Guidance for Completing Supporting People Outcomes for Long-term Services

Transcription

1 Guidance for Completing Supporting People Outcomes for Long-term Services April 2014 March 2015 For Use with the Outcomes Form for Long-term services Version 8 (01/04/14) April 2014 Version 8

2 Contents Page Section 1. Introduction 3 The sample 4 Section 2: Changes to the Outcomes Form for long-term services 7 Section 3: Completing the Outcomes Form for long-term services 8 Provider, Service and Client Information 8 Outcomes: 16 1 Achieve Economic Wellbeing 16 2 Enjoy and Achieve 17 3 Be Healthy 18 4 Stay Safe 20 5 Making a Positive Contribution 23 Contact Details SP Client Record & Outcomes Office CHR - The Observatory University of St Andrews Buchanan Gardens St Andrews Fife KY16 9LZ sphelp@st-andrews.ac.uk Tel: Website: 2

3 Section 1: Introduction This guidance manual should be followed when completing an Outcomes Form for Long Term Services version 8 (01/04/14) for clients of long term housing-related services from 1 st April 2014 onwards. Background The Supporting People Programme was launched on 1 April 2003 and the Client Record system began at the same time. A National Framework for Outcomes was developed and began in May From April 2009 the ring-fence on the Supporting People programme was removed and from April 2010 became part of Area Based Grant. From April 2011 Commissioning Authorities are responsible locally for the collection of any data required to monitor Supporting People services. The Client Record & Outcomes Office at the Centre for Housing Research (CHR) in St Andrews is continuing the collection of Client Records and Outcomes from providers for those Commissioning Authorities who have contracted with us for Sitra carried out a consultation in 2011 to identify a common data framework and CHR is following the recommendations resulting from this (see The common data framework is intended to be used for all housing related support services. Housing related support/community based support is defined as: Support services provided to any person(s) which develop their capacity to live in the community; independently in accommodation, or sustain their capacity to do so, or prevent more costly interventions. Sitra (2012) Guidance on a Common Data Framework, p4 Included Services For the purpose of collecting outcome information, the definition of a long term service is a service that provides support for a period of 2 years or more. This includes both accommodation based services and floating support services. Please note that providers should only complete a Long Term Outcomes Form for clients currently in long term housing-related support services. These may include supported housing, sheltered housing, peripatetic warden, adult placement, supported lodgings, floating support services, very sheltered housing (optional) and almshouses (optional). Excluded Services Services excluded from the Long Term Outcomes Form include any short term housing-related support service that has an intended duration of a period less than 2 years. This includes both accommodation-based and floating support services. These services will collect outcome information under the short term outcome approach. Confidentiality Please note that the Outcomes Form does not record the client s name or date of birth. This is why we require you to assign your own code on each form at Client/Tenant code. 3

4 Completing the forms Providers should complete a Long Term Outcome Form for every client included in the sample for that year. (1 st April to 31 st March). The sample should be taken at the time of the support plan review and submitted within the current submission year. Sampling instructions are given below. Each client should have in place a needs-based, which is reviewed on a regular basis. The form should be completed based on all the support needs identified in all the support plans for the client including the latest support plan. It is important to remember that not everyone will have every support need and therefore it is expected that not all outcome questions will need to be completed. When do I complete an Outcomes Form? From discussions with service providers, the best time for providers to complete and submit outcomes data has been identified as the time of the annual review of the client s support plan. If a review takes place more frequently than annually, then only one set of outcomes data is needed, so only report on ONE of the reviews during the reporting period. Please ensure that the household unit is clearly identified on all relevant service and support planning documentation as being in the sample required for Outcomes. Please ensure that the outcomes information is submitted using one of the two electronic submission methods. Where a service user is included in the sample, but is not due to have a review of the support plan within the reporting period, then outcomes data still needs to be submitted for that user, which may entail doing an earlier review of the support plan. Which clients do I complete a form for? (THE SAMPLE) The process below is to be applied to each Long-term housing-related service and should be identified at the start of the collection year. Services for older people (33.3% i.e. one third): Please make a list / print off a list of all your housing-related household units, one list for each Long Term Contracted Service. Please mark the first household unit on the list and then every 3rd household unit after that on the list. So, for example, where a service has a capacity of 15 household units, you would include unit 1, unit 4. Unit 7, unit 10 and unit 13. Where a household unit included in the sample list has more than one service user in it (a couple), then you should complete and return outcomes data for only ONE of the service users. Shared housing is not considered one unit and everyone within the house should be treated separately as individual units. If you have fewer than 3 household units then you should complete an Outcomes Form for the first household unit on the list. This is your sample for the period 1 st April st March All other services (sample size remains at 50% i.e. half): Please make a list / print off a list of all your SP funded household units, one list for each Long Term SP Contracted Service. Please mark the first household unit and then every 2 nd household unit after that on the list. So, for example, where a service has a capacity of 10 household units, you would include unit 1, unit 3, unit 5, unit 7 4

