Developing an Outcomes Matrix
We have a series of high level outcomes which embody our aims and aspirations for individuals.
These were agreed in the commissioning plan and can be thought of as domains of recovery capital,
areas of need, the sections of a care plan or just dimensions of human life.
1)
2)
3)
4)
Abstinence from drug and alcohol use
Control of drug and alcohol use
Reduction in criminal activity including re-offending
Improved mental health and wellbeing
5) Improved physical health and wellbeing
a. Reduction in risk taking behaviour related to overdose
b. Reduction in risk taking behaviour related to blood borne viruses
6) People are engaged in meaningful and purposeful activity
a. Sustained employment activity including training/volunteering
7) Ability to access and sustain appropriate settled accommodation
8) Ability to maintain a broader social network with those in recovery.
9) Improved relationships with family members, partners and friends
a. The capacity to be a caring and effective parent
b. Carers lead satisfying lives
We would hope that clients would progress in each of these areas or at least that they would not
regress. This progress can be expressed in various ways, reduction of symptoms, improvements in
functioning, progress from chaos to thriving or increasing levels of recovery capital, for instance.
Chaos of
addiction
(pre-covery)
Recovery
initiation
acting out
Tipping
Point
Recovery
maintenance
Building
“better than
well”
Self-sustained
recovery
openning
up
Connecting
to
Poor
functioning
Improved
functioning
Full
Functioning
Low
Developing
Recovery Cap
High Recovery
Cap
Stability
Thriving
Recovery Cap
The simplest description is probably:
Crisis
1
Regardless of the terminology used, we need a shared description of what progress towards each of
the outcomes looks like. Taken together these form an Outcomes Matrix which maps the ways in
which we would hope that clients’ lives would improve. Each square is a milestone describing an
individual’s status or behaviour. Forward movement marks progress towards the outcome.
Crisis
1)
2)
3)
4)
Abstinence from drug and alcohol use
Control of drug and alcohol use
Reduction in criminal activity including re-offending
Improved mental health and wellbeing
5) Improved physical health and wellbeing
a. Reduction in risk taking behaviour related to
overdose
b. Reduction in risk taking behaviour related to
blood borne viruses
6) People are engaged in meaningful and purposeful activity
a. Sustained employment activity including
training/volunteering
7) Improved ability to access and sustain appropriate settled
accommodation
8) People maintain a broader social network with those in
recovery.
9) Improved relationships with family members, partners
and friends
a. The capacity to be a caring and effective parent
b. Carers lead satisfying lives
2
→
Stab →
ility
Thri
ving
This matrix is obviously blank - we have a fairly clear shared sense of what constitutes progress but
we do not currently have an articulated description. Milestones for some of the rows might be:
Individual is
engaged with
formal or
informal peer
led activities,
and/ or has a
network of
friends who are
in recovery
Thriving
Individual has
regular,
ongoing
contact with
others in
recovery but in
a professionally
led setting
↓↓↓↓↓↓↓↓↓↓↓↓↓↓↓
Individual has
ad hoc contact
with people in
recovery
Stability
Individual has
no significant
contact with
people in
recovery
↓↓↓↓↓↓↓↓↓↓↓↓↓↓↓
Crisis
8) People maintain a broader social network with those in recovery
The individual
is role
modelling
recovery to
others engaged in
“giving back”
activities
The individual
has no risk
exposure and
has been tested
since last risk
exposure
Thriving
The individual
has no risk
exposure
↓↓↓↓↓↓↓↓↓↓↓↓↓↓↓
The individual
has low risk
injecting
behaviour
Stability
the individual
has high risk
injecting
behviour
↓↓↓↓↓↓↓↓↓↓↓↓↓↓↓
Crisis
5b) Reduction in risk taking behaviour related to BBV
The individual
has no risk
exposure, has
been tested
since last risk
exposure, and
is accessing
treatment if
needed
Individual in
accommodatio
n appropriate
to needs
Successfully
addressing risk
to current
accommodatio
