'Strengths' Assertive Outreach: A Review of Seven Practice Development Programmes

The following article was first published in the Mental Health Review Journal (June 2008) and is reproduced with their kind permission.

Abstract

Assertive outreach is based on extensive international research and has been promoted in the UK in 1999 as a key area of the National Service Framework for Mental Health. Its primary aim is to provide a specialist service for people disengaged from traditional approaches of mental health services, but very little attention has been paid to how such services can be developed. Practice Based Evidence, a practice development consultancy, has engaged seven assertive outreach teams to focus on development first, and follow-up evaluation of the impact of reflective practice on team functioning. This has prompted a number of strengths-based recommendations for changing the way we think about developing services before we engage in research and evaluation.

PDF: 'Strengths' Assertive Outreach: A Review of Seven Practice Development Programmes

Excerpt from Part 3: Evaluating a Strengths Approach to Practice Development

Developing a tool to guide and capture the strengths messages

The rationale underpinning a strengths approach led to the development of a 13- item tool to help capture some measurement of how practice development and team functioning can influence positive changes in team practice. The tool should also act as a prompt to areas of good practice, so the items are designed to be a sufficiently comprehensive reflection of ethical issues, care process, team functioning, and an underpinning knowledge base. Yet, this also needs to be a manageable tool (i.e. fitting one side of paper) if it is to engage practitioners interests and be used.

Ethical practice
1. Service users are fully involved in determining the ‘priorities’ for the working relationship.
2. As a team, we regularly examine and review the impact of ‘values and principles’ on our practice.
Care process
3. Time for creative approaches to ‘engagement’ is a priority.
4. Our assessment of needs includes the identification of service user ‘strengths’.
5. We identify and manage the appropriate opportunities for ‘positive risk-taking’ in practice.
6. Our working practice draws on a broad range of ‘practical and research based’ approaches.
Team working
7. We are clear about our ‘purpose’ as an assertive outreach team.
8. We have a clearly agreed model of ‘team-working’ (within team).
9. We have effective systems of ‘support and supervision’.
10. We have clear processes of ‘decision-making’ in the team.
11. We ‘link’ effectively with other parts of the mental health system (including primary care).
Knowledge in practice
12. We make full use of the ‘diverse’ knowledge, skill and experience within the team.
13. We access appropriate expertise from outside of the team.

Developing the method of evaluation

The method focuses on evaluation of changes in practice that gives useful feedback to the teams about their global functioning, as well as indicators to priorities they may choose to focus specific attention on. This is not the same as the approach established in many of the well known research projects examining the effectiveness of assertive outreach. The research approach has been one of top-down influences, whereby external sources examine questions relating to their desire to compare outcomes to other known and established research. The evaluation approach is a bottom-up influence, whereby the practitioners are engaged in reflecting on how their team is performing in relation to practice-based outcomes.

Models and Processes

A Working Model

Creative Capability through Practice Based Evidence (a working model)

David Juriansz and Steve Morgan

Creative Capability model	Focus	Core Components
Ethical practice	Individual practitioner capability	Essential values and 'humanity' of practice. Questioning assumptions and judgements. Respecting individual choices and human rights.
Process of care	Practitioner + client capability (the helping relationship)	Engaging a partnership with service users, not because the NSF says we should, but because it motivates their own capabilities to regain better mental health. Recognising service user strengths as well as needs, and promoting their capability to help themselves.
Team working	Practitioner + client + team capability (the team approach)	Promoting and maintaining clarity of team functions and goals. Efficient structures and systems that allow time for creative work. Effective partnerships between the team and the wider network of agencies.
Knowledge in practice	Practitioner + client + team + organisation capability.(the service approach)	The capability of the service to respond to the needs of individuals in a way that is flexible and creative. The sum total of the all the capabilities above, expressed as model or philosophy of the service. An approach to care that works in both theory and practice. A service that is influenced by the service user and pracctitioner experience.

A Working Process

Identifying a team to work with.

Engage the trust of team members (sceptical of external 'consultants').

Confidential 'Creative Capability' interviews (Parts 1 & 2) with all team members (including priorities for team away-day).

Produce a 'team' report of interviews.

'Team' away-day.

Report & summary of participant evaluations from away-day.

Identifying priorities for practice development 'implementation'.

Working with team in creative ways to implement their priorities and decisions for change.

Second 'team' away-day at approximately 6 months (completing Creative Capability Part 2).

Produce comparison of amalgamated team responses to Creative Capability Part 2, identifying positive changes.

Identify small number of local practitioners/team leaders to be mentored as a local 'Practice Development Team' (building up to working one day/week out of existing posts, to establish the local capability to continue the process in local services).

'Take a picture of this' - Steve Morgan and David Juriansz

What's the difference between the Sahara desert and the UK mental health system? If you spent 15 years in each, the likelihood is that you would have a better grasp of the process of change occurring in the Sahara. When taking a wide-angled view-from-above, the desert appears as a vast never-changing entity. However, the up-close view on the ground, examined through the zoom lens, shows change is always happening, slowly and in a way that maintains the ecological balance. Now contrast the same perspectives of the mental health landscape - the wide-angled view is similarly one of a vast entity of constantly shifting sands. However, the detail afforded by the zoom lens does little to clarify the picture for the service users or mental health practitioners - there appears to be little stability and balance afforded by the ever-changing patterns and textures.

Click to read more ...

Bureaucracy Busting

The PDF below is for viewing purposes only and is not to be used without the explicit permission of Steve Morgan

PDF: Framework for Review (15kb)

CPA: a process or an event?

First published in Openmind February 2007 and printed here with kind permission

In the article below, available as a PDF, Steve Morgan argues that we need a radical shift in thinking to support the CPA to deliver in the way originally intended.

PDF: CPA - process or event? - OpenMind article

To read the report above you will need free software called Adobe Reader. This software can be downloaded here.