Outcomes in Practice Event 4th February 2014
Good morning and thank you to James for inviting me along to speak. I have received self
directed support for just over a year now and have been involved a lot in a service user
capacity in the development of SDS in Fife. Before I received SDS I received my support from
the housing association I rent my house from and had a generic support plan.
We are taught to think in a person centred way but unfortunately in a lot of places we have
been fitting people in around what the organisation you work for can offer rather than
being personalised to the person. With SDS we are moving back to thinking in a person
centred way and putting the service user in the centre and planning support around them. A
total culture shift so it isn’t going to be easy to change the way we work but I hope to be
able to share with you some of the benefits of working in an outcome focussed way, what
makes a good outcomes focussed planning process and what it is like having an outcome
focussed support plan versus my old support plan as well as sharing some of the barriers
and difficulties. Instead of referring to people as service users I will be using the word
individuals because that is what outcome focussed practice embraces – seeing people as
individuals with different needs and outcomes as well as having a life out with their support
rather than just being another service user.
Before going down the SDS journey I had not had experience of outcome focused planning
or of setting my own outcomes and goals in as much detail. With my previous support plan
my keyworker ticked off the tasks she felt I needed help with and the amount of time
needed for each of them and I just had a goal for the year e.g. finish my university course.
They had a framework to work to that set out what they had to do which didn’t allow the
service to meet individualised needs and outcomes. With outcome focused planning it has
allowed me to think about what the overall goals I want to achieve are and what I want to
change in my life then look at what needs to change to allow this to happen and how do I
make these changes happen by using my support. I was able to pick out what things I missed
doing which I enjoyed or would like to be able to do as well as identifying the tasks I needed
help with to keep my tenancy. With SDS it is not just about housing support but support
with my whole life which makes a big difference as I can rely on other supports including my
family for some needs and use my time with my personal assistant for other things. I have
done things I never ever expected to be able to do but because I’m at the centre directing
my own support with assistance then I get the chance to improve my life by doing the things
that will make me feel better about myself, improve my health and make me feel more like
other people my age.
When working with individuals on their support plans it’s important to remember that most
people won’t understand what outcomes are but will most likely know what they want to
change, improve or achieve so it is about finding the right language to use for the person
you are working with and being prepared to go about writing the support plan in a
roundabout way rather than filling in the columns one at a time in order. It is easy to make a
mistake and think that the outcome is the activity which the person does when it is actually
what that activity does for them or makes them feel that is the outcome. People may need
help to pick out the outcomes from discussions you have with them about their support
especially if they are new to having an input in their support. One big problem for me is
social isolation so I’ve used my support to help me join a badminton group, go to college
and go on days out which originally is what I thought the outcome was – that I attended
these things – but it is that I make new friends, am happier, improve my health and
wellbeing, and feel part of society. It is easy to get outputs confused with outcomes. Before
the only social part of my support was to go for lunch when I went shopping so I was left
very isolated because my personal outcomes weren’t looked at and I didn’t receive the help
to achieve what I wanted to. Working in an outcomes focussed way is about putting the
individual back in the centre and working to benefit them and achieve their individualised
outcomes and goals rather than fitting their support around what your organisation can
offer. It is hard to shift your way of working but done properly it can have a huge benefit to
the people that you work with and can also mean that support is used more appropriately
and effectively so that the individual can get the most out of their package. There will of
course be problems that could happen along the way and change can be difficult for many
so the process of carrying out an outcome focussed assessment can take longer. It also
means you will need to think more creatively and use different ways of carrying out the
assessment and support planning process with each person from using visual aids for people
with learning disabilities or autism such as drawing pictures to represent what they want to
do and what their outcomes are, or having to break down your sentences and explain them
in a different way for people who have trouble understanding what you are asking them, or
just giving people more time to get to grips with this new way of working as the change can
be difficult and anxiety provoking.
A good outcome focussed assessment and support plan would include:

Being individualised for each person

Using strategies that work for the individual e.g. visual, pictorial, simple language

Giving people the time they need to work through the process – set aside a clear
time to work on it when neither party is distracted by other things

Working at the individual’s pace not the speed that you want to do it at – everyone
will take different lengths of time to get through the support planning process but
it’s important not to rush it as if you get it right then it will save a lot of time in the
future.

Giving the individual the choice about who they want involved – they know who
knows them best and are best able to assist them in identifying their outcomes.
These people can help the individual work on their plan in their own time so that it
takes up less of your time.

Good explanations about what an outcome is and give examples e.g. I want to make
friends, I want to get a qualification so I can get a job, I want to be happier

Let the individual identify what they see their needs as being not just going by any
information provided by professionals involved in their care as they know
themselves best so should have a say in what they need help with although if there
are areas that need to be dealt with they should not be ignored e,g. they need help
with cooking meal

Be clear about the difference between the activities that the person receives support
with and their outcomes – it is hard to understand but without clear outcomes we
cannot measure whether the support is making a difference

Have a way of recording if the outcomes are being met to help initiate progression.

