T
The Outcomes Star
Hotspot for SIAA Conference
Berlin, November 2012
Joy MacKeith
© Triangle Consulting 2011
1
The Outcomes Star™
Provides
meaningful
outcomes
information
Empowers
service users
and supports
them in making
changes
Promotes a consistent,
holistic, assets based
approach to key-work
Tailored versions for different groups
Recovery Star
(mental health)
Life Star
(Learning
Disabilities)
Work Star
Older Person’s
Star
Youth Star
Empowerment
Star
(domestic
violence)
Teen Star
Well-being Star
(long-term health
conditions)
Spectrum Star
(Autistic spectrum)
Family Star
Community Star
Shooting Star
(schools)
Homelessness
Star
Alcohol Star
Music Therapy
Star
Drug and Alcohol
Star
More in the pipeline
 Carers Star
 Children’s Star
 Recovery Star (secure settings)
And in discussion…..
 ADHD Star
 Offenders Star
 Early Intervention Star
Widely recognised in the UK
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 Department of Health mental health White Paper ‘New Horizons’
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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
© Triangle Consulting 2010
Used around the world
Collaborators offering Stars in the following countries
 Australia
 New Zealand
 Canada
 Ireland
 France
 Italy
 Holland
 Denmark
A visual tool
An objective tool
Detailed descriptions of each scale point
Built on a model of change
9-10
Effective parenting
7-8
Finding what works
5-6
Trying
3-4
Aware
1-2
Stuck
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
discussion
of each
area
Agree where
client is on
their
journey in
that area
Triangle Consulting Social Enterprise 2012
Plot on the
star and take
an overview
Decide where
to focus and
develop
action plan
Outcomes info at four levels
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National
outcomes
Commissioner/
organisation
outcomes
Service outcomes
Individual outcomes
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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 interpret
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Score
Interpretation
Mean score on entry to the
service = 3.5
entering the service at the
‘Aware’ stage
Will 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
© Triangle Consulting 2010
St Mungos learning from Star data
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 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
© Triangle Consulting 2010
Resources to support each version
User guide for
workers and
service users
Organisation
guide to aid
implementation
Star On-line
Training
Star online - Flexible use
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 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)
© Triangle Consulting 2011
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...”
© Triangle Consulting 2009
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.
© Triangle Consulting 2009
Outcomes Stakeholders
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 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
Validation Questions?
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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...”
© Triangle Consulting 2011
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
© Triangle Consulting 2011
Workers
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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
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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
© Triangle Consulting 2012
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.
© Triangle Consulting 2011
Outcomes data for Managers (from St Mungos
research)
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 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 progress
 Best outcomes among a minority group with
specialist workers – 86%
 Positive outcomes correlate with participation in
activities in the project and outings
© Triangle Consulting 2011
Commissioners:
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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
© Triangle Consulting 2012
Policy-makers and Researchers
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Two studies carried out on the Recovery Star
1) 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
© Triangle Consulting 2012
MHPF and St Andrews Study
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Based on 2 Star readings for 203 service users
 Normal distribution: Scores on 7 of 10 scales were
normally distributed
 Internal consistency: high
 Item redundancy: low
 Responsiveness (ie the tool recorded change over
time): Good
Study indicated some refinement needed on Addictive
behaviour, responsibilities and work scales
© Triangle Consulting 2012
UCL Study
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Based on Star readings with 172 services users and 120
staff from four inpatient and community services
participated.
 Test:retest reliability
 Inter-rater reliability
 Convergent validity
 Worker views of usefulness and usabillity
 Service user views of usefulness and usability
Some issues with suitability of some of the settings
© Triangle Consulting 2012
To find out more
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 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
© Triangle Consulting 2010