Outcomes & Value part 2 – ensuring effective focus, evidencing meaningful progress

​Are we only as good as our last outcome? I think that's probably something to keep in mind. Our biggest goal for many of the people that we work with - for case managers and also for therapists - is that we ‘do ourselves out of a job’ over time. If the person achieves all of their outcomes and makes the progress they seek, or as near to where they want to be as they can, that can be a fantastic outcome where we no longer have to provide a service to support that person. It means that they've achieved their goals and we've been part of helping them do that.

​​We need to keep in mind that our role includes evidencing when somebody has progressed to the point at which there is less input needed or where we can start to withdraw. We also need to be aware of progressing to a point where needs have changed and where a change to a different approach may be needed.
 
Goals must be SMART; we need to be smart to communicate them effectively.
 
The smart acronym is a structure for writing goals - Specific, Measurable, Accurate, Realistic, and Timely. Case managers need to tease out these elements in the person's expression of what they want to change and ensure this understanding is shared across the team in order that all interventions are contributing towards meaningful progress and achievements for people.
 
It can be challenging to turn the person's words into a SMART structure and bits of it can get lost. It can often end up being an action plan rather than a goal. It is a skill and an art to be able to articulate what can sometimes be quite a nebulous thing that somebody wants to be able to do into something that you can use as a vehicle to then structure their therapy and input around.
 
Our clients may need support to understand how a focus on a specific area, or that doing things in a particular order or a different way comes from the aspirations they have articulated. This is placed alongside skilled assessment which together with the personal aspirations identify the best path toward achieving their goals. The path may not be smooth. It may require experimentation and trial to establish the most effective way forward. It may not be a direct line from A to B, particularly following complex and catastrophic injury. The client’s aspirations may change over time as progress is made and space is needed for the person and the plan to change and evolve.
 
Inputs, outputs, and outcomes – what is the relationship between them?
 
There is an opportunity in case management to take innovative approaches on an individual basis. We can look at different approaches, clients can access services and methods that may not traditionally be part of rehabilitation and recovery pathways. Social Return case managers support the client and their whole team to try things out and experiment within a framework of clear justified reasoning. There is a wide range of experience within the team of innovative approaches to draw upon. The team is beneficial for clients and as a team member within Social Return - you don't have to have all the answers because you can go to the rest of the team and access that shared knowledge and experience with novel solutions or suggestions.
 
How does this approach help Solicitors, Insurers and Deputies?
 
Solicitors and Deputies can rely on our very client-centric approach. It goes back to each individual unique client. There's nothing more powerful than listening to somebody's own individual story and developing a deep understanding of that person’s experience and aspirations for their recovery and their lifestyle. The context is always the client, and their story informs the approach we take and clarity in the documentation of their progress toward their clearly articulated goals.
 
We are mindful when legal processes are going on in parallel and we don’t lose sight of the need to present a clear picture of the situation, the goals, plans and to demonstrate progress and context. Our job as case managers however is to keep the focus on each individual client.
 
What are the challenges to demonstrate and measure outcomes as opposed to outputs?
 
It is about being very clear and very specific using the SMART goal structure to demonstrate the difference in what has been achieved alongside ensuring context and over time that an accurate picture is painted in the data and information collected. It might be crucial to demonstrate a very small difference, or even that somebody has stayed the same because there are times for specific individuals when not getting worse is a positive outcome. This can feel challenging because you want people to get better but on occasion plateaus can occur, often related to the complexity of the issues that some of our clients have. It is then important to recognise that you managed to keep somebody on an even keel as an outcome. Sometimes that's just as difficult as enabling people to progress.
 
A bit about me
 
I came to Social Return as a result of my longstanding connection and relationship with Vicki Gilman and Jackie Waggott, whom I worked with as an independent occupational therapist for many years. I am now leading the development of the service in the south and the South West of England.
 
I was ready for a new and different challenge that would use the skills that I've achieved and developed over the nearly 30 years as an OT and the knowledge of working with case managers for well over a decade.
 
Throughout the roles and opportunities, I've had, I've always been interested in outcome measures and being able to demonstrate the difference that people can achieve through therapy and having case management and support.
 
My Masters dissertation focussed on outcome measures in community rehab, and I've continued to support the use of SMART goals and outcome measures to share and demonstrate the difference made as people develop and change.
 
If you would like to find out more about demonstrating value, please contact me on the below details. 

Rachel Charles
Case Manager
Social Return Case Management.
[email protected]
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