mental health | Triangle

Why relational services matter

Posted on 21st June 202319th June 2023 by Donna

How do you deliver public services that are relational – services that recognise and respond to the unique needs and circumstances of each individual? That was the topic of the conference ‘Towards Relational Public Services’ that I have just had the pleasure to participate in.

Sam Game and I gave a workshop which explored how the Outcomes Star helps to make ‘Enabling Help’ a reality in practice. Working in a relational way is one of the six core principles of Enabling Help, Triangle’s blueprint for effective services.

Sam, who leads the implementation of the Parent and Baby Star in Health Visiting services in Warwickshire, described how using the Star has helped them work in a more relational, collaborative and strengths-based way. Parents have responded incredibly well. They are much clearer about the health visitor’s role and they love the way that Star helps them see what is going well as well as where they have needs. And it isn’t just the parents. It has also helped commissioners to understand and value the service.

Our workshop was one of more than 40 sessions which took place over two days at Newcastle Business School – part of Northumbria University.

For me the highlight was Mark Smith’s presentation on service transformation work in Gateshead. He described how they have implemented an approach to working with people with complex needs in which there are only two rules: ‘do no harm’ and ‘stay legal’. In this ‘liberated method’ case workers have a low caseload and there are no limits on how long they can work with someone or what kind of support can be provided. And case workers have budgets and the discretion to spend money to help solve pressing problems.

What I loved about this approach was that the bureaucracy was stripped out, giving workers the chance to do simple things that could make a big difference and avert much greater problems down the line.

Mark is part of a growing movement of managers, practitioners and academics who are challenging the orthodoxies of New Public Management (sometimes described as the 3 Ms – Markets, Metrics and Management). They are making the case that outcomes emerge from many interacting factors and therefore cannot be ‘delivered’ or dictated. In this complex environment, learning rather than prescription and control is the most effective management strategy. And it makes more sense for commissioners to take a relational approach and to hold service providers accountable for learning rather than targets. This new approach is called Human Learning Systems.

Toby Lowe, Visiting Professor of Public Management and the Centre for Public Impact closed the conference with a call to action – for all of us who want to see services that are more relational, responsive and effective to come together and work with a coalition of the willing to create a paradigm shift in public management. It is an exciting vision, and one that I think the Outcomes Star, a tool with flexible, relational working at its core, can play a role in realising.

Joy MacKeith, Co-creator of Outcomes Star

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Watch Joy’s conversation with Toby Lowe about the synergies between Enabling Help and Human Learning Systems

Find out more about Enabling Help here

Find out more about Human Learning Systems here

CAMHS National Summit 2022: The power of listening

Posted on 28th October 202231st October 2022 by Donna

Speakers noted the UK is in the grip of a mental health crisis, with children and young people suffering in particular. Referrals to NHS Children and Adolescent Mental Health Services (CAMHS) have increased by 180% during the last five years, creating significant pressure on services and raising the threshold for support and treatment. The Adverse Childhood Experiences (ACES) model is routinely used to tot up all the trauma children have experienced, creating feelings of bleakness for support workers. Still, the CAMHS summit were determined we have hope and talked a lot about harnessing the power of listening to help support.

Speakers acknowledged it’s grim out there for young people who are suffering. As Dr Harriet Stewart said, “young people’s mental health was worsening at an alarming rate before the pandemic. In the aftermath of Covid, children present at CAMHS with more complex needs. Staff are exhausted, burnt out, and leaving the service”. When Dr Stewart said, quite bluntly, “if we don’t get it right, we’ll ruin their lives, their opportunities,” it was hard not to feel like we are, as a society, failing our young people. But as she said, “we need to think we can do this.”

I also heard from young people like Katie Hickson, who spoke up about her experiences. She is a young woman who gets involved in conversations with the government and campaigns, making me feel hugely hopeful. Katie so eloquently reminded us, “young people already have a voice; they don’t need to be given it. It’s the job of the professionals, the service providers, and parents to listen to their voice and provide opportunities for them to be heard”.

I also loved hearing Max Davie (who very impressively managed to squeeze in a reference to CBeebies’ Octonauts while debunking some of the myths around early help) talk about listening to the difficulties young people were experiencing as we’ve become a bit fixated on labels, but Max demonstrated the importance of listening first and diagnosing later.

