We are sometimes asked whether changes in Star readings actually reflect the changes that occur during service provision. We have three responses to this: the first two are based on the practices we have in place for the development of new Stars and for training and implementation of the Star. The third is to present the research evidence that the Star readings can be applied accurately and that readings correlate with other measures in the expected way.
Star Development
New versions of the Star are created alongside managers and practitioners to ensure the Journey of Change captures key changes occurring for those using services.
Pilot data is statistically analysed to check that the scales are sensitive enough to detect change.
Service users and practitioners provide end-of-pilot feedback about the extent to which the Star captures the changes made.
Training and Implementation
For the Star to accurately reflect change, practitioners should be well-trained with ongoing support to continue using it well. This is why training is mandatory, we provide free CPD for licensed trainers and encourage refresher training, regular supervision, and auditing.
Research Evidence
Convergent validity: Star readings have been shown to correlate with other validated measures in our own, as well as in external peer-reviewed research.
Predictive validity: Star readings, and change in Star readings, predict hard outcomes such as securing accommodation, employment, and school absenteeism
Inter-rater reliability: different practitioners are able to consistently assign Star readings
We are keen to conduct further analyses of the relationship between Star readings and other measures, so please get in touch if you have linked data and are interested in us exploring it.
To read our three page briefing providing a more detailed version of the above, please download it here (PDF).
When we launched the new and improved Outcomes Star Online platform in 2020, we were aware that what we were launching was a Minimum Viable Product.
We knew it was only the start of where we could use digital technology to help people get the most out of the Outcomes Star.
Following a year of migrating over 1000 organisations from the old platform to the new, we’ve been constantly moving forward with the platform, working closely with our technology partners QES, including:
Filling in gaps that we weren’t able to get to in the initial development (eg action plan PDF downloads)
Introducing features to support better management of data (eg configurable practitioner permissions and restricted access to records, and depersonalisation of dormant records)
Ensuring a strong foundation of compliance for information governance, cyber security and clinical safety (eg new IG statements for UK and Australia, and bringing in a Clinical Safety Officer to set up our Clinical Risk Management System).
We’ve also been working on 2 big projects – integration, and an overhaul of the ‘Live Completion’ feature. Here’s an update on those projects and some of the things we’ve learnt along the way.
Integration
We are clear that the role of Outcomes Star Online is not to be a fully customisable, comprehensive case management system or electronic patient record system. Although for some organisations it may be their central record system, our focus is purely on the Outcomes Star and supporting best practice use across our client organisations.
We have also learnt the hard way that although on the surface it seems simple to allow organisations to build their own digital versions of Stars, and in some cases works well, often it is very difficult to achieve a user experience that matches up to best practice and supports the values underpinning the Star.
Therefore, we knew when launching the new platform that we absolutely had to offer integration with other systems – but at the time, we didn’t really know how to do that. We didn’t know what kind of integration people wanted, or what technology the other systems needed to be ‘talked to’, or where to draw the lines around what should happen within Outcomes Star Online and what we should support in other systems. With over 1000 organisations using all sorts of software and managing that software in different ways, we had to decide where to start – with something that delivered a lot for one setting, or something that delivered something basic but for as many different circumstances as possible.
Following a period of research, design and development, we were delighted to launch our Partner API and our Integration Pilot in April 2023, delivering a ‘Phase 1’ of universally useful endpoints designed to reduce duplication of data entry for practitioners and support a ‘single point of truth’ in primary systems.
Alongside the more technical side of the API development, we also knew we wanted to continue to improve the user experience around completing Stars.
For the last year we’ve been doing some exciting user research and design with Usertopia to look at the ‘Live Star Completion’ feature the pages designed to be shared with someone being supported to complete a Star collaboratively without paper. Here you can see an image of one of our potential alternative designs in action.
