London region outcome training

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Stroke helpline Website 0845 3033 100 www.stroke.org.uk Goals and Outcomes The Stroke Association’s Life After Stroke Services

Transcript of London region outcome training

Page 1: London region outcome training

Stroke helpline Website0845 3033 100 www.stroke.org.uk

Goals and Outcomes

The Stroke Association’s Life After Stroke Services

Page 2: London region outcome training

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

Page 3: London region outcome training

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?

Page 4: London region outcome training

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

Page 5: London region outcome training

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

Page 6: London region outcome training

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

Page 7: London region outcome training

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

Page 8: London region outcome training

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

Page 9: London region outcome training

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

Page 10: London region outcome training

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

Page 11: London region outcome training

Stroke helpline Website0845 3033 100 www.stroke.org.uk

1: Needs Assessment

Page 12: London region outcome training

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

Page 13: London region outcome training

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

Page 14: London region outcome training

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

Page 15: London region outcome training

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

Page 16: London region outcome training

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

Page 17: London region outcome training

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

Page 18: London region outcome training

Stroke helpline Website0845 3033 100 www.stroke.org.uk

SMART Goals

• S Specific

• M Measurable

• A Achievable

• R Realistic

• T Time limited

2: Goals

Page 19: London region outcome training

Stroke helpline Website0845 3033 100 www.stroke.org.uk

What sort of goals might Service Users have?

Here Here And Here

2: Goals

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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

Page 21: London region outcome training

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

Page 22: London region outcome training

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

Page 23: London region outcome training

Stroke helpline Website0845 3033 100 www.stroke.org.uk

Where do outcomes come from?

Action OutputInput Outcome

4: Outcomes

Page 24: London region outcome training

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

Page 25: London region outcome training

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

Page 26: London region outcome training

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

Page 27: London region outcome training

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

Page 28: London region outcome training

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

Page 29: London region outcome training

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

Page 30: London region outcome training

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

Page 31: London region outcome training

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

Page 32: London region outcome training

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

Page 33: London region outcome training

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

Page 34: London region outcome training

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

Page 35: London region outcome training

Stroke helpline Website0845 3033 100 www.stroke.org.uk

Putting it all together

Unmet Need Poor communication abilities

Goal

Action

Outcome

Impact

Page 36: London region outcome training

Stroke helpline Website0845 3033 100 www.stroke.org.uk

1: Unmet need

Page 37: London region outcome training

Stroke helpline Website0845 3033 100 www.stroke.org.uk

2,3,4: Goals, Actions and Outcomes

Page 38: London region outcome training

Stroke helpline Website0845 3033 100 www.stroke.org.uk

5: Impact Reporting

Page 39: London region outcome training

Stroke helpline Website0845 3033 100 www.stroke.org.uk

5: Impact Reporting

Page 40: London region outcome training

Stroke helpline Website0845 3033 100 www.stroke.org.uk

Whats going on at the moment?

CRM Module/ Intermediate fix

Coordinator Training

Updated Commissioner

Report

Page 41: London region outcome training

Stroke helpline Website0845 3033 100 www.stroke.org.uk

Practice

Page 42: London region outcome training

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?

Page 43: London region outcome training

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

Page 44: London region outcome training

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

Page 45: London region outcome training

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

Page 46: London region outcome training

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

Page 47: London region outcome training

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.

Page 48: London region outcome training

Stroke helpline Website0845 3033 100 www.stroke.org.uk

Thank-you and Safe Journey home