Recording outcomes-focused conversations
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This webinar is designed to support outcomes-based working. It can sometimes be a challenge for practitioners to accurately capture the outcomes-focused nature of a conversation so that the written record reads as a reflection of a conversation which is focused on outcomes rather than a task and process account. The webinar provides an overview of some of the practice challenges and solutions to support practitioners in recording outcomes conversations. Aimed at: Practitioners and managers across social care and wider services for adults.
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Recording outcomes-focused conversations
- 1. This webinar is not due to start until 12pm on Tuesday 20th June 2017 Please make sure you have tested your sound before this webinar starts If you need support with this please email: events@ripfa.org.uk or call 01803 847264 Recording outcomes-focused conversations Hosted by Louise Johnstone
- 3. Agenda Time Item 12:00 Agenda, aims and learning objectives 12:05 Why recording is important and what is its purpose 12:15 How can we identify good practice? 12:30 Tools to support practice 12:45 Recording analysis, rationale, decisions and actions 13:00 Close 3
- 4. Webinar objectives To promote awareness of › the importance of recording and its purposes › the practice challenges in recording outcomes-focused conversations › what good practice looks like › tools and techniques to support practice available from RiPfA 4
- 5. Recording – important to practice, or just admin? › Case notes › Assessment / support plan / review › Eligibility / resource allocation › Mental capacity / Best interests / Risk assessment › Safeguarding › Reports for court / other agencies / etc……… › Information about person, place, decision and thought process for future reference › Informing actions, decisions that have direct impact on someone life 5
- 6. What is its purpose? • To inform decisions about next stepsStart of assessment / initial information gathering • Analysing to ensure good decision making, right support, from right source, for right outcomes Main assessment / need, impact, outcomes and eligibility • Enabling right support, from right source, in right way, at right times, right reasons, right budget Support planning / matching support to needs and outcomes • Analysis /decision making re support. Has it worked, if not why not, how needs to change or adjust? Review / checking back on what has come before 6
- 7. Same information different purposes › Practitioners and support workers gathering information direct › Manager reading what has been recorded › Other agency (e.g. NHS) accessing information › Support provider › Commissioner › Performance monitoring / management info › Person 7
- 8. Perceptions of recording - Poll › Why did you feel like that? What affects how you view recording? What are the barriers for you? 8
- 9. How can we identify good recording 9
- 10. How can we identify good recording 10
- 11. Barriers and challenges 11 › Are these the key challenges and barriers? What others have you experienced?
- 12. Tools to support outcomes-focused practice 12 › Web resource − Preparing − Having − Recording − Reviewing − Reflecting ‘Supporting outcomes-focused practice’ http://outcomes.ripfa.org.uk/
- 13. Tools to support recording outcomes-focused conversations 13 › Cornell note taking
- 14. Tips for recording outcomes-focused conversations 14 › Prepare beforehand › Make the purpose clear to the person › Be honest about your style of notetaking › Write down what is important › Actively listen › Note the main points ‘in the moment’ › Take time to reflect and summarise what has been said › Consider using shorthand › Try using a framework › Write up as soon as possible › Read it back to yourself before finalising it, how would it feel if someone wrote that about you
- 15. Recording outcomes-focused conversations - polls 15 1. Preparing for the conversation 2. Talking / listening to the person 3. Taking notes 4. Organising your notes 5. Analysing the information 6. Planning what to write / considering the audience(s) 7. Writing up the information as the formal record 8. Proof reading / reviewing what you have written
- 16. Tools for recording outcomes- focused conversations 16
- 17. Cornell note taking tool Five steps to using the method: 1. Record notes - what is said that is important? 2. Review, organise and analyse notes 3. Plan how to record and where 4. Write up (and read back over) – are the story, need impact and outcomes clear 5. Reflect – are the hallmarks evident? 17
- 18. Other tools for recording outcomes- focused conversations 18 http://outcomes.ripfa.org.uk/wp- content/uploads/2016/06/Tool_Id entifying_outcomes.pdf
- 19. Recording analysis and decisions (1) 19 › What information was gathered, from who and why. › What you thought it meant and why you thought this (analysis and critical thinking). › What your professional judgment was based on what you thought. › What decision was made and who was involved in making it. › What action was, or wasn’t, taken as a result of the above.