With a focus on accessibility, as well as on supporting best Star practice, we’ve uncovered some useful learnings, including:
Lack of wifi when out and about prevents people from using the feature, so an offline solution would be valuable
The lack of imagery and the volume of text on the screen all in one go makes it harder to digest
Rather than just completing a Star, people would like to be able to complete action plans collaboratively and look back over completed Stars to show the visual of change over time
We’re just starting to move from design into development, working closely with Usertopia and QES and planning to collaborate with our research community of Outcomes Star Online practitioners to test out our plans as we go. If you’re interested in finding out more or helping us with this important development, sign up here.
Onwards and upwards
As well as the big projects above we’re committed to continually improving the user experience and technology of Outcomes Star Online. If you have any feedback or requests, or any questions or issues with the platform, please contact us on support@staronline.org.uk.
We’ve been noticing an increase in enquiries about using the Star in children’s social care, which may reflect upcoming changes in the requirements for outcomes measurement and keywork in this sector.
The Department for Education’s recently consulted on a new children’s social care national framework and indicators dashboard, and we were pleased to contribute to this. We welcomed the move towards more person-centred and collaborative care planning and outcomes measurement – the aims set out in the framework being very well aligned with our own (see our Enabling help report). However, we fed back our hope that the final version will include a broader range of indicators and more practical guidance about how to achieve the aims, for example, collaborative assessments to build strong relationships.
The themes of hearing the voices of people being supported, tailoring support and building trusting relationships were also very prominent in the Department for Education ‘Guide to the Supported Accommodation Regulations including Quality Standards’ for looked after children and care leavers aged 16 and 17, which was published in March. Since all providers now have to register with Ofsted and indicate how they will comply with the regulations, we have been working on a guidance document to explain how the Outcomes Star can help with this and how specific versions map across to the principles and quality standards.
Download the How To here. Contact us for more information or to share any learnings about using the Star in these settings.
Introducing the new My Mind Star and a new, improved edition of the Recovery Star
My Mind Star – a much needed and timely tool for early intervention with young people
My Mind Star was developed in collaboration with managers, service users and professionals at leading UK children’s charity, Action for Children. It was also piloted by:
HeadStart Kernow, a Cornwall Council-led partnership programme to develop resilience and mental well-being in young people, funded by the Big Lottery.
This is a new and improved edition, drawing on independent research and feedback from service users, keyworkers and organisations.
The new edition retains the person-centred, strengths based approach of previous editions but with even more accessible language, incorporating trauma-informed thinking and fuller acknowledgement of the impact of external factors.
There is fuller recognition of the necessity of on-going support for enduring and severe conditions. It is backed by a report on independent research into the psychometric properties and a review of literature supporting the Journey of Change and choice of outcome areas.
Both Stars were launched at the Govconnect Mental Health 2019 Conference at the Royal Society of Medicine on 26th September.
If you have any questions about our new Stars, any queries about transitioning between the Recovery Star 3rd Edition and the new Edition, or you would just like find out more about how the Stars can support your service users, keyworkers and organisation, please contact us on info@triangleconsulting.co.uk or +44 (0) 207 272 8765.
Our progress so far and what we’re learning along the way
By Sarah Owen, Product Manager at Triangle
As we explained in our last blog post in June 2019, we’re currently in the middle of a big project to redevelop our widely used online system for the Outcomes Star, working with our partners QES.
With the bulk of the project kicking off at the start of
this year, we now have just under 3 months before the new product will go live
for those new to the Star Online (existing accounts will be migrated from the
old system to the new between January and March 2020).
