With councils under increasing pressure to show that services are effective, John Camm reports on the benefits of outcomes-based working.
The case of one child cared for by Warrington BC’s children’s services shows the benefits of outcomes-based working. The boy was “causing absolute mayhem”, as Norma Cadwallader, strategic director in Warrington’s Children’s Services Directorate, puts it.
Disruptive behaviour meant he was facing exclusion from school, and when not in school he was causing problems in his neighbourhood. There was the danger he might fall into criminal activity.
However, thanks to an outcomes-based approach, which identifies the results that are needed and works back to find out how to achieve them, a successful intervention was made.
Children’s workers identified a number of issues, including problems at home and the fact that the boy was troubled by being small for his age — his most disruptive behaviour coincided with PE at school.
Work was carried out to raise the boy’s selfesteem and he was taken off the PE timetable and given other tasks to do by his teachers. His behaviour improved and as a result more drastic action was avoided.
“What we found was that we were able to turn that situation around,” says Ms Cadwallader. “Otherwise, that intervention would have been that he’d have been excluded. Although he would have had help, the help he needed was actually quite low level.”
Ms Cadwallader says that this case, and many others, illustrate the value of outcomes- based assessment — in this case preventing resources being wasted when a better course of action could be identified.
Effective and value for money
With money tight, measuring outcomes is increasingly important for councils. There is pressure to show that services are effective and offer value for money. In addition, the government is focusing on outcomes, not least in children’s services, where the Every Child Matters (ECM) agenda is based on five broad outcomes.
Outcomes in practice
The Every Child Matters green paper identifies five outcomes that should be the basis of services for children and young people:
- be healthy
- stay safe
- enjoy and achieve
- make a positive contribution
- achieve economic wellbeing
Crucially, there needs to be effective measurement of the outcomes to make sure the right interventions are being used. Fortunately, the councils already successfully implementing outcomes-based approaches have lessons to teach others.
Like many, Warrington wanted to develop a model for integrated working connected with ECM outcomes. The model uses four levels of need, with the lowest being children who are meeting the five targets of ECM, and the highest those who need “intensive support”.
Children and young people are measured on a scale of one to four in each area, and their progress monitored between interventions.
“It’s a very simple system but it has enabled us to see if the interventions have made a difference,” says Ms Cadwallader.
She says the benefits have included making more efficient use of resources and improving the scope for targeted interventions. For example, the council found that data collected as part of its outcomes-based approach showed significant geographical differences in rates of antisocial behaviour. This allowed successful targeted interventions to be adopted by providing activities for young people in some areas on Friday and Saturday nights.
The trend towards measuring outcomes is highlighted by Anne Cowling, manager for the Leeds Healthy School & Wellbeing Programme at Education Leeds. “There’s much more emphasis now on schools demonstrating outcomes around health. The whole wellbeing and measuring of data and outcomes scenario is tightening up nationally,” she says.
In Leeds, by working with the local primary care trust, the council is pointing schools towards four priorities: obesity; teenage pregnancy; emotional wellbeing; and drugs, alcohol and tobacco. However, schools are not necessarily used to collecting data, so “authorities have to have the infrastructure in place so schools are supported to collect data and set baselines,” says Ms Cowling.
She gives an example of outcomes-related work in Leeds, the Be Healthy Challenge. “It’s a young person-led project. We train up young people to go back into school to lead the challenge, for example to eat one more piece of fruit a day.” The aim is to encourage sustainable behavioural change to promote health andwellbeing, and the scheme has been successfully extended into family settings.
One of the challenges of measuring outcomes is that it often involves ‘soft’ rather than ‘hard’ outcomes such as school attendance. Camden LBC has been using a system of ‘outcome stars’, developed by Triangle Consulting, whereby the service user, working with practitioner, defines how they feel about a particular issue — for example their ability to set boundaries for their children. After an intervention, such as support for parenting skills, the service user can report any changes.
Sarah Brown, senior commissioning manager, parenting and family support, explains: “It’s a tool for measuring distance travelled by a service user after a given intervention. If you have one provider working with 10 service users, you can demonstrate the improvement level across the whole cohort.
“That helps me as a commissioner because I can then see what interventions are working. You can take it from an individual one-to-one with the service users right up to corporate level,” she adds.
The Research Centre at City College in Norwich carries out education-related research and evaluation. After identifying a demand from the voluntary sector, it produced the SOUL Record, a toolkit for measuring ‘soft’ outcomes, which is now being used by around 800 organisations.
“Statutory organisations as well as the voluntary sector are being required to measure outcomes,” says Sarah Durke, SOUL coordinator.
“Funding bodies began to understand that soft outcomes are important in their own right.” These soft outcomes can be issues such as personal confidence and timekeeping, again measured by the service user defining their own abilities in certain areas. A major benefit of the SOUL system is that it is client-centred and couched in positive terms. “It looks at what they can do and not what they can’t do,” as Ms Durke puts it.
She explains that even seemingly minor skills such as timekeeping have been shown to “change life dramatically” for certain clients, and advises councils focusing on outcomes to be clear about what they want to achieve.
This view is echoed by councils already successfully measuring outcomes. Carole Bell, assistant director for commissioning and performance in children’s services at Hammersmith & Fulham LBC, points out the need to make a clear distinction between outputs and outcomes across children’s services.
“Simply getting children to attend schools in its own right is not an outcome, it’s an output,” she says. “The issue is clarity about what we’re measuring, [we’re] not saying outputs are a bad thing but the real answer is to ask individuals what the impact of a service is.”
Her council has worked with children in care using a strengths and difficulties questionnaire that has helped build the relationship between youth worker and client. Ms Bell adds that impetus for change can come from a wide range of sources but councils need to provide the structures to help children and families improve their lives — in Hammersmith & Fulham these include family learning, parenting support and healthy school meals.
“In the end it may be what adults in a family decide to do, it may be a TV programme [about obesity] that’s made them go: ‘Oh, gulp, that will happen to my children’.”
Telford & Wrekin Council has a system for measuring outcomes in children’s services that begins with a workshop and culminates in an action plan, the success of which is then measured with an outcomes matrix.
Parvinder Chana, outcomes-based accountability officer at the West Midlands Council, emphasises the need for a team-based approach.
“It’s not just about managers having that information, it’s about relaying it back to frontline staff. We’ve been quite fortunate in that people have been quite happy to implement it [an outcomes-based approach] because they see the benefits,” she says.
She adds that it is important to consult with the people at all levels. “We’ve had head teachers involved and we’ve been able to pick up on the barriers they face.”
The benefits of outcomes-based working are clear, and it is a trend that is well under way and likely to extend to other areas of local government.
There is now a body devoted to promoting outcomes work, C4EO, which offers services and support for local authorities and their Children’s Trust partners.
Christine Davies, director of C4EO, says: “There are many excellent examples of work being done which are already delivering positive outcomes for local children, young people and their families.
“We want to capture these so that they can be shared with colleagues across the sector for the benefit of all.”
Find out more
Tel: 01925 443136 or email: CAF@warrington.gov.uk
Anne Cowling, manager, The Leeds Healthy School and Wellbeing Programme.
Tel: 07891 270337 or email: firstname.lastname@example.org
Children, Schools & Family Directorate.
Tel: 020 7974 1525
Research Centre, City College Norwich.
Tel: 01603 773 364
Children’s Services Department.
Main switchboard: 020 8748 3020
Parvinder Chana, OBA Manager.
Tel: 01952 385 521 or email: Parvinder.Chana@telford.gov.uk