get back to work”• “I want to speak again”• Building single high level goals into
multiple achievable goals• Managing expectations• Developing an honest relationship
Stroke helpline Website0845 3033 100 www.stroke.org.uk
SMART Goals
• S Specific
• M Measurable
• A Achievable
• R Realistic
• T Time limited
2: Goals
Stroke helpline Website0845 3033 100 www.stroke.org.uk
What sort of goals might Service Users have?
Here Here And Here
2: Goals
Stroke helpline Website0845 3033 100 www.stroke.org.uk
3: Action
2: Goals 3: Action
4: Outcomes5: Impact Reporting
1: Needs Assessment
6: Case Studies
Stroke helpline Website0845 3033 100 www.stroke.org.uk
Action
• Who does what by when?
• What is the key thing to bear in mind when ‘allocating tasks’?
• Sets up an expectation for review at a definite point in the future
• Produces a ‘dynamic’ to engagement
• Results in an Outcome
• Example: Amensiac patient
3: Action
Stroke helpline Website0845 3033 100 www.stroke.org.uk
4: Outcomes
2: Goals 3: Action
4: Outcomes5: Impact Reporting
1: Needs Assessment
6: Case Studies
Stroke helpline Website0845 3033 100 www.stroke.org.uk
Where do outcomes come from?
Action OutputInput Outcome
4: Outcomes
Stroke helpline Website0845 3033 100 www.stroke.org.uk
Does something useful result?
• Achieving outcomes for a client is what we exist for• How do you capture this information?
– Case notes and case studies– Impact survey– Personal observations– Thankyou letters
• Does the achievement of an outcome get marked with the client?
• This is the ‘Outcomes’ bit of ‘Goals & Outcomes’– Associates personal achievements with service user records
on CRM
4: Outcomes
Stroke helpline Website0845 3033 100 www.stroke.org.uk
Hard Outcomes
• Clearly definable and quantifiable results that show the beneficiary has made progress towards achieving their personal goals.
• Typically, – completing a computer course, – returning to driving – or employment.
• Usually straight-forward both to identify and to measure
4: Outcomes
Stroke helpline Website0845 3033 100 www.stroke.org.uk
Soft Outcomes
Maybe intermediary steps towards achieving a hard outcome, such as:
• Improved confidence • Practical work focussed skills such as taking up volunteering• Retraining in a different line of business • Equally soft outcomes can be• ‘distance travelled’, where people have moved from, having
improved their mood or well being by engaging in peer support
• other emotional support activities. • Increased, their confidence, in communications strategies
4: Outcomes
Stroke helpline Website0845 3033 100 www.stroke.org.uk
5: Impact
2: Goals 3: Action
4: Outcomes5: Impact Reporting
1: Needs Assessment
6: Case Studies
Stroke helpline Website0845 3033 100 www.stroke.org.uk
Reporting on Outcomes
• In order to record what is achieved with service users, we convert Outcomes into Impacts
• We use a well established and recognised group of indicators to identify the consequential outcomes for people we have supported
• Ideally, this to be achieved with service users• Which are recognised and in many cases their
measurement of choice for commissioners• Meets the requirement for us to be accountable to
our commissioners by giving us the evidence of what we are achieving
5: Impact Reporting
Stroke helpline Website0845 3033 100 www.stroke.org.uk
Our Health, Our Care, Our Say(January 2006)
• Improved health and emotional well-being
• Improved quality of life
• Making a positive contribution
• Choice and Control
• Freedom from discrimination
• Economic well-being
• Personal dignity
5: Impact Reporting
Stroke helpline Website0845 3033 100 www.stroke.org.uk
Considerable overlap
Choice and
control
Choice and
control
Personal dignity
Personal dignity
Freedom from
Discrimination
Freedom from
Discrimination
Economic well being
Economic well being
Making a positive
contribution
Making a positive
contribution
Health And
well being
Health And
well being
Quality of lifeQuality of life
Client Client
Stroke helpline Website0845 3033 100 www.stroke.org.uk
Choice and
control
Choice and
control
Personal dignity
Personal dignity
Freedom from
Discrimination
Freedom from
Discrimination
Economic well being
Economic well being
Making a positive
contribution
Making a positive
contribution
Health And
well being
Health And
well being
Quality of lifeQuality of life
Client Client Outcome:
Giving up smoking
5: Impact Reporting
Stroke helpline Website0845 3033 100 www.stroke.org.uk
Choice and
control
Choice and
control
Personal dignity
Personal dignity
Freedom from
Discrimination
Freedom from
Discrimination
Economic well being
Economic well being
