Dr Erin Wilson - School of Health and Social Development, Deakin University
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Dr Erin Wilson: Are we making a difference? Measuring the outcomes of disability related services and supports ( PDF document 904KB - Delivered at field Outcomes Measurement Models – comparisons, ...

Dr Erin Wilson: Are we making a difference? Measuring the outcomes of disability related services and supports ( PDF document 904KB - Delivered at field Outcomes Measurement Models – comparisons, issues and considerations
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    Dr Erin Wilson - School of Health and Social Development, Deakin University Dr Erin Wilson - School of Health and Social Development, Deakin University Presentation Transcript

    • Are we making a difference?Measuring the outcomes of disabilityrelated services and supportsPresenter: Dr Erin WilsonSchool of Health and Social Development, DeakinUniversityAcknowledgements: Dr Nick Hagiliassis andDr Robert Campain, Scope
    • Background- what do I bring?• Worked with Scope; Perth Home Care Services; WA Mental HealthCommission and others• Worked with team of researchers to develop a range of datacollection and outcome measurement tools in a range of contexts:– Individualised funding and planning– Early Childhood Intervention Services– Flexible funding in early childhood– Therapy and psychology services– Community based mental health services– Assistive technology– Range of disability service models
    • Selection of data collection and analysistools developed and trialedScope Outcomes Framework (used for analysis)• A whole of life outcomes framework across seven life domainsScope Outcomes and Impacts tool• A one page survey rating scale to measure impact (positive and negative) of service on lifedomains of individual or familyIndividualised Planning/Review Tool• A tool based on the categories of a person centred plan to rate achievement against goalsMeasurement of Services and Supports (MOSS) tool• A pre and post measure of change resulting from individual goal setting and services based onthis goalFamily Stress and Coping tool AND Family Capacity tool• Two survey scales rating a family’s self perceived level of coping and capacityEarly Childhood Individualised Support Plan tool• Attachment to Individualised Support Plan to rate outcomes at end of service period, andbarriers and enablers to these1 in 4 poll Social Inclusion Survey• A population level survey rating levels of social inclusion related to service exclusion, economicexclusion and social exclusion
    • Overview• Key terms• WHAT outcomes might we use – selecting anddefining outcomes• HOW to measure outcomes – guidingprinciples
    • How do we know if we’re making adifference?3 key ideas/terms•Process•Output•Outcome
    • Terminology – key elementsWhat are ‘outcomes’?In broadest terms, ‘outcome’ means: what happenedBUT different things are focused on and there is confusion overterms and their relationship:1. PROCESS: did we receive or deliver a quality service? The ways inwhich program services and goods are provided. Practices used.2. OUTPUT: how much service did we receive or deliver, how manypeople received it etc? The goods and services produced (quantity,efficiency: e.g., number of people served, speed of response tocomplaints).3. OUTCOME: what happened (for the person)? The broader resultsachieved through the provision of goods and services (Horsch, 2005)
    • • Under the proposed NDIS, it is possible that measurement will occur acrossoutcomes, but also outputs and processes.– e.g., outputs - number of clients serviced, respite hours, equipment payments,home and vehicle modification data;– e.g., process – degree of service coordination, how disputes are managed.• Measuring process or output is frequently used as a ‘proxy’ measure ofoutcome• This is based on the thinking (and sometimes research) that where agiven process is used (or level of output occurs) this leads to thedesired outcome (eg. Support to exercise leads to better health –measure whether support to exercise provided)• Department of Human Services Standards – largely oriented tomeasure ‘good practice’ i.e process• Output or Process measures ≠ Outcomes.– i.e., They do not reveal what happened as a result of the service orintervention or activity.
