Research Library
This research library includes all original empirical research Triangle has located through periodic literature searches and other means. Other material including service impact evaluations and reflective pieces not based on empirical research are included where they are of particular interest.
A full list of publications by our Research Analyst, Dr Anna Good is available for download here: publications-dr-anna-good2-3, or you may view our psychometric factsheets and development reports here
Search our library of articles, publications, studies and reports about the Outcomes Stars by filtering by Star and/or by theme. If you have any questions about researching the Star please contact us.
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“The development of the Outcomes Star: A participatory approach to assessment and outcome measurement” (Full document)
This peer-reviewed, prize-winning article describes the theoretical underpinnings of the Outcomes Star and the development process used for all versions of the Star. This process, is driven by the needs of service delivery organisations to have practical tools for supporting and measuring change. Each new Star undergoes a very thorough process of testing and revision involving front-line staff, managers and service users.
DownloadMacKeith, J. (2011). The development of the Outcomes Star: a participatory approach to assessment and outcome measurement. Housing, Care and Support, 14(3), 98-106.
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“Putting evaluations to use: from measuring to endorsing social value” (Full document)
This working paper emphasises that the Outcomes Star ‘ideally facilitates the interaction between counsellor and client’ and ‘not only measures outcomes, but is instrumental in helping the desired outcomes to be achieved’. It also discusses the values underlying the Outcomes Star, including ‘the reversal of roles underlined by power and knowledge, usually represented in evaluations by the powerful funder, the mediating evaluator, and a less powerful service user.’
DownloadArvidson, M., & Kara, H. (2013). Putting evaluations to use: from measuring to endorsing social value. Working Paper. Third Sector Research Centre (TSRC), Birmingham.
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“Using Outcomes Star data: Report of our roundtable” by Triangle (Full document)
DownloadThis report documents a seminar in which six organisations using different versions of the Outcomes Star to share their experience of analysing Star data. The report sets out the benefits the organisations had found in using the data and the challenges they faced.
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“Assessing the reliability of the Outcomes Star in research and practice” (Full document)
This peer-reviewed paper describes Triangle’s case study approach to demonstrating inter-rater reliability and provides initial findings for the Family Star (first edition) using a sample of 24 trained workers. The inter-rater reliability reached the accepted threshold of 0.8 for the five-point Journey of Change when three outlying workers were excluded. Following the publication of this article, Triangle found very similar results when re-analysing the data using a chance-corrected reliability statistic.
DownloadMackeith, J. (2014). Assessing the reliability of the Outcomes Star in research and practice. Housing, Care and Support, 17(4), 188-197.
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York Consulting Evaluation of Family Action’s implementation of the Family Star (Full document)
York Consulting evaluated the implementation of the Family Star within Family Action involving the analysis of more than 3000 Stars, interviews with service users and staff across four locations, and interviews with commissioners and Family Action’s management. They concluded that the Star helped develop service users’ resilience and helped workers reflect on their practice, particularly in terms of improving outcomes and that Family Star data can provide valuable insights into the extent and nature of changes occurring, as well as highlighting areas for further investigation.
DownloadYork Consulting (2013). Family Action Family Star Evaluation: Summary Report. Family Action website www.family-action.org.uk.
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“Assessing the value of existing recovery measures for routine use in Australian mental health services” (Abstract only)
A hierarchical criterion based approach was used to evaluate which of 22 instruments of individual’s mental health recovery might be candidates for measuring recovery in the Australian context. Only four tools were identified as promising candidates for routine use in Australian public sector mental health services: Recovery Assessment Scale; Illness Management and Recovery Scales; Stages of Recovery Instrument; and the Recovery Process Inventory. At the time of this study, The Recovery Star was classified as ‘never subject to scientific scrutiny in a peer-reviewed article’, so it was not considered on the remaining criteria.
ViewBurgess, P., Pirkis, J., Coombs, T., & Rosen, A. (2011). Assessing the value of existing recovery measures for routine use in Australian mental health services. Australian and New Zealand Journal of Psychiatry, 45(4), 267-280.
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“Recovery Star: validating user recovery” (Full document)
This study explored the psychometric properties of the Recovery Star using data from 203 adults attending mental health services. The Recovery Star was found to have high internal consistency, a two-factor structure and appeared to measure underlying recovery-oriented construct. The items were responsive to change with statistically significant improvement over time. Correlations between items confirmed little item redundancy. The authors conclude that the ‘Recovery Star has been received enthusiastically by both mental health service providers and service users. This study provides further evidence for its adoption in recovery-focused mental health services’.
DownloadDickens, G., Weleminsky, J., Onifade, Y., & Sugarman, P. (2012). Recovery Star: validating user recovery. The Psychiatrist, 36(2), 45-50.
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“Implementing a patient centred recovery approach in a secure learning disabilities service” (Abstract only)
This article describes the benefits of implementing the Recovery Star approach in a secure learning disabilities service. Key workers found that the tool ‘opened up avenues for discussing topics covered in the domains of the Recovery Star tool which may otherwise have not been discussed as fully’. They concluded that ‘the Recovery Star tool, embedded in a care programme approach process, equips patients and staff for measuring the recovery journey”.
ViewEsan, F., Case, K., Louis, J., Kirby, J., Cheshire, L., Keefe, J., & Petty, M. (2012). Implementing a patient centred recovery approach in a secure learning disabilities service. Journal of Learning Disabilities and Offending Behaviour, 3(1), 24-35.
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“Enhancing recovery: transition intervention service” (Abstract only)
This study demonstrates the responsiveness of the Recovery Star in a transitional intervention service facilitating return to community following mental health crisis. Recovery Star and personal goal achievement data was collected at service entry and exit (181 service users), at four sites in England. There was a significant increase in overall Recovery Star scores with a large effect size, and significant increases in eight of the ten Recovery Star life domains. There were significant increases in the goal scores linked to “Managing mental health”, “Self-care” and “Living skills”.
ViewGriffiths, C. A., Heinkel, S., & Dock, B. (2015). Enhancing recovery: transition intervention service for return to the community following exit from an alternative to psychiatric inpatient admission–a residential recovery house. The Journal of Mental Health Training, Education and Practice, 10(1), 39-50.