n
Thriving
ndividual in
Transitional
accommodatio
n/ safe but not
suitable,
Acknowledging
risk to current
accomm, end of
planned stay
↓↓↓↓↓↓↓↓↓↓↓↓↓↓↓
Individual in
Temporary
unsuitable
accommodatio
n, sofa surfing,
unsupported
accommod'n,
notice to quit
proceedings
commenced
Stability
Individual is
rough sleeping,
NFA, unable to
occupy usual
accommodatio
n,Evictionpendi
ng
↓↓↓↓↓↓↓↓↓↓↓↓↓↓↓
Crisis
7) Individuals access and sustain appropriate settled accommodation
Individual in
appropriate
safe
accommod'n
which meets
needs, safely
and securely
occupied
3
stable
relationship
with parent child living at
home and
parent meeting
physical and
emotional
needs (good
enough
parenting )
Child is thriving
at home with
parent
Thriving
Planning for
child to return
home
↓↓↓↓↓↓↓↓↓↓↓↓↓↓↓
Child is in care
- looked after
and
accommodated
Stability
Child(ren) living
in danger/ at
risk of neglect
or harm
↓↓↓↓↓↓↓↓↓↓↓↓↓↓↓
Crisis
9a) Individuals have improved capacity to be a caring and effective parent
Task 1: Identifying shared milestones
Following an introduction and further explanation, participants will begin the work of completing the
matrix by defining progress towards different outcomes. The key questions are



What does improvement look like?
How would we recognise movement towards recovery?
In an ideal world, would someone be better off if............?
Milestones ARE:
 Ends not means
 “What?” Not “How?”
 Behaviour or status
eg: “not injecting”, “engaged in regular voluntary work”, “not experiencing regular distress”,
“satisfied with family life”, “achieved qualifications”
Milestones are not:
•
Service activities
“Engaged with a service” is not an outcome in itself – the changes achieved while working with
the service are. eg “Offered IEP” is not a milestone - the client’s actual risk behaviour changing
is.
•
Knowledge
Knowledge is not an outcome until it affects behaviour or status (eg a client knowing the risks of
sharing needles is important but their actually changing risk behaviour is the milestone).
•
Indicators
The specific measures that are used to monitor and identify progress (eg “ceasing injecting”,
“not sharing needles but sharing water”, etc). The milestones are not at the level of detail of
indicators, BUT they need to be concrete enough for us to find a way of measuring them later.
•
What we expect everyone to achieve
Not all clients will achieve all milestones in all areas – this is understood by all everyone involved
in substance misuse. For many clients, preventing deterioration will be an achievement for the
individual and the worker.. However, we do need to be ambitious in what we offer to individuals
and to be sure that we offer opportunities for everyone in need in the city. Others, conversely
will have no needs in some areas but extensive needs in others.
The outcomes themselves have been agreed - though I have tweeked the wording a little we do not
have a remit to design new outcomes.
The output from the exercise will be a test of the approach and draft milestones for some of the
outcomes. These drafts will need to be tidied up and consulted on before adoption.
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Using the Matrix
The completed matrix will be used throughout the commissioning cycle – it provides the “WHAT?”
element of the process. How far we enable people travel towards the outcomes will be the basis for
evaluating alliance and collaborative performance.
Our planning phase – the “HOW?” element of commissioning will consist of finding the best possible
ways to meet the outcomes.
This will be over 2 phases
• Describing the expected contributions of each
alliance towards each outcome
System design by
the collaborative
• Plan of activities and interventions to achieve
their parts of the outcome. This might based
on logic modelling, experience, the evidence
Service design by
base etc and gives a lot of scope for innovation.
each alliance
The first of these steps, system design, involves the collaborative defining the contributions of each
alliance to (Eg tasking the overall lead for an outcome or enabling their clients to move beween
particular milestones).
