UNIT 513 - Manage health and social care practice to ensure positive outcomes for individuals
1.1 - Explain outcome based practice
1.1 Over recent decades, there has been a shift in the focus of care from being needs-led, whereby services offered a 'one size fits all' approach to being outcome based, a more proactive approach whereby services tailor the care package to the individual goals and desires of the individual.
Successive governments have supported this change and it has now been incorporated into general practice.
Amongst the evidence which has informed government policies has been an 'outcomes framework', devised and developed by the Social Policy Research Unit at the University of York through work with disabled service users (Bamford et al1., 1999; Harris et al2., 2005).
There are three dimensions to the model which are:
Outcomes involving change - e.g. building self-confidence, improving self-care skills
Outcomes to maintain quality of life
Outcomes involving service delivery, where the individual becomes a stakeholder, is listened to and valued
These dimensions have been categorised by Harris et al. (2005) into a 4-part framework, showing how individuals' needs may be met (see Annex A).
This framework is generally accepted as being a person-centred approach, with the support worker facilitating care pathways.
1.2 - Critically review approaches to outcome based practice
1.2 The British Red Cross has adopted an outcome based approach to it's Support at Home service, subsequently, as the Team Leader for this service in the Cardiff and Vale of Glamorgan area, I adapt this way of working on a daily basis.
I fully understand the approach and I ensure that I, my staff and my team of volunteers all work following these principles, assessing the individual, encouraging the individual to identify the 'Top 3 Goals/Outcomes', the creating a tailor-made 'Action Plan' to try and achieve these.
However, I feel there are limitations to this approach and to illustrate this, I have compared two case studies as follows (names changed to protect anonymity)
Gerald. Gerald is partially-sighted, in fact almost blind as the result of a stroke, although his mobility is quite reasonable. At the referral stage, he said that he had very little social interaction, pretty much just a weekly visit to a day centre for the elderly.
The main goal/outcome was identified as 'increased social inclusion' and to achieve this, the support worker introduced him to Barry Indoor Bowls for the Blind, a group which meets weekly at Hen Goleg Resource Centre, near to his home.
The support offered by the Red Cross' service is time limited to 12 weeks so the support worker took Gerald and returned him home 12 times. During this time, Gerald flourished and developed friendships, resulting in a taxi-share so that he could sustain his new-found social inclusion beyond our support.
This was an excellent outcome for Gerald and for our service.
Edith. Edith was referred to our service by the Primary Mental Health Support Service. She was very depressed and they felt that she had become socially isolated, despite living in sheltered accommodation with central facilities for interaction with other residents. At the root of Edith's depression was the fact that she had lost her adult daughter to breast cancer approximately 4 months before the referral.
The limitations of the 'outcome based practice' became apparent at this stage as, due to her depressive state, Edith felt very lack-lustre about receiving help or support and despite encouragement, did not really engage with the process of identifying needs; the real need in her life was to bring her daughter back which, of course, sadly, was never going to happen.
To nevertheless try and help Edith through the bereavement and depression, the Top 3 goals/outcomes were identified as to lift emotional state, be able to cope with the bereavement and to
