5 Who's Doing What: Outcomes Models for Use With Disabled Children and Young People
5.1 This section presents an illustrative sample of some outcomes models and frameworks being developed for use with disabled children and young people. There is only space here to provide a brief synopsis of a few models and we indicate where possible, sources of further information. The list is not exhaustive as new work in this area is being developed continually. This selection was made on account of their providing insights into different elements of outcomes models.
5.2 This report was intended to be limited to outcomes models and frameworks with disabled children but a further selection of Scottish outcome models, not specifically for disabled children, is provided in Appendix B. There was some concern that wider child and family policies, for example, are likely to have implications for, or need to take account of, outcomes for disabled children7.
5.3 A summary of some other models is in An Outcomes Approach in Social Care and Support: An Overview of Current Frameworks and Tools (CCPs and others 2010), so that work was not duplicated here. This is the only Scottish publication we have found that describes a range of outcomes models in social care. It includes a number of interesting models dealing with different populations. A brief note is made of most of these.
5.4 The four levels of outcomes identified in Section 3 (1: Individual/personal; 2: Service/project; 3: Organisational; 4: National), have been used in grouping these pieces of work. But of course, outcome models involve interactions between different people and organisations (and so levels). The classification cannot therefore, be exact, and is used here mainly to identify the agency responsible for developing the model and their primary purpose.
LEVEL 1: Individual/personal outcomes
5.5 St Andrews Project, Camphill School, Aberdeen
The St Andrew Project at the Camphill School Aberdeen (an independent special school) works with children and young people at the margins of care and education. They have developed an outcomes tool based on Outcomes That Matter (Fulcher and Garfat, 2012).
"This model is based on a 'Circle of Courage', a framework that moves the focus from deficits to strengths, and considers four fundamental growth needs that all human beings share:
- Belonging: the need to establish trusting connections.
- Mastery: the need to solve problems and meet goals.
- Independence: the need to build self-control and mastery.
- Generosity: the need to show respect and concern."
These have been mapped to Scotland's Curriculum for Excellence and are being mapped to GIRFEC. Ten internal and ten external outcomes are highlighted, based on the Circle of Courage. These are worked with on a weekly basis and they focus on the subjective experience of carers and young people, and in particular on daily life, events rather than on standardised outcomes. These are plotted graphically across the four dimensions. The assessments are "ecological", based on the internal logic of the young person, and focussed on how they experience themselves and the world. It is "child-led" rather than "child-centered". Reviews are held six-weekly based on the outcomes data.
The model is being piloted with a small number of students and an evaluation is planned for this year.
Fulcher, L.C. and Garfat, T., (2012) "Outcomes That Matter in Out-of Home Care", Reclaiming Children and Youth, 20 (4) pp 22-28.
Walter, C., and Costa, M., (2012) Camphill St. Andrew's Project: Building Inclusion Using Outcomes That Matter, summary of presentation to EUSARF Conference.
Walter,C. (2013) "St.Andrews' Project: Building inclusion using 'Outcomes that Matter". Scottish Journal of Residential Childcare.
LEVEL 2: Service project initiatives
5.6 Aberlour Child Care Trust
Aberlour Childcare Trust is using the 'Realist Evaluation' approach in its Housing Support Service, commissioned by Moray Council, working with 16-22-year-olds in and around Moray. The questionnaire used is based on a 'domains' approach.
This model and guidance was written with the help of service users. Aberlour hopes to increase the use of Realist Evaluation as part of its strategy to evidence outcomes" (CCPS 2010).
5.7 Educating Through Care Scotland (fEtCS)
fEtCS is the professional network in Scotland for residential special schools. They are collaborating on the development of an outcomes model for use in their member schools, developed by staff from their member organisations, with strong support from Scotland Excel, the procurement organisation. This project started during the second half of 2012 and a pilot is now running (until June 2014). CELCIS is expected to undertake the evaluation.
The pilot involves four children from each of 15 schools taking part (residential students only) and involves 14 local authorities.
The starting point of the model was material developed by Barnardo's UK, adapted to suit the needs of the residential education sector.
The purpose is: "to develop a practical and tangible model for measuring outcomes, which ensures that children are at the heart of the process, and which can be easily used by staff; to develop a model which can be used in partnership with local authorities, children and families; to ensure that any model can be embedded in practice, with additional work minimised; to be a helpful tool for practice and reflection; to enable reporting to a variety of stakeholders; to be as simple as possible."
The components include an outcomes bank, scaling tool, and a range of supporting evidence.
The outcomes bank includes 43 outcomes grouped into the following five categories: education; relationships; health; self-awareness, and emotional wellbeing. Appropriate outcomes are selected for the individual through the assessment, care and planning processes.
The selection of core service outcomes (around ten) is up to each individual organisation within fEtCS. The pilot will consider "consistency", and agreeing a common set of outcomes across all organisations.
