The Outcomes Star: helping make trauma informed philosophy practice

Over the past decade, there has been increasing recognition of both:

  • the high prevalence of complex trauma, adverse childhood events and the different ways in which trauma presents and
  • how important it is to ensure that services are delivered in ways that do not risk people becoming re-traumatised, in relation to how workers engage with them and the topics discussed.

Given the potential of the COVID-19 context and measures to cause, exacerbate and reactivate trauma, it has been argued that –

  “never before has trauma-informed care been so important to promote the health and well-being of all and to protect our marginalised populations at greatest risk”
(Collin-Vézina, Brend & Beeman, 2020)

Trustworthiness, transparency; collaboration and empowerment are key principles of trauma-informed care, which can guide service delivery policies and practices (SAMSHA, 2014). However, there can be barriers to putting these into practice.  Tools that offer a clear framework for translation of the principles of trauma informed care into practice can benefit many organisations and help them overcome these barriers.

The Outcomes Star tools have many features that directly support trauma informed working, including:

Relationship-based – The collaborative process of practitioners and clients completing the Outcomes Star helps to build a trusting and positive relationship, giving service users greater control and voice and within which important connections in the person’s life are discussed.

Empowering – The Journey of Change is sensitive to small but important steps and progress. Visually showing change can be empowering and motivating for both practitioners and clients.

Focuses on the present not someone’s history – completing the Star is a conversation about someone’s life, how things are for them and what they are doing now, rather than bringing up past histories or traumatic experiences.

Strengths based not deficit-based; they use positive language focusing on the process of change and the support and actions needed, not on the severity of problems.

Holistic – the whole person and all relevant life circumstances are recognised. Plotting where someone is on the Star chart provides a clear representation of where support is needed and where things are going well, highlighting the interaction between different areas of someone’s life.

As well as the tools themselves, training and guidance around the Outcomes Star emphasises flexibility in responding to a client’s window of tolerance and preferences – for example, about when and how to introduce and discuss the different outcome areas. There is also guidance about identifying appropriate action plans in a trauma-informed way that is sensitive to the client’s capacity to drive things forward themselves.

Triangle is committed to continuous learning and improvement of the Outcomes Stars and how they are used. Staff have received training and advice from experts on trauma informed care and we are currently reviewing some of our older, widely used Stars using a trauma-informed lens.

*****

For more information, please see our guide on ;How to use the Outcomes Stars with trauma informed approaches’ or get in touch on info@triangleconsulting.co.uk or +44(0) 207 272 8765.

Moving to the Youth Star 2nd Edition

Graphic: text reads, Youth Star (2nd Edition). A new and improved version of the Youth Star for working with young people taking part in community-based youth projects
Key questions and answers about the new Edition of the Youth Star, and how organisations can transition to the new version

The new Youth Star is a new and improved edition of an Outcomes Star designed to support services working with young people and in the youth work and community sectors. 

1 Why a new Edition?

Triangle is responsible for ensuring that the Outcomes Stars stay relevant and are as good as possible; we keep them under review, seeking and analysing feedback and developing new editions as needed. We published the Youth Star in 2012 and since then have developed many more Stars for different sectors, leading to new learning, including how to make the Stars and guidance even more trauma-informed, strengths based and person-centred.

The 1st Edition of the Youth Star was published without detailed scale descriptions, so a key aim of developing a new edition was to develop detailed scales to support training, consistency and clarity. Further, Triangle has gathered feedback about the Youth Star and also about how the youth sector has changed and evolved, resulting in helpful feedback. This also pointed to a need to review this Star to make it as good a fit as possible for youth work today.

2 What has changed?

We have created detailed scale descriptions for the six areas covered by the Youth Star. These are in a new User Guide, along with a graphic of the short scale descriptions. The User Guide is most relevant as an important new resource for workers, in training and initial familiarisation with the Youth Star and for reference to ensure accurate and consistent completion of the Star. However, it is written in accessible language and can be shared with young people who are interested and able to engage with more detail.

There is more detail in the Development Report but in summary the main changes are:

  • The first stage of the Journey of Change is renamed stuck, to recognise that things may feel or be stuck for a young person at that stage for many reasons, not necessarily because they are ‘not interested’, as the language in the 1st Edition implied. This also makes this wording consistent with other versions of the Outcomes Star
  • The first scale is now Interests and activities (replacing ‘Making a difference’). This area still emphasises helping others, group activities and teamwork but is widened to recognise activities and interests such as sports, arts, music that are positive for young people but can be individual not group activities and not aimed at making a difference to others.
  • Health and well-being replaces ‘Well-being’ as it now covers both a healthy lifestyle and emotional health, including managing physical or mental health conditions. It recognises that those who are younger may not have much control over their diet or other choices and that their family may not support living healthily.
  • Education and work now emphasises getting the most out of school/ work rather than focusing on achievement. It was also widened to include training, apprenticeships or internships and to recognise the role of the school, college or workplace in providing extra support where needed, so it is not just up to the young person. 

There are other minor tweaks to scales, with some aspects moving from one scale to another to increase clarity and accessibility and adding references to social media and staying safe online. In addition, we listened to feedback from young people and workers and changed some wording to be more sensitive, trauma-informed and responsive to the issues people faced and created flashcards and new guidance.

