Category: Opinion

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

Posted on by Donna

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!

Posted on by Donna

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

Posted on by Donna

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

Posted on by Donna

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

Posted on by Donna

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

Posted on by Donna

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

Think holistically: Act holistically

Posted on by Donna

Joy MacKeith, Co-Founder and Director of Triangle, and one of the authors of the Outcomes Stars reflects on the Mental Health 2019 conference.

By Joy MacKeith, Director and Co-Founder of Triangle.

This was my second time at this conference bringing together senior NHS policy makers and service providers to chew over the state of the nation’s mental health. There certainly was a lot to think about….

Integration, integration, integration

The strongest message throughout the day was to think holistically about mental health. Duncan Selbie, CEO of Public Health England kicked things off by reminding us that the biggest determinants of mental health are income, housing, work and social connection. This was then driven home by Andrew Herd from the Department of Health and Social Care who is engaged in the mammoth task of rallying all government departments around the cause of mental health and inspiring, cajoling and sometimes requiring them to factor mental health into their policy-making. It was refreshing to hear this holistic drum being banged, music to my ears as one engaged in creating tools which attempt to provide a map for the person’s whole life, not just the problem that brought them through the door.

Young people on the top of the agenda

Most of the conversations that we had on our Outcomes Star stand were about My Mind Star – our newly published tool for early intervention with young people with mental health issues. There was real excitement about the strengths-based focus and intuitive visuals. The fact that it also provides service-wide distance travelled information was usually not the focus of the conversation, but nevertheless seen as an important plus. There is a big scale of up services for this group, Phoebe Robinson, Health of Mental Health for NHS England told us. That isn’t surprising given that a shocking one in three children and young people now have a diagnosable mental health issue.

Get ready for growth in social prescribing

GP, David Smart shared his experience of creating an integrated depression pathway in Northampton. What inspired me about this case study was seeing just how much difference can be made when people step out of their normal ways of doing things and look at a problem freshly. Social prescribing plays an important part in their approach and is an example of integration in action. It was mentioned often through the day as an approach that is on the rise. I was extra pleased when I heard that they are exploring the use of the Well-being Star to collaboratively assess needs and the measure outcomes of their social prescribing work.

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Interested in finding out more about the Outcomes Stars for mental health and well-being?

The Recovery Star Fourth Edition is a new edition of the Outcomes Star for working with mental health and well-being. My Mind Star is the new Outcomes Star for young people young people’s mental health and well-being. Find out more here. To find out more about which which other Outcomes Stars are suitable for organisations working with mental health and well-being, please take a look at our sector page. For more information on the Outcomes Stars and our licensing and training options please contact us: email Triangle at info@triangleconsulting.co.uk, or call on +44 (0) 202  7272 8765.

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Joy MacKeith: Joy is a co-creator of the Outcomes Stars. She leads on innovation, data, research and the theory behind the Star. For more information on the evidence and research that underpins the Outcomes Stars visit our evidence and research library. Please contact us for any further information: email Triangle at info@triangleconsulting.co.uk.

Triangle and our social enterprise model

Posted on by Outcomes Star

Sara Burns, Director and Co-Founder of Triangle, and one of the authors of the Outcomes Stars™ explores what it means to Triangle to be a social enterprise.

By Sara Burns, Director and Co-Founder of Triangle, June 2019.

When we incorporated “social enterprise” into our name in 2009, it seemed entirely natural and obvious to me, yet I gave it little thought and there were few guidelines at the time. Fast forward 10 years and I find myself passionate about the concept and practice of social enterprise, as well as better informed and in a sector that is becoming more defined.

In our case, the expression of our social mission and our enterprise (business activity) are one and the same thing. There are many types of social enterprise, including those who raise money through a neutral business activity in order to fund a separate social mission. As Triangle, we develop Outcomes Stars and other tools and help organisations use them because we believe in their transformative potential. We witness time and again in many sectors how the right tool can support people to really listen, have good conversations, plan and deliver support, gather meaningful information and learn about what works. Like so many people, we are operating in a world where services and funding are severely squeezed, and our aim is to keep listening and learning, so we can continue to innovate and make a contribution.

So why am I passionate about social enterprise?

There are a number of reasons.

We make choices and decisions based on what is helpful at a sector level, not what will bring in the most money. This has been the case since we started. It provides a refreshing clarity and simplicity; even though the choices are not always immediately obvious, we are able to focus on the question of what will be most helpful. Somehow the big decisions and changes of direction over the years have always been made easily and harmoniously, and I believe that is because of this clarity of purpose.

