BETTER OUTCOMES FOR CHILDREN
This one day course is not so much
specifically about Looked After Children, Children in Need or Children in Need
of Protection
but about how outcomes are formulated within plans and the procedure which
should be used to specify outcomes which are
eminently usable AND testable.
Most of the planning which goes
in social care work occurs within high level multi-personnel / inter-agency meetings.
These meetings are time limited and the planning often occurs toward the end of the meetings as in
child protection Case Conferences or child in need
meetings which research has shown, on average, devote just 9 minutes to planning
out of about 1.5 hours.
It is the role of the Core Group (or its equivalent) to work out and EXTEND into DETAIL the Outline Plan which is as far as most of the high level meetings such as Case Conferences ever get. This often doesn't happen:
a) Because many social care staff
/ social care agency staff are unaware of their role regarding detail planning
b) Because the outcome framing model which is often used in the high level
meetings is simply not good enough for detail planning
c) Because many social care staff are unaware of suitably powerful detail
outcome framing models.
d) Because of misunderstandings regarding the concept of outcomes and what it
means for children.
There are several well known outcome framing models commonly used in social care work:
Here are two U.K. social care favourites: (the SMART model is adopted by Every Child Matters and the ICS system):
The A.S.P.I.R.E model
Assessment,
concerned with gathering information, analysing significance and identifying the
issue.
Specify / Specific, ensure that issues and concerns are properly
identified.
Planning, concerned with identifying possible interventions to
correct issues of concern.
Intervention, concerned to implement strategies and tactics to
bring about change.
Review,
concerned to ensure that the implementation programme is on track and make
adjustments where required.
Evaluation, concerned to assess the overall effect of the
intervention. (sometimes the "E" is dropped from this model)
The
S.M.A.R.T model
Specific:
concerned to be precise
about what is required.
Measurable: concerned with to measure progress toward what is required so that its
achievement can be perceived.
Achievable: concerned that what
is required is “doable” rather simply desirable.
Related: Related to the Assessed needs.
Timescaled: concerned with
framing that which is do-able
is done within a realistic time
period.
Discussion
on the ASPIRE and SMART Outcome Models
There is nothing really wrong with either the ASPIRE or SMART models except for the fact that as normally expressed they are way too “high level” to be really useful in specifying what outcomes should look like. And if you don’t know what the outcome looks like then how can you possibly assess or evaluate its achievement? The SMART model is a bit better in terms of its insistence on measurability. Many people cite the SMART model as the "end of" in discussion in outcome framing. However, it says nothing about how this measurability should or could be framed. It is therefore almost useless in practical terms. It sounds good which is perhaps why it has been adopted by Government (ICS system), but it actually isn't very good.
So what else is there?
The Well-Formed Outcome Model (WFO) (from
Neuro-Linguistic Programming – NLP)
 |
The outcome should be stated
in the positive – what is wanted - NOT what is not wanted (you can’t test
for what doesn’t exist). This will need to be agreed by the agency and the
service user. |
|
The outcome must be demonstrated
in sensory experience – what would you and others see, hear, feel (and
possibly taste and smell) when the outcome is realised. This provides for an evidence
procedure to test for achievement of the outcome. |
|
The outcome should be
initiated and maintained by the individual – you are not conditioning rats or
pigeons, you must work in partnership and agree / negotiate outcomes. No
agreement necessitates a differently specified outcome e.g. one determined by a
Court. |
|
The process to achieving the
outcome must be “do-able” – each step needs to be framed in chunks which
are achievable and evaluated in terms of sensory experience. |
|
The outcome should be
ecological in effect – it must maintain (not fragment) the homeostasis
(balance) of the system. This means that any secondary gain (which might be
loss for the individual service user but a
gain for someone else in the family) and which supports an unwanted behaviour must
be taken into account and solutions factored in. If this isn’t done – the
proposed change programme will probably fail. |
|
The outcome evidence
procedure must be time-scaled and a review date set. The timescale must be
realistic, but be framed in reference to the paramountcy of the child’s needs. |
Osiris also has another closely related version of the WFO but which is derived from Brief Therapy - "Criteria for a Well Formed Goal". We also make this available as part of the course.
Further Discussion:
The
"wooliness problem" of the ASPIRE and SMART models is taken care of in the WFO model because of the
model’s insistence on framing an outcome ONLY in sensory based language
– what will you and others see, hear, feel, taste and smell when the outcome
is realised. What will the service user see, hear him / herself saying, feeling
etc? This information, and only this
information, allows you to frame a
publicly
accessible
evidence procedure that you and others can subject to testing.
The WFO also insists that you take into account “secondary gain” (things
that directly or indirectly support the main issue that needs to change) and design interventions to
address these secondary gains which may mean designing interventions regarding
other people in the family system.
The “Well-Formed Outcome Model” (WFO) is that advocated by Osiris Training. The WFO is probably of more practical use in Core Group work (or similar child in need planning groups) where the details (strategies and day-to-day tactics) of the intervention plan should be formulated in detail and implemented. It is not practicable for high level meetings like Case Conferences which would continue to require the use of high level outcome models.
The Course:
Doing the above sounds easy. It is emphatically NOT easy. This course is one day but it is an intensive one day which demands much one-to-one work between trainer and (normally) a pair group. It is for this reason that we prefer to offer this course as a two trainer course for up to 16 participants although we will take up to 22 with two trainers (exception is our Court Work course which is set at a maximum of 14 in all cases)
The course begins with an outline of what general outcomes are obtained in social care work (for the most part pretty dreadful) and how might this be improved.
We then look at the nature of risk (which is all about outcomes) in relation to outcome models.
We then proceed to look at various examples through exercises before turning to working on real case examples brought to the training by participants. We have found from experience that most people do not find this at all easy and often confuse intervention with outcome, think of outcomes in the macro sense without thinking of how to get there via testable sub-outcome framing, persist in framing outcomes in the untestable negative, incorporate conceptual (untestable) thinking as part of outcome formulation (e.g. "improve behaviour") or fail to take into account the losses and gains (and secondary losses and gains) of the individuals involved. As said above, it all sounds easy but is far from easy which is probably why it isn't done very well. But the result is then case drift.
Other courses which may usefully be linked with this course are Analysis and Assessment and Risk training options.