Nicola Harvey, the author of Mindful Little Yogis, shows us how active listening can help young people feel psychologically safe and that without providing that psychological safety, we can’t expect young people to grow up resilient. Reiterating without listening first, we can’t expect better outcomes.

There was a lot of agreement around the need to fund early support hubs, that young people can access without needing a referral.

How can the Outcomes Star help your service?

The Outcomes Stars are listening and conversational tools helping services transform lives. They are keywork tools and measurement tools. If your organisation provides early intervention mental health support for young people, My Mind Star has seven key outcome areas designed to open up conversations between support workers and the young person about their life. My Mind Star doesn’t assess how severe a mental ‘problem’ is. It explores where the young person is now and where they would like to get to in the future. It is a holistic co-production tool involving listening and discussing a young person’s life, situation, priorities, hopes and aspirations. Together the worker and young person co-create goals and action plans. Using the scales to measure the distance a young person travels through the journey of change over a period of time. Star data also helps managers assess workers caseloads to help reduce burnout. Star data also provides service improvement insight to analyse if the support provided is working, individual progression data and aggregated service level data to report impact to funders.

What I personally like about the Outcomes Star approach is that it starts with listening and, when used well, puts young people at the centre of their journey. Rather than defining a young person by statistics, by how many ACEs they’ve experienced, or whether they are ‘unwell enough to warrant service or support, the Outcomes Star is a collaborative tool that supports and measures change.

Learn more about My Mind Star

Mental Health Awareness Day 10th Oct 2021

Posted on 10th October 20217th October 2021 by Donna

I view the Outcomes Stars as a compass, that guides the people we support in a holistic way and empowers them to gain awareness of which important areas of their lives they can improve upon. Which is ultimately is why we are here.

What is your role?
I am trainer/ facilitator working for a charitable organisation called Alternative Futures Group. Our organisation provides support to people who have a range of conditions, learning disabilities, mental health issues, dementia, epilepsy and physical disabilities.

Which Star do you deliver training in?
We use the Recovery Star in our treatment recovery centres and community houses to support people with Mental Health conditions. As well as Outcomes Stars training, I also facilitate a wide range of other training, such as understanding learning disabilities, first aid, organisational inductions.

What do you most like about being a Licensed Trainer
What I appreciate most about being a Licensed Trainer is that we are helping to train and support our staff to use a tool (Outcomes Star^TM), based upon a proactive and proven approach which fits well with our charity’s ethos.

How does the Star benefit your work and support your service users?
Our charity believes that understanding people’s unique needs and exploring how best to support them should be rooted in fact and evidence as this is what ultimately leads to better outcomes. The Outcomes Stars are rooted in these beliefs as well, making them a great fit for our charity.

I view the Outcomes Stars as a compass, that guides the people we support in a holistic way and empowers them to gain awareness of which important areas of their lives they can improve upon. Which is ultimately is why we are here.

The Star is a great tool as it guides our staff to ask the right questions to be able to have meaningful conversations with people about their lives as a whole. This uncovers the areas people need most help with, in a flexible, consistent and trauma-informed way. The Star data collected also helps to inform and improve our service delivery support. As well as evidencing the range of support we have provided for people.

How does it feel to be a licensed trainer?
I find the Recovery Star can truly reflect what an individual’s support needs are, if completed properly, the difference it can make to people’s lives is what inspires me. It’s also very interesting being a Licensed Trainer. The people I train in how to use the Star, often have fantastic insight into the wide range of life experiences people have which is fascinating.

I deliver ‘Introducing the Star’ training, two mornings a week (3.5 hours) remotely and this is working very well for our organisation. My recently completed certificate of online facilitation accreditation (COLF) has also helped improve my online delivery and raise the standard of all remote training at AFG.

Any trainer tips to share?
I would highly recommend recording yourself if you can get permission when doing a session. You will see many things you may not be aware of, such as your pace, tone of voice and clarity. All of which can be improved upon, doing this has worked for me.

The Star benefits our work... being able to clearly demonstrate progress and change for our patients, as well as create action plans that are meaningful is greatly valued.

What do you do/role?
I am a Learning Partner for Alternative Futures Group. We are a social care charity with around 2000 employees covering the whole of the Northwest of England. Training in the olden days (how we now refer to pre -March 2020) meant a lot of travelling around, but today I will be at my desk in my home office, delivering virtual training.

