The Missing Middle Way: How Management by Results can help us not just measure, but also improve outcomes

Joy MacKeith argues that Payment by Results can cause as many problems as it addresses.  Management by Results, which supports ongoing learning and collaboration, is the missing middle way between ignoring outcomes on the one hand, and linking them to financial incentives on the other.

In early September I was privileged to participate in the fifth Social Outcomes Conference, organised by the Government Outcomes Lab at Oxford University. Contributions from both academics and practitioners from all over the world made for a very rich debate in which everyone had their eye on the prize of improving social outcomes.

The debate got me thinking about the limitations of Payment by Results and an alternative – an approach I am calling Management by Results.  This blogpost explains the difference between the two and how Management by Results has the potential to unlock performance improvement.

Why I am a fan of an outcomes approach

In the old days we didn’t measure outcomes.  We counted inputs and outputs.  We collected case studies.  Occasionally we commissioned evaluations or user surveys.  Then came the outcomes revolution.  I have been part of that revolution, spending much of the last 20 years helping organisations to measure their outcomes.

I am a fan because I have seen that defining, measuring, and managing outcomes enables service providers to create services with a clarity of purpose, identify issues and gaps, and ultimately improve what they deliver for service users. It undoubtedly is a good thing for organisations to focus on outcomes.

But what happens when financial imperatives are introduced into the equation?  What happens when a project or organisation’s survival becomes dependent on evidencing that they have achieved certain outcomes?

Why I’m wary of linking outcomes with financial incentives

In the employment sector where Payment by Results (PbR) has been in operation for some time the consequences are quite well documented (Hudson., Phillips, Ray, Vegeris & Davidson, 2010[1]).  Organisations can be incentivised to focus narrowly on the specific targets which are linked to payment and ignore everything else.

This can lead to a narrowing of their work with individuals (just making sure they get a job rather than working on longer-term issues such as addiction or mental health problems that are likely to impact on their ability to keep the job for example).  It can lead to short-termism with less focus on long-term impact and sustainability.  It can lead to ‘cherry picking’ of clients who are most likely to achieve the target (also called ‘creaming’) and not ‘wasting resources’ on those who are not likely to achieve the target within the timescale of the project (also known as ‘parking’).

The fact that there are widely used terms for these kinds of gaming practices reflects the fact that these perverse incentives are widely recognised and understood. In the financial sector Goodhart’s Law[1] that any financial indicator that is chosen by government as a means of regulation becomes unreliable is well accepted. In the words of the anthropologist Marilyn Strathern “When a measure becomes a target, it ceases to be a good measure”.[2]

In addition to this, there are other more subtle but nevertheless powerful impacts.  In Triangle’s work helping organisations to measure their outcomes we have seen time and again that when the impetus for this measurement is commissioner requirement, the organisation is likely to see outcomes as something that is done for the commissioner rather than something they own.

The result is that the quality of the data collected is poorer and the service provider just passes it on to the commissioner rather than mining this outcomes gold for learning and service development.  This is very unfortunate because sending outcomes information to commissioners doesn’t improve outcomes, whereas using it to better understand delivery does.

Another impact of PbR is that it focuses attention on the work of the service provider in isolation as opposed to looking at how the service delivery system as a whole is working. In practice often it is the network of service provision that achieves the outcome rather than a single provider.

Finally, in the market for social outcomes, providers find themselves in competitive rather than collaborative relationships, which can make system-wide cooperation and information sharing more difficult.

The missing middle way
There were several speakers at the recent GoLab conference who argued that financial incentives can work – if they are done well.  I am writing primarily from personal experience rather than extensive research and I trust that what they say is true.  I am also aware myself of PbR contracts and Social Impact Bonds that have been sensitively implemented with all parties understanding the risks and the funding mechanisms carefully designed to build the right incentives.

My concern is that too often the approach isn’t done well and also that the alternative of MbR is not recognised and considered.  In our enthusiasm to embrace outcomes we have gone from one extreme of not talking about or measuring outcomes at all, to the other extreme of linking payment to outcomes.  Between these two poles there is a middle ground – a third way which can unlock the potential of outcome measurement without so many of the downsides.

So what does Management by Results look like and how is it different from Payment by Results?

The Management by Results mindset
Both MbR and PbR involve identifying and measuring outcomes.  But in MbR the emphasis is on the service provider using this information in the management of the service to identify strengths, weaknesses and issues to be addressed.  Whereas in PbR the emphasis for the service provider is on using the information to secure the funding the organisation needs to survive.

For commissioners MbR means requiring the service provider to measure their outcomes and then drawing on that information to assess their performance.  But crucially in MbR the commissioner draws on other information as well and has room for judgement.  PbR is black and white.  Target achieved = good, payment made. Target not achieved = bad, no payment made.

MbR allows for greater subtlety and a more rounded assessment.  The commissioner looks at the data, but they also look at the organisation’s narrative about the data.  Is it a coherent narrative? Are they learning from their data and using the lessons to improve service delivery?  What do others say about the service?  What do you see if you visit and what do service users have to say?

