Research Library

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.

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.’

This 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.

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.

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.

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.

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’.

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”.

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”.

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.

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’.

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.’

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.’

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.

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.

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.

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’.

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’.

This 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.

Southside 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.

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)’.

An 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.

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.

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.

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.

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.”

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).

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.

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.

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’.

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.’

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.

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’.

A 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. 

The 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.”

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).

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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 reliability

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 reliability

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

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 validity

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
· Convergent validity

Since these analyses were conducted, we have had a validation article for the Homelessness Star published in a peer reviewed journal (Good & Mackeith, 2021) – this article reports the relationship between Star readings and future outcomes (predictive validity).

The Preparation Star has been developed to empower patients to share what is important to them when approaching end of life.

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.

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.

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.

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).

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.

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).

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).

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).

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).

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).

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

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

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’.

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.

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).

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.

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.

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.

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’.

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.

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.

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.

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.

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.

This report describes the development process and the results of the pilot of the Gambling Recovery Star including psychometric validation.

• South Warwickshire NHS Trust conducted a review of health visitors use of the Parent and baby Star in their 0-5 public health service
• They were the first health visiting service to use the Parent and Baby Star nationally to support women with perinatal mental health
• The review examined parent and practitioner views on the Parent and Baby Star
• More than three quarters of practitioners felt that using the Star gave a clearer picture of the lived experience of the family.
• 80% of practitioners said that they would recommend the Parent and Baby Star to other health visiting services
• The majority of health visitors reported positive feedback on the Parent and Baby Star from the parents they worked with, including that it was well accepted and considered useful in identifying needs and progress
• Parents valued the focus on them rather than just on the baby

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

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

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

Psychometric factsheet Parent and Baby 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

A report detailing the research and information compiled during the development of the Planning Star: the Outcomes Star for use with unaccompanied asylum-seeking children.

In this study, routinely collected Homelessness Star data was provided by UK women’s centers offering holistic support to women involved with, or at risk of involvement with the criminal justice system. The analyses included assessing factor structure, internal consistency, item-redundancy, (N = 1703), responsiveness (n = 1307) and predictive validity (n = 175) of the Homelessness Star. A unidimensional factor structure was found with good internal consistency, no item redundancy, and an average effect size of r = .38 across outcome areas (range .28 to .44). Higher initial Homelessness Star readings were associated with later accommodation and employment status as well as a greater likelihood of attending education and training. Greater change in the Managing tenancy and accommodation outcome area was also associated with being more likely to transition from being homeless to having housing. These findings support the validity and reliability of the Homelessness Star as an outcomes measurement tool.

This report explored Outcomes Star and other data collected about 544 individuals with multiple disadvantages supported by the Fulfilling lives programme. Of particular interest were associations between Homelessness Star readings (baseline and 12 month follow-up) and a number of objective measures. These objective measures were 1) Experience of prison during the first three quarters of their engagement with the Fulfilling lives programme, 2) Homelessness, 3) Substance misuse, and 4) Offending.

Service users who had experienced prison had significantly lower baseline and follow-up overall Star readings, and there were statistically significant differences between those who had and had not been in prison on many of the individual outcome areas of the Homelessness Star:

• Those who had been in prison had lower baseline Star readings for the Drug and alcohol misuse, Physical health, Emotional and mental health, Meaningful use of time, Managing tenancy and accommodation and Offending outcome areas.

• Those who had been in prison also had lower 12-month follow up readings for Self-care and living skills, Social networks and relationships and Offending.

Homelessness and substance misuse and offending were also associated with significantly lower Star readings.

These findings support the meaningfulness of Star readings because they relate to objective or ‘hard’ measures in the expected direction.

