Tag: mental health

Ways to Wellness: The Well-being Star within social prescribing

Posted on by Outcomes Star

Ways to Wellness recently published a report we contributed to, celebrating six years of their innovative and internationally recognised social prescribing service. 

The service supports people aged 40-74 years old with specific long-term conditions, many of whom have complex medical, practical and social needs. GPs refer patients to receive support from link workers for 18 months and the Well-being Star is used to assess clients at baseline and then approximately every six months. So far, over 4,500 patients have completed two or more Well-being Star readings. 

Triangle are always keen to encourage learning from Star data and we were encouraged that Ways to Wellness recognise the value of ‘analysing impact data and using findings to inform adjustments to the service’. We supported Ways to Wellness to go beyond the outcomes measurement required by the funders, to explore in more depth the needs and progress of their clients. The Star data reports shown in their report are based on those provided by our recently upgraded web application, ‘The Star Online’.  They showed that 86% of clients moved forward in at least one outcome area, with the highest proportion progressing in ‘Your lifestyle’ – an area most frequently identified as needing work by clients.  

Ways to Wellness are a good example of an organisation that shows a commitment to getting the most out of the Well-being Star.  We have also worked with them to explore how consistent and accurate their link workers were in applying the Well-being Star scales, finding good ‘inter-rater reliability’.  

Click here for more information about the Well-being Star including a case study of the use of this version of the Star in health settings and psychometric validation. 

If you would like more information or support about the use of the Well-being Star, please get in touch with us at info@triangleconsulting.co.uk or +44 (0) 207 272 8765.

The importance of listening

Posted on by Donna
Headshot of Tom Currie against a white wall
Ahead of Samaritans Awareness Day this Saturday, 24th July, Trainer and Implementation Lead Tom Currie reflects on the power of listening and why it is so important in relationships that are committed to supporting change.

Hopefully we all know how important listening is. Really listening. Listening fully to what is being said and what is not. In relationships that are committed to supporting change listening is essential, literally, the essence of the purpose of the relationship is to listen. Yes, the listener may need to speak at some point but, when they do, what they say will be a lot more valuable if it is informed by good listening first. What they say is also much more likely to be heard when spoken to someone who has first experienced being fully heard.

In the almost 200 courses that I have led in using the Outcomes Star, listening is always talked about. Usually brought up by practitioners when talking about effective work with clients. They know how important it is to their work.

The Outcomes Star is a relational tool that supports change in keywork relationships. It helps practitioners and their clients to have better conversations. It does this by helping create a better quality of listening. There are three ways that it does this: by creating permission, by providing frameworks and by opening a space for sharing.

Creating Permission

Each Outcomes Star has between 6 and 10 points. Each point describes an Outcome Area, an aspect of life that contributes to the client fulfilling their potential. This holistic model provides a framework for the conversation between keyworker and client that helps create permission to discuss a range of aspects of life that the client may otherwise not have brought into the conversation. It also helps the keyworker build a fuller, more rounded picture of the client and their life, to go beyond the presenting issue and work to support the whole person.

A practitioner working with a Probation Trust to support prisoners through the gates and help them find accommodation told me that the wide-ranging conversations she had with her clients when discussing Outcome Areas like ‘positive use of time’ and ‘mental health and well-being’ helped her build a fuller understanding of them and their interests. This not only meant that she gained an understanding of what would be right for them but helped her, when finding them a new place to live, to present a better account of them to prospective landlords.

Providing Frameworks

All Outcomes Stars are underpinned by the Journey of Change. The Journey of Change is a model that outlines the stages people go through when making sustainable change in their lives. The attitudes and behaviour at each of the points on each scale are clearly defined. There are five different types of Journey of Change. Being able to create a shared language for where someone is and where they have not yet got to on their journey through life is a useful step in helping them get there.

I was delivering training to two women who set up a charity supporting parents of children who developed a neuro-degenerative disease that is sadly commonly fatal before the child reaches adult hood. They use the Support Stars – for use with parents, children and young people facing serious illness – which we developed in partnership with CLIC Sargent.

When supporting parents through these difficult times, they said the Journey of Change was key to helping parents make sense of what they were going through. It helped them to acknowledge the overwhelming nature of the shock of the diagnosis, to take in their new reality and begin to engage with how they might navigate the challenges they faced. As human beings we need to make sense of the experiences we face and be able to own and author the narratives of our lives – listening plays a key role in enabling us to do that.

