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Outcome based care
I have been working recently with rehabilitation services, and I am struck by the very effective outcome based approach to support they use. This is perhaps because of the very clear objective for service users of dealing with their dependency or addiction and leaving it behind if they can. This objective is easily measured as a target to be aimed for, within an agreed timescale.
There are several toolkits available for measuring outcomes. The star diagram is common to several of these, allowing each person to regularly grade their own progress on specific measures of wellbeing and recovery. This results in a series of diagrams which clearly show how they are attaining greater control in their lives and reducing their dependency. People find it a good motivator when they can see visual evidence of their progress.
A vital part of outcome based care is to work in partnership with service users, getting their participation and involvement at every stage. This begins at initial assessment, where outcome targets and provisional timescales for reaching objectives can be set, then ongoing reviews of the person's own views on their progression are used to evaluate and review the further support to be provided.
This approach is essentially target-based and time-scaled, with clear monitoring of the effectiveness of support. It contrasts remarkably with the approach of some other kinds of care services.
For example, in care homes for older people, the initial assessment can be problem based and does not set constructive, positive goals which the person can aim for with the support received. This is clear in recording, which will often consist of phrases like "J--- was fine today"; "no problems this evening"; "slept well". This is ok, but it does not set definite objectives to ensure support is helpful.
Other similar care homes adopt a more creative, positive approach. Assessments might include the objectives of regaining previous skills, renewing family contacts and relationships, and participating in how the service is planned and operated. This outcome based approach is clearly centred on the person, whereas the less focused approach is more based on the routines of the service, and how the person 'fits in'.
Whatever their abilities, people can be encouraged and supported to set their own life aims and aspirations, and the process of attaining these is not only satisfying for the person concerned, but for everyone in the support service as well.
Tony Clarke – QCS Expert Scottish Care Contributor