5 and unit 9. Where a household unit included in the sample list has more than one service user in it, then you should complete and return outcomes data for only ONE of the service users. If you have only one household unit then you should complete an Outcomes Form for ONE service user for that household unit. Shared housing is not considered one unit and everyone within the house should be treated separately as individual units. This is your sample for the period 1 st April st March What happens if a service user who is part of the sample leaves the service or dies? Please use the information already recorded in the service user s support plan to complete and submit outcomes information for this service user. Do I use different clients in my sample for 2014/15 from the clients I used in previous samples? The recommendation from the Sitra consultation in 2011 (see is to include different individuals in the sample each year with the aim that: for older people service, 100% of clients are included over a period of 3 years for all other long-term services, 100% of clients are included over a period of 2 years. How to submit information Outcome forms must be submitted electronically. There are two methods of submission: Web entry system (CROSS) This method is accessible through our website In order to send us Outcome information, providers need a log-in and password. To obtain these, providers need to visit the website and click on Register for a login. Extract information from your own housing management system For organisations that collect Client Record & Outcomes information through their existing housing management systems, submission can be made using XML which enables secure data transmission and improved data quality. Further information on this can be found on our website A PDF document is available from the project website if providers wish to print off the form for their own use. What happens to the data when it arrives at the Client Record & Outcomes Office? Information is validated when you submit it to the Client Record & Outcomes Office. If there are any errors or queries then one of the team will contact the person whose details appear on the submission. When all queries have been resolved then the information becomes part of the Outcomes database. 5

6 Information from Outcomes Forms There is a wide range of service providers from private individuals who provide supported lodgings in their own home, to voluntary organisations, housing associations, local authorities and social services. Whilst completion of Outcomes Forms is not mandatory, service providers are often required to complete them as part of contractual arrangements with their commissioning Commissioning Authority. Each organisation that provides housing-related support is allocated a National Client Record Provider ID for each Commissioning Authority with whom they hold a contract. This ID is allocated by the Client Record & Outcomes Office at the CHR. Outcomes Forms provide information about access to housing-related support services in England. The data is processed by the Client Record & Outcomes Office and passed on to the relevant Commissioning Authority. Each Commissioning Authority receives a complete dataset of Outcomes information about the services they fund. This enables them to analyse data from individual services. Participating Commissioning Authorities are provided with Outcomes datasets every quarter, and the web reporting facility is updated to enable analysis to be undertaken by AAs, service providers and researchers. This information can also be used by Commissioning Authorities working together to coordinate services regionally. Special analyses of Outcomes data are also available from us. If you would like further information, please contact our helpdesk. 6

7 Section 2: Changes for 2014/15 There are no changes to the Outcomes Form for Long-term Services for 2014/15. 7

8 Section 3: Completing the Outcomes Form for Long-term services See Page 4 for information about how to select your sample of clients to include. Provider, Service and Client Information Section (Please note: if you are submitting using the web entry system (CROSS), questions Q0.1 Q0.6 are automatically completed when you select your service from the drop-down menu) PROVIDER ID DETAILS Q 0.1 National Client Record Provider ID Please enter the National Client Record Provider ID. This is a five-digit number which has been allocated to you by the Client Record & Outcomes Office. A separate National Client Record Provider ID is allocated for each Commissioning Authority with whom your organisation holds a contract. If you need to confirm this please contact the Client Record & Outcomes Office Helpdesk on or sphelp@st-andrews.ac.uk. Q0.2 National Provider ID This is an 8-digit number allocated to your provider organisation by DCLG. You can check this number by contacting the Client Record & Outcomes Office Helpdesk (sphelp@st-andrews.ac.uk / tel ). PROVIDER AND SERVICE DETAILS Q0.3 Organisation Name Please enter the name of the organisation which holds the contract for the housingrelated support service. If the service has been subcontracted, always enter the name of the provider who holds the housing-related support contract and not the subcontracted organisation. Q0.4 Name of Commissioning Authority Enter the name of the Commissioning Authority that funds your service. Q0.5 Service Name Please record the name of the service. Q0.6 SP Service ID This is a unique Service ID which is allocated to each housing-related support service funded by the Commissioning Authority. This is a code that is shown on the Supporting People Contract Schedules issued by your funding Commissioning Authority. The format of the SP service ID varies across the country, some are numeric and some are a mixture of letters and numbers, for example SP206, S103, or 125A. Please record the full service ID in the boxes provided. If you have contracts for several services funded by the same Commissioning Authority, each service will have its own SP Service ID. Q0.7 Agreed Support Plan in place Please indicate Yes or No. If No, then there may be limited further information that the provider can supply. 8