Making a positive
contribution
Making a positive
contribution
Health And
well being
Health And
well being
Quality of lifeQuality of life
Client Client Outcome:
Getting driving license
5: Impact Reporting
Stroke helpline Website0845 3033 100 www.stroke.org.uk
Choice and
control
Choice and
control
Personal dignity
Personal dignity
Freedom from
Discrimination
Freedom from
Discrimination
Economic well being
Economic well being
Making a positive
contribution
Making a positive
contribution
Health And
well being
Health And
well being
Quality of lifeQuality of life
Client Client Outcome:
Improved Confidence &
Communication
5: Impact Reporting
Stroke helpline Website0845 3033 100 www.stroke.org.uk
Impact Bingo
1. Giving up smoking2. Getting a driving license3. Improved confidence and communication4. Getting someone re-housed so they can get in and
out without calling on neighbours’ help5. Getting a weight problem under control6. Providing stroke information in hindi and arranging
access to an interpreter7. Getting someone back to work8. Someone can visit their grandchildren
5: Impact Reporting
Stroke helpline Website0845 3033 100 www.stroke.org.uk
Putting it all together
Unmet Need Poor communication abilities
Goal
Action
Outcome
Impact
Stroke helpline Website0845 3033 100 www.stroke.org.uk
1: Unmet need
Stroke helpline Website0845 3033 100 www.stroke.org.uk
2,3,4: Goals, Actions and Outcomes
Stroke helpline Website0845 3033 100 www.stroke.org.uk
5: Impact Reporting
Stroke helpline Website0845 3033 100 www.stroke.org.uk
5: Impact Reporting
Stroke helpline Website0845 3033 100 www.stroke.org.uk
Whats going on at the moment?
CRM Module/ Intermediate fix
Coordinator Training
Updated Commissioner
Report
Stroke helpline Website0845 3033 100 www.stroke.org.uk
Practice
Stroke helpline Website0845 3033 100 www.stroke.org.uk
Scenario for Prevention
• Mary (49) had assessment via TIA clinic.
• She is a smoker, hypertensive, overweight, and takes little exercise. She has a large family with adult children still at home. Husband is unemployed
• The consultant referred requesting you see Mary and assess her for receiving service following his clinic.
• What may you offer Mary?• What will she need to do?
Stroke helpline Website0845 3033 100 www.stroke.org.uk
From a clients perspective
Improved Health andWell being
I have undertaken the smoking cessation course and now do not smokeI have reduced my salt intake
I have been provided with help to make changes I want to makei.e. smoking cessation, dietary advice, healthy cooking lessons
I have accepted the risks but do not want to make the changes yet
I have been provided with information to make lifestyle choices – around smoking, losing weight, taking exercise
Assessing and discussing risksAgreeing individual goals- I want to give up smoking/lose weight/start to take
exercise
Stroke helpline Website0845 3033 100 www.stroke.org.uk
Referral to Back to Life or CIS
• Referral via IAS (FACS)
• John, had stroke nine months ago, still receiving support from the service but John feels ready for moving forward with his life.
• He lost his job as an HGV driver due to stroke (licence withdrawn)
• He misses driving, wants to take up some social activity which may lead to future employment options
• Is anxious about his finances and not had benefits update
Stroke helpline Website0845 3033 100 www.stroke.org.uk
Example of an identified goal
Economic well being
Benefits secured,LAS grant awarded client feeling happier about financial circumstances
Resulting in requiring an appeal.Coordinator, assisting/signpostingLAS grants , other grants applied for
Source form filling assistance/ completed sent off
Coordinator to refer to /or provide information regarding benefit entitlement
Assessment and goals relating to economic pressures
Stroke helpline Website0845 3033 100 www.stroke.org.uk
Key Points to Take Away
• Personal goals ascertained through observation, assessment, • Discussion and agreement
• Consider options and priorities and agree with client/service users-they are their goals not ours
• Plan approach, resources etc
• Review progress, success and record outcomes
• Ask client, family about impact, request Impact survey completion if appropriate
• Record outcomes in CRM and identify absolute ‘doozy’s’ to your manager
Stroke helpline Website0845 3033 100 www.stroke.org.uk
Next
• Exploring the goals set we want you to identify the impact you believe this has had on the service user from the given scenarios and outcomes- from their perspective.
Stroke helpline Website0845 3033 100 www.stroke.org.uk
Thank-you and Safe Journey home