This study evaluated a 6-week sub-acute inpatient intervention program for service users with a diagnosis of serious mental illness. Recovery data were collected on admission, at discharge, and at 3- and 6-months post-discharge using self-report, collaborative and clinical measures. The three clinician-rated measures (assessing therapeutic engagement, functioning, and life skills) revealed linear improvements from admission to 6-month follow-up as did the self-reported social connection measure (Mental Health Recovery Star, MHRS). There were also curvilinear improvements in self-determination and self-reported MHRS symptom management and functioning scores; however, only modest changes were detected in hope (Herth Hope Index) and MHRS self-belief scores. The study’s findings are encouraging, to the extent that they demonstrate recovery-focused sub-acute inpatient programs can promote clinical recovery and aspects of personal recovery.

The aims were to develop and validate a tool for monitoring and supporting the mental health of young people. Based on extensive experience of developing similar tools, the hypothesis was that a user-friendly tool could be produced with sound psychometric properties.

The Outcomes Star is a suite of collaboratively completed, strengths-based tools with the dual roles of both supporting and monitoring change. Service users are empowered through their active involvement in identifying their strengths and creating their care plan. Triangle, the creators of the Outcomes Star was approached by a number of organisations to develop a version of the Star for young people with mental health issues in early intervention services and also to support young people in managing a diagnosed mental illness.

Using a series of focus groups and an iterative process of refinement we gathered data from practitioners and service users on the domains in which they wish to create change, and the steps of the change process. A draft version of the new tool was piloted in two organisations by 67 workers and 177 young people over six months. The pilot data were analysed to assess the psychometric properties of My Mind Star (acceptability, skew, factor structure, internal consistency, item redundancy and responsiveness).

The resulting tool, My Mind Star consisted of seven domains: Feelings and emotions, Healthy lifestyle, Where you live, Friends and relationships, School, training and work, How you use your time and Self-esteem. Almost all young people and practitioners (94%) agreed that their completed Star was ‘a good summary of my life right now’ and that it gave a better idea of service users’ support needs. Psychometric analyses indicated a unidimensional structure with good internal consistency (α = .76) and no item redundancy. My Mind Star was responsive to change between the first and second readings, with medium and small-medium effect sizes.
Conclusion

Initial findings suggest that My Mind Star has good psychometric properties and is perceived as acceptable and useful by young people and practitioners, Further research is planned to conduct a full validation of the psychometric properties of this Star including inter-rater reliability and predictive validity.

Background The government is committed to increasing access
to palliative care that meets best-practice guidelines advocating
patient-centred and holistic support (Our commitment to you
for end of life care. The government response to the review of
choice in end of life care. Department of Health, 2016;
Siouta, van Beek, Preston, Hasselaar et al., 2016). The Preparation
Star was developed in response to this commitment,
and to calls within the palliative care sector for a tool to
empower patients to talk with professionals, family or support
workers about what is important for them and make plans
when approaching end of life.
Aims The development of the Preparation Star addressed the
need for a collaborative tool as identified above, particularly
in relation to psychosocial support needs. Specific aims were
to determine the outcome areas and the Journey of Change
describing movement in each area, and to conduct initial validation
work on the pilot version.
Methods A literature review informed the first focus group,
which included professionals from two hospices and two
organisations managing care homes. Scales were drafted and
discussed at a second focus group and refinements made
before piloting in the organisations. Patient feedback and pilot
data was discussed at two final focus groups before further
refinements.
Results The Preparation Star identified patients’ needs, with
91% reporting significant issues in at least one area. All
patients reported that completing the Preparation Star was
positive and 88% felt it provided a helpful picture of their
situation. It was completed most successfully in hospice outpatient
facilities with those not immediately facing end of life.
Internal consistency was good (a=0.79) and there was no
item redundancy.
Conclusions Initial findings suggest that the Preparation Star
has good psychometric properties and is perceived as acceptable
and useful. It may be best suited for use earlier in the
end of life pathway. Further research is planned to conduct a
full validation of the psychometric properties of this Star
including factor analysis and responsiveness.