9 Q0.8 Does the client agree with the outcomes reported? Please indicate whether the client agrees or not with the outcomes being reported This question is designed to capture whether the service user has been involved in and agrees with the outcomes that are being reported. Since this information is being captured as part of the review of the support plan, we anticipate that service users will be involved and in agreement with the assessment of the actual outcomes being captured for them in relation to their identified needs. If this is not the case, there is the option to indicate No. Q0.9 Service Type The Long Term Outcomes Form should be completed for all the services users currently in the housing-related support service who are included in the sample for the year. Where a service encompasses more than one of the definitions shown below, the predominant service type should be shown on the form. Long Term Supported housing (i.e. with an intended service duration of 2 years and over) support is provided together with accommodation as an integral package. The service may be shared housing, self-contained housing clustered on the same site or dispersed self-contained housing. Sheltered housing is not included in this definition. Sheltered housing - accommodation designated for older people where residents receive support. It may have communal facilities and services. Long Term Adult placement (also referred to as Shared Lives) (i.e. average service duration of over 2 years) long-term accommodation where care and support is provided to 1-3 adults, placed by and through an Adult Placement Scheme or by an Adult Placement Carer approved scheme. Long Term Supported lodgings (i.e. with an intended service duration of 2 years and over) accommodation where a private individual or family provide varying levels of support in their own home to one or more people living with them, usually young people. Floating support a service not attached to accommodation; it can be delivered in a variety of ways. For example in the client s home, at drop-in sessions and surgeries. Very sheltered housing sheltered accommodation for physically or mentally frail older people, with on site support and enhanced communal facilities, specialist design features and the capacity to offer a range of care and support services. Almshouse accommodation provided by almshouse charities, often set up in previous centuries by companies or landowners for the benefit of local people in need. 9

10 Q0.10. Did your service work in partnership with other agencies to deliver this support? You should indicate whether the housing-related support service being provided to the client was delivered in partnership with any of the agencies below in order to meet the client s needs. Please note that this question focuses on partnership working to deliver services to this particular client. There is a similar question on the Client Record Form that focuses on partnership working undertaken by the service in general. Examples of delivering in partnership can include: consortium working where your organisation works very closely with other providers to provide a service or range of services sub-contracting where a larger generic organisation often contracts with a smaller more specialist service to provide support to clients that it does not have the time or requisite skill set to meet otherwise informal working arrangements which could include agreed referral routes and signposting arrangements with other agencies/services If YES then please indicate the agencies which your housing-related support service worked in partnership with in order to meet the client s needs. More than one option may be ticked if your service worked closely with more than one agency. The categories are: Health Education/Training Social Services Benefits Housing services Debt services Drug/alcohol services Employment agencies/job centre Police/probation Other Youth offending teams Health - including NHS trusts, GPs or voluntary sector services whose main focus is health related both physical and mental health. Social Services work in conjunction with Social Service departments. Housing services including any statutory or voluntary sector organisation whose main remit is housing and/or homelessness. Drug/alcohol services including NHS or voluntary organisations whose main focus is treatment and/or support of people with addictions to drugs or alcohol. Police/probation services including organisations working in community safety and probation. Youth Offending Teams Youth Offending Teams are made up of representatives from the police, Probation Service, social services, health, education, drugs and alcohol misuse and housing officers, whose main remit is to respond to the needs of young offenders. Education/training any organisation with a main remit to provide education and/or training services. Benefits including benefits advice agencies and the Citizen s Advice Bureau. 10