Receiving an income from the expression of our social mission in the world, rather than relying on grants or other funding, gives us relative freedom and independence. Ultimately, the majority of our income from training and licenses can be tracked back to the UK government, we collaborate widely in developing Stars and other tools and respond as best we can to different needs and agendas. Yet, at the end of the day, we are the authors and can make decisions based on our learning and experience of what works. And we can plan ahead without the limiting factor of short term funding and the inevitable uncertainties that brings. 

Similarly, because we have an income and are committed to reinvesting at least half of the surplus each year, we have some freedom to be generous and experiment. We offer training and licenses at (often below) cost to enable small organisations to use the Outcome Stars if it’s right for them. We provide implementation support according to need, not based on what people pay. We take risks and invest in new developments before there is a market for them.

All this contributes to a working life that is more fun and meaningful. Money is powerful and I enjoy the potential it affords to be successful in making a contribution – to use the very particular expertise we have built up over the years for good.

My anecdotal impression is that some people who enter the social enterprise sector, while passionate about their social mission, feel ambivalence or even resistance to the enterprise/business aspect, to money and charging. Ultimately, this can result in lack of sustainability and good ideas not getting off the ground. When everything feels too tight financially, that can be stressful and less enjoyable. Being confident about embracing the enterprise aspect and charging realistically for services and products can open some space. Space is important for people to be able to move freely, take risks, be creative and innovate. That is the culture we seek to develop and maintain within Triangle, so that everybody working with us feels able to contribute ideas and enjoy the sense of purpose, clarity and independence, so that we can be as helpful as possible in the challenged world of health and social care.

Interested in finding out more about Triangle’s mission and values?

For more information on Triangle, please take a look at our Values. For more information on the Outcomes Stars and our licensing and training options please contact us: email Triangle at info@triangleconsulting.co.uk, or call on +44(0)202  7272 8765.

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Sara Burns: Sara is co-creator of the Outcomes Stars. She leads on and is continually inspired by developing new versions for new sectors, as well as overseeing all the other ways Triangle can be helpful and support people to use the Star well.

For more information on Triangle and the team behind the Outcomes Stars, please take a look at our About Triangle pages. For more information on the Outcomes Stars and the values that underpin each version, or explore the history of the Star at About the Star or please contact us with any questions: email Triangle at info@triangleconsulting.co.uk.

The interplay of internal and external factors in creating change

Posted on by Outcomes Star

In this blog Joy MacKeith, one of Triangle’s founding Directors, explores the interplay of internal and external factors, particularly in the context of austerity in the UK, and sets out Triangle’s approach to the Outcomes Star. 

The context of austerity
In the 12 years since the first version of the Outcomes Star was published, the political climate in the UK has changed dramatically; funding for services to support vulnerable people has been cut and both employment and housing are increasingly insecure. 

The Outcomes Star is a suite of tools which are designed to help service users and service providers work in a constructive partnership toward achieving greater well-being and self-determination.  They are designed to be used in the context of an adequately funded service delivered by well trained staff.  They are also rooted in the assumption that decent housing and employment are available.

Increasingly in the UK these foundations are not in place and that has understandably led to anger on the part of some service users and service providers.  Whilst we believe that the Outcome Star tools continue to have an important role to play in helping people to deal with the challenges they face we also recognise that personal change on its own is not enough and that addressing structural issues of poverty, poor housing, insecure employment and rising inequality are essential to creating a society in which everyone can thrive and contribute.

The agency of the individual
In a climate of cuts and reduced services, some may be sceptical about the benefit of services and tools that focus on the agency of the individual.  At worse it could feel like people are being asked to ‘pull themselves up by the bootstraps’ or even blamed for their difficulties without adequate recognition of the very real challenges that they face and the sense of despair that can build when the odds are stacked against you (Johnson and Pleace (2016), Friedli and Stearn(20 15)).  So how do skills, habits and attitudes – the main focus of the Star, interact with opportunity and life situation?  I think the Cycle of Action model presented by NESTA and OSCA in their report ‘Good help: bad help” helps to answer that question.

Their model draws on the ‘COM-B model’ developed by Susan Michie, Director of the Centre for Behaviour Change, University College London.  It shows these internal characteristics in a dynamic interaction with a person’s life circumstances so that not only do difficult circumstances decrease confidence, purpose and ability to act, but also these internal states can also impact on outer circumstances.