The commissioner draws on all this information to make their assessment.  Of course, life would be a lot easier if you didn’t have to do this and could reduce a project’s effectiveness to a few numbers.

But you can’t.

There is always a wider picture, for example in the employment sector, what is happening in the service user’s personal life, what is happening in the local economy, what other services  the person is receiving and what impact are they are having. The numbers have a part to play but they are never the whole answer.

How Management by Results changes the questions and supports learning
An organisation that is managing by results will take a systematic approach to collecting and analysing outcomes data and will then use that data for learning and accountability.  The job of the manager is to ask: “Why did this work – what good practice can we share?”  and “Why didn’t this work, what do we need to change and where can we learn from others?”

The job of the commissioner or investor is to assess “Is this organisation taking a sensible and systematic approach to measuring its outcomes? And is it learning from its measurement and continually changing and improving what it does?” PbR encourages hiding of poor results and exaggeration of positive results as well as the creaming and parking described above.  This positively hinders learning and obscures what is really happening.

MbR encourages collaboration between service provider and commissioner in identifying and achieving their shared goals.  PbR obscures these shared interests by incentivising service delivery organisations to prioritise their own survival.

The table below summarises the differences:

Payment by ResultsManagement by Results
A black and white approach.  Achieving the target is assumed to equate to successRecognises the complexity of service delivery and that success must be interpreted in context
Payment is linked to achievement of targets.  There is no room for skilled judgement or for considering wider contextual informationOutcomes information is placed in a wider context.  There is room for skilled judgement
Obscures the shared goals of commissioner and service provider and encourages service providers to focus on organisational survivalEmphasises the shared goals of service provider and commissioner and encourages the provider to focus on achieving intended outcomes
Encourages a gaming culture because service providers are assessed on whether they have met the targetBecause service providers are assessed on whether they are using outcome measurement to address issues and improve services it encourages a learning culture
Service providers are incentivised to withhold information from commissioners and even falsify dataService providers are incentivised to share information and learning with commissioners and problem solve together for the benefit of clients

Management by results is not easy but it is worth the effort

Management by Results is not easy.  At Triangle we support organisations to implement the Outcomes Star and in practice this means that we are supporting them to build a MbR approach.  This involves forging new habits, behaviours and organisational processes, creating new interdepartmental links, new reports and new software.

It isn’t easy and it takes time, even for the most willing and able.  But we also see the benefits for those that stick with it – managers with a much better handle on what is happening in their services, who can pinpoint and address issues and share good practice as well as evidence achievements.

I believe that if the sector put more energy, funding and research into supporting organisations to manage by results, it would really start to unlock the potential to not only measure, but also improve outcomes.

What do you think?

[1]Hudson, M., Phillips, J., Ray, K., Vegeris, S., & Davidson, R. (2010). The influence of outcome-based contracting on Provider-led Pathways to Work (Vol. 638). Department for Work and Pensions.

[2] Goodhart, C.A.E. (1975). “Problems of Monetary Management: The U.K. Experience”. Papers in Monetary Economics (Reserve Bank of Australia

[3] http://www.atm.damtp.cam.ac.uk/mcintyre/papers/LHCE/goodhart.html

***

Triangle is the social enterprise behind the Outcomes Star™. Triangle exists to help service providers transform lives by creating engaging tools and promoting enabling approaches. To talk to Joy MacKeith or another member of the Triangle team, or for any other information, please email info@triangleconsulting.co.uk.

A Society in which everyone is able to thrive

Triangle Director Joy MacKeith reflects on the Social Value Matters 2020 international conference which took place last week and how it helped locate Triangle’s work in a wider movement for a fairer world.

The Social Value Matters 2020 conference was a truly immersive event.  The organisers took the opportunity of moving the event online to create a 24-hour programme so there was something for everyone, in every time zone, at every possible hour of the day.  

The result was a somewhat overwhelming amount of content but also a tremendous sense of being part of an international community looking for ways to measure things that really matter from environmental impact to worker’s rights to social inclusion.  And importantly looking for ways to make sure these things are not only valued but drive decision-making as well.

What was most interesting and encouraging for me was hearing the way that diverse agendas seem to be converging. 

Philanthropic organisations are more interested in systems change – understanding the underlying dynamics which keep the problems they are trying to address in place.  Corporations are going beyond the traditional domain of corporate social responsibility to engage with wider issues such as inequality. 

Governments are providing incentives to business owners to transfer ownership to their employees. Third sector organisations are using the language and practices of the market to express their achievements in terms that are engaging to governments and investors.  It seems that it is becoming easier, at least for some, to talk across sectoral boundaries. 

The wider vision that underpinned many of the contributions was the idea that if companies can be required to report on their environmental and social impact and demonstrate ethical governance (the ‘ESG’ agenda) then capitalism can start to serve the many and not just the few.

It seems that a growing number of investors want this and that many of the challenges are now technical – finding common metrics and benchmarks to allow comparability.  Jeremy Nicolls, one of the founders of Social Value International, urged everyone to be pragmatic and make it happen rather than spend time in pursuit of an impossible perfection.  There was a real sense of the possibility of change, and of the urgency too.