11 Debt services again, including Citizens Advice Bureau or local debt management service and advice groups. Employment agencies/job centres organisations whose main goal is to assist people into paid work, for example, Job Centre Plus and local employment and careers services. Other only use this option if there was an agency with which you worked that does not fit any of the above categories. Q0.11. Does the client have an Individual Budget (IB)? Individual Budgets means that the client or someone acting on that behalf receives a set amount of money which can then be spent on any activity the individual chooses; which will help improve their life and will enable them to live more independently. Currently, not all client groups funded by Supporting People are offered Individual Budgets. However, if a client is also receiving a package of care and support which includes adult social care funding, then it is more likely that the individual will have been offered an Individual Budget. The purpose of an Individual Budget is to give greater choice and control over the type of services clients receive, which are then tailored to meet the needs of the individual. Additional information is available from the CROSS web page of the project website: Please indicate whether the client has been given an Individual Budget (IB). If YES, is the client using some or all of their Individual Budget to purchase this service? Yes/No/Don t Know. You should record YES if the client using any of their Individual Budget to purchase this service. Q0.12 Date of Completion Please indicate the date on which this outcomes form was completed. CLIENT CHARACTERISTICS Q0.13 Client / Tenant Code The Long Term Outcomes Form is designed to be anonymous: it does not record details of the client s name or date of birth. Please fill in the same code on the Outcome form that was used to complete the Client Record Form for the client in question. If no Client Record Form was completed please construct a number of your choosing. The Client Record & Outcomes Office will use this code to contact providers with any queries about the information on the form. Providers should keep a record of the codes used. Enter the details required for the Client for whom you are completing the outcomes form. Information about other members of the client s household is not required. Q0.14 Age/Sex/ Economic Enter age in years in whole numbers. Sex Enter M for male or F for female. Economic status This should be completed for the client, using the codes specified listed on the form: 11

12 Full Time Work (24hrs or more/week)- working 24 hours or more per week in paid employment. Part Time Work (Less than 24hrs/week)- working less than 24 hours per week in paid employment. Government training/work Programme - on a government training scheme e.g. Employment on Trial or employed within the Work Programme. This includes people across the working age range Job seeker - receiving Job Seeker s Allowance. In order to do this they must be: aged 18 or over and aged under 65 capable of working and actively seeking/available for work; and not working or working on average less than 16 hours per week OR year olds if they are forced to live away from parents, suffer severe hardship or are a member of a couple who has responsibility for a child. Retired - fully retired from work, usually in receipt of a state and/or occupational pension, usually aged 65 and above. Note: those who are receiving pension but are still in paid work should be coded under Working full-time or Working part-time as appropriate. Not seeking work - those who are unwaged or carrying out unwaged work. For example: Voluntary work Those caring for small children or other dependents Those choosing to remain at home and so not available for work Clients described by this category would not be registered as unemployed or job seeker but may be in receipt of income support. Full-time student - aged 16 or over and in full-time education at school, college, university or other educational institution. Full-time is defined as at least 12 guided learning hours per week. Unable to work because of long term sickness or disability long-term sick includes people who receive statutory sick pay, incapacity benefit, or employment support allowance Disabled includes people who are in receipt of Disability Living Allowance, Disabled Person s Tax Credit, Vaccine Damage Payment, War Disablement Pension, Severe Disablement Allowance or other disability allowance. Other adult - other adult aged 16 years or over who does not fit into categories 1 to 8. Q0.15 Ethnic Origin The client should define the response to this question. If the client does not wish to answer this question, please tick the Did not wish to disclose category. Note that the categories used are based on the 2011 Census.. Q0.16 User defined ethnic coding Optional use for provider to record more detailed description, if required by the funding Commissioning Authority. 12

13 Q0.17a Religion The client should define the response to this question. If the client does not wish to answer this question, then please tick the Did not wish to disclose category. Whilst it is accepted good practice to collect this information, it may be the case that the provider does not currently routinely collect this information so there is also the Not Known option, as the client may not be present when completing the Short Term Outcomes Form. The categories used are the same as those for the 2011 UK Census. Q0.17b Sexual orientation The client should define the response to this question. If the client does not wish to answer this question, then please tick the Did not wish to disclose category. Whilst it is accepted good practice to collect this information, it may be the case that the provider does not currently routinely collect this information so there is also the Not Known option, as the client may not be present when completing the Short Term Outcomes Form. Q0.17c Transgender The client should define the response to this question. If the client does not wish to answer this question, then please tick the Did not wish to disclose category. Whilst it is accepted good practice to collect this information, it may be the case that the provider does not currently routinely collect this information so there is also the Not Known option, as the client may not be present when completing the Short Term Outcomes Form. Q0.17d Ex-Armed forces personnel The client should define the response to this question. If the client does not wish to answer this question, then please tick the Did not wish to disclose category. Ex-Armed forces refers to any people who have served or been reservists in the armed forces. It is important to capture whether the client considers themselves to part of the armed forces community. (See: /the_armed_forces_covenant.pdf Q0.18 Disability The client should define the response to this question. Is the client a disabled person within the meaning of the Equality Act The Equality Act replaced most of the Disability Discrimination Act (DDA), although the Disability Equality Duty in the DDA continues to apply. The definition of disability under the Equality Act means that if their condition has a significant (more than minor or trivial) effect on day-to-day living and the adverse effect is long-term (meaning it has lasted for 12 months, or is likely to last for more than 12 months or for the rest of their life) then they would be considered a disabled person within the meaning of the Act. People with HIV, Cancer or Multiple Sclerosis however are covered by the Disability Discrimination Act from the date of diagnosis and do not have to demonstrate that their condition has a significant effect on their day-to-day living. Again, if the client does not wish to answer this question, then please tick the Did not wish to disclose category. 13

