© Triangle Consulting 2011 1 T The Outcomes Star Hotspot for SIAA Conference Berlin, November 2012 Joy MacKeith.

© Triangle Consulting 2011 1

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The Outcomes Star

Hotspot for SIAA ConferenceBerlin, November 2012

Joy MacKeith

The Outcomes Star™

Tailored versions for different groups

More in the pipeline

Carers StarCarers StarChildren’s StarChildren’s StarRecovery Star (secure settings)Recovery Star (secure settings)

And in discussion…..And in discussion…..ADHD StarADHD StarOffenders StarOffenders StarEarly Intervention StarEarly Intervention Star

Widely recognised in the UK

Department of Health mental health White Paper ‘New Horizons’ features the Recovery Star. DoH has funded the use of the mental health version of the Star in five of the ten strategic health authorities in England and the new Well-being Star

National membership bodies Homeless Link, Mental Health Providers Forum and Alcohol Concern publish and promote the version for their sector

Local Authorities including Camden, Kirklees, Westminster and Derbyshire are writing the Outcomes Star into their contracts

Chartered Institute of Housing is featuring the Homelessness Star in its new qualification for key-workers in homelessness services

Big Lottery funded the development of the Outcomes Star website Service providers are using it in USA, Australia, Italy, Denmark as

well as UK

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Used around the world

Collaborators offering Stars in the following countriesAustraliaNew ZealandCanadaIrelandFranceItalyHollandDenmark

A visual tool

An objective tool

Detailed descriptions of each scale point

Built on a model of change

Discuss each area in turn

Then plot on Star for overview

Repeat at later point to see change

Notes provide more detailed information

And links directly to action planning

Integrated within case-work

Open discussionof each

area

Agree whereclient is on

their journey in that area

Plot on the star and take an overview

Decide whereto focus and

developaction plan

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Outcomes info at four levels17

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Service outcomes

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Service outcomes (detail)

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Service outcomes as Star

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Service outcomes (detail)

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Compare services

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Compare services (detail)

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Benchmark externally

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Benchmark externally (detail)

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Advanced Service Report

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Advanced Service Report

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Data is easy to interpret28

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Score Interpretation

Mean score on entry to the service = 3.5

entering the service at the ‘Aware’ stageWill attend appointments but need high level of encouragement, supervision and monitoring

Mean score on exit = 6 Leaving the service at the ‘Trying’ stage. Clients are trying to do things differently but still need a lot of support

St Mungos learning from Star data

73% of clients benefit (11% staying stable & 62% progressing)

Best outcomes among a minority group with specialist workers (86% made progress) – demonstrating that this approach works

Women did not progress in the hostels – need to rethink provision for women or avoid hostels?

Outcomes reduce after 12 months, especially without progression and activities in a hostel – need for move-on accommodation

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Resources to support each version

Star online - Flexible use

Can be used on its own or linked via API to an existing system

Works on Ipad and Iphone

Can complete Stars on paper and enter info online afterwards if preferred

Can be purchased as part of a package (eg Substance Views)

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Service users like it

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“I felt fully involved; it was clear and easy to understand and focused on me as a whole person, not just as a problem. It felt like a conversation; felt like the first time someone had really listened to me...”

And so do workers and managers

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“The services are more client-focussed because the Star makes us think about the client and what is changing for each individual.....

It has helped staff to start thinking creatively about how to get greater improvements as well.

Outcomes Stakeholders

Service users need: Tools which empower them to make changes

Workers need: tools which help them work effectively with stakeholders

Managers need: tools which help them identify service strengths and weaknesses

Commissioners need: tools which enable them to identify effective providers

Researchers and policy makers need: tools which help establish which interventions are most effective

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Validation Questions?35

Service Users – lots of case study evidence

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“I felt fully involved; it was clear and easy to understand and focused on me as a whole person, not just as a problem. It felt like a conversation; felt like the first time someone had really listened to me...”

A Mental Health Tribunal

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The RMO spoke of the Recovery Star and how her team uses it tool with patients..... The sense of progressive momentum and optimism that seems to be possible with this tool is just so lovely to hear about, and such a privilege to see in action. This was a lad who could so easily have gone on to be crippled with such early psychotic distress, but instead seems to be facing an energised sense of his own capabilities

Workers

1) Burns, MacKeith and Graham (2008) Looked at 25 organisations that had been using the homelessness version of the Outcomes Star for two years or more

All 25 organisations reported that key-work had improved as a result of using the Outcomes Star

Key-work had become more focused on service user change more systematic and consistent and covered a wider range of issues

2) Study carried out by the University of Newcastle and Hunter New England Mental Health, Australia on the Recovery Star found that clinicians viewed all Recovery Star domains as important for care planning

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And lots of case study evidence too

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“The services are more client-focussed because the Star makes us think about the client and what is changing for each individual.....

It has helped staff to start thinking creatively about how to get greater improvements as well.

Outcomes data for Managers (from St Mungos research)

73% of clients benefit (11% staying stable & 62% progressing)

Most progress seen in accommodation and substance misuse, least in living skills and mental health

Only 46% of women make progressBest outcomes among a minority group with

specialist workers – 86%Positive outcomes correlate with participation in

activities in the project and outings

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Many commissioners are writing the Star into their contracts and are requiring reporting on Star data – in some cases as part of PbR contracts (in Supporting People)

We recommend that Star data is collected alongside severity and risk data

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Commissioners:

Policy-makers and Researchers

Two studies carried out on the Recovery Star1)Study carried out by Mental Health Providers Forum and St Andrews “Recovery Star: validating user recovery” published in 2012 in the Psychiatrist

2)Study carried out by Dr Helen Killaspy at University College Hospital, London, submitted for publication

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MHPF and St Andrews Study

Based on 2 Star readings for 203 service users

Normal distribution: Scores on 7 of 10 scales were normally distributed

Internal consistency: highItem redundancy: lowResponsiveness (ie the tool recorded change over

time): Good

Study indicated some refinement needed on Addictive behaviour, responsibilities and work scales

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UCL Study

Based on Star readings with 172 services users and 120 staff from four inpatient and community services participated.

Test:retest reliabilityInter-rater reliabilityConvergent validityWorker views of usefulness and usabillityService user views of usefulness and usability

Some issues with suitability of some of the settings

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To find out more

Visit www.outcomesstar.org.uk to find out more about the Outcomes Star and download and try out paper versions of the Star for free

Visit www.staronline.org.uk and click on 30 day free trial to experiment with using the Star online yourself

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