A space for Sharing

The Journey of Change is a universal model that resonates with all the people I have shared it with and provides new insights about our own part in the challenges we face. This creates the opportunity for keyworker and client to meet on a more human level and share more honestly about their own experience, moving beyond the usual paradigms of service provider and service user to a space that is more human, more healing and more hopeful.

In my own life, taking time to reflect on where I am in my own journey through the lens of the five stage Journey of Change often provides me with new insights on ways that I am stopping my own progress, whether by not asking for support or hanging on to outdated behaviours that no longer fit with who and where I am. It helps me to listen more deeply to my own truth.

So, for all these reasons, I celebrate the Samaritans Awareness Day as a chance to champion all those who support people to change by offering the generous, supportive, curious and subtle art of listening. Let’s all listen to each other (and ourselves).

*****

Tom is a member of Triangle’s Training Team and provides support to our clients across London and the South East, including 18 London Boroughs, a number of County Council services and a couple of national charities. He lives near Oxford and is a trustee for Spark Inside, an organisation delivering coaching programmes in prisons, where he leads on impact and evaluation.

The Support Stars were developed for use with children and young people who are facing serious illness. The Support Star (Parents) is designed to support their families.

“Tom is a fantastic trainer, very engaging and entertaining. We are on break at the moment but can honestly say it’s been flawless from start to finish”
Dewi Richards-Darch
Dewi Richards-DarchCurriculum Coordinator, Itec Training Solutions Ltd, Cardiff, July 2021

Women and the Homelessness Star

Posted on by Donna
Headshot of Dr Anna Good

Research Analyst, Dr Anna Good reflects on her recent attendance at Homeless Link’s conference on women and homelessness and shares how Triangle’s improvements to the Homelessness Star align with many of the event’s themes.

I had the privilege of attending the ‘Delivering for Women: Women’s Homelessness Conference’ organised by Homeless Link on the 29th June 2021. The timing could not have been better as Triangle is amid creating a new edition of the Homelessness Star, with a focus on applying our learning about how to be more gender- and trauma-informed.

The Homelessness Star was developed for and with both men and women, but much has changed in the 15 years since the first edition was published, including an upward trend in the number of women experiencing homelessness and the proportion of these women with multiple disadvantages. There are now services exclusively for women which use the Homelessness Star. A number of women’s centres provided data for our recent article, published in the Journal of Social Distress and Homelessness: ‘Psychometric validation of the Homelessness Star’.  

Tailored support

The need for more tailored support was emphasised throughout the conference, with ‘gender neutral services’ described as often meaning designed for men. Concern was expressed that only two local authorities offered segregated accommodation as part of the Government’s ‘Everybody in’ scheme during the pandemic. There were powerful arguments for the harm that can be caused by the failure to address this, including the strong role of domestic abuse in causing women’s homelessness and the risk of service users encountering their abusers. Explicit references to domestic abuse and being the victim of crime are some of the key changes in the draft new edition of the Homelessness Star. The centrality of children highlighted in the conference is also reflected in the new edition.

Compassion and curiosity

Another key theme that resonated with the changes in the draft new edition (and with the overarching principles of the Outcomes Star), was the need to be compassionate and curious when women do not engage with support. Women tend to arrive at services with more complex needs, and many will have been let down repeatedly and felt unable to trust anyone throughout their lives. The Outcomes Star specifically assesses readiness to accept help and acknowledges that the situation can feel ‘stuck’ when people have additional barriers to engaging with support. The new edition of the Homelessness Star further emphasises that when people don’t accept help it is often because previous experience has made them anxious or distrustful of services, or because the help offered is not suitable for them.

A speaker with lived experience of homelessness and sex work, spoke passionately about being asked to rate her mental health as a tick-box exercise but not being offered appropriate support. Here again, the Outcomes Star is important because it not only measures outcomes but is also an integral part of keywork to improve these outcomes. As put succinctly by Becky Rogers MBE, “a good assessment of need leads to a more successful intervention”.

Triangle’s commitment

As I listened to the presentations, I became increasingly aware of the value of the investment we are making to ensure that the Homelessness Star is up to date with the advancements that have been made around the need for services to actively ensure that they are gender- and trauma-informed. I also noticed how well the existing Homelessness Star addresses so many of the factors identified as important during the conference, including being strengths-based and holistic.