Work-in-progress preview of the new design and interface for the Star Online – with a streamlined homepage featuring easy-to-access actions and notifications
Making progress
During the last 9 months, we’ve made some significant
progress:
Establishing an Agile process – using the iterative, user-focused development approach but in a way that fits with redeveloping an existing, established product already on the market
Weekly (and sometimes daily) sessions between Triangle and QES, to flesh out the specification and turn it into well over 100 user stories – a simple way of capturing what the system needs to do from the point of view of its users
A high-level prototype of the key elements of the system, to ensure a shared understanding between everyone working on the development and to iron out key design decisions
A work in progress site, developed with over 10 sprints so far (a sprint is a two or three week chunk of time with planned goals and tasks) – iterated and improved as we go
Ongoing input and direction from a Think Tank made up of practitioners, managers and data analysts – reviewing key decisions and the prototype as it developed
Work-in-progress screen from the Star Online prototype – with a new Summary page for each person being supported with the Star
A work-in-progress example of the new Star data reports that will be available through the new system – focusing on distance travelled and the outcomes being achieved
What we’re learning
It has been a fascinating project for us so far. As a social enterprise our expertise is not
in software development, but in building tools that help organisations to
create change and help people to achieve the outcomes that matter to them. We knew that building an effective
relationship with our new partner QES was vital both for the short and long
term.
In the early stages, we had to learn how best to communicate our ideas and requirements. Taking the time to do this has paid dividends now that we are in the thick of the detailed development, with greater understanding from both sides. Our experience of working closely with our existing partners, Jellymould and TappetyClick, has also proved invaluable, especially as we balance continuing to support the current system and preparing for the new one.
Next steps
We are running a period of testing with practitioners, managers and commissioners, as well as our team across Triangle, into October. We’ll then be busy incorporating that feedback and finishing the development up to the end of November.
In parallel, our Helpdesk team will be working closely with
organisations already using the Star Online, to share information and plan the
migration of each account.
If you have any questions about the new system, please
contact us on info@triangleconsulting.co.uk or +44(0)20 272 8765.
Introducing our new vision for the digital home of outcomes-focused keywork
By Sarah Owen, Product Manager at Triangle
Screenshot of the existing Star Online system showing a Star visual with 2 sets of ‘completion lines’ representing 2 Stars completed with a service user over time
The Star Online web application for the Outcomes Star was first launched by Triangle in 2011. As the Star has grown in popularity and in use across different sectors and services, so has the Star Online.
Today the system is used by over 800 organisations and 45,000 frontline practitioners, to support over half a million people and to record nearly 900,000 completed Stars.
Listening and responding to feedback
Over the last 8 years, we have heard from many of the practitioners, managers and commissioners that use the system. You told us that, although many aspects of the original design still hit the mark, there are frustrations with the system, such as the limited range of reports available and the lack of flexibility in how services can be configured.
Alongside this feedback, technology has improved exponentially since the original development, with digital service design now utilising cutting edge, user focused tools and programming approaches.
To respond to this, we have committed to a significant level of investment in the Star Online, and since last year, we have been working with QES to completely redevelop the system.
Collaborating with specialists and practitioners
Logo for QES – specialist developer of web based and offline apps
QES is a specialist developer of web based and offline apps, supporting secure digital data solutions to a diverse range of public and private sector clients. Other QES developments include the eCDOP (online recording, casework and reporting for child deaths) and Holistix Early Help case management system.
The development of the new system is well underway. We’re retaining a focus on intuitive, simple design whilst also radically improving what is on offer – for example, with a complete overhaul of reports and tools for analysing Star data, and by introducing more options for how services, teams and people can be configured. Throughout the process, we are collaborating with a small group of practitioners, managers and Star Leads – also known as our Think Tank – who represent a broad selection of organisations using the current system in the UK and in Australia, and who are reviewing our plans and testing out the system.
Timings and next steps
Our timeline is to launch at the end of November 2019 for
new users, and to support existing clients using the current Star Online to
migrate over to the new system by March 2020.
We will have more information for existing clients soon and are working
to make the migration from old to new as straightforward as possible. We will of course be providing guidance and
support throughout the process.
For more information
If you have any questions or any ideas you’d like to share with us, contact us on info@triangleconsulting.co.uk or +44(0)20 272 8765.
Sara Burns, Director and Co-Founder of Triangle, and one of the authors of the Outcomes Stars™ explores what it means to Triangle to be a social enterprise.