Have outcomes that allow for a person to progress and become more independent
in the things that they can do – with my old support I had no opportunity for
progression and use my support for other things once I was capable of one thing.
With SDS I can use my support for time limited activities such as help with settling
into college then once I was settled and able to attend myself then I was able to use
my hours for something difference
By carrying out a good outcome focussed assessment and support plan it

Gives the individual ownership of their support plan

Make the individual feel listened to

Helps build a better relationship with their support staff

Helps the individual feel happier and more in control of their life

Gives the individual the chance to achieve their personal goals

Gives the individual the chance to participate in activities they enjoy and which
would have a benefit to them but couldn’t do without support

Promotes progression and independence

Gives opportunities for the individual to look at trying new things

It is person centred and is all about individual needs and outcomes not generic ones

Makes the evaluation and monitoring process easier
What approaches to planning are not helpful?

Too much paperwork at once - do it in small chunks according to how much the
individual can manage in one go

Putting words into the individuals mouth – give them time to think about what their
needs and outcomes are

Jargon – keep language simple and make sure the individual is clear about what an
outcome is, re-phrase until the person understands. Some people might understand
it better verbally but others may need it written down.

Sticking to a rigid assessment process – not all people are the same and so things
might not progress smoothly through the planning process but will go back and forth
and you might have to do things in a different order for different people. Again it’s
about working around what works best for the individual you are working with.
Some people might be able to identify their needs easily but not their outcomes and
others might know what their outcomes are but not know how to achieve them.

Taking too long to produce the support plan – if there is a delay in getting things
done keep the individual updated so that they are not left waiting and waiting for
you to get back to them

Tokenism – the individual should be fully involved in their support planning and their
views should be what directs the support planning process not just heard and
discarded. It is their views that matter the most not your own or other professionals.

Too much going on – make sure that you set aside specific time to work on the
support planning process so that both you and the individual can put aside other
things to concentrate purely on the planning process and not be distracted by other
things

Using the same process for everyone – not everyone’s brains work in the same way
so make sure you have several different creative ideas for how to gather information
and put together a plan e.g. using pictures to represent the activities and outcomes,
using mind maps, re-phrasing questions, life maps – looking at where they are now
and where they want to be to help identify what they need to do to get there, or
allowing the individual to spend time on their own writing down or drawing their
views on what they want.
The impact of poor approaches to planning

Your support plan will be returned to you – if it’s not done properly it will just be
rejected and sent back so it’s important to take the time to do it properly.

The individual’s mental health could be affected – if the process becomes too
stressful then the individual’s mental health might be affected so it’s important to
check on how the individual is feeling during the process.

A service led plan – the plan doesn’t belong to the individual and is not personal to
them which results in them not having ownership of their support plan, not being
given the chance to do the things they want to or work towards their outcomes.

The individual becomes stuck – they are left doing the same things and not being
given the chance to reach their full potential and feel part of society

Takes more time – if it’s not done properly then it will just take you longer to get
done as it goes back and forth until it is approved. Take time to make sure that you
are clear about the individuals outcomes and that they can be supported with them
as well as writing the plan according to how your organisation needs it set out.

It becomes a generic plan – instead of being individualised it is just continuing with
the tick box type of support plan.

It’s not person centred – instead of seeing the individual as the most important the
one who is the expert their views aren’t taken on board and it affects their health &
wellbeing, their confidence in the service provider, and their progress.
Moving to SDS has been a great opportunity for me as it has allowed me to get back into the
community and pick up hobbies and interests, given me the chance to do things that other
people my age do as my personal assistant will assist me to go to events and go out to
different places, get the support I need to help me stay well or keep safe when unwell, and
have the support to make choices about my life and make changes to improve things so that
I am able to move forward rather than staying stuck in a rut and feeling that I have no
chance to progress. I’ve now gone back to playing badminton, I’m studying at college, I’ve
got a dog, I’ve been on days out, am re-organising my house and getting it tidied rather than
just doing the bare minimum of cleaning, and I’ve had the support to attend appointments
and understand what people are telling me so I have a better grip on my health. I found the
outcome focussed approach time consuming but it became my personal support plan which
I have ownership of and reflects what I want to achieve. I’ve managed to progress so much
in the short time I have had SDS compared to before. If you get the outcome focussed
approach right it will have a huge benefit on the individuals you work with. I hope my talk
has helped you understand things better from the point of someone who receives SDS. I am
happy to answer any questions you have or come out and speak to your organisations about
SDS from a service user’s point of view. Thank you.