We are already well underway with the new edition of the Homelessness Star. We reviewed it through many conversations and meetings, as well as a round table, drew together the feedback we received and created a draft edition 4 and are now inviting feedback and comments from those using the Star. More information on the new edition to follow.

*****

The Homelessness Star is one of the first Outcomes Stars and was created in collaboration with St Mungo’s through the London Housing Foundation Impact through Outcomes Programme. For more information on the Star or the new edition, its implementation and how it could support services working to support homeless folks, please contact Triangle.

The Outcomes Star: helping make trauma informed philosophy practice

Posted on by Donna

Over the past decade, there has been increasing recognition of both:

  • the high prevalence of complex trauma, adverse childhood events and the different ways in which trauma presents and
  • how important it is to ensure that services are delivered in ways that do not risk people becoming re-traumatised, in relation to how workers engage with them and the topics discussed.

Given the potential of the COVID-19 context and measures to cause, exacerbate and reactivate trauma, it has been argued that –

  “never before has trauma-informed care been so important to promote the health and well-being of all and to protect our marginalised populations at greatest risk”
(Collin-Vézina, Brend & Beeman, 2020)

Trustworthiness, transparency; collaboration and empowerment are key principles of trauma-informed care, which can guide service delivery policies and practices (SAMSHA, 2014). However, there can be barriers to putting these into practice.  Tools that offer a clear framework for translation of the principles of trauma informed care into practice can benefit many organisations and help them overcome these barriers.

The Outcomes Star tools have many features that directly support trauma informed working, including:

Relationship-based – The collaborative process of practitioners and clients completing the Outcomes Star helps to build a trusting and positive relationship, giving service users greater control and voice and within which important connections in the person’s life are discussed.

Empowering – The Journey of Change is sensitive to small but important steps and progress. Visually showing change can be empowering and motivating for both practitioners and clients.

Focuses on the present not someone’s history – completing the Star is a conversation about someone’s life, how things are for them and what they are doing now, rather than bringing up past histories or traumatic experiences.

Strengths based not deficit-based; they use positive language focusing on the process of change and the support and actions needed, not on the severity of problems.

Holistic – the whole person and all relevant life circumstances are recognised. Plotting where someone is on the Star chart provides a clear representation of where support is needed and where things are going well, highlighting the interaction between different areas of someone’s life.

As well as the tools themselves, training and guidance around the Outcomes Star emphasises flexibility in responding to a client’s window of tolerance and preferences – for example, about when and how to introduce and discuss the different outcome areas. There is also guidance about identifying appropriate action plans in a trauma-informed way that is sensitive to the client’s capacity to drive things forward themselves.

Triangle is committed to continuous learning and improvement of the Outcomes Stars and how they are used. Staff have received training and advice from experts on trauma informed care and we are currently reviewing some of our older, widely used Stars using a trauma-informed lens.

*****

For more information, please see our guide on ;How to use the Outcomes Stars with trauma informed approaches’ or get in touch on info@triangleconsulting.co.uk or +44(0) 207 272 8765.

Moving to the Youth Star 2nd Edition

Posted on by Donna
Graphic: text reads, Youth Star (2nd Edition). A new and improved version of the Youth Star for working with young people taking part in community-based youth projects
Key questions and answers about the new Edition of the Youth Star, and how organisations can transition to the new version

The new Youth Star is a new and improved edition of an Outcomes Star designed to support services working with young people and in the youth work and community sectors. 

1 Why a new Edition?

Triangle is responsible for ensuring that the Outcomes Stars stay relevant and are as good as possible; we keep them under review, seeking and analysing feedback and developing new editions as needed. We published the Youth Star in 2012 and since then have developed many more Stars for different sectors, leading to new learning, including how to make the Stars and guidance even more trauma-informed, strengths based and person-centred.

The 1st Edition of the Youth Star was published without detailed scale descriptions, so a key aim of developing a new edition was to develop detailed scales to support training, consistency and clarity. Further, Triangle has gathered feedback about the Youth Star and also about how the youth sector has changed and evolved, resulting in helpful feedback. This also pointed to a need to review this Star to make it as good a fit as possible for youth work today.

