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.

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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.

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.