It all seemed a far cry from our Triangle world of supporting better conversations, enabling personal change and giving managers tools for service learning and development.  However, it was good to put our mission of helping service providers transform lives into a wider global context.  Triangle’s vision is a society in which everyone is able to thrive.  Every contributor at the event was, in one way or another, addressing that cause.  I hope that we can all find our place in the bigger picture so that we can play as full a part as possible in achieving this vision.

***

Triangle is the social enterprise behind the Outcomes Star™. Triangle exists to help service providers transform lives by creating engaging tools and promoting enabling approaches. Through the Outcomes Star, they work with services to promote and measure individual change and to enable learning at an individual, service, organisation and sector-wide levels. The Outcomes Star™ is an evidence-based management tool for both supporting and measuring change. For more information email info@triangleconsulting.co.uk.

Carers Star makes collaboration count

How do you get someone whose life is centred on another person to look after themselves? For more than 50 carer organisations, the answer is with the help of the Carers Star.

Published in 2014, the year of the Care Act, the Carers Star filled an immediate need for services and commissioners alike – to measure the impact of “care for the carers”. But the Star isn’t just about good outcomes data. Even more crucial is its ability to engage struggling carers in the first place. And the key to the Star’s success here is collaboration.

 “Carers don’t want someone to come in and take over,” says Victoria Mellor, lead care advisor on the CarerLinks project for Crossroads Together. “There’s nothing worse than an assessment where someone’s in front of you scribbling away and you don’t know what’s being written. It can make you feel a bit paranoid – how is someone going to use that information?”

Example image showing the cover of the Carers Star User Guide and a open spread with the detailed scales for one area

By contrast, she says, the Carers Star is a tool that both worker and carer can see. Its visual form – the star shape – makes it instantly clear what is working and not working in each of seven areas of a carer’s life. Worker and carer fill it in together, in any order, led by the carer’s immediate concerns.

“Carers usually have something they want to focus on straightaway,” says Victoria. “With the Star you can look at that first, so the carer gets their priorities straight in their head. Then you work with them and map things out together – this is going to be your job, and these things are going to be mine. It really empowers the carer.”

How you fill in the Star is equally
flexible. Crossroads Together use it for assessment at the first home meeting,
but sometimes carers are in crisis or just not ready and it doesn’t feel
appropriate to complete the Star. “Then I just use it as a guide and a prompt
to bring things back if the conversation goes off at a tangent, and I fill it
in when I’m back in the office,” says Victoria.

“Later on, when things are brighter
for them, we use it reflect on what’s changed. They like to look back at the
journey – they ask ‘what did I say the first time? I’m in a different place
now’”. That’s really helpful. One of our main aims is to empower them to take
responsibility for what they need and how they can achieve it.”

At the original Carer Star
training, some Crossroads Together workers worried that carers wouldn’t like
the Star. “But carers do want to
engage,” says Victoria. “There’s no typical carer – they definitely keep you on
your toes. But that’s the great thing about the Star – you’re able to use it in
different ways with different people. It’s very adaptable.”

Stephen Taylor, service delivery manager at Carers Leeds, agrees. “There are lots of different ways to get the carer to engage with it. Carers like the visual stuff, they like the scaling, and they like to see change. The Star is about their journey – it helps carers to stay focused on the bigger picture, not just a bad week they’re having.”

Traditional assessments, he
says, tend to focus on what is wrong. “The Star is much more collaborative.
Because it’s strengths-based, people are really engaging in their own care
plan. Through good conversations, they’re coming up with their own ideas about
what works with them. The collaborative approach is a very powerful thing.”

And the collaboration isn’t just
between worker and carer. Both Crossroads Together and Carers Leeds have found
that the Star can help with spreading good ideas and ways of working across
their organisations.

“If an adviser has a really
successful Star, we use it as an example in a team meeting,” says Victoria. “It
helps show what’s working, say in Liverpool, that we might want to duplicate in
Shropshire.”

“There’s real potential to
share good practice when you see the variations,” says Stephen. “When I look at
the data, I try and look across the individual teams and how they’re doing in
particular Star areas. For example, are our mental health specialists doing
better on the “How you feel” scale for carers? It’s about asking good questions
– what are you doing well?”

“I think the Star’s great – I like the questions it raises.”


Using the Carers Star

  • The Star works well for carers with complex or ongoing needs
  • It’s typically used over three to six months
  • Each scale is underpinned by a five-stage Journey of Change – cause for concern, getting help, making changes, finding what works, as good as it can be
  • It’s also possible to use the Carers Star on the phone – Triangle can advise on good practice
  • For young carers, consider My Star instead of the Carers Star.

The Carers Star is available to all organisations with a Star licence, and full training can be given for workers and managers. Triangle is exhibiting at the Carers Trust Network Partner conference from 11th to 12th March. If you are attending and would like to meet the team, or want more information on the Carers Star, please contact us on info@triangleconsulting.co.uk or +44 (0) 207 272 8765.