14 Q0.19 Client group by which the client is defined Primary Client Group One client group should be selected from the list shown under Primary. The primary client group should accurately describe the predominant needs or circumstances of the client. This question should only be answered in relation to the individual client and should not be a description of the primary purpose of the service (although in most instances they are likely to be the same). For example, where a service user is in receipt of an accommodation based service and is an older person you will need to take into consideration the overriding needs of the individual (e.g. mental health problems) to determine the client group by which the individual is defined (in this case the client group will be older people with mental health problems). Secondary Client Groups (optional) Up to three additional categories can be chosen to describe the secondary client groups by which the client is defined. If the client can be defined by one primary client group, do not tick any of the secondary options. Client Groups Older people with support needs older people, usually aged 55 and over, who need to be supported to be independent and without support could be at risk. Older people with dementia and mental health problems older people with support needs relating to their age and mental health, for example dementia. Frail elderly older people, usually aged 75 and over, who are physically disabled or frail from the effects of aging (for example experiencing significant pain problems, arthritis, cancer, etc.) and require extra care and support to maintain their lifestyle and home. Mental health problems people with a diagnosed or undiagnosed mental health problem who need support to maintain independence. They may be: people with enduring but relatively low level mental health problems that interfere with their ability to cope or function on a day to day basis, people whose behaviour is a concern for their own safety or that of others, people at risk of suicide or depression, people who have been diagnosed as mentally ill and who have had, or are having, specialist treatment. Learning disabilities people with a learning disability who need support to maintain their level of independence. They may have challenging behaviour, deficits in social functioning and/or adaptive behaviour. Learning disabilities are usually present from childhood. Physical or sensory disability people with mobility difficulties, sensory impairments (for example sight or hearing), suffering any loss or abnormality of an anatomical structure or function, or suffering from a debilitating or long-term illness, (for example multiple sclerosis) who need support to maintain their level of independence. Single homeless with support needs single people who are considered by the service provider to be homeless, who may or may not be owed a homeless duty (See 14

15 Alcohol misuse problems people with alcohol misuse problems who need support to maintain their independence as a result of their alcohol misuse problems. Drug misuse problems people with drug or other substance problems who need support to maintain their independence as a result of their drug misuse problems. Offenders or at risk of offending offenders or people at risk of offending who are having difficulties in sustaining their accommodation or living independently as a result of their offending behaviour. Mentally disordered offenders convicted people with mild to acute mental health needs whose offences relate to their mental health. Young people at risk young people aged who are homeless or in insecure accommodation, and who need support to be able to take care of themselves or to protect themselves from harm or exploitation. Young people leaving care young people leaving local authority care who have been looked after for a continuous period of at least 13 weeks after the age of 14. People at risk of domestic violence people who are experiencing, or are at risk of experiencing, domestic violence/domestic abuse. They may have left their home, or who be having difficulties in maintaining their home or their personal safety and security. People with HIV/AIDS people with HIV/AIDS who are requiring support to maintain their independence within the community. Homeless families with support needs families with dependent children who are considered by the service to be homeless, who may or may not be owed a homeless duty (See ). Refugees people who have been officially accepted as refugees, or who have been given indefinite or exceptional leave to remain. This excludes those seeking asylum who do not have recourse to public funds. Teenage parents Young single parents (usually aged less than 20) needing support and vulnerable young women in this age group who are pregnant. Rough sleeper a person bedded down for the night on the street or sleeping outside or sleeping in buildings or other places not designed for habitation, for example stations, car parks, sheds. Gypsies and Travellers with support needs people with a cultural tradition of nomadism or of living in a caravan and all other persons of a nomadic habit of life, whatever their race or origin, who need support to live independently. Generic/Complex needs select this option for people who have individual or multiple / complex needs needing support to achieve or maintain their independence within the community who cannot be properly described by the other pre-defined client groups or categories. User defined primary client coding Optional use for provider to record more detailed description, if required by the funding Commissioning Authority. 15

16 Q0.20 Is the Client intending this service to provide a home for life? This question is only applicable to clients in receipt of a long term accommodation based service and seeks to establish whether, regardless of the person s health problems, level of frailty or disability, the client considers and intends that the service will provide a home for life for them. This question should not be completed for clients in receipt of a long term floating support service. 16

