The Ladder of Change
One of the key features of the Outcomes Star™ is that all versions are based on an explicit model of the steps that service users take on their journey towards independence - the Ladder of Change.
These models are informed by literature within that sector and are always developed empirically through interviews and workshop discussions with workers, managers, and service users where possible. This gives the Star coherence, rigour and credibility with staff.
The Ladder of Change, above, is that used in the Homelessness Star and Mental Health Recovery Star. Although it was developed independently by Triangle, the model maps closely onto the Cycle of Change which is widely used in the addiction field. The journey of change in the Mental Health Recovery Star was informed by by a review of user accounts of recovery. For references, please scroll to the bottom of this page.
1 At the beginning of the journey we are not interested in thinking about or discussing this aspect of our lives. Although we are far from achieving our full potential and may be causing harm to ourselves or others, we are cut off and not aware of problems, or unwilling to talk about them out of fear or mistrust. Because of this we are stuck.
2 As 1 except with moments of feeling fed up with how things are. We may even tell a worker we are fed up, but the feeling may be fleeting and we won’t engage with support in any real or meaningful way.
3 The feeling that we don’t like how things are gets stronger and now we really want things to be different. Change may seem impossible or frightening and we may not know what we want, but we know we don’t want to carry on living as we have been. At this point we will meet workers or others offering help and accept their help with pressing problems, though our willingness or ability to do this may come and go.
4 As 3 but engaging with support in a fairly consistent way, talking things through and following agreed actions. However, we do not take the initiative and rely on others for change. Without workers driving the process we can slip back and may criticise workers if things don’t work out.
5 This is the point of really believing that things could be different in this area of our life. We get a sense of what it is we want – what we are moving towards as well as what we are moving away from. We can see that change won’t happen unless we help to make it happen. This is a change in the way we view things. There is a sense of being engaged rather than just going along with other people’s plans.
6 We are putting this belief into action by doing things differently in the world. We are experimenting, trying out new ways of doing things. Sometimes things work, sometimes they don’t, so it’s a difficult stage to be in. Change is hard and at both 5 and 6 we need a lot of support to ride the highs and lows and keep the belief going.
7 At this stage we have a sense of what works for us in moving towards our goal in this area of our life. This is really motivating and helps to strengthen our belief in ourselves and our ability to achieve our goals. For this reason we start to become more consistent in doing things that are helpful for our journey and get us closer to where we want to be. However, we are learning and still need quite a lot of support to keep things going and without it setbacks can knock us off course.
8 By this stage we have effectively achieved the outcome in this area of our lives but still need regular, on-going support from the service to keep it going.
9 As 8 but with a low level of support needed to keep things going. Our new ways of doing things in this area of our life are now quite well established and feel more natural or automatic. Most of the time we can maintain the changes on our own without support but, at times of crisis, we are vulnerable to slipping back. This means it can be helpful to have someone who checks that all is well and helps us to recognise the danger signs and take action when necessary.
10 We have no issues in this area and behave in ways that work well for us and those around us. Our support needs are met by friends, family and/or generic community services. We know when we need more support and how to get it.
The Cycle of Change is credited to Prochaska and DiClemente, C. C. (1982) Transtheoretical Therapy: Towards a more integrative model of change Psychotherapy: Therapy, Research and Practice, Vol. 19 pp 276-88.
Anderson, R. Oades, L. And Caputi, P., (2003) Australian and New Zealand Journal of Psychiatry, volume 37, number 5, pp 586-594 The experience of recovery from schizophrenia: towards an empirically validated stage model.