By Sara Burns, Director and Co-Founder of Triangle, June 2019.
When we incorporated “social enterprise” into our name in 2009, it seemed entirely natural and obvious to me, yet I gave it little thought and there were few guidelines at the time. Fast forward 10 years and I find myself passionate about the concept and practice of social enterprise, as well as better informed and in a sector that is becoming more defined.
In our case, the expression of our social mission and our enterprise (business activity) are one and the same thing. There are many types of social enterprise, including those who raise money through a neutral business activity in order to fund a separate social mission. As Triangle, we develop Outcomes Stars and other tools and help organisations use them because we believe in their transformative potential. We witness time and again in many sectors how the right tool can support people to really listen, have good conversations, plan and deliver support, gather meaningful information and learn about what works. Like so many people, we are operating in a world where services and funding are severely squeezed, and our aim is to keep listening and learning, so we can continue to innovate and make a contribution.
So why am I passionate about social enterprise?
There are a number of reasons.
We make choices and decisions based on what is helpful at a
sector level, not what will bring in the most money. This has been the case
since we started. It provides a refreshing clarity
and simplicity; even though the choices are not always immediately obvious,
we are able to focus on the question of what will be most helpful. Somehow the
big decisions and changes of direction over the years have always been made
easily and harmoniously, and I believe that is because of this clarity of
purpose.
Receiving an income from the expression of our social
mission in the world, rather than relying on grants or other funding, gives us
relative freedom and independence.
Ultimately, the majority of our income from training and licenses can be
tracked back to the UK government, we collaborate widely in developing Stars
and other tools and respond as best we can to different needs and agendas. Yet,
at the end of the day, we are the authors and can make decisions based on our
learning and experience of what works. And we can plan ahead without the
limiting factor of short term funding and the inevitable uncertainties that
brings.
Similarly, because we have an income and are committed to
reinvesting at least half of the surplus each year, we have some freedom to be generous and experiment. We offer
training and licenses at (often below) cost to enable small organisations to
use the Outcome Stars if it’s right for them. We provide implementation support
according to need, not based on what people pay. We take risks and invest in
new developments before there is a market for them.
All this contributes to a working life that is more fun and meaningful. Money is powerful
and I enjoy the potential it affords to be successful in making a contribution –
to use the very particular expertise we have built up over the years for good.
My anecdotal impression is that some people who enter the social enterprise sector, while passionate about their social mission, feel ambivalence or even resistance to the enterprise/business aspect, to money and charging. Ultimately, this can result in lack of sustainability and good ideas not getting off the ground. When everything feels too tight financially, that can be stressful and less enjoyable. Being confident about embracing the enterprise aspect and charging realistically for services and products can open some space. Space is important for people to be able to move freely, take risks, be creative and innovate. That is the culture we seek to develop and maintain within Triangle, so that everybody working with us feels able to contribute ideas and enjoy the sense of purpose, clarity and independence, so that we can be as helpful as possible in the challenged world of health and social care.
Interested in finding out more about Triangle’s mission and values?
For more information on Triangle, please take a look at our Values. For more information on the Outcomes Stars and our licensing and training options please contact us: email Triangle at info@triangleconsulting.co.uk, or call on +44(0)202 7272 8765.
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Sara Burns: Sara is co-creator of the Outcomes Stars. She leads on and is continually inspired by developing new versions for new sectors, as well as overseeing all the other ways Triangle can be helpful and support people to use the Star well.
For more information on Triangle and the team behind the Outcomes Stars, please take a look at our About Triangle pages. For more information on the Outcomes Stars and the values that underpin each version, or explore the history of the Star at About the Star or please contact us with any questions: email Triangle at info@triangleconsulting.co.uk.
Triangle, the social enterprise behind the Outcomes Stars, has grown rapidly in the last few years, as more and more frontline services aim to support and measure change by implementing the Outcomes Star.