17 General Guidance for Outcomes questions (1 to 5) The outcomes questions that follow should be completed based on information in all the support plans for the client including the latest support plan. Each of the remaining questions follows a consistent format, which is detailed below. There is an initial question asking if the client needed support in a particular area. If the answer to that question is no, leave the remaining sections of that question as missing, and move on to the next one. If the answer is yes, however, then move on to the next part of the question, which will ask if the need was met for this particular area. If the need has been met for the client, then answer yes to this part of the question, and move on to the next part of the question, which will ask if the client needs ongoing support with this. We are aware that in long term services outcomes may have been achieved, but for some clients continual support is need to maintain this. If the need has not been met, however, then answer No, and use the list provided to record why the outcome did not happen. These lists include factors relating to the client, the support service, or other local factors. A maximum of three reasons can be recorded for each question. 1 Achieve Economic Wellbeing 1a) Does the client need support to maximise their income, including receipt of the correct welfare benefits? This includes the need to apply or re-apply for any type of welfare benefit provided by the State that may be relevant to the client s circumstances. Welfare benefits relate to any practical or financial support in regard to unemployment, looking for work, low income, disability, bringing up children, retirement or benefits in relation to housing. Examples may include job seekers allowance, income support, disability allowance, carers allowance, tax credits, housing benefit or other benefits provided by the Department for Work and Pensions, local authorities, HM Revenue and Customs or other government departments. Similar monetary benefits may include releasing income from pensions, bonds or equity, fuel payments and equity release. Please note - Community Care Grants have been excluded as a welfare benefit. 1b) Does the client need support to reduce their overall debt? This includes any type of debt, e.g. debt owed for rent/mortgage arrears, domestic bills, credit cards, personal loans, service charges etc. Support to reduce debt includes helping the client to find ways to make affordable payment arrangements with creditors and ensure that critical/ priority debts are addressed as well as non-priority debts. It also includes helping the client to find ways of making payments on a sufficiently regular basis to reduce the overall debt 17

18 and ensure that creditors do not pursue legal action against the client. This could be informal as well as formal debts. Any amount of debt reduction is a positive outcome it does not matter how MUCH the debt has been reduced by the client as long as there has been an overall reduction in levels of debt 1c) Does the client need support to obtain paid work? Paid work refers to all types of work for which the client receives financial payment. This includes full-time, part-time, temporary and other paid employment. This DOES NOT include voluntary/ unpaid work as this is covered in Section 2 Enjoy and Achieve. There are two possible outcomes here the first relates to the client actually being in paid work at the point of departure from or ceasing to receive the support service and the second relates to the client having participated in paid work whilst in receipt of the service. This includes any type of paid work for any amount of time. Both of these outcomes are of interest under Economic Wellbeing, since being in paid work for a period of time also represents financial and economic benefits for the client and can help in obtaining future paid work. 2 Enjoy and Achieve 2a) Does the client need support to participate in training and/or education Training refers to any course which enhances employability or develops new skills, e.g. Youth Training, the Work Programme, Training for Work, National Traineeships or NVQs. There will not necessarily be a formal qualification associated with this but there may be a certificate awarded to provide evidence of having completed the course. Education refers to any nationally recognised qualification, e.g. GCSEs, A Levels, Degrees, Diplomas in higher education, teaching and nursing qualifications, HND, OND or BTEC. There are two possible outcomes here the first relates to the client having taken part in their desired training/ education and the second relates to achieving their desired qualification(s), where applicable. Not all training or education courses lead to a formal qualification and this outcome may not be applicable. However, if it is applicable please record whether the client has achieved their desired qualification(s). 2b) Does the client need support to participate in leisure / cultural / faith and/or informal learning activities? This question covers activities that the client wants to do for enjoyment as well as activities that will help them improve and develop a range of skills, self-confidence and self-esteem. Leisure activities can be defined as participation in clubs, pursuing a hobby, sporting/fitness activities etc. and can also include social activities within the community that foster development in confidence, self-esteem and social networks, 18