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“Psychometric properties of the Mental Health Recovery Star” (Full document)
The Recovery Star had good acceptability, test-retest reliability and convergent validity between social domains of the Star and a well-established, standardised measure of social functioning. Service user only readings did not converge with the Mental Health Recovery Measure (MHRM; Young & Bullock, 2003), however the MHRM has been described as ‘containing items that are not consistent with the definition of psychological recovery’ (Anderson et al. 2006) and it is recommended that the Star completed collaboratively with service users. There was relatively poor convergence between worker-only Star readings, which emphasises the importance of staff and service-users collaborating to produce accurate scores. Several critiques of this article have been published.
ViewKillaspy, H., White, S., Taylor, T. L., & King, M. (2012). Psychometric properties of the Mental Health Recovery Star. The British Journal of Psychiatry, 201(1), 65-70.
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“Supporting recovery: Evaluation of routinely collected outcome data” (Abstract only)
This study showed significant increases in Recovery Star scores and achievement of personal goals from entry to exit of a crisis house. Recovery Star and personal goal scoring data were for 722 services users. There were statistically significant increases in all Recovery Star domains. The authors note that the findings ‘highlight the value of using recovery-oriented support planning and outcome capture tools in routine practice’.
ViewLarsen, J., & Griffiths, C. (2013). Supporting recovery in a third sector alternative to psychiatric hospital admission: evaluation of routinely collected outcome data. The Journal of Mental Health Training, Education and Practice, 8(3), 116-125.
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“Using the Mental Health Recovery Star as an outcome measure” (Abstract only)
This is a review of the utility of the Mental Health Recovery Star as a clinical outcome measure. Service users at a Mental Health Recovery Service in Queensland, Australia completed the Recovery Star. Service users identified that they needed assistance in work, social networks, managing mental health and identity and self-esteem. The review concluded that the Recovery Star was ‘useful in service mapping and assisting recovery clinicians to identify areas that they needed to focus on when providing treatment and following service user's progress. It complemented other outcome measures used by the service.’
ViewLloyd, C., Williams, P. L., Machingura, T., & Tse, S. (2015). A focus on recovery: using the Mental Health Recovery Star as an outcome measure. Advances in Mental Health, 1-8.
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“Routine mental health outcome measurement in the UK” (Abstract only)
A short history of routine clinical outcomes measurement (RCOM) in UK mental health services. The authors note that ‘one of the issues of patient reported outcome measures is the degree with which, although completed by service users, they address actual concerns of service users…as opposed to those of clinicians, managers, service providers and governments. The Mental Health Recovery Star is designed with this in mind’. The review also states that ‘experience by United Kingdom Routine Clinical Outcomes Measurement in Mental Health Network (UKRCOM) members suggests that it is a useful tool for a collaborative approach to care planning and perhaps outcomes measurement.’
ViewMacdonald, A. J., & Fugard, A. J. (2015). Routine mental health outcome measurement in the UK. International Review of Psychiatry, 27, 4, 1-14.
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“The experience of recovery from the perspective of people with common mental health problems” (Abstract only)
This study demonstrates that the Recovery Star is responsive to change. Service users completed the Recovery Star before and after sessions with a Psychological Wellbeing Practitioner. For the three biggest areas of change, service users were asked, ‘‘What difference has this change made to your life?’’ There was improvement across all areas of the Star, with the biggest improvement in the managing mental health area.
ViewMcEvoy, P., Schauman, O., Mansell, W., & Morris, L. (2012). The experience of recovery from the perspective of people with common mental health problems: Findings from a telephone survey. International journal of nursing studies, 49(11), 1375-1382.
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“An overview of the Mental Health Recovery Star” (Full document)
A description of the origin, development and increasing application of the Recovery Star within the UK. It was found that the Recovery Star has been instrumental in promoting social inclusion for many service users, their carers and families. The Recovery Star has rapidly established itself as the recovery tool of choice for many service users and providers and fits in well with the personalisation agenda.
DownloadOnifade (2011) The mental health recovery star. Mental Health and Social Inclusion, Vol. 15 Iss: 2, pp.78 – 87
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“Professionals’ perception of the Mental Health Recovery Star” (Abstract only)
This paper recognises that the Mental Health Recovery Star (MHRS) has received focus at a national policy level and reports the views of 12 mental health professionals about its use within clinical practice. The tool was considered useful for informing care planning and gathering new information (e.g. the wider context of mental health difficulties). The collaborative nature of completing the Recovery Star was valued and service users had given positive feedback about their experience of the Star. It was also emphasised that it is beneficial to have a good relationship with service users before completing the first Star.
ViewTickle, A., Cheung, N., & Walker, C. (2013). Professionals’ perceptions of the Mental Health Recovery Star. Mental Health Review Journal, 18(4), 194-203.
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“Brief Group Psychotherapy for Eating Disorders (Chapter 10) (Full document)
The Recovery Star model was used as a guide for discussion in group work sessions in residential programmes for anorexia nervosa. Patients brainstormed skills and issues associated with each area of the Recovery Star and also self-completed the Star. Group therapy based on the Recovery Star was an important component of treatment. The authors ethos of the residential treatment programme for Anorexia Nervosa was ‘epitomised in the Recovery Star model’.
ViewTchanturia & Baillie (2015) Brief Group Psychotherapy for Eating Disorders: Inpatient Protocols edited by Kate Tchanturia (Chapter 10)
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“Exploring the use of the Outcomes Star” (Full document)
In this doctoral theses, a literature review examined the utility of the Recovery Star and similar instruments in recovery oriented mental health services. Preliminary findings were that the Outcome Star is effective in monitoring and facilitating change. The Outcome Star was found to possess many of the aspects of recovery model: empowering clients to make change, seek supportive environments, promote inclusion, meaning and importance in relationships. The author concluded that “it is possible that the Outcome Star will become adopted by many recovery orientated mental health services’.
DownloadKeen (2010). The Outcome Star: A tool for recovery orientated services; and, Exploring the use of the Outcome Star in a Recovery Orientated Mental Health Service.
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“Report of a research seminar on the Recovery Star” (Full document)
DownloadThis report documents a seminar in which six UK academics, three service providers and one service user came together to share ideas and expertise around the academic studies that have been carried out on the Recovery Star and set the research agenda going forward. The report sets out key conclusions on the validity of the tool and actions to take knowledge forward.
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“Implementing the Recovery Star at Southside” (Full document)
DownloadSouthside Partnership and the Mental Health Providers Forum (MHPF) undertook a piece of action research in which a Recovery Star Project Coordinator worked with 15 services within Southside to support implementation of the Recovery Star and evaluate the impact of using the Star. The report was published by MHPF in 2009 and found positive impacts on service users, frontline staff and managers.
