The assertive outreach teams of Julian Housing (voluntary) and Norwich City NHS (statutory) work with some of the most complex and difficult to engage people in the area; people who don't want a service.
With small case loads of 10 clients per worker, they aim to engage people, stabilise mental health, reduce hospital admissions and address other key issues. Ben Curran first introduced the Outcomes Star within the assertive outreach team of Julian Housing two years ago, and recommended it to Jane Lambert, Team Manager of the statutory service because of their success with it. Here, Ben and Jane describe their experience:
Ben Curran, Julian Housing
We sought an outcomes tool to benefit service users
The Director of Practice Development at
Julian Housing is an outcomes champion. Taking her lead, we set out to find a tool that would make sense to our clients - people not keen to engage with formal processes - and enable staff to measure outcomes.
Essentially, we wanted a service user tool, something meaningful to our clients, to enable us to help them better.
Obviously we also have funding requirements and needed something to report our outcomes to funders, but our primary motivation was to benefit service users.
Within assertive outreach, the Star is now integral to the support plan; the Star Chart is on the front sheet, we have adopted the ladders [depicting the journey of change within each outcome area] and then have a section for what the client wants to prioritise based on their Star.
There were issues getting the team to embrace the Star
Some staff used to say that service users didn't like paperwork but actually we found that it was the staff who didn’t like paperwork! Service users were actually very enthusiastic about the Star. However all staff have now embraced the Star as standard.
They like the fact that it is visual. We still need to keep reminding staff to look back with people at their previous Star so it is not just done as a stand-alone measure. And we make sure that we market the Star to service users so that they can use it as in effective engagement tool and motivator.
We spent some time adapting the Star within our team, tweaking it to better measure the outcomes of our particular client group and leaving some of the outcome areas blank so that service users could decide what to measure.
However, we have had only varying degrees of success in encouraging clients to use the blank scales and have now decided to revert back to the original Outcomes Star so that we can use the outcomes Star system [online database]. We have so far struggled to produce outcomes data across the team and the OSS is fantastic, just what we need.
The Star increases focus and opens interesting conversations
Through using the Star, our work with service users and as a team has become more focused.
Plus we have had interesting conversations with many service users.
By completing the Star they find they have high scores in some areas and we can discuss how they can learn from those areas to tackle difficulties in their lives.
The Star has raised our profile as a voluntary organisation
Within a context where the voluntary sector can be seen as amateur, it has been good for us because the statutory services and funders are also interested. The Star links nicely to the supporting people outcomes; these are the areas agencies are increasingly being asked to demonstrate.
We are now looking at how we can use outcomes from the Star more to show our funders that we are effective.
We do use the supporting people outcomes form, but this is only on case closure and due to the nature of our work, we do not close many cases.
Key for us is to keep the Star dynamic and live
We have to keep it on the team agenda.
It is a dynamic tool and needs a level of input and discussion within the team.
You can't just introduce a tool like the outcomes Star and leave it.
You need to constantly check how it's going.
It needs ongoing training and discussion and to be a feature of quarterly development sessions, finding out how people are getting on with it and discussing why some service users and not engaging and how it might be possible to pitch the Star differently to maximise engagement.
Our team has pioneered the use of the Star within Julian Housing and the director of service development is now very interested in using it across the organisation.
Norwich City assertive outreach team
Over the years, we have tried a number of tools and measures but none quite fitted our clients.
We get very involved with people, looking at their whole life.
Many have complex social needs and we get involved on practical levels too.
The Star is good for both clients and demonstrating achievements
We wanted to use something our clients could engage with and which could involve clients right from the word go.
The Star is one of the few tools that is useful for both clients and staff and helps us demonstrate what we're doing - it ticks a lot of boxes!
It is person-centred and whole life.
Time-consuming CPA documentation is a barrier to implementation
At the moment some team members are using it and some
aren’t. As a statutory organisation we are subject to the Care Plan Approach process. Currently this is a very bureaucratic system and the documentation is vast, very time consuming, and geared more to problems than strengths. We now, as part of National Targets, also have to do the HONOS outcome measurement. However, we had looked at this about 7-8 years ago and decided it wasn't a very client-centred tool. It is staff-led, and does not fit well with what we do. Certainly the staff in the team who are doing both prefer using the Outcome Star.
It is likely that these heavy documentation demands have effected how much the Star is used. In addition, w
e did not organise staff training initially in the star and suspect that is also a reason why we had a rather a faltering start.
Further, one staff member was supposed to lead on the implementation but they didn't do it and then left the organisation, so the process was not very organised.
However, w
e are now making the outcomes star standard practice within our team.
Both clients and staff members find the Star useful
It opens interesting discussions with people about trying to get to a common, shared understanding of what the problems are.
And it is very visual.
One approach that has been very useful for us is where the worker has completed the Star initially and shown it to the client and used it to prompt clients to start engaging where they had not done so before.
The Star identifies strengths which can be built on
The Star helps us demonstrate that we provide a good quality service with results as good as or better than what is expected. It also helps us and our clients to see that we're moving forward and things are getting better, whether that is minutely or in leaps.
It is also good for people to look at their whole life and see what's going well and what is causing problems and see what needs to change for the rest of their life to shift. The current paperwork is very problem orientated and the Star identifies where things are going well so it means we can use someone's strengths and skills from one area to tackle another. And where things are not changing, the Star helps us identify what we can look at to get things moving.
We have been involved in a big review process and pressures related to that have been occupying people. But we are gradually winning people over and showing that the Star is useful with the clients not just as a paper exercise.
For example it be a very helpful tool to complete it before a care planning meeting or it can be used as a basis for discussion about a forthcoming care planning meeting.
The Star really fits with our ways of working
It really helps us to focus on the next three or six months with someone.
It's going to be a slow process for us; I have considered making the Star compulsory and decided against, at least for now. But other teams are now interested and we are presenting the Star at the national assertive outreach conference in July.