19 e.g. socialising in the pub, as long as the activity is clearly directed and appropriate to the client s support plan. Cultural or faith activities refer to support to engage in activities specifically related to culture or identity. These could include activities concerned with religion, sexuality, gender, worship, spirituality, disability awareness, or activities targeted at making a fresh start. Informal learning can cover a range of activities which may take place in settings outside the service, e.g. in a community resource centre, and cover things like confidence building or parenting skills. It can also include learning opportunities delivered within the service, such as budgeting skills, development of a range of life skills or any sort of informal learning that the client is interested in. This specifically excludes any learning that is defined in section 2(a) Training and Education. 2c) Does the client need support to participate in any work-like activities, e.g. unpaid work/work experience/work-like experience/ voluntary work? Work-like activities refer to any work that is unpaid including work experience, work placement or any voluntary work. This can be voluntary work done as a route to potential employment or voluntary work done because the client enjoys it. This might also include traineeships which are also designed as a route into potential employment. Work-like activities are all those that have not been captured in 2(a) or 2(b). 2di) Does the client need support to establish contact with external services/ groups? This question refers to any other specialist support agencies that the client may wish to establish contact with in order to access specialist support that is not provided by the service. 2dii) Does the client need support to establish contact with friends or family? This question refers to an identified support need in the support plan for the client to establish/re-establish contact with friends/ family. Clearly, the need for support in terms of rebuilding contact with family networks/ friends will have been considered within the needs assessment & support planning process for the client in question, since not all previous connections/ relationships will have been ones that were beneficial to the client. This may include directing clients to agencies that support the rebuilding of family ties. 3 Be Healthy 3a) Does the client need support to better manage their physical health? This question covers all aspects of the client s physical health, including supporting access to primary health care, such as supporting the client to register with and access a local GP, as well as supporting the client to make appropriate use of primary health care, such as visiting the GP when unwell rather than making use of A&E. It could also include supporting the client to develop better awareness around food and nutrition, fitness and exercise and other areas which may be relevant for the client in terms of being better able to manage their physical health. It is important to remember that this will not always be about the client physically improving, since that 19

20 is not always within the remit of the service to achieve, but it is about supporting the client to better manage their physical health. Primary health care services are those provided outside hospital. Please note This question does not include Mental Health or Drug and Alcohol services, as these are dealt with in separate questions below. 3b) Does the client need support to better manage their mental health? This question covers all aspects of the client s mental health including supporting access to specialist mental health services when needed, as well as supporting the client to make appropriate use of mental health services, such as contacting them when unwell rather than only making use of emergency provision. It could also include supporting the client to develop better awareness of managing everyday stresses and recognising how to better manage their own mental health issues. It is important to remember that this will not always be about the client s mental health improving, since that is not within the remit of the service to achieve, but it is about supporting the client to better manage their mental health. Mental health services include outpatient appointments with a psychiatrist, psychologist, involvement with Community Mental Health Teams including CPNs and Social Workers in the field of mental health, and also includes involvement with a counsellor provided by a GP or involvement with a specialist mental health worker. Note: Local day centres or drop in centres do not count as mental health services. 3c) Does the client need support to better manage their substance misuse issues? This covers all aspects of the client s substance misuse issues and could include supporting access to specialist substance misuse services when needed, as well as supporting the client to make appropriate use of substance misuse services, such as contacting them when unwell/ in crisis rather than only making use of emergency provision. It could also include supporting the client to develop better awareness around managing everyday stresses and recognising how to better manage their own substance misuse. It is important to remember that this will not always be about the client s substance misuse stopping, since that is not necessarily within the remit of the service to achieve, but it is about supporting the client to better manage substance misuse. Substance misuse services refer to in-patient drug treatment, home based detox, residential rehabilitation, specialist prescribing, GP prescription, structured day programme or other specialist counselling. If the client joins the service following a course of rehabilitation, then this question should be answered Yes if the client remains free from substance misuse while receiving the service. Of course, a relapse would mean that the outcome is unlikely to have been achieved, since they are not managing their substance misuse better at the point of departure from the service. 20

21 3d) Does the client need assistive technology / aids and adaptations to maintain independence? This question is trying to capture the impact that assistive technology/aids and adaptations have had on the client since these aids have been in place, rather than simply whether assistive technology/ aids and adaptations have been provided. For example, if aids have been provided to the client to improve their mobility, did their mobility improve therefore allowing them greater independence? Similarly, if aids have been provided to the client to help them avoid falling, did the client experience fewer falls as a result of having these aids or did the aids make no difference? Therefore, when answering this question, please focus on the impact that assistive technology/aids and adaptations have had on the client since these aids have been in place. It may be the case that the client is in need of assistive technology/ aids and adaptations but has yet to receive them, due to waiting lists. If there is an identified need in the support plan for assistive technology/aids and adaptations to assist the client to establish or maintain independent living, but the client is not able to manage independent living better as a result of assistive technology/ aids and adaptations because they have yet to be provided, then this should be reported as NO to actual outcome and the relevant external factor used to indicate this. 4 Stay Safe 4ai) Does the client need support to maintain their accommodation and avoid eviction? This is intended to focus on those clients who have a specific identified support need to enable them to maintain their accommodation and avoid eviction, e.g. those with a history of tenancy breakdown or repeat unplanned loss of accommodation, those who have been served with a formal Notice of Intent to Seek Possession or Notice to Quit, or those who are subject to suspended possession orders. It also includes clients who are currently experiencing difficulties in maintaining their accommodation, e.g. those receiving tenancy support services, or who may not have lived independently prior to receiving the support service and are likely to need to learn the skills to maintain their accommodation. 4aii) Does the client need support to secure / obtain settled accommodation? Settled accommodation refers to accommodation arrangements where the occupier has security of tenure / residence in their usual accommodation in the medium to long term, or is part of a household whose head holds such security of tenure / residence. 4b) Does the client need support to comply with statutory orders and related processes, in relation to offending behavior? This includes clients who are subject to a range of statutory orders and related processes within the criminal justice system. Statutory orders and related processes include the following: 21