    • Steps in developing an outcomes measurementapproach for human services1. Decide the desired areas of change– i.e desired outcomes and for whom2. Define these areas & unpack complex terms– eg. what do we mean by ‘communication competence’, ‘awareness’,‘community inclusion’, ‘support’, ‘partnership’?3. Identify the indicators of these changes– how will we know, what will we see if change occurs?4. Decide how these indicators can be measured– How to collect data. How to analyse data. Do measures exist? Can existingmeasures be modified? Do measures need to be developed?5. Combine and present the resulting information in a clear andinformative way. (Adapted from ABS, 2001, ch 1).1. Decidethe desiredareas2. Define theseareas &unpackcomplex terms3. Identifytheindicators4. Designhow tomeasure5. Presentinformation
    • Steps of outcomes measurement Task1. Decide the desired areas of change(what are the outcomes?)Check if specific outcome areas areidentified by funder, government policy,or by others such as individuals who setspecific goals for services. Consultstakeholders (practitioners and servicerecipients)2. Define these areas & unpack complextermsCheck published literature for conceptdefinition and sub domains of concepts.Consult stakeholders3. Identify the indicators of these changes Check published literature to identifyindicators; consult with stakeholders4. Decide how these indicators can bemeasuredCheck published literature for existingdata collection instruments and methods;consult stakeholders; design methods5. Combine and present the resultinginformationReport and publication writing
    • Step 1: decide the desired areas –YYWhich processes should we measure?Processes / practice approaches we might measure:– Family centred practice• (Process measurement tool is Measure of Processes of Care (MPOC), King,Rosenbaum & King, 1995)– Person centred practice– Individualised service delivery– Strengths based practice– Recovery based practice– Etc, etc
    • Steps 1,2, 3:Decide desired areas; Define these areas; Identify indicators.An example: Family Centred Practice1. Decidethe desiredareas2. Definethese areas& unpackcomplexterms3. IdentifytheindicatorsFamilyCentredPractice5 Domains:1. Enabling andPartnership2. Providing generalinformation3. Providing specificinformation4. Co-ordinated andcomprehensive care5. Respectful andsupportive care(King, Rosenbaum and King, 1995)Enabling and Partnership e.g.,Parents felt like partners in theirchild’s careProviding general information e.g.,Parents received adequateinformation about their child’sdisabilityCo-ordinated and comprehensivecare e.g., Looking at the needs of the‘whole’ child (e.g. Mental, emotionaland social needs) instead of justphysical needs
    • Steps 1,2, 3:Decide desired areas; Define these areas; Identify indicators.An example: Department of Human Services Standards1. Decidethedesiredareas2. Definethese areas& unpackcomplexterms3. IdentifytheindicatorsDepartmentof HumanServicesStandards(VIC)4 Areas:1. Empowerment2. Access andEngagement3. Wellbeing4. Participation(DHS, 2012)Empowerment e.g.,Rights and responsibilities are developed andprovided in an accessible format thatfacilitates understanding by all peopleAccess and Engagement e.g.,Service-delivery hours are responsive to theneeds of people accessing the serviceWellbeing e.g., People actively participate inan assessment of their strengths, risks, wantsand needsParticipation e.g., The service providersupports people to develop and maintain theirpersonal, gender, sexual, cultural, religious andspiritual identity
    • Steps 1,2, 3:Decide desired areas; Define these areas; Identify indicators.An example: Person Centred Practice1. Decidethe desiredareas2. Definethese areas& unpackcomplexterms3. IdentifytheindicatorsPersonCentredPracticeDomains / major areas:????
    • Step 1: decide the desired areas of change –yyWhich outcomes should we measure?Outcomes for whom?• Person with a disability• Family /carer of person• Service provider• Service sector• Community members/organisations• Wider society and social structuresFrequentlycapacitybuildingand socialchangeoutcomes
    • Step 1: decide the desired areas of change –yyWhich outcomes should we measure?• What outcomes were seen asimportant by panel?• What others would you add?• What are the most important?