To help lead Triangle into our next exciting chapter, we have appointed Graham Randles in the new role of Managing Director.
Graham joins us from the New Economics Foundation (NEF). As Managing Director of NEF Consulting, Graham worked with organisations to prove and improve their impact by understanding and measuring outcomes, leading a team delivering consultancy, training and capacity building.
Graham brings to Triangle his significant experience in the fields of health and wellbeing, social care and environmental sustainability, such as his role in developing the first total contribution report for the Crown Estate and creating the 40-year impact report for the Prince’s Trust. Throughout Graham’s varied career in the UK and internationally, he has focused on challenging the status-quo to unlock ideas and new ways of working.
Recently Graham has worked on projects to assess the implementation of the Public Services (Social Value) Act across the health and care sector for NHS England and to measure the value for money of FareShare, the UK’s largest charity fighting hunger and food waste.
Graham will work alongside Joy MacKeith and Sara Burns, co-founder Directors of Triangle and creators at the Outcomes Star, to lead our social enterprise – supporting our teams to support our licensed Star users, and building the presence of Triangle in the wider world. Graham is an accomplished international public speaker with a focus on measuring impact, having recently spoken at the World Health Forum in Gastein and delivered workshops for Public Health Wales and the UK’s Care Quality Commission.
Graham has a BSc in business Administration and an MSc in Responsibility and Business Practice, both from the University of Bath, and he is also a trustee for the sight loss charity Sutton Vision.
If you have any questions about our new role, any queries about Triangle or the Outcomes Star or would just like to say hello, please contact us on info@triangleconsulting.co.uk or +44(0)207 272 8765.
In this blog Joy MacKeith, one of Triangle’s founding Directors, explores the interplay of internal and external factors, particularly in the context of austerity in the UK, and sets out Triangle’s approach to the Outcomes Star.
The context of austerity In the 12 years since the first version of the Outcomes Star was published, the political climate in the UK has changed dramatically; funding for services to support vulnerable people has been cut and both employment and housing are increasingly insecure.
The Outcomes Star is a suite of tools which are designed to help service users and service providers work in a constructive partnership toward achieving greater well-being and self-determination. They are designed to be used in the context of an adequately funded service delivered by well trained staff. They are also rooted in the assumption that decent housing and employment are available.
Increasingly in the UK these foundations are not in place and that has understandably led to anger on the part of some service users and service providers. Whilst we believe that the Outcome Star tools continue to have an important role to play in helping people to deal with the challenges they face we also recognise that personal change on its own is not enough and that addressing structural issues of poverty, poor housing, insecure employment and rising inequality are essential to creating a society in which everyone can thrive and contribute.
The agency of the individual In a climate of cuts and reduced services, some may be sceptical about the benefit of services and tools that focus on the agency of the individual. At worse it could feel like people are being asked to ‘pull themselves up by the bootstraps’ or even blamed for their difficulties without adequate recognition of the very real challenges that they face and the sense of despair that can build when the odds are stacked against you (Johnson and Pleace (2016), Friedli and Stearn(20 15)). So how do skills, habits and attitudes – the main focus of the Star, interact with opportunity and life situation? I think the Cycle of Action model presented by NESTA and OSCA in their report ‘Good help: bad help” helps to answer that question.
Their model draws on the ‘COM-B model’ developed by Susan Michie, Director of the Centre for Behaviour Change, University College London. It shows these internal characteristics in a dynamic interaction with a person’s life circumstances so that not only do difficult circumstances decrease confidence, purpose and ability to act, but also these internal states can also impact on outer circumstances.
The implication is that those disadvantaged by difficult life circumstances such as physical or mental health issues, poverty, discrimination or homelessness are likely to also experience less confidence and ability to act and that ‘good help’ which builds these aspects is likely to positively impact on life circumstances. The report is at pains to stress that practical help is also necessary because the external barriers are very real. But the right kind of help, that which builds confidence, sense of purpose and ability to take action, can create a positive, reinforcing virtuous cycle of change. Whilst bad help does the reverse.