2 What has changed?

We have created detailed scale descriptions for the six areas covered by the Youth Star. These are in a new User Guide, along with a graphic of the short scale descriptions. The User Guide is most relevant as an important new resource for workers, in training and initial familiarisation with the Youth Star and for reference to ensure accurate and consistent completion of the Star. However, it is written in accessible language and can be shared with young people who are interested and able to engage with more detail.

There is more detail in the Development Report but in summary the main changes are:

  • The first stage of the Journey of Change is renamed stuck, to recognise that things may feel or be stuck for a young person at that stage for many reasons, not necessarily because they are ‘not interested’, as the language in the 1st Edition implied. This also makes this wording consistent with other versions of the Outcomes Star
  • The first scale is now Interests and activities (replacing ‘Making a difference’). This area still emphasises helping others, group activities and teamwork but is widened to recognise activities and interests such as sports, arts, music that are positive for young people but can be individual not group activities and not aimed at making a difference to others.
  • Health and well-being replaces ‘Well-being’ as it now covers both a healthy lifestyle and emotional health, including managing physical or mental health conditions. It recognises that those who are younger may not have much control over their diet or other choices and that their family may not support living healthily.
  • Education and work now emphasises getting the most out of school/ work rather than focusing on achievement. It was also widened to include training, apprenticeships or internships and to recognise the role of the school, college or workplace in providing extra support where needed, so it is not just up to the young person. 

There are other minor tweaks to scales, with some aspects moving from one scale to another to increase clarity and accessibility and adding references to social media and staying safe online. In addition, we listened to feedback from young people and workers and changed some wording to be more sensitive, trauma-informed and responsive to the issues people faced and created flashcards and new guidance.

3 Should I move to the new edition?

We believe that the 2nd Edition of the Youth Star is better, and the additional resources will make it a more effective tool for supporting and measuring change with young people, so we recommend you do transition your service to the 2nd Edition. However, the 1st Edition will continue to be available for the foreseeable future, so you have a choice and time to decide.

The 2nd Edition of the Youth Star is available for those with a Star licence to access on the Star Online, so you can download and it and review the new resources for yourself to help make a decision.

4 What should I do to move the to the new, 2nd Edition?

If you already have Star licences, there is no extra cost to using the new edition and no requirement for additional training, though you may want to consider refresher training. Talk to Triangle about your current licencing and how to make the most of the transition to support good use of the Star.

Consider how you will introduce the new edition to practitioners, for example by finding ways to ensure that they familiarise themselves with the User Guide with detailed scales, changes in wording and other new resources, including the flashcards and updated guidance. This can be done through refresher training, supervision sessions, discussions in team meetings and by sharing and promoting the “introducing the new Youth Star 2nd Edition” poster for practitioners, available from the Star Online or Triangle.  

You also need decide when and how to introduce the 2nd Edition. The main options are:

  1. Introduce the 2nd Edition for new clients and keep using the 1st Edition for existing clients who have already completed at least one Star. The advantage of this approach is that clients only have to engage with one version and their change shown from one reading to the next is valid because it is gathered using the same version
  2. Decide on a date from which to introduce the 2nd Edition with all clients, both new and existing. This is more straightforward for the service because than using both versions and makes the move more swiftly to the new edition. However, change measured from one reading to another is not valid and may be misleading if different editions are used with the same person (see data section below). This has implications for both keywork/ action planning with that individual and for the validity of the service’s Star data overall.

5 What about my Star data?

Because some of the Youth Star scales have significant changes and others have minor changes, data gathered using the 1st Edition will not be directly comparable to data gathered using the 2nd Edition. The most marked example is that someone actively and positively pursuing individual interests such as arts or sports, may be at 1 in the first scale of the 1st Edition (Making a difference) but could be at 5 in the 2nd Edition (Interests and activities). The other differences are summarised above and set out in more detail in the development report.