3 Should I move to the new edition?

We believe that the 2nd Edition of the Youth Star is better, and the additional resources will make it a more effective tool for supporting and measuring change with young people, so we recommend you do transition your service to the 2nd Edition. However, the 1st Edition will continue to be available for the foreseeable future, so you have a choice and time to decide.

The 2nd Edition of the Youth Star is available for those with a Star licence to access on the Star Online, so you can download and it and review the new resources for yourself to help make a decision.

4 What should I do to move the to the new, 2nd Edition?

If you already have Star licences, there is no extra cost to using the new edition and no requirement for additional training, though you may want to consider refresher training. Talk to Triangle about your current licencing and how to make the most of the transition to support good use of the Star.

Consider how you will introduce the new edition to practitioners, for example by finding ways to ensure that they familiarise themselves with the User Guide with detailed scales, changes in wording and other new resources, including the flashcards and updated guidance. This can be done through refresher training, supervision sessions, discussions in team meetings and by sharing and promoting the “introducing the new Youth Star 2nd Edition” poster for practitioners, available from the Star Online or Triangle.  

You also need decide when and how to introduce the 2nd Edition. The main options are:

  1. Introduce the 2nd Edition for new clients and keep using the 1st Edition for existing clients who have already completed at least one Star. The advantage of this approach is that clients only have to engage with one version and their change shown from one reading to the next is valid because it is gathered using the same version
  2. Decide on a date from which to introduce the 2nd Edition with all clients, both new and existing. This is more straightforward for the service because than using both versions and makes the move more swiftly to the new edition. However, change measured from one reading to another is not valid and may be misleading if different editions are used with the same person (see data section below). This has implications for both keywork/ action planning with that individual and for the validity of the service’s Star data overall.

5 What about my Star data?

Because some of the Youth Star scales have significant changes and others have minor changes, data gathered using the 1st Edition will not be directly comparable to data gathered using the 2nd Edition. The most marked example is that someone actively and positively pursuing individual interests such as arts or sports, may be at 1 in the first scale of the 1st Edition (Making a difference) but could be at 5 in the 2nd Edition (Interests and activities). The other differences are summarised above and set out in more detail in the development report.

There are three main options for how to approach data and reporting when making the transition to the second edition of the Youth Star, as set out below

We believe that different options will work for different services. The most appropriate approach for your service will depend on how long you have been using the Youth Star and the amount of data you have and the importance for you of being able to monitor trend over a number of years. Talk to Triangle if you would like advice. However, in general:

  1. We would normally recommend the first option as it’s the most straightforward. Although this is likely to lead to difficulty presenting the data in the year in which you make the change to the 2nd Edition, this disadvantage is short lived, and the issues can be explained to those using the data internally and to funders or commissioners.
  2. The second option is generally only recommended for services with a small data set, particularly those who have started using the Youth Star within the last year, and where it is important to maintain continuity of monitoring over the time of the transition to the 2nd
  3. We strongly advise against combining the datasets from the 1st and 2nd Editions as in option 3, as there are significant changes to the scales that make the transition somewhat like moving to a different version of the Star. However, if you would like to be able to create high level reports across the two editions, we have a briefing called ‘reporting on different versions of the Star’ that would help with this and you can contact Triangle for advice as needed.

6 Questions and next steps

If you have any queries about the Youth Star, new editions or what would work best for your service, please get in touch with your Implementation Lead at Triangle, email us on info@triangleconsulting.co.uk or ring us on 0207 272 8765

5 things licensed trainers and keyworkers need to know about trauma-informed approaches

As part of Triangle’s Licensed Trainer option, trainers are expected to complete a certain number of continuing development programs over the course of each year. Nick Karr will be running a session, this May, for Licensed Trainers on how the Star is becoming more trauma informed and how this can be embedded into Outcomes Star training. He shares 5 key things that people should know about trauma-informed approaches.

5 things licensed trainers and workers should know about trauma-informed approaches:

  • A trauma-informed approach, like the Star, uses the client centred and strengths based approaches you already know about and use with clients
  • It shifts the perspective from ‘what is wrong with you’ to ‘what has happened to you’
  • You can’t take away the client’s past – but a supportive relationship with a worker, can make a big difference
  • The conversations you have with clients when using the Star contribute to a trauma sensitive approach, as we are focusing on the present, not the past
  • It isn’t all up to you as a worker – a trauma-informed approach, like the Outcomes Star, needs buy in from your organisation and you need their support.

On May 24, 2021, Nick Karr will host a short session on the Star and trauma informed approaches and training. These CPD sessions are free but available for Licensed Trainers only. Nick Karr has worked with Triangle for seven years. He delivered the first Outcomes Star training in the USA in 2010 and then helped launch and run the Outcomes Star in Australia for two years. Nick is a London based psychotherapist where he has worked in a range of specialist clinical roles, and is now the Lead in an NHS service for people with mental health and substance misuse problems. He completed a Masters’ in Social Work at the Tavistock Clinic, taught on university social work and mental health programs, and is also a Professional Advisor for Young Minds.

****

For more information on how the Stars can support organisations and keyworkers to work in a more trauma-informed manner, please take a look at our guide, or contact Triangle for a more in depth conversation about the Stars, which Stars may be appropriate for your organisations and more information on our training offers.

The interplay of internal and external factors in creating change

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.

*****

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