By Anna Good, Research Analyst at Triangle, the social enterprise behind the Outcomes Stars.
The Outcomes Stars are a family of evidence-based, sector-wide and person-centred tools for frontline services, available under licence and with training.
Outcomes Stars are evidence-based tools designed to support positive change and greater wellbeing, with scales presented in a star shape and measured on a clearly defined ‘Journey of Change’.
The Outcomes Star is completed as part of conversations between individuals and support practitioners such as key workers. All workers complete a one-day training course as a minimum, focused on how to complete the Star collaboratively and how to use the Journey of Change to target action planning.
There are over 30 versions of the Star tailored to different sectors, settings and service user groups, such as The Family Star Plus for working towards more effective parenting, or the Well-being Star for people with long-term health conditions (figure below).
The Wellbeing Star focuses on eight areas that patients, doctors and other health professionals have identified as being central to maximising well-being and independence when living with a long-term health condition.
The outcome areas are supported by research evidence showing for example, the importance of addressing social isolation, poor mental health and material hardship among those with long-term health conditions (Emerson, Honey, Madden & Llewellyn, 2009; Mossabir, Morris, Kennedy & Blikham, 2014).
Both the development process and the use of the Stars in practice are based on the empowerment, collaboration and integration principles of Participatory Action Research (Lewin, 1946). They aim to empower service users to be active participants, working collaboratively to devise solutions alongside professionals. The Outcomes Star has been said to encourage a “reversal of role, underlined by power and knowledge, usually represented in evaluations by the powerful funder, the mediating evaluator and a less powerful service user” (Ardvison & Kara, 2013, p.13).
In the Star development process, service users, managers and key workers take part in workshops and provide feedback on the tool as part of an iterative process.
All versions of the Stars are then tested for at least 6 months in frontline settings, with feedback from all parties captured and the psychometric properties of the Star examined. This makes sure that the constructs and language in the tool are relevant, robust and as helpful as possible for the people who use the tool. A review of existing literature in the sector is also undertaken to support development (for more information, see MacKeith, 2011.)
SUPPORTING EFFECTIVE CONVERSATIONS WITH PRACTICAL AND POSITIVE TOOLS
In contrast to many outcome measures, completing the Outcomes Star is an integral part of keywork and is intended to support as well as measure distance travelled.
Emphasising the keywork benefits, a team leader using the Wellbeing Star in a community Pulmonary Rehabilitation team, notes that “used as part of initial conversation with someone referred to the service, the Star provides a consistent structure for that first interaction, and the information captured with the Journey of Change helps the team prioritise the right mix of interventions and personalise the programme so it can be as effective as possible”.
This team is led by an Occupational Therapist and uses the Wellbeing Star alongside clinical measurement tools in a 6-week programme helping people with lung or respiratory complaints manage and live well with their condition.
The integration of outcomes, measurement and keywork can minimise the resistance often encountered when measurement is seen simply as a ‘tick box exercise’ and means of surveillance. Organisations using the Outcomes Star report that the process of engaging with the Journey of Change and reflecting on the data can itself result in positive movement and naturally facilitates person-centred and outcomes-focused action planning (York Consulting, 2013). Formal research is planned to evaluate the impact of the Star as an intervention in itself.
Service users respond positively to the Outcomes Star, and value being involved in identifying their strengths and needs and of seeing their progress visualised on the Star. The Journey of Change underpinning the scales is strengths based and identifies progress in terms of attitude, motivation, and engagement with services as well as changes in practical circumstances and behaviour. There is a growing consensus that these outcomes are important to achieving longer term change and maintenance of positive change and well-being (McNeil, Reeder & Rich, 2012).