The scaling tool is used to assess baseline levels for a number of outcomes chosen for each child, from the core services outcomes. It is not expected to focus on more than six outcomes (or less) for a child at one time. These are reviewed three to six times every month, to assess progress on a ten-point scale. NOTE: for some young people, holding steady will be a success.
The "wheel of change" provides a dynamic visual representation of progress for the children, to help them understand and participate in outcome evaluations.
The supporting evidence must be triangulated using at least three pieces of information, e.g. feedback from children, families/carers and professionals; use of assessment tools; key worker observations; and care plans and reviews. Paper recording is currently used.
GIRFEC: The children they work with have specific and complex sets of needs. They needed a set of outcomes that would allow them to work on more specific outcomes than the broad SHANARRI headings. This area is a work in progress as local authorities prefer them to list outcomes under the SHANARRI headings.
This is one of the few models being developed specifically for disabled children and young people.
5.8 Secure State Care Providers
There are five secure care providers in Scotland and the Scottish Government (SG) is working with them to develop an outcomes model that will fit with their service. It is hoped that all secure units will be able to embed an outcomes strategy in their work by the end of 2013.
The process to deliver this work started with a stakeholder event in May 2012. During this meeting it became clear very quickly that this process would not be straightforward. Participants at the event were not able to easily identify individual outcomes and when asked to do so often identified service outcomes or interventions. It was obvious there would be a great deal of work required to deliver a real shift in approach to enable units to measure outcomes for young people in their care. Following that event Scottish Government recognised units would require support and guidance to progress this work and Dr Emma Miller of Strathclyde University was commissioned to provide that support. From the outset Dr Miller advised the units that the best way to successfully deliver this work was through collaboration. Units were encouraged to work together to share their ideas and experiences. Unfortunately this approach proved difficult to implement. Due to the competitive nature of the Secure Care Framework agreement units were reluctant to collaborate. The new tender process was due to commence in early 2013 with the new contract due to be awarded in June 2013. It is hoped that, when the new contract is awarded, this will provide some stability across the estate and units will be more open to collaboration on this piece of work.
The models being developed apply to all children and young people within the secure units, although a proportion are disabled and covered by the ASL Act (as cited in Section 2 above).
This has been a steep learning curve for all the participants and described as a "hard task". Units have been encouraged to develop their own outcomes model by selecting a current outcomes tool then developing that tool to fit the needs of their organisation. The Scottish Government did not want to recommend the use of a particular tool as they felt none would fully meet the meet the needs of the secure estate and, more importantly, none of the tools had been adequately evaluated.
All the models currently being developed across the estate are based on GIRFEC and the SHANARRI wellbeing indicators to ensure that there is a basic consistency of approach.
Secure unit managers have been asked to ensure that the message comes from the top and that resources are in place to develop their outcomes strategy. To ensure there is buy-in from staff and children, managers have been encouraged to fully involve them from the start by asking for, and acting on, their comments.
Although there was initially a proposal to develop a pilot, the units decided to progress with embedding outcomes across their organisations.
All five units are now focused and working towards embedding outcomes in their service. Two of units are quite advanced in their implementation and are able to provide at least six months of evidence in assessing and improving outcomes for the young people in their care. The other three units are still working on developing their outcomes measuring tool.
The secure care outcomes working group will provide a report towards the end of 2013 to report and reflect on progress and discuss the next steps.
Further information: Reports have been written about this work in progress, but they are not public documents. More information can be obtained by contacting: David.cotterrell@Scotland.gsi.gov.uk
5.9 Scottish Women's Aid: Outcomes Evaluation for Children and Young People Experiencing Domestic Abuse
The Scottish Government expects Women's Aid to conduct monitoring and self-evaluation of their services each year. Scottish Women's Aid worked with local Women's Aid groups to refine a framework, developed by a Scottish Government working group in 2006.
They developed a set of outcomes/indicators for children experiencing domestic abuse. In particular, they wanted to determine whether: their needs are being met better; social and leisure activity needs are understood and acted upon; there is more involvement in decisions about their lives; there is increased understanding of how to maintain and develop healthy relationships; there is a better understanding of their feelings and how to deal with them; a better understanding of domestic abuse and how it affects themselves and others; and an enhanced sense of being safer.
The particular outcomes are selected on an individual basis according to how the children describe their own situation and needs. There is a toolkit to support workers to measure the new outcomes and indicators. A small trial has been carried out.
This example is drawn from CCPS and others (2010).
www.scotland.gov.uk/Resource/Doc/1137/0087632.doc (framework) and
LEVEL 3: Organisational
5.10 Local Authorities
Most local authorities (LAs) appear to be implementing outcomes work through their regular assessment and reporting systems. One senior LEA officer observed: "Generally, LA practice is engaged in a big shift to an outcomes-focussed approach. However, the legislation around ASL is still about prescribing inputs. It is now time for a paradigm shift to be more consistent with what we do with other children. But the approach to implementing an outcomes approach is devolved to individual schools."