There are three main options for how to approach data and reporting when making the transition to the second edition of the Youth Star, as set out below

We believe that different options will work for different services. The most appropriate approach for your service will depend on how long you have been using the Youth Star and the amount of data you have and the importance for you of being able to monitor trend over a number of years. Talk to Triangle if you would like advice. However, in general:

  1. We would normally recommend the first option as it’s the most straightforward. Although this is likely to lead to difficulty presenting the data in the year in which you make the change to the 2nd Edition, this disadvantage is short lived, and the issues can be explained to those using the data internally and to funders or commissioners.
  2. The second option is generally only recommended for services with a small data set, particularly those who have started using the Youth Star within the last year, and where it is important to maintain continuity of monitoring over the time of the transition to the 2nd
  3. We strongly advise against combining the datasets from the 1st and 2nd Editions as in option 3, as there are significant changes to the scales that make the transition somewhat like moving to a different version of the Star. However, if you would like to be able to create high level reports across the two editions, we have a briefing called ‘reporting on different versions of the Star’ that would help with this and you can contact Triangle for advice as needed.

6 Questions and next steps

If you have any queries about the Youth Star, new editions or what would work best for your service, please get in touch with your Implementation Lead at Triangle, email us on info@triangleconsulting.co.uk or ring us on 0207 272 8765

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

Posted on 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 Mackieth

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 1st-4th 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, 1st September. You can register to attend free of charge via Eventbrite.

***

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 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, 1st September. Register to attend free of charge via Eventbrite.

***

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.

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 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 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.

Young people and mental health: How to make the conversation count

Posted on by Donna

As Children’s Mental Health Awareness Week 2020 draws to a close, Joy MacKeith, co-author of My Mind Star, reflects on what the development process taught her about how schools and services can support real change for young people.

This week is Children’s Mental Health Awareness Week and there certainly is a lot going on. Yesterday a colleague attended a conference on mental health in schools in Manchester and next week Triangle will be hosting a stand at Oxfordshire’s Youth in Mind conference. This is all happening against the backdrop of a Government Green Paper on children and young people’s mental health and increasing concern in the media.

Catching up with my colleague after the conference yesterday, it is evident that the commitment to equipping schools to take a bigger role is certainly there, but thoughts about how to do this in practice are still developing. So it seems like a good moment to draw out some of the lessons from our work with Action for Children to develop My Mind Star, a tool for engaging and supporting young people around their mental health and measuring their progress.

After initial discussions and scoping in 2017, the development process began in earnest in 2018. Over the course of a year and a half we held a series of workshops with young people, front-line workers and service managers to find out what really makes a difference when working with young people. My Mind Star, a version of the Outcomes Star for mental well-being in young people, was then developed and piloted across 11 Action for Children services and also HeadStart Kernow. 

Here are some of the highlights from that process.

Recognising the need for help is a crucial first step

Talking about change with the people directly involved is always fascinating. What emerged early on in the workshops was that young people often don’t seek help because they don’t realise that things could be much better. Not recognising that what they are experiencing is mental distress, they cope as best they can on their own. So, a really crucial first step for many young people is reaching out for help. Interestingly, this year’s Children’s Mental Health Week theme is ‘Find Your Brave’ and a key message is to be brave enough to ask for help.

Don’t look at mental well-being in isolation

Another clear learning point was that we must look at mental well-being in the context of the whole of the young person’s life. The workshop participants identified eight key areas that should be part of the conversation. After piloting this was reduced to seven because it emerged that safety is an important aspect of all of these areas, rather than something that should be discussed in isolation. 

The final seven outcome areas are:

  • Feelings and emotions,
  • Healthy lifestyle,
  • Where you live,
  • Friends and relationships,
  • School, training and work,
  • How you use your time and
  • Self-esteem.

Participants emphasised that it was vital to cover all these areas when talking to a young person, even if they were not what was immediately presented as part of the problem.

Involve young people in defining what ‘good’ mental health and well-being looks like

Developing the scales for a Star involves in-depth discussions about what ‘good’ looks like. The scales for each outcome area or domain describe a journey from things being very bad to the desired outcome being achieved. This means pinning down what ‘bad’ means, what the desired outcome looks like, and what steps people take as they travel from one to the other. 

When it came to the ‘How you use your time’ scale, there was an interesting conversation about time spent on screens. Questions raised, included, is time used this way always bad or can it also be a positive way of accessing support, information and entertainment? There was a definite difference of perspective between the generations and it was very important to have young people in the room to share what good looked like for them.

My Mind Star helps young people identify issues and set goals

My Mind Star was piloted over six months with 67 workers and 177 young people and the pilot was evaluated using feedback forms and a further workshop. Both workers and service users really valued the way that the visual Star Chart summarised their life and helped them identify priorities.