This rebuttal explains why Sweet et al.’s assertions are not well founded and raise unsubstantiated doubt over the use of the Family Star Plus and the entire Outcomes Star suite of tools as outcomes measures.
Evidence is presented of flaws in the analysis, reporting and conclusions of an article published in this journal (Sweet et al., 2020).
Sweet et al. failed to mention a body of Outcomes Star validation work, including over 20 online reports and a manuscript they had seen of a now published article supporting the reliability and validity of the Family Star Plus (Good & MacKeith, 2020). There are significant issues with their methodology, presentation of results and conclusions including a) reliance on statistical significance with a small sample size, b) use of statistics not intended for ordinal data and c) inappropriate conclusions from convergence with measures conceptually different to the Family Star Plus.
Evidence is presented that the Family Star Plus is a useful and valid outcome measure and that Sweet et al.’s conclusions can be attributed to issues with their methodology and interpretation.

A service evaluation was undertaken to explore staff perspectives about the useful elements and barriers associated with using the Recovery Star (3rd edition). Semi-structured interviews were conducted with nine staff members in an inpatient rehabilitation service. It emerged that the Recovery Star was a helpful tool in this context, with many participants reporting that the Recovery Star was positive and person-centred, which was in keeping with the care they aimed to provide to patients. In particular, they appreciated how it focuses on the patient’s journey, facilitates conversations and realises potential. The Recovery Star was underused due to constraints such as lack of time, and other barriers such as the patients’ mental health and willingness to use the tool. Amendments to the tool were suggested. Since the evaluation was conducted, significant amendments to the Recovery Star have been made and a fourth edition has been published.

This study evaluated a “Recovery and Enablement Track” (RET) aiming to promote recovery and well-being, reduce distress and maintain independence from secondary care following discharge, for people with established psychosis and long histories of secondary care. The size of increase in Recovery Star scores comparing assessment with discharge was large (d = 0.93) and increase between midpoint review and discharge was medium (d = 0.52).

The aim of this study was to assess the effectiveness of a community-based complex mental health intervention within informal urban communities while simultaneously addressing social determinants of mental health among disadvantaged people with severe and common mental disorders and epilepsy. There was a statistically significant change between the 2 periods with increases in the Recovery Star and the Engagement index and decreases in PHQ9 and WHODAS 2.0.

Recovery orientated practice involves ‘helping people choose and work toward personal goals; helping people find meaningful occupations and build support networks; helping people gain skills to manage their everyday activities and their mental health; providing opportunities for sharing experiences with peers; encouraging positive risk-taking; developing self-esteem and
confidence; and validating people’s achievements’ (NICE, 2020). This qualitative research identified barriers and enablers to implementing this approach. The Recovery Star was highlighted as a helpful tool for enabling the implantation of recovery-orientated practice in community mental health provider organizations.

This comprehensive literature review (CLR) set out to determine the evidence for the Mental Health Recovery Star (MHRS) as an effective outcome measure for determining the functional progress of people experiencing mental illness, and the evidence-based strategies for the effective implementation of the MHRS in a community mental health service in Aotearoa New Zealand. The project involved using a Comprehensive Literature Review (CLR) methodology to source and analyse the literature, with an emphasis on published articles; inclusion of literature published in the last 10 years; studies that focused on the use of the MHRS and/or change management/implementation; and the inclusion of secondary/grey information sources (dissertations and thesis). Main results: Findings from the review confirmed that the MHRS was an effective outcome measure for determining the functional progress of people living with mental illness due to its established recovery model characteristics of being client-centered, collaborative and recovery-focused. The MHRS was also found to have robust psychometric properties that have great potential to enhance its effectiveness in practice. Conclusions or implications: The MHRS was found to be effective as an outcome measure for determining the functional progress of people living with mental illness.

Boholdt-Petersen and colleagues asked all patients admitted to a dual diagnosis ward to complete the Recovery Star alongside other validated measures. They found significant correlations in the expected directions with the Beck Depression inventory, the Beck Anxiety Inventory and the Robson Self-concept questionnaire.