Which Star do you deliver training in?
Our charity mainly provides support for people with learning disabilities and people with mental illnesses. We use the Recovery Star to support people’s recovery journey deliver our mental health services in 6 independent hospitals.

What do you most like about being an LT?
I have only recently completed the accreditation to become a Licensed Trainer and it was really enjoyable. I am very lucky as I work as part of a very supportive team. I am looking forward to co-delivering with my colleague Anthony, so that I can try out my new knowledge, with support.

How does the Star benefit your work and support your service users?
Being able to clearly demonstrate progress and change for our patients, as well as create action plans that are meaningful is greatly valued. We’ve had lots of positive feedback from both the staff and the people we support since we launched the Recovery Star in our hospitals.

Any top training tips?
We have recently undergone a Certificate of Online Facilitation, which has really opened our eyes to the differences between face to face and online delivery. A tip about online delivery is that learners need to be encouraged to contribute every three to five minutes, as what worked in a classroom, will not necessarily work online. It helps keep the learner engaged which has always been the key to effective training.

Together we are pushing for a cultural change towards openness and honesty surrounding mental health and that can only be a boost for everyone. Thanks for reading.

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The Recovery Star is the Outcomes Star for mental health and well-being. Other Stars developed specifically for use with organisations working in the mental health sector include: My Mind Star (for use with young people) as well as the Recovery Star Secure, Preparation Star and the Parent and Baby Star. Stars developed with other sectors also include an area focussing on mental health.

For more information on how to become a Licensed Trainer and/or the other training needed for using the Outcomes Star, or for any information about how the Stars could support your organisation please contact Triangle.

Launching the Gambling Recovery Star in Australia

Posted on 28th June 202117th June 2021 by Donna

The event included brief addresses by Relationships Australia Queensland, CEO Ian Law and the Hon. Shannon Fentiman (Attorney-General) and an informal morning tea where the Gambling Recovery Star resources (printed and laminated) were showcased and discussed in small groups. The launch included a small number of participants invited to the gather, due to COVID19 restrictions and other colleagues from UCC and Centacare accessed the opening addresses via videoconference.

At the launch, Dr Ian Law emphasised the “spirit of collaboration at the heart of the project” with involvement from the Queensland Government Department of Justice and Attorney General, the Outcomes Star in the UK, Unique Outcomes in Australia, Lifeline Darling Downs and South East Queensland, UnitingCare, Centacare and RAQ.

Dr Law further explained that, with 5 million Australians effected by problem gambling each year, there is a keen interest in improving clinical practice and collecting data about what works. He also acknowledged the importance of the Outcomes Star in fostering a dynamic approach to assessment and planning, centred on client’s voices and priorities. He said the Gambling Recovery Star is now routinely used with almost all clients in Queensland’s Gambling Help Services, “Empowering clients to be agents of change”.

The Executive Director of the Office of Regulatory Policy, David McKarzel, shared that contributing to the development of the Gambling Recovery Star had been a welcome opportunity for policy staff to work with these services in a different way- toward the creation of a clear and consistent methodology for service provision.

Marty O’Hare, Counsellor/Community Educator for RAQ said the real advantage of using the Gambling Recovery Star is that “you’re able to dial into conversation with clients about various aspects of their lives… and the Gambling Recovery Star helps us broaden the conversation, so they see gambling in context, see connections to issues relating to their emotional wellbeing… Many people have compartmentalised gambling and not realised it’s effects in other areas of their life and relationships.”

Although several Australian organisations have been involved and collaborated with new Star development over the years, this was pAul’s first experience of being involved from the start. pAul recently shared his thoughts and experiences on the Star in a blogpost. To find out more and read his full blogpost please visit Unique Outcomes website.

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The Gambling Recovery Star is an Outcomes Star that has been devised purposely for organisations that work with individuals to help them recover from harmful gambling and its effects. For more information on the Gambling Recovery Star or any of the other Stars for use in similar sectors (including addiction or substance misuse) please contact Triangle, or if you are based in Australia or New Zealand you can reach out to Unique Outcomes.