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“Clinicians’ views about rehabilitation and recovery: Care planning and practices” (Full document)
This multi-component service evaluation project focused on questions about the importance of the Recovery Star domains for care planning, and the perceived impact of current treatment practices on these recovery domains. The researchers concluded that ‘the ten domains extracted from the Mental Health Recovery Star appear to provide a useful basis for examining recovery (at both an individual and a service level)’.
DownloadLewin, T. J., Sly, K. A., Conrad, A. M., Frost, B., Rajkumar, S., Petrovic, K., & Srinivasan, T. (2009). CLINICIANS’ VIEWS ABOUT REHABILITATION AND RECOVERY: CARE PLANNING AND PRACTICES.
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“Cultural competency of the Recovery Star” (Full document)
DownloadAn evaluation of the effectiveness of the Recovery Star for people from black and minority ethnic backgrounds. The Recovery Star was considered to be a valuable part of key-working sessions by the majority of service users, and most areas on the Star were seen to have cross-cultural relevance. The research showed that improvements could be made by providing further acknowledgement of the cultural practices that shape and impact on the lived experience of mental ill health and as a result of this study a second edition of the Recovery Star was published which addressed the specific issues highlighted in the study.
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“Can Health Trainers make a difference with difficult to engage clients?” (Abstract only)
A peer-reviewed article. The Homelessness Star was completed by prisoners at beginning and end of a training programme delivered by Health Trainers. There was improvement in all areas except alcohol and family relations. Attitudes to alcohol use stayed positive and constant because they were unable to obtain alcohol. Family relations were reported more negatively after the training because it helped them understand that their criminal behaviour had been influenced by damaging family relationships. To conclude, this study demonstrates that the Homelessness Star is responsive to change in key areas.
ViewBailey, D., & Kerlin, L. (2015). Can Health Trainers Make a Difference With Difficult-to-Engage Clients? A Multisite Case Study. Health promotion practice, 16, 5, 756-764.
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“Findings from the Making Every Adult Matter service pilots” (Full document)
This peer-reviewed study looked at changes in wellbeing and use and cost of wider local services (police, health, housing etc.) within the Making Every Adult Matter (MEAM) service pilots. The Homelessness Star was completed by 39 clients, with an average period of nine months between initial and final measurements. There were significant improvements in wellbeing for nearly all clients across three quantitative measures (including the Homelessness Star). The evaluation also recorded changes in the use and cost of local services. In Cambridgeshire, the reduction in crime costs (£100,000 or 31 percent) was large enough to lead to an overall cost reduction.
DownloadBattrick, T., Hilbery, O., & Holloway, S. (2013). Findings from the Making Every Adult Matter (MEAM) service pilots: a summary paper. Advances in Dual Diagnosis, 6(2), 66-75.
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“Single point of access to third sector services: the Conwy collaborative approach” (Full document)
A peer-reviewed article. An evaluation of a multi-agency project aimed at improving services from the third sector to support health and social care needs. The majority of the 100 patients saw significant improvements in most areas of the Homelessness Star Outcomes Star. The only areas with little improvement were drug and alcohol (which was not an area of great need in this client group), and accommodation.
DownloadDickinson, H., & Neal, C. (2011). Single point of access to third sector services: the Conwy collaborative approach. Journal of Integrated Care, 19(2), 37-48.
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“An interventional study of guiding homeless persons to self-reliance using the Outcomes Star” (Full document)
A peer-reviewed article. The Homelessness Star was used with 15 men in a homeless shelter over a 6-week period. Each participant chose two domains on which to focus their change efforts. The study found that participants demonstrated statistically significant change. The authors conclude that the tool is effective in guiding homeless people towards self-reliance and could “change the face of the way that shelters provide and share care with the homeless population.”
DownloadPetersen, V. A., Ellis, P., Lorenz, R., & Armbrecht, E. (2014). An Interventional Study of Guiding Homeless Persons to Self-Reliance Using the Outcomes Star™ for Homelessness. Clinical Scholars Review, 7(1), 30-41.
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“Coaching desistance? Life coaching for offenders in a ‘who works’ environment” (Full document)
A peer-reviewed article. An evaluation of a life coaching programme (Coaching Inside and Out; (CIAO) for offenders using the Outcomes Star. The change on the Outcomes Star was ‘impressive, showing positive movement in the average scores across all areas, most pronounced in motivation/ responsibility and emotional and mental health’. The movement in the lowest scores was particularly good - in all areas bar one (accommodation), this was 1 or 2 at the start of coaching, rising to at least 5 (conscious desire for change).
DownloadSmyth, G. (2014). Coaching desistance? Life coaching for offenders in a ‘who works’ environment. Probation Journal, 61(4), 365-380.
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“The Outcomes Star: Supporting change in homelessness and related services” (Full document)
All 25 organisations included in this evaluation reported that key-work had improved as a result of using the Outcomes Star; that key-work had become more focused on service user change, more systematic and consistent and covered a wider range of issues than before the Outcomes Star was used; and those organisations that analysed the data that they collected found that the data was helpful in assessing the effectiveness of the service and identifying areas for improvement.
DownloadBurns, S., Graham, K., & MacKeith, J. (2008). The Outcomes Star: Supporting change in homelessness and related services. Homeless Link.
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“Implementing the Outcomes Star well in a multi-disciplinary environment” (Full document)
This article reports on an in-depth action research study of the implementation of the Homelessness, Drug & Alcohol and Empowerment Star within St Kilda’s Crisis Support Network in Australia. The report identifies 20 benefits to the project of using the Star at organisation, programme, practitioner and client level and concludes that the Star provides a unique innovation in human service delivery.
DownloadHarris, L., & Andrews, S. (2013). Implementing the Outcomes Star well in a multi-disciplinary environment. RMIT University, published by The Salvation Army, Crisis Services Network, Victoria, Australia
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“Meeting the psychological and emotional needs of homeless people” (Abstract only)
This article supports the person-centred approach of the Homelessness Star. The authors state that: ‘current advice suggests that supportive and collaborative relations with the client are more effective than technical or coercive interventions. This supports the experiences of many housing resettlement staff that user-defined outcomes are the strongest basis on which to build. Use of person-centred approaches such as the ‘Outcomes Star’ can give this a specific focus’.
ViewMaguire, N., Johnson, R., Vostanis, P., & Keats, H. (2010). Meeting the psychological and emotional needs of homeless people. National Mental Health Development Unit Website.