The Association of Directors of Education in Scotland (ADES), at its last annual conference, held a workshop on the topic of outcomes. There was consensus about developing a set of outcomes and indicators to use in conjunction with the implementation of the ASL Act in all the schools.
Most LAs carry some information about the implementation of GIRFEC on their websites (though this has not been consistently reviewed within the context of this work).
There is no comprehensive, up-to-date list of what all local authorities are doing in this area. We received information about outcomes development work in Angus, the City of Edinburgh, Fife, Glasgow, Moray, North Lanarkshire, Stirling and Tayside. We also know of work in North Ayrshire and Dumfries and Galloway.
Projects within local authorities
5.11 Glasgow City Council Social Work Services
An outcomes model grounded in GIRFEC and the SHANARRI indicators has been developed within the Glasgow City. It is led by a district team leader seconded to the Child and Families Division.
The initiative is focussing currently on self-directed support for the funding of short breaks, starting with a pilot with 20 families who will "come up with their own ways of meeting their planned outcomes." The integrated assessment on which it is based is dominantly within Social Services - "Education and Health do not currently contribute".
The GIRFEC Child's Plan leads on the "desired outcomes and milestones for achievement", based on a "talking points" sheet. This is a chart with a series of SHANARRI indicators on one axis, applied to the child, the family and the community. The other axis is used to report the degree to which needs have been met.
Occasional Extra Support
Extra Support Sometimes
Extra Support Often
High Level of Support Always
Desired Outcome: How much support is needed for each of the following:
There is a support need but it is met by the family and/or community
The level of need is small, occasional, and/or temporary
The level of need is over the week and mid to long term
The level of need is significant, daily and long term
The level of need is complex, round the clock and lifelong
Ch: To understand about risks
Ch: To keep myself safe
F: To support and promote my child's safety at home
Com: To ensure safe access to community resources
Ch: For physical health
Ch: For mental health
F: To support my child and family's health & wellbeing
Com: To access medical care
ETC: for all the SHANARRI indicators
This is supported by a range of documentation prepared for use by families and children,
One piece of work in Highlands developed a set of "Targeted" My World Triangles for children and young people with different conditions or in different situations.
This is an online model, which the user personalises by selecting from the range of additional support needs, namely:
* Autism spectrum disorder
* Complex health conditions
* Difficulties at home
* Hearing impairment
* Learning disability
* Looked-after children
* Through-care, after-care
* Transition, and
* Young carer.
In each case the model provides a set of prompts around a series on each side of the Triangle (How I grow and develop; What I need from people who look after me; My wider world). Using the example of the autism spectrum disorder we have the following prompts:
How I grow and develop
When I am well …
Being responsible …
What I am good at …
How I communicate …
Confidence in who I am …
Looking after myself …
My wider world
Play and fun …
Help for my family …
Why school is important …
Out of school places and activities …
What I Need from People Who Look After Me
Help with making choices …
Knowing what is going to happen and when …
My family …
The help and care I need
Keeping me safe …
The house I live in …
The care I need …
Checking any of the prompts leads to a page seeking responses in a number of formats (e.g. multiple choice, free text, checklists etc). Combined, these allow the child to help develop statements specific to their condition and situation and so to create their own profile of needs by themselves, if they can and wish to do so, though of course this is still within pre-determined categories.
There are no suggestions about how the model should be used nor do we have any evidence of its effectiveness in practice, but it clearly demonstrates the potential to develop interactive software as part of outcomes models.
Further information: www.myworldtriangle.co.uk
SUMMARY OF FINDINGS
Developing an outcomes model, especially at Levels 1 (Personal/Individual) and 2 (Service/Project), needs to involve collaborative work both with professionals and with disabled children and young people, as well as their families and carers.
Developing an outcomes model also involves multiple professionals and therefore, an intensive collaborative process. It requires buy-in and active engagement from both front-line staff and management. Even if the process does work seamlessly, it is still time-consuming and must include a period of piloting, trial and evaluation.
Many of the outcomes models at Level 2 are being developed as a response to demands from commissioners or other funders. They tend to have a focus on the efficacy of their work, while still being rooted in the needs of the children with whom they work.
Models at Levels 3 (Organisational) and 4 (National) do not involve children and families directly. There need to be defined mechanisms to relate all the levels to each other, with a common framework of indicators. GIRFEC being the context, these should be based on SHANARRI.
Given the work being devoted to developing outcomes models, any development of models at national level should be built around these initiatives with the aim of determining how best these feed, together and separately, into national outcomes for disabled children and young people. Development should be based on this practice and experience, not developed separately from the top down.
Email: Fiona McDiarmid
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