The importance of relationships with youth in mind

Tom Currie, Outcomes Star’s Implementation Lead, shares his thoughts after attending Oxfordshire Youth’s Youth in Mind conference.

It was a real pleasure to spend a day at Youth in Mind, the annual conference about young people and their mental health. The event was beautifully hosted by Oxfordshire Youth and Oxfordshire Mind with 400 delegates and a wide range of presenters from a diverse mix of organisations speaking on several subjects. But one thing that kept coming up in the talks, demonstrations and workshops was the importance of relationships in supporting young people to maintain optimal mental health.

Relationships: a key component

Whether it was Rowen Smith and Mary Taylor from Family Links talking about resilience and managing difficult emotions, or Julia Belton from Clear Sky describing how she uses play to engage children who had Adverse Childhood Experiences (ACE), relationships kept being identified as a vital ingredient.

The value of relationships was also highlighted in the Step Out workshops, hosted by two Donnington Doorstep Junior Ambassadors, young people who deliver sessions on Protective Behaviours to year 5 students. These peer led sessions offer yet another example of how you can use the power of relationships to gain credibility and influence with the people you work with. (They were preaching to the converted with me on this one, as I have been a strong advocate for the power of relationships for a few decades.)

What are the vital ingredients of a supportive relationship?

This question came up in my conversation with Julie Belton in the exhibition hall just after her presentation on how to engage children with ACEs. We agreed that many practitioners would probably say that good relationships are at the core of their work but that they may well mean different sorts of relationships. And that makes assuring the quality of those relationships tricky. Luckily some clever people at Search Institute in Minneapolis have done some great work researching and articulating these qualities in their Developmental Relationships Framework, which is free to download

The Developmental Relationships Framework identifies five elements:

  • Express Care – Show me that I matter to you
  • Challenge Growth – Push me to keep getting better
  • Provide Support – Help me complete tasks and achieve goals
  • Share Power – Treat me with respect and give me a say
  • Expand Possibilities – Connect me with people and places that broaden my world

Each of these elements is then linked to three to five well defined actions, so it really is a practical, useable framework. I believe the Search Institute are spot on with the balance of the elements they have articulated. If you want to put their theory into your practice, then you could download the framework and start to strengthen these elements in your work.

If you are interested in using a tool that helps provide a structure for four of the elements they identify, and also provides useful evaluation information, then get in touch and we could talk about whether one of the Outcomes Stars for young people would suit your way of working. It would be a pleasure to talk to you about what you are trying to achieve, because all supportive relationships include good conversations.

Speaking of good conversations, I had a great one with Bethia McNeil  (CEO of the Centre for Youth Impact), when I saw her a few months ago and she told me about the Supportive Relationships Framework. She knows a thing or two about frameworks having written the seminal Framework of Outcomes for Young People in 2012 as well as its brilliant 2019 sequel, predictively titled: A Framework of Outcomes for Young People 2.0.


If you’d like to talk to Tom following his attendance at the event, please call +44 (0) 20 7272 8765 or email info@triangleconsulting.co.uk.

Young people and mental health: How to make the conversation count

As Children’s Mental Health Awareness Week 2020 draws to a close, Joy MacKeith, co-author of My Mind Star, reflects on what the development process taught her about how schools and services can support real change for young people.

This week is Children’s Mental Health Awareness Week and there certainly is a lot going on. Yesterday a colleague attended a conference on mental health in schools in Manchester and next week Triangle will be hosting a stand at Oxfordshire’s Youth in Mind conference. This is all happening against the backdrop of a Government Green Paper on children and young people’s mental health and increasing concern in the media.

Catching up with my colleague after the conference yesterday, it is evident that the commitment to equipping schools to take a bigger role is certainly there, but thoughts about how to do this in practice are still developing. So it seems like a good moment to draw out some of the lessons from our work with Action for Children to develop My Mind Star, a tool for engaging and supporting young people around their mental health and measuring their progress.

After initial discussions and scoping in 2017, the development process began in earnest in 2018. Over the course of a year and a half we held a series of workshops with young people, front-line workers and service managers to find out what really makes a difference when working with young people. My Mind Star, a version of the Outcomes Star for mental well-being in young people, was then developed and piloted across 11 Action for Children services and also HeadStart Kernow

Here are some of the highlights from that process.

Recognising the need for help is a crucial first step

Talking about change with the people directly involved is always fascinating. What emerged early on in the workshops was that young people often don’t seek help because they don’t realise that things could be much better. Not recognising that what they are experiencing is mental distress, they cope as best they can on their own. So, a really crucial first step for many young people is reaching out for help. Interestingly, this year’s Children’s Mental Health Week theme is ‘Find Your Brave’ and a key message is to be brave enough to ask for help.

Don’t look at mental well-being in isolation

Another clear learning point was that we must look at mental well-being in the context of the whole of the young person’s life. The workshop participants identified eight key areas that should be part of the conversation. After piloting this was reduced to seven because it emerged that safety is an important aspect of all of these areas, rather than something that should be discussed in isolation. 

