3.8 Needs or outcomes? Children, young people and adults
We now return to considering outcomes in relation to people of all ages.
Although we are moving towards personalisation in health, social care and other services, it is still the case that professionals have to assess someone’s needs to decide whether they are entitled, or eligible, for a service. So long as those who are providing or funding services need to determine eligibility, someone who is not the service user, parent or other carer will have to decide whether an eligibility criterion has been met. If ‘need’ is only defined by professionals on the basis of 'expert' knowledge, then this definition potentially acts as a barrier to finding out what service users see as important to them. Nevertheless, assessment of 'need' still has a central role in law – and of course people do have needs and it would be very difficult to obliterate ‘need’ from the language.
The next activity explores the relevance of outcomes to a young person and her extended family.
Activity 3.9: Sara and her family: an outcomes-focused approach
You met Sara and her family in the introduction and the first two sections of this course.
There are two tasks for this activity:
- Note down some outcomes that you think may be important to each family member in your learning log . If you are unsure whether these are outcomes, you can check your understanding about:
- How do you think that finding out what matters to family members might be important in providing the right kinds of services to support the family?
Although of course we can only conjecture about what might be important to Sara, Lela, Gita and Sam, the information you have will have given you some clues. For example, you may have thought that some important outcomes for Sara were being 'Included' (at school, in activities, in opportunities to meet friends). At the moment her grandfather, Sam, is a prime mover in making this happen, but his health problems may mean that it is time to consider drawing on other forms of support that allow him to take life a bit easier. Considering what's important for Sam, however, may make you think about how his support to Sara may be an important role for him, as well as a positive experience for her. And Sara, as we know, likes to be independent and do things for herself. So, when we think about services that might support this family, we need to explore ways of providing support that enables Sara to exercise and develop her independence, and that do not undermine relationships that are important to her and to other family members.
In other words, when we are thinking about Sara, we need to make sure that services are personalised – that they relate to Sara, and her family, and address what matters to her and those who support her. Of course, often members of a family may have conflicting needs and goals. Sara may want Sam to continue to be actively involved in supporting her to be independent. And that may not be possible for Sam to do without compromising his health. So determining outcomes in the context of the family and wider community involves complexity and sometimes tensions as competing needs and wishes are negotiated.