    • Step 1: decide the desired areas of change -Which outcomes should we measure?• Outcomes for persons with disability might include:– Quality of life– Social inclusion– Participation• (community participation, cultural participation, socialparticipation, political participation, economic participation….)– Satisfaction (with services, with life…)– Loneliness– Autonomy, independence, choice….– Etc, etc
    • What are the outcomes sought underthe NDIS?“An important component of the evidence base under theNDIS will be the systematic collection of data on outcomesof particular services or interventions for people withdisabilities. Data on outcomes in employment, education,social participation, and capacity for self-care, and on themeasures that contributed to those outcomes, would helpto build an evidence base for analysing which interventionsor forms of assistance are more effective, and why”.p 576, Productivity Commission Report, Disability Care and Support, 2011
    • What are the outcomes sought in other importantpolicy documents and Conventions?Convention on the Rights of Persons with Disabilities (UN, 2006):• Full and effective participation of all people with disabilities in all areas of communityand economic life• equality, autonomy, independence, opportunity, accessibility, identity, participationand inclusion.National Disability Strategy:• Inclusive and accessible communities– Proportion of people using public transport; proportion participating in common cultural andrecreational activities• Rights, protection, justice and legislation– Feelings of safety; participation in civic life• Economic security– Average income; housing stress; participation in labour market• Personal and community support– Access to and unmet demand for disability services, etc• Learning and Skills• Health and Wellbeing
    • Step 2: Define these areas & unpack complexterms– eg. what do we mean by ‘social inclusion’Step 3. Identify the indicators of these changes– how will we know, what will we see if changeoccurs?2. Definethese areas& unpackcomplexterms3. Identifytheindicators
    • Steps 1,2, 3:Decide desired areas; Define these areas; Identify indicators.An example: Social Inclusion (as used in 1 in 4 poll)1. Decidethe desiredareas ofchange2. Definethese areas& unpackcomplexterms3. IdentifytheindicatorsSocialinclusionSocial exclusionService exclusionEconomic exclusion(Saunders et al 2007a,2007b & 2008)Social exclusion e.g.,Having social contact withother peopleService exclusion e.g.,Accessing medical servicesEconomic exclusion e.g.,Having enough money to getby on
    • The 1 in 4 Poll - Social Inclusion Survey(example items from on line and paper based survey in Easy English)4. Designhow tomeasure
    • Steps 1,2, 3:Decide desired areas; Define these areas; Identify indicators.An example: Quality of life1. Decidethe desiredareas ofchange2. Definethese areas& unpackcomplexterms3. IdentifytheindicatorsQualityof Life1. Emotional wellbeing2. Interpersonalrelations3. Material wellbeing4. Personaldevelopment5. Physical wellbeing6. Self determination7. Social inclusion8. Rights(Schalock, 2004)Emotional wellbeing e.g.,Contentment (moods, enjoyment);Self concept (eg self esteem)Material wellbeing e.g.,Financial status (income, benefits);Employment; HousingPhysical wellbeing e.g., Health;Activities of daily living; leisure
    • Steps 1,2, 3:Decide desired areas; Define these areas; Identify indicators.An example: Outcomes Star (Services Connect)1. Decidethe desiredareas ofchange2. Definethese areas& unpackcomplexterms3. IdentifytheindicatorsOutcomesStarServicesConnect1. Motivation and taking responsibility2. Self care and living skills3. Managing money and personaladministration4. Social networks and relationships5. Drug and alcohol misuse6. Physical health7. Emotional and mental health8. Meaningful use of time9. Managing tenancy andaccommodation10. Offending (Triangle, n.d)
    • Reflections on WHAT outcomes tomeasure: Guiding principles1. Outcomes selected must be meaningful• Must capture what is important to people mostaffected.– Consider whole of life rather than focus on single aspects– Consider broad outcomes list to include ALL that isimportant to people– Consider allowing individuals to name own outcomes (eggoal focused) – able to be configured to the individualisedservice and support context.
    • Example: A Whole Of Life, Whole Of Person ApproachScope Outcomes Framework (Wilson, 2006)• Encapsulates nine life areas:Personal, Social, Economic, Political, Educational, Recreation and Leisure,Cultural, Spiritual, Environment• Reflects– multidimensional aspects of a person’s life– move away from outcomes measurement approaches that have a narrowerfocus, e.g., those that focus on physical functioning exclusively.– whole of life/person approach (not just the piece of it the service addresses).• Drawn from a wide range of literature (and concepts) such as:– Personal Outcomes Measures (Accreditation Ontario, 2000),– National Core Indicators (Human Service Institute, 2003),– Quality of life and subjective well being concepts (e.g., Cummins, 2007; Shalock,2004; International Wellbeing Group,2005),– wide range of other literature (happiness, friendship, social capital, etc),– lived experiences of clients, families and communities involved in Scopeservices.