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“Measuring Member engagement” (Full document)
This article reviews measures of member engagement. In relation to the Outcomes Star, the author notes that ‘expectations at each of the points on each scale are clearly defined… The flexibility of this approach allows different stakeholders to contribute their own perspectives to the evaluation, which, in turn, allows different questions to be answered for different people….’ They conclude that ‘The Outcomes Star is a useful tool for self-evaluation.’
DownloadSimmons, R. (2015) Measuring Member Engagement: Building A Model OF Change? CO-OPERATIVES FOR SUSTAINABLE COMMUNITIES, 239.
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“3 Dimensions of Care for Diabetes” (Abstract only)
A peer-reviewed article. The responsiveness of the Well-being Star is demonstrated in this evaluation of 3DFD (3 Dimensions of Care for Diabetes) – a service for improving glycaemic control and reducing diabetes complications in South London’s multi-ethnic, disadvantaged diabetes population. The service produced improvements in glycaemic control, psychological status (including significant change on the Well-being Star) and health service use.
ViewDoherty, A. M., Gayle, C., & Ismail, K. (2015). 3 Dimensions of Care for Diabetes: integrating diabetes care into an individual's world. Practical Diabetes, 32(9), 345-349.
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“Implementing a psychologically informed environment in a service for homeless young people” (Abstract only)
This peer-reviewed article describes how a youth homelessness service (‘1625’) implemented the conceptual ideas of the psychologically informed environment (PIE) into a practical and beneficial service for very challenging young people who have been homeless, are leaving care or have left custody. The author’s note that the Young Person’s Outcomes Star is ‘embedded in the organization and provides a valuable tool for evaluation and measurement of outcomes’.
ViewWoodcock, J., & Gill, J. (2014). Implementing a psychologically informed environment in a service for homeless young people. Housing, Care and Support, 17(1), 48-57.
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“Piloting the Spectrum Star at the Northern Trust” (Full document)
DownloadThis report concluded that the Spectrum Star is "a very useful tool to use with young people with ASD, given its holistic and visual approach to the assessment" and that it "empowers young people to make decisions with regards to intervention, while still including parents/carers at the action planning stage." The Star was recommended as a "valuable tool to implement into service delivery within the Paediatric ASD Service.”
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“Piloting the Life Star at the Grange Centre for people with learning disabilities” (Full document)
DownloadA study of 12 pairs of keyworker and service user experience of using the Life Star found that "clients enjoyed the experience of talking about various areas of their life", and that the "Journey of Change appeared to resonate with the experience of participants." Workers found the Life Star conversations helpful in understanding their clients and that it complimented and accentuated the existing Person-Centred approach. In addition, the study found that "the Life Star's emphasis on collaboration promotes more choice and control for the client, which ultimately leads to empowerment." There was a degree of scepticism around data privacy and use, highlighting the importance of clear communication and engagement with staff and service users when implementing the Star.
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“Developing a common approach to supporting young people towards employment: piloting the Work Star at Hounslow” (Full document)
DownloadThe final report of a project evaluating the use of the Work Star with vulnerable 16+ young adults across 6 services including the Connexions team and local, partner organisations. The study found that feedback from partners involved the pilot was “overwhelmingly positive,” with particularly strong endorsements for the way the Work Star created “a consistent approach within and between organisations in how we describe where particular clients are on their journey towards employment” and the opportunities it gives for “line managers to systematically review case work and engage in outcome-focused discussions during supervisions linked to specific casework.”
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“Autism and Enablement: Occupational Therapy Approaches to Promote Independence for Adults with Autism” (book)
The Spectrum Star was used as a keywork and outcomes tool within a 12-week specialist Enablement intervention. The majority (83%) of participants made progress in every area and all participants progressed in at least one area. The Star readings suggested that improvements in some areas can increase after finishing the intervention. It was concluded that Spectrum Star is useful in helping people with autism to understand their condition, and in informing decisions about the outcomes individuals want to achieve. The authors recommend the Spectrum Star to others, and state that it provides ‘a fuller and more personalised assessment than any Standard Care Act 2014 template’.
Triangle conducted additional analyses on data from this intervention and found correlations between Star readings, the Rosenberg self-esteem scale and baseline costs to the service.
ViewBushell, M., Gasson, S., & Vann, U. (2017). Autism and Enablement: Occupational Therapy Approaches to Promote Independence for Adults with Autism. Jessica Kingsley Publishers.
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“The Mental Health Recovery Star: Validation study and features of the Italian version” (Full article)
This study evaluated the acceptability and psychometric properties (convergent validity, test-retest reliability and inter-rater reliability) of the Italian version of the Mental Health Recovery Star (MHRS).Convergent validity was assessed by examining readings on MHRS scales and the relevant scales of other validated tools: the Health of the Nation Outcome Scales (HoNOS), World Health Organisation Quality of Life-BREF (WHOQoL-B) and Global Assessment of Functioning (GAF). Temporal stability was tested by 117 service users completing the MHRS two months apart. Finally, inter-rater reliability was examined by 42 keyworkers giving readings for a clinical case, which was described and discussed at the end of a training session.
Service users and keyworkers perceived the Recovery Star as acceptable and easy to use. Convergent validity was demonstrated and there was good test-retest reliability for all areas of the Star. Cohen's kappa coefficient was calculated as a measure of inter-rater reliability and all pairs reached acceptable levels of at least 0.70. The authors note that using a larger number of case studies would have made the finding more generalisable*.
* Placentino and colleagues refer to Killaspy et al. (2012), in which keyworkers assessed 85 service users, but since these readings were taken without collaboration with service users or using a written case study, we cannot know what information was being used by each keyworker and it is likely that they were missing important information upon which to base their readings. These and other limitations of Killapsy et al.’s method are discussed in letters published in the British Journal of Psychiatry (e.g. MacKeith, 2012).
DownloadPlacentino, A., Lucchi, F., Scarsato, G., & Fazzari, G. (2017). Rivista di Psichiatria, 52(6), 247-254.