The milestones should help in expressing these. For instance in the case of “Individuals maintain a
broader social network with those in recovery”, the contributions might be
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Individual is
regularly
engaged with
formal or
informal peer
led activities,
and/ or has a
network of
friends who
are in recovery
Thriving
Individual has
regular,
ongoing
contact with
others in
recovery but
in a
professionally
led setting
↓↓↓↓↓↓↓↓↓↓↓↓↓↓↓
Individual has
ad hoc contact
with people in
recovery
Stability
Individual has
no significant
contact with
people in
recovery
↓↓↓↓↓↓↓↓↓↓↓↓↓↓↓
Crisis
8) Individuals maintain a broader social network with those in recovery
The individual
is role
modelling
recovery to
others engaged in
“giving back”
activities
The aftercare alliance would not focus particularly on clients of other alliances achieving milestones
2 and 3 but would have primary responsibility for all people in the city being able to reach the the 4th
and 5th milestones. To meet this outcome, the alliance might develop activities such as:



enabling peer led recovery activities in non treatment settings
facilitating social events,
training people in developed recovery to offer peer-support
The counselling and hubs alliances would have primary responsibility for their clients moving to the
second and third milestones. To meet this outcome, the alliance might develop activities such as



creating in-reach placements within their services
actively linking people to mutual aid,
offering professionally led
The Residential alliance would have primary responsibility for their clients moving to milestones 3
and 4 – the hope would be that people in rehab are able to engage with formal peer support and to
develop links to the recovery community during their treatment.
Note that there are natural interdependencies between the alliances. For instance, the hubs and
counselling alliances would need the aftercare alliance to ensure that suitably trained peer supporters
are available and the aftercare alliance needs the hubs alliance to provide placements for the peer
supporters that it has trained. However, the broad responsibility for has been allocated to the right
specialist alliance to work on.
Task 2: Describing alliances’
contributions to each outcome
Taking the agreed milestones for each outcome, outline where we would expecting each alliance to focus its
efforts.
•
•
•
•
Indicate lead responsibility for helping people to move between milestones
Outline each alliance’s possible contributions imagine possible roles, not describe current ones
Note ambiguities – roles are negotiable
Note interdependencies with other systems
Note that
1) We are only looking in broad strokes at this point and there will be some inevitable discrepancies.
There may also be disagreements about the respective roles of alliances and the best use of each of
their specialist skills and approaches. - part of the aim is that we have a common language to discuss
those inconsistencies but if they cannot be resolved in the course of the session they need to be
noted for later discussion
2) We are not looking to define the exact activities. Only the responsibility of each alliance.
3) In some cases, we will overlap with other services (eg “mental health” at the crisis relies very much on
acute psychiatric resources). In terms of this exercise, we should probably just note the
interdependency with other systems.
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Glossary
OUTCOME: the overall aim – e.g. Reduction in risk taking behaviour related to blood borne
viruses
MILESTONES: the stages of progress towards the outcome, from the most extreme crisis to the full
achievement of the outcome. Each is described by a brief statement of where the client is. Reaching
each milestone marks significant progress for the individual. Eg
The client has
no risk
exposure
The client has
no risk
exposure and
has been
tested since
last risk
exposure
Thriving
The client has
lower risk
injecting
behaviour
↓↓↓↓↓↓↓↓↓↓↓↓↓↓↓
the client has
high risk
injecting
behviour
Stability
Individual has high risk injecting behaviour
Individual has lower risk injecting behaviour
Individual has no risk exposure
Individual has no risk exposure and has been tested since last risk exposure
Individual has no risk exposure, has been tested since last risk exposure, and is accessing
treatment if needed
↓↓↓↓↓↓↓↓↓↓↓↓↓↓↓
Crisis
1)
2)
3)
4)
5)
The client has
no risk
exposure, has
been tested
since last risk
exposure, and
is accessing
treatment if
needed
INDICATOR: the tools used to show whether the client is reaching the milestone eg. “clients score
less than 7 on Injecting risks behaviour scale” or “clients reports no sharing of water” – these will
form part of service specs and contract monitoring but are NOT part of the milestones.
ACTIVITIES: the things that the alliance will do to achieve the outcome “eg provide IEP from Monday
to Friday 9-5, Assess BBV risks at every stage of treatment, engage clients with etc”. These decisions
will be made in the alliances and are also not milestones
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