The final seven outcome areas are:

  • Feelings and emotions,
  • Healthy lifestyle,
  • Where you live,
  • Friends and relationships,
  • School, training and work,
  • How you use your time and
  • Self-esteem.

Participants emphasised that it was vital to cover all these areas when talking to a young person, even if they were not what was immediately presented as part of the problem.

Involve young people in defining what ‘good’ mental health and well-being looks like

Developing the scales for a Star involves in-depth discussions about what ‘good’ looks like. The scales for each outcome area or domain describe a journey from things being very bad to the desired outcome being achieved. This means pinning down what ‘bad’ means, what the desired outcome looks like, and what steps people take as they travel from one to the other. 

When it came to the ‘How you use your time’ scale, there was an interesting conversation about time spent on screens. Questions raised, included, is time used this way always bad or can it also be a positive way of accessing support, information and entertainment? There was a definite difference of perspective between the generations and it was very important to have young people in the room to share what good looked like for them.

My Mind Star helps young people identify issues and set goals

My Mind Star was piloted over six months with 67 workers and 177 young people and the pilot was evaluated using feedback forms and a further workshop. Both workers and service users really valued the way that the visual Star Chart summarised their life and helped them identify priorities.

The vast majority (94%) of young people said that the scales helped them to describe how life was for them at that moment. While 85% said that the scales helped them to understand what they needed in the way of support. In the words of one worker: “I liked that it gave the young people the opportunity to see where their priorities are, not what someone else thinks we should work on. This gives them some ownership and increases motivation”.

Evidencing change is motivating for everyone

Three quarters of the workers valued the way that My Mind Star opened up better conversations. And both workers and service users found it encouraging to see progress when the second My Mind Star was completed. As one young person said, “I liked doing the Star because it reflects the improvements I have made in the past months”

Psychometric analyses showed that the outcome areas were coherent and the scale was responsive to change. Managers very much valued the fact that it enabled them to evidence the progress that young people had made.

Following the pilot, amendments were made to the tool based on the feedback and the final version was published in September 2019.

Take-aways for those working with young people and mental health

Based on our learning from this project, and on personal experience, just letting young people know about different kinds of mental illness isn’t enough and can even be counterproductive. Young people can mistake the natural highs and lows of the teenage years for a mental health problem or start to identify as being ‘anxious’ or ‘compulsive’. Rather than knowing the labels, young people need to know what mental well-being looks like in simple and everyday terms so that they know when they need to ask for help. 

Also, when they do ask for help, schools and others need to make sure that there is ‘no wrong door’ and that everyone is equipped to have that initial conversation, to signpost them to others if needed and to keep a watchful eye. As in so many areas of life, prevention or early intervention is better than leaving things until there is a crisis. 

Ultimately, the evidence from our pilot is that My Mind Star can really help make those early conversations count and give everyone working with young people a framework, a shared language and a way of evidencing the difference they are making.


Triangle will be at the Youth in Mind conference on 12th February at the King’s Centre in Oxford. If you’re attending the event and would like to arrange a meeting with us on the day, or if you have any questions about My Mind Star, other versions of the Outcomes Star for the mental health or young peoples sectors, or would like any information on the new Star Online, or anything else, please contact us on info@triangleconsulting.co.uk or +44 (0) 207 272 8765. 

We may not live in Hawkins, but young people face stranger things than you or I had to deal with!

Ahead of attending Oxfordshire Mind and Oxfordshire Youth’s Youth in Mind conference next month, Tom Currie, Outcomes Star’s local Implementation Lead, reminisces and reflects on his adolescence and how it compares to that of today.

Kids sitting on a wharf, with ominous colours

If you were an adolescent in 2020, how would you be coping? I, for one, am not so sure I would be doing as well as I did in my decade of pubescent angst – the ‘80s. From my 15 years working in youth sector organisations, it is clear to me that helping young people develop the skills and resources to maintain good mental health is of the utmost importance. In this blogpost I look at a couple of the challenges we face and present a solution that could help. 

There is an ever-increasing number of challenges to good mental health invading the space young people inhabit. These include: the multiple platforms on which they relate to others, the growing complexity of gender, sexuality and identity, a rising awareness of the challenges facing the world in their lifetime and the depleting natural resources with which to face those challenges. And all of this sits within a backdrop of rapidly changing political and social landscapes. The children and young people I talk to are more informed about the environmental and political crises they face, yet, as a society, we have less to offer them by way of a vision for the future to sustain their spirits in overcoming these challenges. So, I am thrilled that in February I  am spending a day with experts talking about how best to support young people to develop emotional intelligence and strengthen their mental health at the Youth in Mind conference. It looks like a fantastic line up of presenters and delegates.

Third sector organisations play an important role in supporting young people’s mental well-being. Continuing cuts to council budgets and the already decimated youth service provision across the country means that many local authority Youth Services are simply no longer able to meet that growing need. Young people need healthy relationships with caring and interested adults to help them navigate the challenges of adolescence and enter adulthood successfully. So, relationships that see and support the whole person, their strengths and capabilities as well as the challenges they face, are key ingredients for services helping to maintain good mental health. First challenge: how do we support holistic, client-centred, relational keywork?