    • Scope Outcomes Framework / Life domains model(Wilson, 2006)Personal and familywellbeingThat is, in the area of health and function, happiness, wellbeing, safety, sense ofindependence and choice.Social life That is, in the area of friendship and relationship, community involvement and senseof belongingPolitical life That is, in the area of having a say about things that affect you (eg in a local serviceor community group, about your area, school, funding etcCultural life That is, being involved in cultural activities (eg. arts, music, theatre, dance at anylevel). This might be through attending activities or playing an active part. Or beingpart of your own cultural groupRecreational andleisure lifeThat is, being involved in recreational or leisure activities at any level. This might bethrough attending activities, playing an active part or doing what you enjoyEconomic life That is in terms of your finances, employment or business.Educational life That is, any aspect of your family’s education, training, personal or professionaldevelopment.Spiritual life That is, any aspect of your family’s religious or spiritual activitiesYour environmentThat is, your family’s access to and enjoyment of public spaces (eg parks, pools,theatres, shopping centres, public transport etc) or your own private space (eg. yourhome). Making environments you use more accessible and appropriate (egplaygroups, kindergartens, library, etc).
    • Outcomes across whole of life focus: Outcomes and Impacts tool based onthe life domains model (Wilson, 2006)
    • Thinking about whole of life or breadth of outcome coverageScope/Wilson life domains Personal Outcome Measures (Council on Quality Leadership, 2012)Personal and family wellbeingPeople are safePeople have the best possible healthPeople exercise rightsPeople are treated fairlyPeople are free from abuse and neglectPeople experience continuity and securityPeople decide when to share personal informationPeople choose where and with whom they livePeople choose servicesPeople choose personal goalsPeople realize personal goalsSocial life People are connected to natural support networksPeople have intimate relationshipsPeople interact with other members of the communityPeople perform different social rolesPeople participate in the life of the communityPeople have friendsPeople are respectedPolitical lifeCultural lifeRecreational and leisure lifeEconomic life People choose where they workEducational lifeSpiritual lifeYour environmentPeople use their environmentsPeople live in integrated environments
    • Reflections on WHAT outcomes to measure:Guiding principles continued2. Information collected should be able to guideimprovement– “The point is not to collect information - it is to learn enoughabout how things are going so we can keep going or changedirection with confidence. We want monitoring which leads toaction to improved… [practice], and to have a positive impact onpeople’s lives” (Ritchie et al, 2001: 177)– Identification of factors affecting outcomes: enablers, barriers.
    • 2. What worked for you? What helped you achieve your goal?• People, activities, equipment/aids/resources, finances, environment, policies, time. What else?• Which of these was the biggest help?Comments from person with a disabilityComments from others (please specify role, eg. paid support worker, family):Practitioner comments:3. What stopped you from achieving your goal? What made achieving your goal difficult?• People, activities, equipment/aids/resources, finances, environment, policies, time. What else?• Which of these was the biggest barrier?Comments from person with a disability:Comments from others (please specify role, eg. paid support worker, family):Practitioner comments:Example from MOSS: Enablers and Barriers focus
    • Step 4: Design HOW these indicatorscan be measuredGuiding principles for HOW to measure:1. Self report2. Achievable3. Accessible4. EffectiveSee also Andresen, 20004. Design howto measure
    • HOW to measure: Guiding principles1. Self report of person with disability (or those mostaffected, e.g. carer)– Capture the view point of a person with a disability– Create alternative ways a person can give information directlyabout themselves• E.g. Use of multi media• Provide a scribe to assist write, type or enter data– If must use proxy to report, give explicit instruction to reportfrom the viewpoint of person they represent– Be clear who is providing data• Identify different respondent views – distinguish between personwith disability (service recipient), staff, and others– Have a mechanism for informed consent of the person
    • Examples of self report• Ensuring the perspective of the person with a disability iscaptured – explicit instruction to proxies;– 1 in 4 poll:67.4% of respondents completed the survey independently;15% had carers complete the survey on their behalf.The survey is being completed by: A person with disability without assistance A person with a disability with assistance A carer of person with disability (someone speakingon behalf of a person with a disability who cannotexpress their views themselves)Where support is provided, the survey should be completed from theperson with a disability’s view point
    • Examples of self report• Ensuring the perspectiveof the person with adisability is captured;– MOSS:offers three rating scales indifferent formats to enableindividuals to select whichone is meaningful to them.Accessible for some peoplewith intellectual disability
    • 2. What worked for you? What helped you achieve your goal?• People, activities, equipment/aids/resources, finances, environment, policies, time. What else?• Which of these was the biggest help?Comments from person with a disabilityComments from others (please specify role, eg. paid support worker, family):Practitioner comments:3. What stopped you from achieving your goal? What made achieving your goal difficult?• People, activities, equipment/aids/resources, finances, environment, policies, time. What else?• Which of these was the biggest barrier?Comments from person with a disability:Comments from others (please specify role, eg. paid support worker, family):Practitioner comments:Example from MOSS: Different viewpoints
    • HOW to measure: Guiding principles2. Achievable– Brief and easy to use– Avoids administrative burden– Considers time, workload, training, data analysisallocations– Considers BOTH how data will be collected ANDhow data will analysed
    • HOW to measure: Guiding principles3. Accessible– Instrument can be used (with and without support by others) bypeople with a wide range of disabilities including people withintellectual disabilities;– Has alternative formats:• Easy English format and/or visual supports;• simple visual scaling;• physical administration demands low;• allows for simple verbal responses (e.g., ‘yes’ or ‘no’);– Considerations to item/instrument bias; reliability, validity vsinternal inconsistency; acquiescence;– Culture/ language adaptations.