22 o Youth Justice Orders (Crime and Disorder Act 1998) o Anti-Social Behaviour measures (Anti-Social Behaviour Order [ASBO] or Individual Support Order [ISO] o Sentences in the Community (Supervision Order, Community Rehabilitation Order, Community Punishment Order, Action Plan Order, Attendency Centre Order, Referral Order, Reparation Order, Fine Conditional Discharge or Absolute Discharge.) o All sentences to the community are open to the following orders: Curfew Order, Parenting Order, Drug Treatment and Testing Order o Sentences to Custody (Detention and Training Order Section 90/91) although these are custodial sentences they can lead to community based restrictions following release part way through a sentence, for example, tagging. o Noise Abatement Notices, Litter Abatement Notices. o Early Release/Licence arrangements, Bail Restrictions and Conditions, Restraining orders. o Community orders relating to: unpaid work, specified activities, programmes aimed at changing offending behaviour, prohibition from certain activities, curfew (usually with electronic monitoring), exclusion from certain areas (usually with electronic monitoring), residence requirement, mental health treatment, drug rehabilitation requirement, alcohol requirement, alcohol treatment, supervision requirement, attendance centre requirement (for under 25s) and suspended sentence order (custody minus). o Any child protection orders. If the client has complied with ALL their statutory orders/ related processes at the point of departure from the service or ceasing to receive the service then the actual outcome can be recorded as YES. Note: this can only be reported as YES if the client has complied with all the orders and processes known to be in place whilst the client is in receipt of the service. 4ci) Does the client need support to better manage self-harm? Self-harm is when someone deliberately hurts or injures themselves. This covers all aspects of the client s self-harming, e.g. supporting access to specialist support services when needed, supporting the client to make appropriate use of specialist services. It could also include supporting the client to develop better awareness of managing everyday stresses and recognising how to better manage their own self harm issues. Note: Meeting this need will not always be about the client s self-harm stopping, since that is not necessarily within the remit of the service, but it is about supporting the client to better manage their self-harm. Success in managing self-harm can vary, and so the assessment of whether the user is better managing their self-harm at the point of departure needs to be made. A pragmatic approach is needed here and the outcome reported needs to be reflective of the support plans at the point of departure and the views of the user and the provider as to whether that support need was met. 4cii) Does the client need support to avoid causing harm to others? Clients likely to cause harm to others may include those who are known or likely to demonstrate ASB, be violent to others, who have a criminal conviction/s regarding violence to others, who are under MAPPA supervision, who are known sexual 22

23 offenders, clients who have committed domestic violence offences or clients who have present concerns related to abuse under POVA. This covers all aspects of the client s potentially harmful behaviour to others, e.g. supporting access to specialist support services when needed, supporting the client to make appropriate use of specialist services. It could also include supporting the client to develop better awareness of managing everyday stresses and recognising how to avoid causing harm to others. Achieving this outcome is about the client avoiding causing harm to others. 4ciii) Does the client need support to minimise harm/risk of harm from others? Clients at risk of harm from others e.g. people with a range of vulnerabilities who need the protection of POVA to safeguard them from harm or abuse, young people who may be at risk, clients at risk of DV, clients who are at risk of racial violence or racial harassment, clients who may be at risk of harm as a result of previous links in community or their previous lifestyle, for example links to gangs/ prostitution etc. This covers all aspects of minimising the client s risk of harm from others e.g. supporting access to specialist support services when needed, supporting the client to make appropriate use of specialist services. It could also include supporting the client to develop better awareness of managing the risks of harm from others and recognising how best to minimise the risk of harm from others. Note: Meeting this need will not always be about avoiding harm or risk of harm caused by others, since that is not necessarily within the remit of the service or the client to achieve, but it is about supporting the client to minimise the risk of harm from others. Success in minimising the harm/ risk of harm from others can vary, and so the assessment of whether the user is minimising the harm/ risk of harm from others, at the point of departure, needs to be made. A pragmatic approach is needed here and the outcome reported needs to be reflective of the support plans at the point of departure and the views of the user and the provider as to whether that support need was met. 23