On top of this, in order to gain funding and win commissions, charities and other organisations providing these services need to be able to prove the value of their work to funders or commissioners. Success often looks like the aversion of a mental health episode or other tragic event, like self-harm or suicide. Which brings us to the next challenge: how do you measure and demonstrate what did not happen as a result of your intervention?

One useful tool to consider for addressing these challenges is the My Mind Star. Published in September 2019 after a two-year process of design, development, piloting and refining, this new Outcomes Star is the result of a creative partnership between Triangle, Action for Children and Headstart. My Mind Star is designed to be used with young people who are experiencing poor mental health, including low mood, stress, anxiety, anger, sleeplessness or self-harming, or who have a diagnosed mental health condition. It is intended for use in early intervention services that aim to prevent the onset or development of a mental health condition wherever possible, and to fill the gap in mental health services before one is diagnosed. This Star may also be used to support young people in managing a mental health condition.

My Mind Star meets the first challenge of supporting holistic, client-centred, relational work because it is essentially a key working tool designed to be used as part of a supportive relationship. The seven holistic outcome areas of My Mind Star help young people explore how the different parts of their life affect or are affected by their mental health:

  1. Feelings and emotions
  2. Healthy lifestyle
  3. Where you live
  4. Friends and relationships
  5. School, training and work
  6. How you use your time
  7. Self-esteem

The second challenge, of measuring what your service prevented from happening, is addressed by My Mind Star’s scale. All the Outcomes Stars use the five-stage Journey of Change to measure changes in attitude and engagement. This makes them effective at evidencing hidden, intrinsic outcomes, like shifts in attitudes, beliefs and thinking patterns, as well as measuring the more visible, extrinsic outcomes like improved engagement at school or college. All the Outcomes Stars are available on Star Online, our web-based platform for recording and analysing the data provided by the Stars, so it makes reporting and representing your impact a much quicker and easier task.

I’m attending the conference with my colleague Marie Buss, so if you are interested in finding out more about My Mind Star or any of our other Outcomes Stars for young people then come and find us in the exhibition area. We may not be able to remove all the triggers and challenges that young people are facing around maintaining strong mental health, but we can give them the tools to take an active role in overcoming those challenges together.


The Youth in Mind conference takes place on 12th February at the King’s Centre in Oxford. Tickets are available until 3rd February. If you’re attending the event and would like to arrange a meeting with Tom or Marie on the day, or if you have any questions about our new Stars, or would like any information on the new Star Online, or anything else, please contact us on info@triangleconsulting.co.uk or +44 (0) 207 272 8765.

Year in review: Shining brightly in uncertain times

Joy MacKeith, one of Triangle’s directors and co-founders, and co-author of the Outcomes Stars, explores her year in review, and shares her thoughts on the impact and successes of 2019, including the new Star Online and new Stars.

It’s week one back in the office after my new year’s break. My inbox is surprisingly full and the office is already buzzing with activity. Not everyone has taken two weeks off it seems. Before taking a deep breath and diving into the patiently waiting emails I allow myself the luxury of a moment to reflect on a very busy 2019 and anticipate what 2020 has in store.

Star Online 2 is unveiled

For me 2019 will always be the year that we built our new, improved software system and 2020 will be the year that the one thousand organisations working with the Star Online started to use it. The initial feedback from those who helped us test it in development has been amazing. I know many of our clients will be particularly excited about the reporting capability, with new visuals, new customisation and new time period reporting options. Other new features will make it much easier to manage implementation and data quality.  The fact that we now have a state-of-the-art platform for further developments is also very exciting. An off-line app is high on the list of new features we have planned. The new system is now live for new clients.  A massive thanks goes to Sarah Owen, our team member, who has led the project and QES our software development partners.

Making an impact

I will also remember 2019 as the year we conducted our strategic review. Thirteen years since the publication of the first Star it was time to look at how well the suite of tools had stood the test of time and how Triangle and the Star need to develop to stay at the cutting edge of practice. As part of the review we carried out a summer survey of our clients to find out what difference the Star makes. I know that people love the Star, so I was expecting broadly positive findings, but the level of appreciation and impact took me by surprise. Here are a few highlights:

  • 87% of Star users report that their keywork is more effective as a result of using the Star
  • 81% said that Star data reports enabled them to monitor and report on their outcomes more effectively
  • 95% say that the Star supports good conversations and collaboration between staff and service users
  • 92% say that helps service users to get an overview of their situation
  • 93% say that the Star supports person-centered, strengths-based working
  • 92% say that the Star is motivating for staff and service users because it makes change visible.

There were so many stand-out findings that it is hard not to keep adding more, but you get the idea. Of course there are always things that can be improved, but it was heartening to hear that many of the developments people were asking for focused around the Star Online so it was wonderful to know that in just a few months those needs would be met.