The vast majority (94%) of young people said that the scales helped them to describe how life was for them at that moment. While 85% said that the scales helped them to understand what they needed in the way of support. In the words of one worker: “I liked that it gave the young people the opportunity to see where their priorities are, not what someone else thinks we should work on. This gives them some ownership and increases motivation”.

Evidencing change is motivating for everyone

Three quarters of the workers valued the way that My Mind Star opened up better conversations. And both workers and service users found it encouraging to see progress when the second My Mind Star was completed. As one young person said, “I liked doing the Star because it reflects the improvements I have made in the past months”

Psychometric analyses showed that the outcome areas were coherent and the scale was responsive to change. Managers very much valued the fact that it enabled them to evidence the progress that young people had made.

Following the pilot, amendments were made to the tool based on the feedback and the final version was published in September 2019.

Take-aways for those working with young people and mental health

Based on our learning from this project, and on personal experience, just letting young people know about different kinds of mental illness isn’t enough and can even be counterproductive. Young people can mistake the natural highs and lows of the teenage years for a mental health problem or start to identify as being ‘anxious’ or ‘compulsive’. Rather than knowing the labels, young people need to know what mental well-being looks like in simple and everyday terms so that they know when they need to ask for help. 

Also, when they do ask for help, schools and others need to make sure that there is ‘no wrong door’ and that everyone is equipped to have that initial conversation, to signpost them to others if needed and to keep a watchful eye. As in so many areas of life, prevention or early intervention is better than leaving things until there is a crisis. 

Ultimately, the evidence from our pilot is that My Mind Star can really help make those early conversations count and give everyone working with young people a framework, a shared language and a way of evidencing the difference they are making.

Triangle will be at the Youth in Mind conference on 12th February at the King’s Centre in Oxford. If you’re attending the event and would like to arrange a meeting with us on the day, or if you have any questions about My Mind Star, other versions of the Outcomes Star for the mental health or young peoples sectors, or 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. 

Year in review: Shining brightly in uncertain times

Posted on by Donna

Joy MacKeith, one of Triangle’s directors and co-founders, and co-author of the Outcomes Stars, explores her year in review, and shares her thoughts on the impact and successes of 2019, including the new Star Online and new Stars.

It’s week one back in the office after my new year’s break. My inbox is surprisingly full and the office is already buzzing with activity. Not everyone has taken two weeks off it seems. Before taking a deep breath and diving into the patiently waiting emails I allow myself the luxury of a moment to reflect on a very busy 2019 and anticipate what 2020 has in store.

Star Online 2 is unveiled

For me 2019 will always be the year that we built our new, improved software system and 2020 will be the year that the one thousand organisations working with the Star Online started to use it. The initial feedback from those who helped us test it in development has been amazing. I know many of our clients will be particularly excited about the reporting capability, with new visuals, new customisation and new time period reporting options. Other new features will make it much easier to manage implementation and data quality.  The fact that we now have a state-of-the-art platform for further developments is also very exciting. An off-line app is high on the list of new features we have planned. The new system is now live for new clients.  A massive thanks goes to Sarah Owen, our team member, who has led the project and QES our software development partners.

Making an impact

I will also remember 2019 as the year we conducted our strategic review. Thirteen years since the publication of the first Star it was time to look at how well the suite of tools had stood the test of time and how Triangle and the Star need to develop to stay at the cutting edge of practice. As part of the review we carried out a summer survey of our clients to find out what difference the Star makes. I know that people love the Star, so I was expecting broadly positive findings, but the level of appreciation and impact took me by surprise. Here are a few highlights:

  • 87% of Star users report that their keywork is more effective as a result of using the Star
  • 81% said that Star data reports enabled them to monitor and report on their outcomes more effectively
  • 95% say that the Star supports good conversations and collaboration between staff and service users
  • 92% say that helps service users to get an overview of their situation
  • 93% say that the Star supports person-centered, strengths-based working
  • 92% say that the Star is motivating for staff and service users because it makes change visible.

There were so many stand-out findings that it is hard not to keep adding more, but you get the idea. Of course there are always things that can be improved, but it was heartening to hear that many of the developments people were asking for focused around the Star Online so it was wonderful to know that in just a few months those needs would be met.