    • Examples of accessibility• Value in engaging Easy English experts totranslate content• Checked by people with intellectual disabilityE.g. 1 in 4 poll:High ‘user friendliness’ ratings (mean rating 8.5)
    • Examples of accessibilityMOSS tool• offer simplified choices and rating scales
    • HOW to measure: Guiding principles4. Effective– Items well match the outcome concepts identified (concept captureand validity)– Indices of change/measurement are responsive – sensitive to andable to capture small changes– Considers timing of data collection – when will outcomes beachieved and apparent? (at moment of intervention, long term)– Has credibility: indicators provide sufficient information about acondition or result to convince both ‘supporters’ and ‘sceptics’(Andresen, 2000)– Allows for aggregating up for generating comparative data, e.g.,comparison to general population, benchmarking data• Data can be analysed at the individual, service provider, disability system andsocietal level.
    • Deciding the ‘when’ of outcomes: outcomesat what moment?– e.g., outcomes for the personwith a disability
    • Example: Deciding the ‘when’Outcomes for the person with complex communicationneeds– at the moment of intervention (e.g. use of communicationboard in a shop)• can communicate effectively• able to make an effective transaction• increased confidence– beyond the moment of intervention - ie on person’s life as awhole• increased ability to shop independently (decrease support costs)• increased choice and range of places can participate in
    • Issues we’ve confronted• Selecting the ‘right’ indices of measurement (e.g.performance, achievement, satisfaction, impact, difficulty,etc)• Aggregating data – moving from a focus on an individual’soutcomes (highly individualised) to whole of service /population outcomes• Data analysis – difficulties in quantifiers, thematising etc –time consuming and often highly subjective• Administration compliance – getting staff to administerdata collection tools (correctly)• And more…..
    • Data collection and analysis toolsdeveloped and trialedScope Outcomes Framework (used for analysis)• A whole of life outcomes framework across seven life domainsScope Outcomes and Impacts tool• A one page survey rating scale to measure impact (positive and negative) of service on lifedomains of individual or familyIndividualised Planning/Review Tool• A tool based on the categories of a person centred plan to rate achievement against goalsMeasurement of Services and Supports (MOSS) tool• A pre and post measure of change resulting from individual goal setting and services based onthis goalFamily Stress and Coping tool AND Family Capacity tool• Two survey scales rating a family’s self perceived level of coping and capacityEarly Childhood Individualised Support Plan tool• Attachment to Individualised Support Plan to rate outcomes at end of service period, andbarriers and enablers to these1 in 4 poll Social Inclusion Survey• A population level survey rating levels of social inclusion related to service exclusion, economicexclusion and social exclusion
    • CautionOutcome measurement is a not an exact science – it tells us somethings but not everything, only part of the storyNot everything that can be counted counts,and not everything that counts can be counted. (Albert Einstein)It is very difficult to establish what CAUSED outcomes – that is, to attributethe change to your service/support. Be cautious in your conclusions.Be careful not to spend more time in outcome measurement and itscomplexities than in taking action to improve the lives of people
