What I Tell You Three Times Is True

1
What I Tell You Three Times Is True

• trying to make sense of outcomes within a non
  government organisation providing mental health
  support services.

2
Our Challenge

• Providing community-based mental health support
  services is a multi-faceted business.
• How do we balance and manage the complex, diverse
  and sometimes competing interests and
  expectations of
• People who use services (meeting individual
  needs, safety, recovery)
• their families / whanau, friends and carers
  (participation, reassurance, recovery...
• People who provide services (the workforce)
• The community (eg. neighbours / general
  population, providers of health and social
  services and resources, employers, interest
  groups and stakeholders)
• The organisation (operationally efficient and
  effective, accountable and sustainable.)

3
A Framework To Pull It All Together

• A four quadrant model
• Based on the work of philosopher Ken Wilber
• Fundamental focus upon integration and holism
• A Brief History Of Everything
• An ambitious, systemic approach to consider the
  world as a whole
• All four quadrants must operate effectively and
  in balance for the system to function well
• Each is essential and integral to one another.
• Where one quadrant dominates the influence of
  others, the theory suggests that chaos will ensue

4
Wilbers Four Quadrants
Subjective
Objective
It Exterior - Individual Behavioural Social
Sciences example BF Skinner Observation of
behaviours displayed.
I Interior - Individual Intentional Social
Sciences example Freud Psychoanalysis
interpreting peoples interior experiences.
Individual
We Interior - Collective Cultural Social
Sciences example Jung Archetypes that reflect
human collective unconscious.
Its Exterior - Collective Social Social
Sciences example Marx Economic theory considers
the external behaviour of society.
Social
5
Four Quadrants - Traditional Mental Health
Objective
Subjective
Individual
Service User
Clinical / Medical Perspectives
Social
Family / whanau
Community
6
Four Quadrants - Reformed Mental Health
Individual
Collective
Clinical / Medical Perspectives
Individual
Service User
Family / whanau
Community
Social
7
Four Quadrants - Recovery
Individual
Collective
Personal Recovery
Clinical Recovery
Individual
Cultural Recovery
Social Recovery
Social
8
Four Quadrants - WALSH Trust
Individual
Collective
Organisational Effectiveness Effectiveness may be
determined by organisational structure
policies and procedures sustainability
contractual obligations growth and renewal
innovation and development meeting goals /
targets / objectives defining excellence
demonstrating excellence
Staff / Clients / People This may be evidenced
by people realising hope meaning growth
and development satisfaction their
potential a sense of personal identity a
sense of being valued
Individual
Service Delivery / Organisational Culture This
may be shaped / influenced by shared
understandings and partnerships mutual support
teamwork peer support change
evidenced-based best practice qualitative
outcome measures respect, transparency,
sharing new possibilities and potentials
pride achievement vision
Community Successful outcomes may be evidenced
by people in employment improved community
mental health dialogue / sharing / listening
participation and contribution collaboration
and partnership innovation driven by community
priorities continued deinstitutionalisation /
reform of mental health services A greater
proportion of the total mental health spend
will be received by the NGO sector.
Social
9
Four Quadrants - WALSH Trust
Individual
Collective
Staff / Clients / People This may be evidenced
by people realising hope meaning growth
and development satisfaction their
potential a sense of personal identity a
sense of being valued
Organisational Effectiveness Effectiveness may be
determined by organisational structure
policies and procedures sustainability
contractual obligations growth and renewal
innovation and development meeting goals /
targets / objectives defining excellence
demonstrating excellence
Individual
Service Delivery / Organisational Culture This
may be shaped / influenced by shared
understandings and partnerships mutual support
teamwork peer support change
evidenced-based best practice qualitative
outcome measures respect, transparency,
sharing new possibilities and potentials
pride achievement vision
Community Successful outcomes may be evidenced
by people in employment improved community
mental health dialogue / sharing / listening
participation and contribution collaboration
and partnership innovation driven by community
priorities continued deinstitutionalisation /
reform of mental health services A greater
proportion of the total mental health spend
will be received by the NGO sector.
Social
10
Principle Assumption

• Outcomes cannot be considered in isolation to
  everything else for example
• Organisational culture, philosophy and values
  will impact on how outcome measures are applied
  and interpreted
• Is it a good outcome if services users needs are
  completely fulfilled, but the organisation has to
  close 12 months later?
• You cannot expect to achieve excellent outcomes
  for services users if you are achieving very poor
  outcomes for staff

11
Outcome Indicators Currently In Use (1)

• People Who Use Services
• Life Skills Profile
• Developed 1989 high validity and reliability
• Simple to use an inter-subjective measure
• Satisfaction With Life Scale (self report)
• An amalgam of 2 self-reporting measures developed
  to assess the quality of life of people who
  experience mental illness
• Mastery Scale (self report)
• 7 item self assessed indicator of personal
  control and self efficacy
• Each are fundamentally flawed!
• Impossible to reduce a human-being to 1 or 2
  sheets of paper
• They can offer a number of blurry snapshots
  which can be useful alongside of other blurry
  snapshots

12
Outcome Indicators Currently In Use (2)

• Annual Client Satisfaction Survey
• Paper based score responses to statements with
  the option of providing additional narrative
• Face to face interview with Peer Support
  Specialist where requested
• We Can Do It Better! forms
• People in employment
• Length if time employed
• Wages earned
• Length of time people continuously use a service

13
Using Life Skills Profile
14
Using Life Skills Profile
15
Using Life Satisfaction and Mastery Scales
16
Outcomes For People Who Are Employed To Deliver
Services

• A great place to work?

17
Skills - based Remuneration Framework
Based on a conscious-competency model
The Framework Is Based In Six Skill Sets
Base Annual Salary 100
Awareness in all six skill sets 3.38
Max. 113
Awareness
Max. 116.38
Competency Skills
Mentoring Skills
Max. 137.67
Max. 147.81
To qualify for this a person must be able to
1) clearly articulate their own or family /
whanau member's process of recovery 2) clearly
articulate their own lived experience either of
mental illness or supporting a family / whanau
member who experiences mental illness 3) relate
/ share the above in a way which supports the
recovery of others, but does not prescribe the
recovery of others based on their own experience
The maximum salary a support worker may
receive, after completing the requirements of
each level (ie. awareness, competency and
mentoring), is calculated at 147.81 of the base
annual salary.
18
Outcomes - Staff Development
19
10 Items With The Most Change Between 2005 and
2006
20
Storing, Collating and Managing Information
21
Lessons From Considering Outcomes

• Benefits (include)
• Provide feedback and direction to staff
• Identify training needs
• Promotes discussion/awareness of intended
  outcomes
• Assists with the improvement of services,
  learning, improves accountability
• Challenges (include)
• Interpretation / their meaning
• Tendency to reinforce understandings of complex
  matters as simple cause and effect relationships
• Staff development / organisational culture for
  example
• scales detract from the therapeutic
  relationship
• too busy doing the important work to have time
  for outcomes
• a management tool to check up on staff?
• Why do we need to be accountable?
• I cant tell him I think he smellsit would
  affect our relationship
• Im empowering him to live alone he doesnt
  want or need better social contacts

22
Summary

• Outcomes need to be considered as an integral
  component of all that happens in an organisation
• You cannot reduce a person to 1 or 2 sheets of
  paper - no matter how sophisticated the measure
  
• Introducing outcome measurement is a workforce
  development issue - requiring changes in practice
  and culture
• Collecting, storing, managing and reporting
  outcome measures is an organisational capacity
  issue