Tyrone’s story: How the Star helped me change my life

Posted on 1st September 202020th August 2020 by Donna

Just before lockdown, Tyrone Stanley attended Outcomes Star training to help him in his work to reach violent criminals and gang members. For Tyrone this was coming full circle – because he knows from personal experience just how powerful the Star can be.

“I’m a project worker for Catch22’s Violence Reduction Service in Wolverhampton. I deal with the resettlement of 18-30-year-olds, predominantly violent criminals and gang members.

But my early life was very different. There was always violence in the home when I was younger, and I started to develop anger issues when I was about 12 or 13. I got sent to prison for the first time in 2011 when I was 16 and got remanded, but didn’t really learn my lesson. I got arrested again and sentenced to two years.

That time I was more productive with my time in prison – I did every single course available to me.

Not a tick box exercise

At the start of a course from the Prince’s Trust, the tutor pulled out the Outcomes Star. She said it was something that was for me, and that was the first thing that made me think ‘oh, OK’. Obviously I was used to doing tick box exercises for different organisations, but the way she approached me for the Outcomes Star was the key element in why it was so beneficial for me.

I was really honest with my answers. I was excited about what the next Outcomes Star would reveal about my progress – it became something to be excited about rather than to be self-critical about. I put an honest reflection of me on paper, and I looked at it and looked at it. Then when I did my next Star I was logging things I was doing, feeling happy about all the good change I’d made.

I got onto an enhanced wing, I even got released on temporary licence. I got out of the bubble I was in – mainly because the Outcomes Star made me see my faults on paper. It gave me a perspective on my actual life – from the outside looking in rather than the false mirage that I’d created.

The key thing in the Outcomes Star that made me think hard was when I realised I didn’t have any long-term friends apart from one or two – they were all connected through badness. I thought about it – like, who are all my friends? Who enjoys my company? I wrote it down on paper and I thought, you know what, I’m not really any good at relationships. Certain things really resonated with me; they made me think I wasn’t the person that I wanted to be when I was a young boy.

It broke me down, man. Peeled off all the layers. Got to the root cause and started again from scratch.

Changing my life

Everything changed – my lifestyle, my circle of friends, the way I spoke. From then on I’ve never stopped working. After various jobs I started with Catch22. My job was to go out and talk to young people about the effects of knife crime and gang culture – and it really helped that I knew exactly what they were going through. Within 18 months I was promoted to my resettlement role.

Honestly, one of the key things in changing the way I thought about myself was being valued – not having people look at me like I was a dreg. I just couldn’t look people in the eye, and I knew no one wanted to look me in the eye. But when I started to do good things, all the blessings started to coming through, non-stop man, non-stop.

And I want to project that to young people. It just goes to show that anyone can change as long as you’ve got the right intervention at the right time.”

Tyrone: How I introduce the Star with service users

“OK, so this is an Outcomes Star. Now I know it may seem like a way of recording data for our benefit but I can assure you that this is one of the best proven ways to track your progression. It can also be a great tool to learn things about yourself that you may not have thought about much at all. I have first-hand experience completing an Outcomes Star myself and it was the best start to my journey. By the end I was shocked and amazed at the progression. So be honest, and you will see changes by the end. This is the best way to help me to help you.”

Read Tyrone’s full story here and explore the Stars available for the sector you work in.

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My Star is the Outcomes Star for children, especially children in families that are identified as vulnerable/trouble and receiving services, or looked after by foster carers or in a children’s home. The Young Persons Star is for young people moving to independent living and the Youth Star is for youth work, while the Justice Star is the Outcomes Star for people in the criminal justice sector. If you have any questions on which Star to use for your sector, or if you would like any information on the new Star Online, or anything else, please contact us on info@triangleconsulting.co.uk or +44 (0) 207 272 8765.

Triangle measures what matters at GO Lab’s Social Outcomes conference

Posted on 25th August 202025th August 2020 by Donna

Triangle’s Co-founder and Director contributes to GO Lab’s Social Outcomes conference programme to share learning from using the Well-being Star in a large social prescribing programme and how vital it is that measurement approaches are designed with relationship building and behaviour change in mind.

Hosted by The Government Outcomes (GO) Lab, the Social Outcomes conference brings together researchers, policymakers and practitioners working to improve social outcomes. Joy MacKeith, Triangle’s Co-founder and Director features at this year’s virtual event; she will share learning from 20 years of measuring individual outcomes to contribute to a debate about how commissioning approaches and Social Impact Bonds in particular can help or hinder the achievement of social outcomes.