Not only do the findings underline the positive way that the Star helps workers take an enabling, strengths-based approach, but they are also a powerful affirmation of Triangle’s decision to invest heavily in implementation support through our client services team, our trainers and our regionally based implementation leads.

Research shows that better results are obtained from good implementation of a poor tool than from poor implementation of a good one. We aim to provide both an excellent tool and excellent implementation support. It is so affirming to see that this powerful combination is really making a difference. 

The strategic review concluded that the Star is a tool whose time has now come because of the increasing recognition of the importance of person-centred, outcomes focused collaborative working. Although it is well known in some sectors and regions, it is still largely unknown in many others so the potential for further impact is substantial. A key theme for 2020 and beyond will therefore be doing more to communicate what the Star is, the way that it can transform service delivery and the wealth of research behind it.

An organisation with a mission

As well as fact finding, our strategic review also involved some deep reflection and soul searching on Triangle’s role in the current service delivery climate. We are painfully aware that the service delivery landscape has changed since 2006 when the first version of the Star was published. Assumptions that if someone is motivated to change then the services will be there to support them no longer hold. Many services are now much lighter touch and can find it challenging to make the time for an in-depth conversation about needs and plans. This has resulted in requests for ‘lighter touch’ or self-completion Stars.

Should the Star stick to its original formulation as a comprehensive and reflective tool or adapt to new realities? There are no easy answers, but we have re-affirmed and sharpened our mission as an organisation that is committed to both advocating for an enabling approach to service delivery and helping service providers make this a reality in practice.

We now begin a new strand of work to shape the debate around what matters in service delivery through research, blogs, conference presentations and making links with the many others advocating for this kind of approach.

Drawing together the evidence base

The Outcomes Star was born out of practice rather than research and quickly took root because many organisations were hungry for a tool that would evidence the effectiveness of their work without getting in the way. When they discovered that the Star positively helped them achieve their outcomes, there was no stopping it. 

As a result, the formal research evidence for the Star lagged behind its use. 2019 was the year that changed and we were finally able to draw together a decade of work on validation to publish psychometric factsheets on nearly all versions (we are still collecting the data on very recently published Stars). 2020 will see the publication of a paper in a peer-reviewed journal setting out the psychometric properties of the Family Star Plus, the most widely used of the suite of Stars. This is an incredibly important landmark for us in establishing the Outcomes Star as a different kind of tool that straddles the aims of both promoting and evidencing change.

Hello and goodbye

Closer to home, 2019 has been an important year of hellos and goodbyes. Hello to our first Managing Director, Graham Randles, who joined us from the New Economics Foundation consultancy service, and goodbye to Paul Muir, our Operations Director who pioneered our work on implementation support and much else besides. Hello to Tamara Hamilton who will be covering Sarah Owen’s maternity leave this year and goodbye to Susan Goodbrand who covered Emily Lamont’s maternity leave. Goodbye also to Roxanne Timmis who has moved on to an exciting new role with Think Ahead, a charity that supports graduates into mental health social work. Best of all, we have said hello to four new babies including Ziya Nisi born on 28th December to Giorgia, one of the staff at Unique Outcomes, our Australian implementation partner.

And finally

Triangle also gave birth to five new Stars in 2019 in a year of unprecedented Star development activity. We now have a Star for preparing for the end of life. Together with our Parent and Baby Star this means the Stars really can take you from cradle to grave.  2020 sees the publication of our new 3-5 year plan, a project to build on interest in the Star in the USA, the full implementation of our new software system and much more besides. 

It is incredible to see how something that started as an approach for one organisation in one sector has evolved and flourished over so many sectors and countries around the world. As we approach a very uncertain new decade, it gives me hope that when people collaborate to address specific issues with commitment, persistence, flexibility and creativity, we really can make a difference.

Graphic introducing the Planning Star - linking to the Planning Star webpage
Image introducting the Preparation Star - linking to the Preparation Star webpage
Image introducing the Pathway Star with a graphic linking to a blog on how the Pathway Star is a person-centered tool
Graphic introducing the Recovery Star Fourth Edition, linking to a blog post on the new Star
Image linking to a blog post introducing the new My Mind Star for use with organisations supporting young people's mental health and well-being

If you have any questions about our new Stars, or would like any information on the new Star Online, or anything else, please contact us on info@triangleconsulting.co.uk or +44 (0) 207 272 8765.

Christmas newsletter round-up

Our December 2019 newsletter round-up included news on the new and improved Star Online system, as well as new and upcoming Outcomes Stars. Our directors have recently attended several conferences and share their thoughts and reflections on the events: Sara Burns shares her thoughts on Hospice UK’s annual conference while Joy MacKeith shares her reflections on the Mental Health Conference. We also included information on our new Stars.

Other updates included

  • The new Star Online system is now live for new clients, find out more about the system and watch a short video of it in action: the new Star Online
  • We have recently published the Pathway Star, a new Star for the employment sector: read our blog exploring how it can help vulnerable service users in overcoming challenges and taking steps towards the world of work.
  • We have recently published two more new Stars: the Planning Star which is a vital new tool for organisations working with unaccompanied asylum-seeking children and the Preparation Star, a new Outcomes Star to support individuals in living well right to the end.

