Outcomes and self-directed support
The strategy for self-directed support in Scotland outlined the need for culture change to enable citizens to have choice and control over their support. One of the strategy's aims is that people will be 'confident in identifying and agreeing the outcomes they want' (Scottish Government, 2010b, p.32). The Social Care (Self-directed Support) (Scotland) Act 2013 sets out the ways in which this aim is to be achieved in practice, underpinned by one of the guiding principles of the Act, 'collaboration':
Professional staff and the person must work together to make a plan for the person’s care and support. They will agree on outcomes for the person – what they want to see happen in the person’s life. The plan will help the person work towards this.
The Act enables children, young people and their families to direct their own support. Sixteen and 17-year-olds have the right to decide for themselves how support is offered. Responsibility for decisions about under 16-year-olds lies with their parents (or other adult with parental responsibility for the child). However, children must have the opportunity to contribute their views about what is important to them. This is consistent with a central aim of Getting it right for every child (GIRFEC), to:
Keep the child at the centre: Children and young people should have their views listened to and they should be involved in decisions that affect them.
This requirement is also one of the overarching principles of the Children (Scotland) Act 1995. To achieve the level of collaboration required to agree realistic and achievable outcomes that matter to each individual, professional staff require well-honed skills in communication, including relationship building, problem-solving and negotiation. For social services workers, these capabilities are set out in the.
Activity 3.5: Outcomes and self-directed support
In this activity you will be listening to several voices discussing thinking about outcomes for Cameron, a young man with autism who uses self-directed support. First, you will hear his parents discussing these outcomes and how they were decided upon, and then one of Cameron's personal assistants, Kayleigh, explains her involvement in supporting him to meet those outcomes. The second podcast features Mamta Kanabar, Children's Services Service Manager at the Barnardo's Scotland project, Apna , who talks about the place of outcomes in her team's work with children with disabilities and their families.
Now use your learning log to answer the following questions:
- What outcomes have Cameron, and the young people that Mamta describes, been able to achieve through self-directed support?
- How do these outcomes relate to the eight well-being indicators (or SHANARRI outcomes) that you explored in the previous activity?
- Who decides what the outcomes of care and support should be?
You will have heard Cameron's father and his support worker, Kayleigh, talking about the kinds of outcomes that Cameron has decided, with his family and professionals, to work towards. For example, at the moment his outcomes include working towards the ability to travel and to use money more independently. You will have noted that Cameron, although he chose not to contribute to the podcast, is an active participant in establishing what the most important outcomes for him are. There is evidently a process of negotiation between him, his parents and professionals that establishes which outcomes should be pursued. This suggests that, in practice, outcomes are not only 'what matters to the person', but also driven by other considerations about what is considered to be important, affordable and safe. In some circumstances, negotiating outcomes can be particularly challenging for families and professionals, especially when, for example, there is a high level of family disharmony, lack of a stable adult figure in the child's world or families are adjusting to parental loss or divorce. The Institute for Research and Innovation in Social Services (IRISS, 2011, p.17), writing about outcome-based practice and substance misuse, identifies the importance of establishing trusting relationships with families so that the outcomes identified and worked towards are truly helpful to children, young people and their families.
Mamta makes the point that outcomes are not always about working towards change – they may also be about ensuring that services are consistent and sustained over time. Her team aims to support children and parents in ways that promote the well-being of both children and parents. Mamta identifies a number of broad outcomes that are identified by the SHANARRI framework, including being 'Respected' and 'Included'. A number of organisations have sought to develop tools and guidance that help practitioners and others put GIRFEC's approach to outcomes into practice in different practice contexts. These tools are also important because they enable the achievement of outcomes to be measured, allowing the impact of support provision to be evaluated. You may want to explore all or some of these resources through the links below.
This activity illustrates how important having control over an individual budget can be very important to children, young people and their families. However, money of course is not everything. In Control (2012) makes the point that an individual budget is only one part of the ' real wealth ' that the child and his or her family has to draw on to meet the child's support needs.
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