This report describes the development process for the Little Star, including feedback from workers and service users and initial work supporting the psychometric properties of this version of the Star.

This report describes the development process for the Victim of Crime Star, including feedback from workers and service users and initial work supporting the psychometric properties of this version of the Star.

This report describes the development process for the Preparation Star, including feedback from workers and service users and initial work supporting the psychometric properties of this version of the Star.

This describes the development of the Homelessness Star and the subequent creation of the Home Star

Outcomes Star™ Psychometric Factsheet: Recovery Star (4th Edition)™

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

This quasi-experimental study used a pre-post intervention design examining outcomes (including ‘hard outcomes’) before and after the introduction of the Family Star Plus and My Star within family services in the Czech Republic. After the Star was implemented, more goals were formulated and achieved, fewer children were removed by court order, case management was longer and more services were accessed. The evaluators and social workers also identified numeroud benefits that the Star had for keywork.

Abstract This Comprehensive Literature Review set out to consider the evidence which underpins the Mental Health Recovery Star as an effective outcome measure for determining the functional progress of people experiencing mental illness. John Kotter’s evidence-based strategies for the implementation of change to practice were also reviewed.
Main results: Findings confirmed the Recovery Star to be effective due to its established recovery model characteristics of being client-centred, collaborative and recovery-focused and having robust psychometric properties. There was also evidence to support the successful use of John Kotter’s model for implementing practice change.

This factsheet shows the psychometric tests completed by Triangle for the Home Star. These tests include:
· Factor analysis
· Internal consistency
· Item redundancy
· Responsiveness

Outcomes Star™ Psychometric Factsheet: Alcohol Star™

This factsheet shows the psychometric tests completed by Triangle for the 4th Edition of the Mental Health Recovery Star. These tests include:
· Factor analysis
· Internal consistency
· Item redundancy
· Responsiveness

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

This report describes the development of the Family Star and Family Star Plus, including the new editions published in 2023. It includes details of the changes in the new editions, and research evidence suppoting comparability of data with the old editions.

This study evaluated the impact of ‘holistic’ link-workers on service users’ well-being, activation and frailty in Torbay and South Devon NHS Foundation Trust. The Well-being Star, PAM, WEMWBS and other measures were used before and after the 12-week intervention period. Statistically significant improvements were found on the Well-being Star and the other measures, with the Well-being Star showing the largest improvement and improvements in most outcome areas. This supports the responsiveness of the Well-being Star to change occurring within services.

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

This factsheet shows the psychometric tests completed by Triangle for the published version of the Pathway Star. These tests include:
· Factor analysis
· Internal consistency
· Item redundancy
· Responsiveness
-Known-groups validity

This report describes the development process for the Disaster Recovery Star, including feedback from workers and service users and initial work supporting the psychometric properties of this version of the 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

This factsheet shows the statistical analyses completed by Triangle to validate the published version of the New Mum Star. These tests include:
· Factor analysis
· Internal consistency
· Item redundancy
· Responsiveness

This factsheet shows the statistical analyses completed by Triangle to validate the published version of the Little Star. These tests include:
· Factor analysis
· Internal consistency
· Item redundancy
· Responsiveness

This factsheet shows the statistical analyses completed by Triangle to validate the published version of the Victim of Crime Star. These tests include:
· Factor analysis
· Internal consistency
· Item redundancy
· Responsiveness

This review of the Performance Evaluation Framework for Birmingham City Council’s Adult Social Care Prevention Portfolio describes the Star as a ‘critical element in the performance evaluation framework’ and recommends ‘that providers use an Outcomes Star to collect primary outcomes where possible and appropriate’. The authors note that a large number of providers were already using the Star and mapped the Homelessness, Empowerment and Young Person’s Stars onto their framework.