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Outcomes Star™ Psychometric Factsheet: Alcohol Star™
This factsheet shows the psychometric tests completed by Triangle for this version of the Outcomes Star. These tests include:
· Factor analysis
· Internal consistency
· Item redundancy
· ResponsivenessDownloadGood, A. & Lamont, E. (2019). Outcomes Star™ Psychometric Factsheet: Alcohol Star™. Triangle Consulting Social Enterprise Ltd
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Outcomes Star™ Psychometric Factsheet: Independent Living Star™
This factsheet shows the psychometric tests completed by Triangle for this version of the Outcomes Star. These tests include:
· Factor analysis
· Internal consistency
· Item redundancy
· ResponsivenessDownloadGood, A. & Lamont, E. (2019). Outcomes Star™ Psychometric Factsheet: Independent living Star™. Triangle Consulting Social Enterprise Ltd
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Outcomes Star™ Psychometric Factsheet: Work Star™ 2nd Ed
This factsheet shows the psychometric tests completed by Triangle for this version of the Outcomes Star. These tests include:
· Factor analysis
· Internal consistency
· Item redundancy
· ResponsivenessDownloadGood, A. & Lamont, E. (2019). Outcomes Star™ Psychometric Factsheet: Work Star™. Triangle Consulting Social Enterprise Ltd
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Outcomes Star™ Psychometric Factsheet: Attention Star
This factsheet shows the psychometric tests completed by Triangle for this version of the Outcomes Star. These tests include:
· Factor analysis
· Internal consistency
· Item redundancy
· ResponsivenessDownloadGood, A. & Lamont, E. (2019). Outcomes Star™ Psychometric Factsheet: Attention Star™. Triangle Consulting Social Enterprise Ltd
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Outcomes Star™ Psychometric Factsheet: Independence Star™
This factsheet shows the psychometric tests completed by Triangle for this version of the Outcomes Star. These tests include:
· Factor analysis
· Internal consistency
· Item redundancy
· ResponsivenessDownloadGood, A. & Lamont, E. (2019). Outcomes Star™ Psychometric Factsheet: Independence Star™. Triangle Consulting Social Enterprise Ltd
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Outcomes Star™ Psychometric Factsheet: Student Star™
This factsheet shows the psychometric tests completed by Triangle for this version of the Outcomes Star. These tests include:
· Factor analysis
· Internal consistency
· Item redundancy
· ResponsivenessDownloadGood, A. & Lamont, E. (2019). Outcomes Star™ Psychometric Factsheet: Student Star™. Triangle Consulting Social Enterprise Ltd
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Outcomes Star™ Psychometric Factsheet: Sexual Health Star™
This factsheet shows the psychometric tests completed by Triangle for this version of the Outcomes Star. These tests include:
· Factor analysis
· Internal consistency
· Item redundancy
· ResponsivenessDownloadGood, A. & Lamont, E. (2019). Outcomes Star™ Psychometric Factsheet: Sexual health Star™. Triangle Consulting Social Enterprise Ltd
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Outcomes Star™ Psychometric Factsheet: Family Star™
This factsheet shows the psychometric tests completed by Triangle for this version of the Outcomes Star. These tests include:
· Factor analysis
· Internal consistency
· Item redundancy
· ResponsivenessDownloadGood, A. & Lamont, E. (2019). Outcomes Star™ Psychometric Factsheet: Family Star™. Triangle Consulting Social Enterprise Ltd
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Outcomes Star™ Psychometric Factsheet: Family Star™ Early years
This factsheet shows the psychometric tests completed by Triangle for this version of the Outcomes Star. These tests include:
· Factor analysis
· Internal consistency
· Item redundancy
· ResponsivenessDownloadGood, A. & Lamont, E. (2019). Outcomes Star™ Psychometric Factsheet: Family Star™ Early years. Triangle Consulting Social Enterprise Ltd
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Outcomes Star™ Psychometric Factsheet: VIP Star™
This factsheet shows the psychometric tests completed by Triangle for this version of the Outcomes Star. These tests include:
· Factor analysis
· Internal consistency
· Item redundancy
· ResponsivenessDownloadGood, A. & Lamont, E. (2019). Outcomes Star™ Psychometric Factsheet: VIP Star™. Triangle Consulting Social Enterprise Ltd
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Outcomes Star™ Psychometric Factsheet: Teen Star™
This factsheet shows the psychometric tests completed by Triangle for this version of the Outcomes Star. These tests include:
· Factor analysis
· Internal consistency
· Item redundancy
· ResponsivenessDownloadGood, A. & Lamont, E. (2019). Outcomes Star™ Psychometric Factsheet: Teen Star™. Triangle Consulting Social Enterprise Ltd
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Outcomes Star™ Psychometric Factsheet: Drug & Alcohol Star™
This factsheet shows the psychometric tests completed by Triangle for this version of the Outcomes Star. These tests include:
· Acceptability
· Factor analysis
· Internal consistency
· Item redundancy
· ResponsivenessDownloadGood, A. & Lamont, E. (2019). Outcomes Star™ Psychometric Factsheet: Drug & Alcohol Star™. Triangle Consulting Social Enterprise Ltd
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Outcomes Star™ Psychometric Factsheet: Life Star™
This factsheet shows the psychometric tests completed by Triangle for this version of the Outcomes Star. These tests include:
· Acceptability
· Factor analysis
· Internal consistency
· Item redundancy
· ResponsivenessDownloadGood, A. & Lamont, E. (2019). Outcomes Star™ Psychometric Factsheet: Life Star™. Triangle Consulting Social Enterprise Ltd
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Outcomes Star™ Psychometric Factsheet: My Star™
This factsheet shows the psychometric tests completed by Triangle for this version of the Outcomes Star. These tests include:
· Acceptability
· Factor analysis
· Internal consistency
· Item redundancy
· ResponsivenessDownloadGood, A. & Lamont, E. (2019). Outcomes Star™ Psychometric Factsheet: My Star™. Triangle Consulting Social Enterprise Ltd
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Outcomes Star™ Psychometric Factsheet: Older Person’s Star™
This factsheet shows the psychometric tests completed by Triangle for this version of the Outcomes Star. These tests include:
· Acceptability
· Factor analysis
· Internal consistency
· Item redundancy
· ResponsivenessDownloadGood, A. & Lamont, E. (2019). Outcomes Star™ Psychometric Factsheet: Older Person’s Star™. Triangle Consulting Social Enterprise Ltd
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Outcomes Star™ Psychometric Factsheet: Young Person’s Star™
This factsheet shows the psychometric tests completed by Triangle for this version of the Outcomes Star. These tests include:
· Acceptability
· Factor analysis
· Internal consistency
· Item redundancy
· ResponsivenessDownloadGood, A. & Lamont, E. (2019). Outcomes Star™ Psychometric Factsheet: Young Person’s Star™. Triangle Consulting Social Enterprise Ltd
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Outcomes Star™ Psychometric Factsheet: Youth Star™
This factsheet shows the psychometric tests completed by Triangle for this version of the Outcomes Star. These tests include:
· Acceptability
· Factor analysis
· Internal consistency