Joy Said:

“When people design a Social Impact Bond or any other commissioning approach, they need to be mindful of how it will impact at the front line because that is where the real change happens. Research tells us that the quality of the engagement between workers and service users is absolutely critical to behaviour change but sometimes payment mechanisms can unintentionally impact in a negative way."

"The Outcomes Star has been designed to provide service-wide outcomes data whilst at the same time supporting that collaboration and helping people take the small steps that together add up to achieving their goals.“

Joy is joined by Tara Case, Chief Executive of Ways to Wellness – a large-scale social prescribing service and the first health service in the UK (and globally) with social impact funding. Ways to Wellness, with Bridges Fund Management as investors and Newcastle Gateshead CCG as commissioners, has been using the Well-being Star since 2015 as part of the support their service provides and to capture client-reported wellbeing improvements; the Star was specified in the outcomes-based funding contract for the programme.

Tara said:

“We have found that the Well-being Star helps to open up conversations that might have been hard to broach without it. It helps our Link Workers take a holistic approach and make links between different aspects of someone’s situation. It helps services to tailor what they do to support the person whilst also providing a standardised framework for reporting results.”

The Well-being Star was created for people living with a long-term health condition, to measure their progress in living as well as they can, and support self-management, rehabilitation and person-centred approaches. Triangle recently conducted further validation work on the Well-being Star within the Ways to Wellness service and shared their findings.

GO Lab’s Social Outcomes Conference runs 1^st-4^th September. Triangle is contributing to “Back to the Future? Learning from the UK”s experience with impact bonds: what should we take with us and what should we leave behind?” which takes place 15.30–17:00 (UK BST) on Tuesday, 1^st September. You can register to attend free of charge via Eventbrite.

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Triangle is the social enterprise behind the Outcomes Star™. Triangle exists to help service providers transform lives by creating engaging tools and promoting enabling approaches. Through the Outcomes Star, they work with services to promote and measure individual change and to enable learning at an individual, service, organisation and sector-wide levels. The Outcomes Star™ is an evidence-based management tool for both supporting and measuring change. For more information email info@triangleconsulting.co.uk.

Ways to Wellness is a service for people in the west of Newcastle whose daily lives are affected by certain long-term health conditions. GPs and their primary care teams use social prescribing to refer patients to the service. Ways to Wellness adds to and complements the medical support that people receive, to help them feel more confident to manage their long-term conditions and make positive lifestyle choices. For more information email info@waystowellness.org.uk.

The Well-being Star and The Family Star Plus are available to all organisations with a Star licence, and full training can be given for workers and managers. For more information on the Outcomes Star, please contact us on info@triangleconsulting.co.uk or +44 (0) 207 272 8765.

Recent updates on the Well-being Star™ for adults self-managing health conditions

Posted on 24th August 202024th August 2020 by Donna

The Well-being Star is a holistic, person-centred, outcomes focused and strengths-based tool. It encourages people with long-term health conditions to consider a range of factors that have an impact on their quality of life.

The completed well-being Star — Figure 1

It was developed with DoH funding in collaboration with North East Essex PCT and can be used in a variety of settings from hospices to rehabilitation centres and social prescribing services. The Star supports and measures progress in eight areas identified by patients, health professionals and researchers as central to maximising well-being and independence when living with a long-term health condition (See Figure 1).

Service users may begin at the bottom of the Journey of Change (‘Not thinking about it’) and the aim is to progress to things the situation being ‘as good as it can be’.

We have recently conducted further validation work on the Well-being Star within Ways to Wellness, a social prescribing service using the Well-being Star. Ways to Wellness is an innovative service for people whose daily lives are affected by certain long-term health conditions such as diabetes, epilepsy or heart disease.

Our psychometric validation presents evidence that the eight outcome areas form a coherent measure, with no repetition and good sensitivity to detecting change. Since publishing the first version of this factsheet we have expanded the sample of link workers who have taken part in our peer-reviewed case study method for assessing how reliably workers apply the scales. The findings using the larger sample confirmed initial positive results showing good understanding of how to use the Well-being Star’s scale descriptions.