The Outcomes Stars have always focused on the agency of the service user. For many of the original Stars, including those for use in the homelessness, mental health and family sectors, the model of change revolves around a shift from an external locus of control (“things happen to me and there’s nothing I can do”) to an internal locus of control (“I want things to be different and there are things I can do to make that happen”).
However, as time has gone on, two things have happened. The first is that we have developed versions of the Star for service user groups who have less control over their circumstances, such as children or those with profound learning disabilities. The second is that the service delivery climate has become more challenging and therefore the external barriers faced by many service users have increased.
For these reasons we increasingly recognise the importance of acknowledging and recording the external barriers as well as supporting the motivation and capability of the service user to overcome barriers. We do this in a number of ways including our guidance for workers on how to use the Star and in the introductions to the User Guides which are used directly with service users . The version of the Star that recognises the importance of external factors the most comprehensively within the tool scales themselves is My Star – the Outcomes Star for children in which some of the scales measure the child’s progress towards resilience and some of the scales measure the extent to which those caring for the child are providing them with what they need to thrive.
Although our intention is to keep the focus of the Stars on supporting agency and ability to act, new editions of existing Stars and new versions are developed with a heightened awareness of the importance of acknowledging the external barriers.
As the NESTA report (page 20) states:
“‘Good help’ is not a substitute for addressing in-work poverty, structural inequalities or discrimination, but it has an important role to play in supporting people to manage the elements that are within their control.”
Our aim in that the Outcomes Star suite of tools enable good help, support people to manage the elements of life that are in their control and help service providers to point to the barriers that are getting in the way so that commissioners and policy makers can play their part in making change possible.
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Sources
Friedli, L. and Stearn, R (2015) “Positive affect as coercive strategy: conditionality, activation and the role of psychology in UK government workfare programmes’ Critical Medical Humanities. This article does not mention the Outcomes Star but the authors are linked to Recovery in the Bin who have published the ‘Unrecovery Star’ ((https://recoveryinthebin.org/unrecovery-star-2/)
Johnson, G. and Pleace, N. (2016) “How Do We Measure Success in Homelessness Services?: Critically Assessing the Rise of the Homelessness Outcomes Star” European Journal of Homelessness. The focus of this article is a critique of the Homelessness Outcomes Star
Wilson, R. and Cornwell, C. and Flanagan E. and Nielsen, N. and Khan, H. (2018) “Good and bad help: how confidence and purpose transform lives” NESTA and OSCA
The report harvests the best of current practice in behaviour change programmes alongside a description of the historical development of behaviour change, from Maslow’s hierarchy of needs and Bandura’s work on self-efficacy to motivational interviewing and Susan Michie’s contemporary COB-B model.
Looking at the seven characteristics of ‘Good Help’, we were struck by how nearly all of these are hardwired into the Stars and the Journey of Change that underpins them. To unpick this and to respond to the challenge in the report of putting ‘Good Help’ into practice, we’ve written a short piece demonstrating how the Outcomes Star can help frontline services to put these values into action. Read our response here:
Good help and the Outcomes Star
We very much welcome the Good Help report and project, and believe that the powerful concept of ‘good help’ could help to focus a cross-sectoral movement for change which recognises that the most important ingredient in the change recipe is the goals, capabilities and motivation of service user themselves. We would like to add our voice to the Good Help movement and hope that the Outcomes Stars can be part of the toolkit that enables organisations to make that vision a reality.
To join the mailing list for the latest news about the Good Help project from OSCA and NESTA, sign up here.
The Star made a massive difference to me because it showed me that there were things I could do to become the person I wanted to be: a more rounded person with a more rounded Star. The Outcomes Star showed me that there were goals I could achieve. When you’re ill, the thought that you can be well seems very daunting but the Star breaks it down into baby steps and you start to feel yes, I can do this. That really built my confidence and gave me hope.” Young person