· Item redundancy
· ResponsivenessDownloadGood, A. & Lamont, E. (2019). Outcomes Star™ Psychometric Factsheet: Youth Star™. Triangle Consulting Social Enterprise Ltd
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Outcomes Star™ Psychometric Factsheet: Shooting Star™
This factsheet shows the psychometric tests completed by Triangle for this version of the Outcomes Star. These tests include:
· Acceptability
· Factor analysis
· Internal consistency
· Item redundancy
· ResponsivenessDownloadGood, A. & Lamont, E. (2019). Outcomes Star™ Psychometric Factsheet: Shooting Star™. Triangle Consulting Social Enterprise Ltd
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Outcomes Star™ Psychometric Factsheet: Tenancy Star™
This factsheet shows the psychometric tests completed by Triangle for this version of the Outcomes Star. These tests include:
· Acceptability
· Factor analysis
· Internal consistency
· Item redundancy
· ResponsivenessDownloadGood, A. & Lamont, E. (2019). Outcomes Star™ Psychometric Factsheet: Tenancy Star™. Triangle Consulting Social Enterprise Ltd
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Outcomes Star™ Psychometric Factsheet: Justice Star™
This factsheet shows the psychometric tests completed by Triangle for this version of the Outcomes Star. These tests include:
· Acceptability
· Factor analysis
· Internal consistency
· Item redundancy
· Responsiveness
· Inter-rater reliabilityDownloadGood, A. & Lamont, E. (2019). Outcomes Star™ Psychometric Factsheet: Justice Star™. Triangle Consulting Social Enterprise Ltd
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Outcomes Star™ Psychometric Factsheet: Carers Star™
This factsheet shows the psychometric tests completed by Triangle for this version of the Outcomes Star. These tests include:
· Acceptability
· Factor analysis
· Internal consistency
· Item redundancy
· Responsiveness
· Inter-rater reliabilityDownloadGood, A. & Lamont, E. (2019). Outcomes Star™ Psychometric Factsheet: Carers Star™. Triangle Consulting Social Enterprise Ltd
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Outcomes Star™ Psychometric Factsheet: Well-being Star™
This factsheet shows the psychometric tests completed by Triangle for this version of the Outcomes Star. These tests include:
· Factor analysis
· Internal consistency
· Item redundancy
· Responsiveness
· Inter-rater reliabilityDownloadGood, A. & Lamont, E. (2019). Outcomes Star™ Psychometric Factsheet: Well-being Star™. Triangle Consulting Social Enterprise Ltd
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Outcomes Star™ Psychometric Factsheet: Recovery Star™ 3rd Ed
This factsheet shows the psychometric tests completed by Triangle for this version of the Outcomes Star. These tests include:
· Factor analysis
· Internal consistency
· Item redundancy
· Responsiveness
· Inter-rater reliability
Predictive/convergent validityDownloadGood, A. & Lamont, E. (2019). Outcomes Star™ Psychometric Factsheet: Recovery Star™. Triangle Consulting Social Enterprise Ltd
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Outcomes Star™ Psychometric Factsheet: Homelessness Star™
This factsheet shows the psychometric tests completed by Triangle for this version of the Outcomes Star. These tests include:
· Factor analysis
· Internal consistency
· Item redundancy
· Responsiveness
· Inter-rater reliability
Predictive/convergent validityDownloadGood, A. & Lamont, E. (2019). Outcomes Star™ Psychometric Factsheet: Homelessness Star™. Triangle Consulting Social Enterprise Ltd
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The development of the Preparation Star
The Preparation Star has been developed to empower patients to share what is important to them when approaching end of life.
DownloadDr Anna Good and Sara Burns: Triangle Consulting Social Enterprise
Mark Stogdon, Trudi Leighton and Manjit Aujla-Starr: North London Hospice -
The development of the Parent and Baby Star
The Parent and Baby Star covers the critical first 1001 days of life, from conception to age 2, during which the foundations are laid for each baby’s physical, emotional and social development and long-term life chances – promoting the earliest of early intervention and prevention for babies and infants.
This poster describes the development process and results of the pilot.
DownloadDr Anna Good and Sara Burns: Triangle Consulting Social Enterprise
Mark Stogdon, Trudi Leighton and Manjit Aujla-Starr: North London Hospice -
New Mum Star development report
The New Mum Star has been developed for women as they prepare to be mums and after their baby is born. It is primarily designed to be used with first time young mums but can be used more broadly. This report describes the development process and the results of the pilot including psychometric validation.
DownloadJoy MacKeith and Sara Burns with Emily Lamont and Dr. Anna Good Triangle Consulting Social Enterprise Ltd
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Family Star (Relationships) development report
Family Star (Relationships) has been developed for parents, and others with a key parenting role, who need support to tackle disagreements in a healthy way.
DownloadJoy MacKeith and Sara Burns with Emily Lamont and Dr. Anna Good, Triangle Consulting Social Enterprise Ltd
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The Evaluation of the Early Intervention Support Service in Northern Ireland: A response from Triangle Consulting, creators of the Outcomes Star
Family Star Plus – validity as an outcomes tool: Researchers at Queen’s University Belfast published an evaluation of the Early Intervention Support Service (EISS) in Northern Ireland (Winter, Neeson, Sweet & Connolly, 2018). This service uses several versions of the Outcomes Star, and the report confirms previous findings that practitioners and families are very positive about the tool. The evaluation reports a good level of change shown using the Star despite the relatively short duration of the intervention. However, we wrote a response to address serious concerns that readers will be misled by the way in which the Outcomes Star has been described.
DownloadGood, A. & MacKeith, J. (2019).
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Integration Star Development Report
This report describes the development process for the Integration Star, including feedback from workers and service users and initial work supporting the psychometric properties of this version of the Star ( Factor structure, Internal consistency, Skew and Item redundancy).
DownloadJoy MacKeith and Sara Burns with Sandra Greaves and Dr. Anna Good Triangle Consulting Social Enterprise Ltd
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“Meitheal and Child and Family Support Networks Process and Outcomes Pilot Study. Galway: UNESCO Child and Family Research Centre, National University of Ireland Galway” (Full document)
In this process and outcomes pilot, the Outcomes Star scales were described as ‘easy to understand, with easy instructions and wording, a clear format, and age-appropriate’. Practitioners liked it even if they were aware that training for these scales was necessary and that it was more involved to complete than the other scales. Children and young people also provided positive feedback and liked their versions of the scales. After the pilot study was completed, it was decided that Family Star, Youth Star, and My Star would be used in the large Process and Outcomes Study.