    • Relevant publications by research teamCampain, R.& Wilson, E. (under review) Life is what happens while you’re busy making plans: issues inthe development of outcome measurement for individualised plans for people with disability.Quilliam, C. & Wilson, E. (2011). Literature Review - Outcomes measurement in disability services: areview of policy contexts, measurement approaches and selected measurement tools.Melbourne: Deakin University.Hagiliassis, N., Nicola-Richmond, K., Mackay, A., & Wilson, E. (2011). Administration Manual -Measuring Outcomes in Services and Supports (MOSS) tool: a means to assess the outcomes ofperson-directed goals. Melbourne: Scope.Nicola-Richmond, K., Wilson, E., Hagiliassis, N., & Mackay, A. (2011). Summary Sheet - MeasuringOutcomes in Services and Supports (MOSS) tool. Melbourne: Scope.Quilliam, C., Wilson, E., Hagiliassis, N. & Nicola-Richmond, K. (2010). Measurement of Services andSupports (MOSS): Project Overview and Findings. Melbourne: Deakin University.Wilson, E. & Campain, R. (2011), Above and Beyond: Exploring outcomes and practices of ScopeSouthern Region Early Childhood Intervention Service for children with disability, Melbourne:Scope (Vic).Wilson, E. & Campain, R. (2008). Problem solving, people skills, and personalised arrangements. Earlyresults of research into individualised approaches for young adults receiving ‘Futures’ funding atScope. C.Bigby & C. Fyffe (Eds.). Achieving their own lives. Proceeding from the Third IntellectualDisability Policy Roundtable, La Trobe University, OctoberWilson, E. (2006). Defining and measuring the outcomes of inclusive community for people withdisability, their families and the communities with whom they engage. C. Bigby; C. Fyffe & J.Mansell (Eds). From Ideology to Reality: Current issues in implementation of intellectual disabilitypolicy. Proceedings of the Roundtable on Intellectual Disability Policy. Bundoora: La TrobeUniversityWilson, E.; Jenkin, E. & Campain, R. (2011). Outcome Measurement of Community Based MentalHealth Services in Western Australia: Literature and Concept Summary. Melbourne: InclusionMattersPLUS many conferences and workshops and seminars
    • ReferencesABS (2001) 4160.0 Measuring Wellbeing: Frameworks for Australian Social Statistics. Viewed at:http://www.abs.gov.au/Ausstats/abs@.nsf/0/0120F9081822AAEBCA256B5F00804216?Open, on 31 October2005.Andreson E (2000), Tools of disability outcomes research: criteria for assessing the tools of disability outcomesresearch, Archives of physical medicine and rehabilitation, Vol. 81, No. 12, pp. S1-S4.Commonwealth of Australia (2011) . 2010-2020 National Disability Strategy. An initiative of the Council of AustralianGovernments. Canberra.http://www.fahcsia.gov.au/sites/default/files/documents/05_2012/national_disability_strategy_2010_2020.pdfDepartment of Human Services (2012) Department of Human Services Standards self-assessment report and qualityimprovement plan. http://www.dhs.vic.gov.au/about-the-department/documents-and-resources/reports-publications/department-of-human-services-standards-self-assessment-report-and-quality-improvement-planHorsch, K. (2005). Indicators: Definition and use in a Results-Based Accountability System. Harvard Family ResearchProject viewed at http://www.gse.harvard.edu/hfrp/pubs/onlinepubs/rrb/indicators.html on 31 Oct 2005.King, S.; Rosenbaum, P. & King, G (1995). The Measure of Processes of Care: A means to assess family-centredbehaviours of health care providers, McMaster University, Neurodevelopmental Clinical Research, Hamilton,Canada.Schalock, R.L. (2004). The concept of quality of life: what we know and do not know, Journal of intellectual disabilityresearch, 48, (3): 203-216.Saunders, P., Naidoo, Y. & Griffiths, M. (2008). Left out and missing out: Disability and disadvantage. Social PolicyResearch Centre, Sydney, Australia.Saunders, P., Naidoo, Y. & Griffiths, M. (2007a). Deprivation & social exclusion in Australia. Social Policy Research Centre,Sydney, Australia.Saunders, P., Naidoo, Y. & Griffiths, M. (2007b). Towards new indicators of disadvantage: Deprivation and socialexclusion in Australia. Social Policy Research Centre, Sydney, Australia.Triangle (n.d.) Outcomes Star. http://www.outcomesstar.org.uk/
    • ContactDr Erin WilsonSenior Lecturer, School of Health & Social DevelopmentDeakin Universityerin.wilson@deakin.edu.auDr Nick HagiliassisResearch CoordinatorScopenhagiliassis@scopevic.org.au