Not only do the findings underline the positive way that the Star helps workers take an enabling, strengths-based approach, but they are also a powerful affirmation of Triangle’s decision to invest heavily in implementation support through our client services team, our trainers and our regionally based implementation leads.

Research shows that better results are obtained from good implementation of a poor tool than from poor implementation of a good one. We aim to provide both an excellent tool and excellent implementation support. It is so affirming to see that this powerful combination is really making a difference. 

The strategic review concluded that the Star is a tool whose time has now come because of the increasing recognition of the importance of person-centred, outcomes focused collaborative working. Although it is well known in some sectors and regions, it is still largely unknown in many others so the potential for further impact is substantial. A key theme for 2020 and beyond will therefore be doing more to communicate what the Star is, the way that it can transform service delivery and the wealth of research behind it.

An organisation with a mission

As well as fact finding, our strategic review also involved some deep reflection and soul searching on Triangle’s role in the current service delivery climate. We are painfully aware that the service delivery landscape has changed since 2006 when the first version of the Star was published. Assumptions that if someone is motivated to change then the services will be there to support them no longer hold. Many services are now much lighter touch and can find it challenging to make the time for an in-depth conversation about needs and plans. This has resulted in requests for ‘lighter touch’ or self-completion Stars.

Should the Star stick to its original formulation as a comprehensive and reflective tool or adapt to new realities? There are no easy answers, but we have re-affirmed and sharpened our mission as an organisation that is committed to both advocating for an enabling approach to service delivery and helping service providers make this a reality in practice.

We now begin a new strand of work to shape the debate around what matters in service delivery through research, blogs, conference presentations and making links with the many others advocating for this kind of approach.

Drawing together the evidence base

The Outcomes Star was born out of practice rather than research and quickly took root because many organisations were hungry for a tool that would evidence the effectiveness of their work without getting in the way. When they discovered that the Star positively helped them achieve their outcomes, there was no stopping it. 

As a result, the formal research evidence for the Star lagged behind its use. 2019 was the year that changed and we were finally able to draw together a decade of work on validation to publish psychometric factsheets on nearly all versions (we are still collecting the data on very recently published Stars). 2020 will see the publication of a paper in a peer-reviewed journal setting out the psychometric properties of the Family Star Plus, the most widely used of the suite of Stars. This is an incredibly important landmark for us in establishing the Outcomes Star as a different kind of tool that straddles the aims of both promoting and evidencing change.

Hello and goodbye

Closer to home, 2019 has been an important year of hellos and goodbyes. Hello to our first Managing Director, Graham Randles, who joined us from the New Economics Foundation consultancy service, and goodbye to Paul Muir, our Operations Director who pioneered our work on implementation support and much else besides. Hello to Tamara Hamilton who will be covering Sarah Owen’s maternity leave this year and goodbye to Susan Goodbrand who covered Emily Lamont’s maternity leave. Goodbye also to Roxanne Timmis who has moved on to an exciting new role with Think Ahead, a charity that supports graduates into mental health social work. Best of all, we have said hello to four new babies including Ziya Nisi born on 28th December to Giorgia, one of the staff at Unique Outcomes, our Australian implementation partner.

And finally

Triangle also gave birth to five new Stars in 2019 in a year of unprecedented Star development activity. We now have a Star for preparing for the end of life. Together with our Parent and Baby Star this means the Stars really can take you from cradle to grave.  2020 sees the publication of our new 3-5 year plan, a project to build on interest in the Star in the USA, the full implementation of our new software system and much more besides. 

It is incredible to see how something that started as an approach for one organisation in one sector has evolved and flourished over so many sectors and countries around the world. As we approach a very uncertain new decade, it gives me hope that when people collaborate to address specific issues with commitment, persistence, flexibility and creativity, we really can make a difference.

Graphic introducing the Planning Star - linking to the Planning Star webpage
Image introducting the Preparation Star - linking to the Preparation Star webpage
Image introducing the Pathway Star with a graphic linking to a blog on how the Pathway Star is a person-centered tool
Graphic introducing the Recovery Star Fourth Edition, linking to a blog post on the new Star
Image linking to a blog post introducing the new My Mind Star for use with organisations supporting young people's mental health and well-being

If you have any questions about our new Stars, or 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.