Chief Executive of Ways to Wellness, Tara Case is talking alongside our Strategic Director, Joy MacKeith, about the Well-being Star in the context of social prescribing and payment by results at the upcoming Government Outcomes Lab International Social Outcomes Conference.

Their session “Measuring what matters: an innovative outcomes tool capturing what is most important to beneficiaries” contributes towards the broader topic “Back to the Future? Learning from the UK’s experience with impact bonds: what should we take with us and what should we leave behind?” and takes place 15.30–17:00 (UK BST) on Tuesday, 1^st September. Register to attend free of charge via Eventbrite.

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Triangle is the social enterprise behind the Outcomes Star. Triangle exists to help people reach their highest potential. Through the Outcomes Star, they work with services to promote and measure individual change and to enable learning at an individual, service, organisation and sector-wide levels. The Outcomes Star is an evidence-based management tool for both supporting and measuring change. For more information email info@triangleconsulting.co.uk.

The Well-being Star is available to all organisations with a Star licence, and full training can be given for workers and managers. For more information on the Outcomes Star, please contact us on info@triangleconsulting.co.uk or +44 (0) 207 272 8765.

The importance of relationships with youth in mind

Posted on 26th February 202018th March 2020 by Donna

Tom Currie, Outcomes Star’s Implementation Lead, shares his thoughts after attending Oxfordshire Youth’s Youth in Mind conference.

It was a real pleasure to spend a day at Youth in Mind, the annual conference about young people and their mental health. The event was beautifully hosted by Oxfordshire Youth and Oxfordshire Mind with 400 delegates and a wide range of presenters from a diverse mix of organisations speaking on several subjects. But one thing that kept coming up in the talks, demonstrations and workshops was the importance of relationships in supporting young people to maintain optimal mental health.

Relationships: a key component

Whether it was Rowen Smith and Mary Taylor from Family Links talking about resilience and managing difficult emotions, or Julia Belton from Clear Sky describing how she uses play to engage children who had Adverse Childhood Experiences (ACE), relationships kept being identified as a vital ingredient.

The value of relationships was also highlighted in the Step Out workshops, hosted by two Donnington Doorstep Junior Ambassadors, young people who deliver sessions on Protective Behaviours to year 5 students. These peer led sessions offer yet another example of how you can use the power of relationships to gain credibility and influence with the people you work with. (They were preaching to the converted with me on this one, as I have been a strong advocate for the power of relationships for a few decades.)

What are the vital ingredients of a supportive relationship?

This question came up in my conversation with Julie Belton in the exhibition hall just after her presentation on how to engage children with ACEs. We agreed that many practitioners would probably say that good relationships are at the core of their work but that they may well mean different sorts of relationships. And that makes assuring the quality of those relationships tricky. Luckily some clever people at Search Institute in Minneapolis have done some great work researching and articulating these qualities in their Developmental Relationships Framework, which is free to download.

The Developmental Relationships Framework identifies five elements:

Express Care – Show me that I matter to you
Challenge Growth – Push me to keep getting better
Provide Support – Help me complete tasks and achieve goals
Share Power – Treat me with respect and give me a say
Expand Possibilities – Connect me with people and places that broaden my world

Each of these elements is then linked to three to five well defined actions, so it really is a practical, useable framework. I believe the Search Institute are spot on with the balance of the elements they have articulated. If you want to put their theory into your practice, then you could download the framework and start to strengthen these elements in your work.

If you are interested in using a tool that helps provide a structure for four of the elements they identify, and also provides useful evaluation information, then get in touch and we could talk about whether one of the Outcomes Stars for young people would suit your way of working. It would be a pleasure to talk to you about what you are trying to achieve, because all supportive relationships include good conversations.

Speaking of good conversations, I had a great one with Bethia McNeil (CEO of the Centre for Youth Impact), when I saw her a few months ago and she told me about the Supportive Relationships Framework. She knows a thing or two about frameworks having written the seminal Framework of Outcomes for Young People in 2012 as well as its brilliant 2019 sequel, predictively titled: A Framework of Outcomes for Young People 2.0.

If you’d like to talk to Tom following his attendance at the event, please call +44 (0) 20 7272 8765 or email info@triangleconsulting.co.uk.

Category: mental health