The implication is that those disadvantaged by difficult life circumstances such as physical or mental health issues, poverty, discrimination or homelessness are likely to also experience less confidence and ability to act and that ‘good help’ which builds these aspects is likely to positively impact on life circumstances.  The report is at pains to stress that practical help is also necessary because the external barriers are very real.  But the right kind of help, that which builds confidence, sense of purpose and ability to take action, can create a positive, reinforcing virtuous cycle of change.  Whilst bad help does the reverse.

 

The Outcomes Stars have always focused on the agency of the service user.  For many of the original Stars, including those for use in the homelessness, mental health and family sectors, the model of change revolves around a shift from an external locus of control (“things happen to me and there’s nothing I can do”) to an internal locus of control (“I want things to be different and there are things I can do to make that happen”). 

However, as time has gone on, two things have happened. The first is that we have developed versions of the Star for service user groups who have less control over their circumstances, such as children or those with profound learning disabilities.  The second is that the service delivery climate has become more challenging and therefore the external barriers faced by many service users have increased.

For these reasons we increasingly recognise the importance of acknowledging and recording the external barriers as well as supporting the motivation and capability of the service user to overcome barriers. We do this in a number of ways including our guidance for workers on how to use the Star and in the introductions to the User Guides which are used directly with service users . The version of the Star that recognises the importance of external factors the most comprehensively within the tool scales themselves is My Star – the Outcomes Star for children in which some of the scales measure the child’s progress towards resilience and some of the scales measure the extent to which those caring for the child are providing them with what they need to thrive.

Although our intention is to keep the focus of the Stars on supporting agency and ability to act, new editions of existing Stars and new versions are developed with a heightened awareness of the importance of acknowledging the external barriers.

As the NESTA report (page 20) states:

 “‘Good help’ is not a substitute for addressing in-work poverty, structural inequalities or discrimination, but it has an important role to play in supporting people to manage the elements that are within their control.”

Our aim in that the Outcomes Star suite of tools enable good help, support people to manage the elements of life that are in their control and help service providers to point to the barriers that are getting in the way so that commissioners and policy makers can play their part in making change possible.

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Sources

Friedli, L. and Stearn, R (2015)  “Positive affect as coercive strategy: conditionality, activation and the role of psychology in UK government workfare programmes’ Critical Medical Humanities. This article does not mention the Outcomes Star but the authors are linked to Recovery in the Bin who have published the ‘Unrecovery Star’ ((https://recoveryinthebin.org/unrecovery-star-2/)

Johnson, G. and  Pleace, N. (2016)  “How Do We Measure Success in Homelessness Services?: Critically Assessing the Rise of the Homelessness Outcomes Star” European Journal of Homelessness.  The focus of this article is a critique of the Homelessness Outcomes Star

Wilson, R. and Cornwell, C. and Flanagan E. and Nielsen, N. and Khan, H. (2018) “Good and bad help: how confidence and purpose transform lives” NESTA and OSCA 

“Good Help” and the Outcomes Star™

Posted on by Outcomes Star

From our experience supporting hundreds of frontline services to use the Star, we know that how services help people matters.

We were excited to see the “Good Help” report, which proposes a simple and powerful distinction between ‘Good Help’ and ‘Bad Help.‘

The report harvests the best of current practice in behaviour change programmes alongside a description of the historical development of  behaviour change, from Maslow’s hierarchy of needs and Bandura’s work on self-efficacy to motivational interviewing and Susan Michie’s contemporary COB-B model.

Looking at the seven characteristics of ‘Good Help’, we were struck by how nearly all of these are hardwired into the Stars and the Journey of Change that underpins them.  To unpick this and to respond to the challenge in the report of putting ‘Good Help’ into practice, we’ve written a short piece demonstrating how the Outcomes Star can help frontline services to put these values into action.   Read our response here:  Good help and the Outcomes Star

We very much welcome the Good Help report and project, and believe that the powerful concept of ‘good help’ could help to focus a cross-sectoral movement for change which recognises that the most important ingredient in the change recipe is the goals, capabilities and motivation of service user themselves. We would like to add our voice to the Good Help movement and hope that the Outcomes Stars can be part of the toolkit that enables organisations to make that vision a reality.

To join the mailing list for the latest news about the Good Help project from OSCA and NESTA, sign up here.

The Star made a massive difference to me because it showed me that there were things I could do to become the person I wanted to be: a more rounded person with a more rounded Star. The Outcomes Star showed me that there were goals I could achieve. When you’re ill, the thought that you can be well seems very daunting but the Star breaks it down into baby steps and you start to feel yes, I can do this. That really built my confidence and gave me hope.” Young person