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Social Work Scotland

Outcomes Focussed Assessment

Emma Miller
Meaningful and Measurable: Background
• Long term programme (since 2006) between research, policy and practice
• Meaningful and Measurable project (Nov 2013 until Feb 2015) was ESRC
funded. Involved 3 universities, 7 health and social care organisations, 1
children and families service and national bodies in Scotland and Wales
• We needed evidence about the difference made by outcomes approach
• AIMS: Develop approaches to using qualitative and quantitative outcomes data
• Capture good practice and share widely
• Explore tensions between meaning and measurement in services and find ways
to overcome them (also needed to test our own assumptions)
‘The definition of outcomes is the impact or end
results of services on a person’s life. Outcome-focused
services and support therefore aim to achieve the
aspirations, goals and priorities identified by service
users (and carers) – in contrast to services whose
content and/or form of delivery are standardised
or determined solely by those who deliver them.’
(Glendinning et al, 2006)

• What matters and why

What is the role of assessment?
• Assessment, planning and review are at the heart of the provision of services
and support in health and social care in the community, providing key means
through which professionals interact with people using their services. These
interactions provide opportunities for relationship building, with evidence that
involving the person in identifying their priorities and required support can itself
improve outcomes. At the same time, professionals use assessment to assess
eligibility for support, and assessment has also increasingly become a
mechanism for data gathering, to inform a range of requirements at local and
national level including planning, commissioning, inspection and performance
management. Despite attempts to move assessment from being service-led to
person-centred, meeting such a broad range of objectives and requirements can
create tensions at the front line, influencing both how interactions are
conducted, and the resulting decisions. (Miller 2010)
Values and principles paper, POC website
Outome Focus Example
Individual/pers Defined by the person as what I want to feel more confident in
onal is important to them in life school but I don’t want other kids
to know about my learning
Service/project Defined by a project or service We support children and young
as a key focus to work towards people with learning support needs
with people

Organisation Defined by a local authority, NHS We support young people to

board or provider as a key area to achieve their potential
work towards. Will increasingly
be required to be defined across
organisational boundaries

National Defined by Government to focus Achieving

activity across sectors and Included
Changing the Conversation

What else
Instead of
What difference
Prompt questions

Person’s story

- getting through difficulty
Acknowledge - coping managing better
 Listening to Exceptions - improving mobility
problems Coping - reducing symptoms

Source :JIT and Thistle Foundation (2014): Good Conversations Training

MM Evidence: Good conversations: Benefits
Summary of Learning from the Meaningful and Measurable project:
Identity, action and decision making around personal outcomes
• Opportunity to reflect on disrupted life narrative
• Focus on people’s strengths and assets, and not just deficits
• Build a shared sense of purpose about what needs to happen
• Clarify the roles different people can play in working towards the
same outcomes
• Good conversations are an effective intervention in their own right
• As well as conversations at the frontline, the project confirmed the
critical importance of dialogue at all levels in the organisation
• Supportive factors at organisational level include sharing good
practice examples and storytelling, changing the conversation at
every level, practitioners feeling valued and listened to, and a
feedback loop to practitioners about how info used
Dr Emma Millar
Questions and comments?
Challenges and strategies
Recording outcomes: Lifting a rock
Measuring outcomes
• With caveats and not in isolation
• Some measurement tools work well with some people e.g.
wellbeing webs etc
• Expectations of standardised data problematic
• Consistency of understanding of measures within a
team/service is important to get something useable
Pressures on the record
It was acknowledged that
practitioners were facing diverse and
competing demands in their recording practice
Findings on the importance of narrative recording
• We wrote up the case study from the carer service as a journal
article, focusing on the role of recorded narrative in supporting
carer, practitioner and organisational memory, including the
narrative supporting relationship building with the carer
• Practitioners identified their wish to find a balance between
recording in a concise way so that information is manageable and
retrievable, and ensuring that meaning is not lost
• Across the project as a whole, a range of conflicting pressures were
identified on narrative recording, with some distinctions noted
between statutory and voluntary sectors
Recording: Achieving a balance
Recording influences self-perception, continuing dialogue and how
the person is viewed by all involved agencies
‘And I know it’s a balance between recording in way that’s kind of
clear and concise, but also meaningful isn’t it, which is a whole skill in
‘And the conversation is the crucial thing. It’s about how you record
it. You know, and it’s the difference between having a conversation
and going and recording it, as opposed to having a record…or a way
of recording, which is then imposed on the conversation.’
Personal Outcomes: The Missing Piece of the
Information Jigsaw

Source Image adapted. Used in Cook A & Miller E (2012) Talking Points Personal Outcomes Approach, A
Between story and statistics
Category of data use Example(s) from practice
Practice and service Supporting good conversations
development Improving recording practice
Understanding measurement
Monitoring scores for
Using qualitative data
Performance management Improved quality monitoring
linked to practice/service
Understanding that numbers to
be used ‘with caveats and not in
Planning and Improved understanding of
commissioning effectiveness and impact, again
linking back to practice
What resources are available

Personal outcomes collaboration website


Meaningful and Measurable reports