DownloadRodriguez, L., Cassidy, A., & Devaney, C. (2018). Meitheal and Child and Family Support Networks Process and Outcomes Pilot Study.
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My Mind Star Development Report
This report describes the development process for the My Mind Star, including feedback from workers and service users and initial work supporting the psychometric properties of this version of the Star (Internal consistency, Factor structure, responsiveness, skew and Item redundancy).
DownloadJoy MacKeith, Sara Burns, Susie Goodbrand and Dr Anna Good, Triangle Consulting
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Justice Star Development Report
This report describes the development process for the Justice Star, including feedback from workers and service users and initial work supporting the psychometric properties of this version of the Star (Responsiveness, Internal consistency, Skew and Item redundancy).
DownloadJoy Mackeith and Sara Burns with Emily Lamont and Anna Good; Triangle Consulting Social Enterprise Ltd
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Pathway Star Development Report
This report describes the development process for the Pathway Star, including feedback from workers and service users and initial work supporting the psychometric properties of this version of the Star (Responsiveness, factor structure, Internal consistency, skew and Item redundancy).
DownloadJoy MacKeith and Sara Burns with Susie Goodbrand, Sandra Greaves and Dr Anna Good; Triangle Consulting Social Enterprise Ltd
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Planning Star Development Report
This report describes the development process for the Planning Star, including feedback from workers and service users and initial work supporting the psychometric properties of this version of the Star (Responsiveness, Internal consistency, Skew and Item redundancy).
DownloadJoy MacKeith, Sara Burns and Dr Anna Good with Sandra Greaves; Triangle Consulting Social Enterprise Ltd
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Support Stars Development Report
This report describes the development process for the Support Star (parents) and Support Star (young people), including feedback from workers and service users and initial work supporting the psychometric properties of this version of the Star (Internal consistency, Skew and Item redundancy).
DownloadJoy MacKeith, Sara Burns, Emily Lamont and Dr Anna Good; Triangle Consulting Social Enterprise Ltd
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Tenancy Star Development Report
This report describes the development process for the Tenancy Star, including feedback from workers and service users and initial work supporting the psychometric properties of this version of the Star (Responsiveness, Internal consistency, Skew and Item redundancy).
DownloadJoy MacKeith and Sara Burns with Emily Lamont and Dr Anna Good; Triangle Consulting Social Enterprise Ltd
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Salvation Army (Hong Kong): Evaluative Study on Support Service for Street Sleepers and underprivileged by using the “Outcome Star” Model’
This study compared outcomes for service users who completed the Homelessness Star versus standard care during support from the Salvation Army.
While the sample was small, there was some indication that outcomes were better for those completing the Homelessness Star:
• Anxiety reduced for those using the Star and increased for those not using the Star
• Social acceptance and social interaction outside of interaction with keyworkers increased for those using the Star and reduced for those not using the Star
• Financial management improved for those using the Star and worsened for those not using the Star
• The life satisfaction index (including exercise, personal hygiene, relaxation, communication etc.) increased for those using the Star and did not change for those not using the Star
Service users felt that the Homelessness Star helped them with goal setting, taking responsibility and taking action. They found it useful to review goals and progress on a regular basis. The care and respect of staff was seen as critical in implementing the Outcomes Star.
Staff reported the advantages of the Outcomes Star to be its strength-based approach, emphasizing motivation to change and taking responsibility and expressing where someone is ‘concisely with scores’. They appreciated the collaborative method and the motivational benefits of the small and feasible goals set using the Star and of visualizing progress. The report noted that the ‘comprehensive framework and mechanism of regular review also facilitated conducting continuous assessment on service users’. Staff noted that the Star provides and overall framework to understand the situation, but success depends on the professional skills of staff.
Service users and staff expressed some concerns that external factors such as economic structure and aging were insufficiently covered, and Triangle is committed to addressing this.Dr. Wong Hung and Dr. Wong Yu Cheung
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Outcomes Star™ Psychometric Factsheet: Support Star (Young People)™
This factsheet shows the psychometric tests completed by Triangle for this version of the Outcomes Star. These tests include:
· Factor analysis
· Internal consistency
· Item redundancy
· ResponsivenessDownloadGood, A. (2020). Outcomes Star™ Psychometric Factsheet: Support Star (Young People)™. Triangle Consulting Social Enterprise Ltd
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Outcomes Star™ Psychometric Factsheet: Support Star (Parents)™
This factsheet shows the psychometric tests completed by Triangle for this version of the Outcomes Star. These tests include:
· Factor analysis
· Internal consistency
· Item redundancy
· ResponsivenessDownloadGood, A. (2020); Triangle Consulting
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“Care pathways, engagement and outcomes associated with a recovery-oriented intermediate stay mental health program”
This study examined care pathways, engagement and key outcomes within a 6-week sub-acute inpatient program, which provided psychosocial interventions guided by and assessed using the Recovery Star.
There were significant improvements in self-reported overall symptom severity and on each Recovery Star outcome area. Over 60% of clients moved to a higher journey of change stage in at least two outcome areas, and these clients had a mean reduction of 4.24 in the number of pre-action recovery domains. This subgroup improving in at least two outcome areas showed better symptom management and functioning assessed using the Health of the Nation Outcome Scale (HoNOS). The authors concluded that a ‘clear strength was the collaborative use of the MHRS (in addition to other measures) to assess clients’ stage-of-change and functioning across ten recovery domains’ and findings ‘reinforce calls to target recovery-focused interventions based on client's needs, preparedness to engage, and stage-of-recovery’.ViewSly, K. A., Lewin, T. J., Frost, B. G., Tirupati, S., Turrell, M., & Conrad, A. M. (2020).
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“An evaluation of recovery in a forensic mental health service” (Abstract only)
This service evaluation aims to gain service users’ and staff members’ perspectives on one forensic mental health service’s approach to recovery; to provide feedback about awareness of recovery, what has worked well and what needs improving; and to ensure the service’s recovery action plan is shaped by and is responsive to the needs of those it affects. Surveys for staff and service users were developed and disseminated to all. The responses revealed positive outcomes in relation to the awareness of recovery and the use of the Mental Health Recovery Star tool at the service. Areas where there was a need for improvement were highlighted and have informed recommendations.
