Introduction to Personal Outcomes and the Talking Points Approach Dr Ailsa Cook

What do we mean by outcomes? The impact or end result of service(s) on a person ’ s life The user or carer is involved in identifying desired outcomes = setting goals in partnership with services

Which outcomes? Research with service users and carers identified most important outcomes across Community Care – University of York ( ) – University of Glasgow ( ) – JIT / VOCAL / East Renfrewshire ( ) Two outcomes frameworks underpin Scottish Government Community Care Outcomes Approach

Outcomes: service user Quality of lifeProcessChange Feeling safe Having things to do Seeing people Staying well Living as you / where want Listened to Having a say Treated with respect Responded to Reliability Improved confidence Improved skills Improved mobility Reduced symptoms

Outcomes: people living in a care home Quality of lifeProcessChange Feeling safe and secure Seeing people Having things to do Live in a nice place Live life as I want and where I want Stay as well as I can Belong to a community Treated as an individual Valued and respected Listened to Having a say Support to live well/ plan for end of life Family and friends involved Trust staff and rely on them to respond Privacy is respected Improved skills Improved confidence and morale Improved mobility Improved health / reduced symptoms Settled into home

Outcomes: Carer QoL cared for person QoL carerManaging the caring role Process Quality of life for the cared for person Maintaining health and well- being A life of their own Positive relationship with cared for person Freedom from financial hardship Choices in caring Feeling informed/ skilled/ equipped Satisfaction in caring Partnership with services Valued/respected and expertise recognised Having a say Flexible and responsive Positive relationship with practitioners Accessible, available and free at point of need

Standards of Care for Dementia in Scotland Knowledge and Skills Framework QoL Outcome IndicatorsTalking Points Outcomes  I have the right to a Diagnosis  I have the right to be regarded as a unique individual and to be treated with dignity and respect  I have the right to access a range of treatment and supports  I have the right to end of life care that respects my wishes  I have the right to be as independent as possible and be included in my community  I have the right to have carers who are well supported and educated about dementia  People with Dementia have access to a timely and accurate diagnosis of Dementia  People with Dementia feel empowered and enabled to exercise rights and choice, maintain their identity and to be treated with dignity and equity  People with Dementia maintain their best level of physical, mental, social and emotional wellbeing  People with Dementia have access to individuals, groups and organisations that can support their spiritual or personal beliefs and reflect their cultural wishes  People with Dementia have access to quality services and can continue to participate in community life and valued activities  People with Dementia feel safe and secure and are able to be as independent as possible  People with Dementia are able to maintain valued relationships and networks, and have the opportunity to develop new ones both personal and professional  People with Dementia, and their family, friends and carers, have access to the information, education and support that enhances the wellbeing of the person with dementia and those that support them. Not explicitly covered Process outcomes Change outcomes, plus Stay as well as can Live as you want, have a say, seeing people, dealing with stigma, discrimination. Having things to do, seeing people Feeling safe Carers outcomes: managing the caring role

Development of the Approach Build on previous research at Universities of Glasgow and York Work with JIT since 2006 Workshops with 7 partnerships 2006 Pilot work with 10 early implementer Partnerships 2007 – 2008 Outcomes embedded in CCOF and NMIS Name changed from UDSET – Talking Points late 2008

Talking Points: Personal Outcomes Approach Embeds focus on outcomes in day to day practice through: – Identification of outcomes important to service users / carers at assessment – Negotiating outcomes focussed care and support plans – Determining whether outcomes achieved at review, why/why not and what more can be done Conversations about outcomes semi-structured and tailored to individual Information on outcomes recorded at every stage through short narratives and tick boxes

EXCHANGE INFORMATION - Identify desired outcomes Exchange Model of Assessment

Talking Points: Personal Outcomes Approach Information recorded at assessment, support plan and review used to ensure experiences of service users and carers included in: – Service improvement – what is working well, for whom and why? – Planning – what are the key issues facing client groups / communities? How do services need to change to address these? – Performance management – are we delivering good outcomes for service users and carers in this service / partnership? – Commissioning and contract management – which providers deliver the best outcomes? Qualitative and quantitative data on individual outcomes gathered systematically and consistently Information used in a range of ways – Maximising outcomes for individuals – Service improvement / staff development – Planning, commissioning, performance management Staff training and feedback essential to data quality

Dimensions of change implementing an outcomes approach CULTURE PRACTICESYSTEMS ImprovementPerformance

Progress in implementation Almost all partnerships and approx 40 providers using Talking Points approach – From whole systems implementation to focussed / early pilots e.g. intermediate care Consensus on principles and philosophy underpinning approach Considerable shared learning on effective implementation Increasing alignment across policy areas, nb scrutiny bodies, reshaping care, LTC, dementia strategy, SDS Support for implementation via JIT website and COP Continued development work nb commissioning, communication, engagement with health, pilot in care homes

Is it making a difference? Lots of evidence that service users and carers feel more listened to and empowered Growing numbers of individuals whose lives have been transformed Staff doing their job the way they want Organisations working and thinking differently Supports personalisation, re-ablement, community capacity building People realise getting the views of service users and carers – Essential – Possible

Implementation with people with dementia Semi-structured nature of approach inclusive to people with dementia Communication tools such as Talking Mats have been used to support work Successful implementation with providers and assessment and review teams (including in care homes) Non specialist staff required additional support to include people with dementia in approach – Lack of confidence and experience at engaging with people with dementia – Time for relationship building and more exploratory approach to capturing info needs to be protected

Talking Mats

Support for implementation Material and resources posted on JIT website ( areas/user-and-carer-involvement/) areas/user-and-carer-involvement/ – NB digital stories – Communication Skills (communication difficulties and outcomes focussed conversations) – Using Outcomes Data – Care Home Pilot and Framework (coming soon) Community Care Outcomes Community of Practice