In this article, Sam Game describes the experience of being the first health visiting service in the UK to use the Outcomes Star. They conducted an audit of the experience of using the Parent and Baby Star one year after it was introduced. More than three quarters of health visitors reported that using the Star gave them a better picture of the lived experience of families, and that they would recommend the Star to other health visiting services. Health visitors also responded positively to open-ended questions – for example, one stated that ‘It helps parents to self-assess, which increases their confidence, breaks down barriers and aids further support being accepted’. Parents were also asked to give feedback, with one quote being: ‘It helped me feel I mattered, as it wasn’t all about the baby’. The article also showed how they used Star data, and concludes with their plans to expand their use of the Star.

Service users in a high secure mental health setting using the Recovery Star (Secure) were interviewed about their experiences, with the report noting benefits of the Star for keywork and recovery:
‘for some, the Recovery Star was an important vehicle for supporting positive relationships, providing a set of openings to focus on individual recovery, or to think about routine care in these terms. Receiving explanations for decisions was appreciated, this in the context of user involvement forum ‘You go from thinking ‘they’re taking everything away from us’ and we never get a say to having an explanation to take back to other patients’.(service user)…for those service users actively involved in developing the hospital’s programme of recovery work, there was a neat sense that this also contributed to personal recovery journeys: ‘I’ve been involved in Recovery Star meetings to develop the Recovery Star. I was part of the development group. We have tailored it for high secure ourselves. I feel proud that I’ve been involved in creating the Recovery Star – it’s a sense of achievement’. (service user)

The Family Impact Star has been developed for people affected by the addictive behaviour of a family member. This report describes the development process and the results of the pilot including psychometric validation.

A Case Study exploring the creative usage of Triangle Consulting’s Shooting Star with children and young people considered at risk of becoming involved in Serious Youth Violence in Manchester. Manchester is one of ten taskforces in England who were chosen to take part in this project; the Manchester SAFE Taskforce started in April 2022 with the first mentors starting into schools in January 2023.

A Case Study on Plymouth local authority's Start for Life – Family Hubs journey. The programme was launched in the local authority in 2022 as part of their Early Help offer following a consultation carried out with families and practitioners across the city between 2018 and spring 2020. The project was awarded government funding in the autumn of 2022 along with 75 other local authorities to develop ‘Family Hubs’ for children 0-19 (25 with SEND). This funding included a ‘Start for Life’ offer for families in the first 1001 days of baby’s life. The Family Star Plus was used as an integral part of the delivery of the programme.

Background: In the last decade, Italy has made progressed in adopting the personal recovery-oriented approach.
However, full adherence to international recommendations for implementation remains incomplete.
Aims: This study aimed to explore the feasibility, acceptability, and impact of integrating recovery-oriented
practices in an Italian Mental Health Service (MHS).
Methods: This pilot study used a longitudinal design with two focus groups. At baseline and follow-up data
collected was users’ socio-demographic and clinical characteristics, symptoms, functioning, needs for
care, functional autonomy. The Mental Health Recovery Star (MHRS) was used to facilitate and monitor
recovery. Professionals and users provided feedback using qualitative interviews. Descriptive analyses
were conducted.
Results: Nineteen professionals completed the MHRS with 25 users. From baseline to follow-up users showed an
increase in romantic relationship (p<0.001), employment (p<0.001) and addiction (p<0.001), and improvements in the MHRS (p=0.003), functioning (p=0.015), psychopathology (p=0.001), functional autonomy (p=0.003), along with a reduction of unmet needs (p=0.026). Focus groups witnessed active and consistent participation. Both professionals and users positively assessed the study, expressing a desire for more education on recovery, and, generally, saw improved satisfaction and recovery-oriented approaches from baseline to follow-up. Professionals reported higher motivation for work, while users reported comfort sharing views and greater involvement in care, despite some challenges with adherence and collaboration

This report describes the development process for the Discovery Star, including feedback from workers and service users and initial work supporting the psychometric properties of this version of the Star.

This factsheet shows the psychometric tests completed by Outcomes Star for the Spectrum Star. These tests include:
· Factor analysis
· Internal consistency
- Item redundancy
- Responsiveness
- Convergent validity