ViewMorgan, S., & Rees, S. (2019).
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“Implementation of a recovery-oriented model in a sub-acute Intermediate Stay Mental Health Unit (ISMHU)” (Full document)
This article reports on a service evaluation conducted on a targeted 6-week program within a sub-acute Intermediate Stay Mental Health Unit (ISMHU). Client needs and priorities were identified collaboratively using the Mental Health Recovery Star (MHRS). Marked improvements in MHRS Symptom management and functioning were identified, followed by Social-connection and Self-belief. This was accompanied by a mean reduction of 2.59 in the number of pre-action MHRS items from admission to discharge. Factor analysis was also conducted, and the authors concluded that ‘a single factor solution does a reasonably good job at accounting for variation among the item ratings (Cronbach’s α=0.88).
DownloadFrost, B. G., Turrell, M., Sly, K. A., Lewin, T. J., Conrad, A. M., Johnston, S., ... & Rajkumar, S. (2017).
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“An Integrated Recovery-oriented Model (IRM) for mental health services: evolution and challenges.” (Full document)
This paper recommends the MHRS as part of a comprehensive assessment plan. They authors state that: ‘collaborative measures such as the MHRS provide a framework and shared language for discussing pathways to recovery and wellbeing that may be employed across a range of service settings including clinical and non-clinical. The strength of this particular tool lies in its ability to connect with people with SMI in identifying need, developing individually tailored recovery and relapse prevention plans, and reflecting progress along the recovery journey’. They also note that marked improvement was seen in MHRS readings.
DownloadFrost, B. G., Tirupati, S., Johnston, S., Turrell, M., Lewin, T. J., Sly, K. A., & Conrad, A. M. (2017).
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“How do clients experience the alliance when working with the Mental Health Recovery Star in rehabilitation settings?” (Full document)
This thesis employed Grounded Theory Methods to explore the therapeutic alliance within the context of using the MHRS in rehabilitation mental health services. Semi-structured interviews were carried out with ten clients and four workers across three services. The findings are presented in a theoretical model that explains the core category that emerged from this study – “being engaged in working together towards improved wellbeing”. Working with the MHRS was seen to inform three particular alliance processes: collaborative working; negotiating new or shared perspectives; and motivation towards improved wellbeing. The findings also highlighted challenges that can hinder these processes when using the MHRS, calling for improvements in practices of negotiation and better support for workers. Further clinical implications alongside avenues for future research are discussed.
DownloadJoy-Johnson, L. (2016).
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“Assessing Family Functioning: Psychometric Evaluation of the Family Star Plus” (Abstract only)
This article examined the psychometric properties of the Family Star Plus. In phase 1, interrater reliability was assessed. Phase 2 established factor structure, internal consistency, item-redundancy and responsiveness; and in phase 3, the Family Star Plus was used to predict children’s unauthorized school absence. It was found that workers reliably applied Family Star Plus scales. A unidimensional factor structure was found with good internal consistency and responsiveness. School absence was predicted by the Family Star Plus. These findings demonstrate the validity of the Family Star Plus as a tool for assessing needs and measuring progress of family support interventions.
ViewGood, A. & MacKeith, J. (2020).
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“Befriending and Re-ablement Service: a better alternative in an age of austerity” (Full document)
This is an evaluation of the Befriending and Re-enablement Service (BARS) developed by Age Concern. The report was positive about the Older Person’s Star used in this context: ‘many new referrals found the Star useful in pinpointing their needs and aspirations. Age Concern Liverpool and Sefton felt that the Older Person’s Star helped them and the older person to understand their needs’.
DownloadMcGoldrick, C., Barrett, G. A., & Cook, I. (2017).
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“Advancing services for adult ADHD: the development of the ADHD Star as a framework for multidisciplinary interventions” (Full document)
This article describes the development of the ADHD Star. Following the methodology used in previous related research that utilises a Participatory Action Research approach, data was gathered from clinicians and service users on the domains of living in which they wish to create change, and the steps and end point of the change process. This data was utilised, alongside data gathered from previous research and policies, to develop the domains of assessment for the ADHD Star, and the scale on which change is assessed. The resulting tool, the ADHD Star, consists of eight domains: understanding your ADHD, focus and attention, organising yourself, friends and social life, thinking and reacting, physical health, how you feel and meaningful use of time. Each domain is rated on a five-point scale, the ‘ladder of change’, ranging from ‘stuck’ to ‘choice’. The ADHD Star offers a guiding framework for the development of care pathways and subsequent service provision for adults with ADHD, based on multi-disciplinary, holistic and person-centred care.
DownloadAdamou, M., Graham, K., MacKeith, J., Burns, S., & Emerson, L. M. (2016).
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“Psychometric validation of the Recovery Star” (Full document)
This report summarises the findings of seven peer reviewed articles plus Triangle’s own psychometric validation work conducted on the Recovery Star. Evidence is presented for Acceptability, Factor structure, Internal consistency, Convergent validity, Responsiveness, Test-retest reliability and inter-rater reliability.
DownloadGood, A. (2019)
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“Assessing the reliability and validity of an outcomes star” (Full document)
Sweet et al. report positive feedback about the Family Star Plus from practitioners and service users. They also report good internal consistency and many statistically significant correlations between Family Star Plus readings and validated measures. However, they describe as ‘concerning’, the finding that not all of the correlations between these measures and the Star reached statistical significance, the greater sensitivity of the Family Star Plus compared to other measures and the results of their Principal Components Analysis. As we discuss in a rebuttal article sent to the journal, it is in fact their interpretation of the findings – and the possible consequences of this, that is concerning. The article contains incorrect statements about Triangle's guidance and the existing evidence and there are major issues with the methodology and conclusions of the article.
DownloadSweet, D. Winter, K., Neeson, L. & Connolly, P. (2020)
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Support Stars Development Report
This report describes the development process for the Support Star (parents) and Support Star (young people), including feedback from workers and service users and initial work supporting the psychometric properties of these versions of the Star.
DownloadBurns, S., Greaves. S., MacKeith, J. & Good, A.
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Change Star Development Report
This report describes the development process for the Change Star, including feedback from workers and service users and initial work supporting the psychometric properties of this version of the Star.
DownloadSara Burns, Sandra Greaves, Joy MacKeith and Anna Good
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Development of the Recovery Star (4th edition)
This describes the development process of the Recovery Star including the 4th edition
DownloadAnna Good