Read the full newsletter here.

Contact Triangle at info@triangleconsulting.co.uk or +44(0) 20 7272 8765 for more information on our Outcomes Stars, the new Star Online and our licence and training options. Sign up for our newsletter here.

Safeguarding Students: Two key questions

Sara Burns, co-creator of Triangle and the Outcomes Star, explains how she learnt more than she set out to at the Safeguarding Students conference in Manchester

I had two main questions when I registered for the Safeguarding Students conference: what aspects may be relevant in a Star for university students with mental health issues and is My Mind Star – published earlier this year – a good fit? Those questions faded into the back of my mind by lunchtime and further in the afternoon.

Throughout the morning, one speaker after another talked about the factors behind the sharp increase in mental health problems for young people and difficulty accessing the right services. 100 student suicides a year are the tip of the iceberg[1]. Like most of the people in the room (confirmed by a show of hands) I was listening as a parent as well as a professional and despite already knowing much of what was said, it was impossible not to find the presentations poignant and disturbing. My son and daughter are now young adults and I have witnessed one negotiate university and the other struggle without access to the right mental health support. I imagine there were many other parents in the room with similar experiences; one speaker talked about the loss of his son to suicide.

In the afternoon we heard about the student mental health crisis as a symptom of much wider problems within universities and society; the takeaway phrases for me were ‘persecutory perfectionism’ and ‘university as an anxiety machine’ – how ‘anxiety at university is inherent in a neoliberal Higher Education sector that distorts the student experience into a value-for-money exercise’. We also heard about the emphasis on metrics and performance in a marketized environment. Student speakers throughout the day stressed the pressure to perform, to be perfect, to succeed – that ‘failure is not an option’.

Answering my questions

After 15 years of developing versions of the Outcomes Star I’m still fascinated by the process and my mind is so used to engaging in this way that it even though my original questions were far from front of mind, I still answered them. I concluded that My Mind Star is a good enough fit to be worth piloting in a student welfare and support service, but there are key differences, such as money and the roles of family and peers, which we would include if we produced a tailored variant.

I didn’t get a strong sense of need or fit for the Star within student support, but that may be my lack of knowledge. The Outcomes Stars are most helpful within one to one, holistic support over months or years, which some students may need and receive but support appears to vary a lot. However, if you support university students with mental health, do look at My Mind Star and contact me if you think it – or a variant for students – might support your work; I’d love to find out more.

To talk to Sara Burns and share your thoughts, call 020 7272 8765 or email info@triangleconsulting.co.uk.


[1] Safeguarding Students Conference 2019, Manchester

Reflections: Hospice UK’s annual conference

Sara Burns, co-founder and director of Triangle and one of the authors of the Outcomes Stars reflects on her attendance at Hospice UK’s annual conference in Liverpool.

We recently launched the Preparation Star – developed to empower patients to share what is important to them when approaching end of life. We were invited by Hospice UK to exhibit a poster at their two-day annual conference, to demonstrate the development and design behind the publication of this new Outcomes Star.  

Conversations had at the conference

Smiling retired senior man sitting on sofa with female home carer at care home

I spent a large proportion of my time talking to delegates and learning more about them, their work and experiences. End of life is a conversation that many people struggle with or avoid altogether, so it was refreshing to meet people at the conference who were open to talking about this topic in a straightforward, confident and relaxed way.    

I shared detail on the Preparation Star and the background as to how it became to be: I was personally pleased when North London Hospice approached us three years ago to develop a Star for end of life. The Department of Health and Social Care’s guidance, based on research, recommends and stresses the importance of a conversation about end of life. Outcomes Stars enable and support good conversations – which support better outcomes – and I felt honoured to be developing a version for what is often the most difficult conversation there is.

86% of people helped by hospices receive ‘hospice at home’1

I had previously thought of a hospice as a safe and relatively pleasant place where people went to die, until learning of this fact. I explained this to conference delegates and that most hospice support is now provided in day centres and the community. This is where the Preparation Star is best used as a tool to enable patients to talk about their wishes and develop a plan with 6-12 months still to live, maybe longer, and provide services with a measure of patient well-being outcomes. I also explained to delegates that it was clear from our pilot that the Preparation Star isn’t suitable for hospice inpatient services – most patients were too close to end of life to use the Star.

Wider conversations about Outcomes StarTM

I met people who already knew the Outcomes Star from previous roles, including in homelessness and family support, and were excited to see one designed for end of life. Others new to the concept could easily recognise it as a visually engaging way to support a conversation and for managers to get some much-needed information on service outcomes. Although I saw some other excellent tools to start a conversation, the Star fills a gap in focusing a conversation to give a picture of how things are, to support planning, and measure outcomes.

How to find out more about the Preparation Star:
You can download a preview version of the Preparation Star and explore the nine areas covered in conversation. To talk to Sara Burns or another member of the Triangle team, call 020 7272 8765 or email info@triangleconsulting.co.uk.

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1 Hospice UK conference presentation