- 20. Recording analysis and decisions (2) 20 As a general rule the record should always: › Reference relevant legislation and guidance e.g. around mental capacity or coercive control › Reference other relevant assessments or reports which have been undertaken e.g. Best Interests or Capacity assessments › Distinguish between fact, opinion, professional judgement and hearsay
- 21. Recording analysis and decisions (3) 21 As a general rule the record should always: › Use appropriate language i.e. non-judgmental, unambiguous › Clearly state your hypotheses, why you think X or Y rather than A or B › Explain how you arrived at decision the ‘workings out’ i.e. be defensible › Consider the level of risk in conjunction with the person’s desired outcomes
- 22. Questions/ comments › Pop them in the pod! 22
- 23. Create an online account - for Partners You can access our learning resources by creating an online account at: https://www.ripfa.org.uk/login/ create-account/ With an account you can: › Download resources › Book places at webinars and workshops › Subscribe to RPU / bulletins 23
Editor's Notes
- - Introduce the delegate workbook and other handouts
- Quick poll here: Frontline worker recording information direct from person (face to face or on the phone) Manager who uses information recorded by others to make decisions on budgets or safeguarding actions Commissioner who uses records to inform commissioning or development Other – e.g. someone using information for quality monitoring or practice development If you are watching as a group then just answer for the person signed in. Remember if you are watching a recording, please don’t try and respond as your vote won’t be counted and you may still be charged!
- All of these should involve and reflect the outcomes focused conversations with the person and their wider support network (formal and informal). In the context of this webinar we are concentrating on recording outcomes focused conversations, for example a large number will happen as part assessment support planning and review and result in records and case notes. Outcomes focused conversations will also be important part of safeguarding and positive risk taking and may form part of legal evidence, court reports and so on. We aren't looking to define writing for court today but we must be mindful of the potential that any information we record, any conversation that we have could end up being required in that context. What is critical is to remember that what we are recording is information about a person, their life, their home, what they thought what we thought and decisions made with them and about them. What we record, or in some cases what is omitted from records, has a direct and potentially massively significant impact on a person life. It will to an extent shape and determine what happens to them
- At a basic level thinking about assessment of need the purpose of recording is to document the information gathered so that it can inform the next steps (from start of assessment), form the body of the assessment containing the information which will be analysed and used to make key decisions that will affect whether, and if so how, the person gets support to meet the outcomes associated with their needs. The impact of what is recorded and how it is used has potential to affect them personally, physically / emotionally / financially – has implications for them, their families / friends /carers – the wider community / provider organisations / council.
- The information we record has multiple audiences and, as we have said, is used to inform multiple actions – we mustn’t lose sight of this and need to bear in mind the possible uses of what we record. However, what is key in recording outcomes focused conversations is to remember the record should reflect the person, their thoughts and feelings, hopes and aspirations – these should be visible to all audiences so that they can be taken account of.
- A quick poll – not at all scientific but to get you reflecting on you perceptions. Q. Thinking about the last piece of information you recorded, how did you feel about this? What was your perception of the importance? Its anonymous so do be honest. If you haven’t done any recording of direct conversations with service user for a while think about supervision or other conversations you needed to record – supervision also has an impact not only for staff but for the people they are supporting. Poll – Perception of recording – answers (multiple choice) I saw it as a necessary chore to get done as quickly as possible so I could get on with other things I allocated as much time I could to do a decent job but was frustrated by getting things in the right boxes to satisfy our procedures I thought about the wider purpose and audience, I had this in mind and recorded what I felt was proportionate based on the context of these I thought about the purpose of what I was writing and the impact for the person, the organisation(s) and me as a professional Not going to ask you to answer the questions below but these might be useful to reflect on afterwards. Research, and personally my experience, suggests that recording can be seen as a chore. Something we rush to complete so we can get on with other stuff. There are a number of barriers and challenges to good recording, which is fit for purpose. Evidence policy, process and practice have been followed appropriately, demonstrating professionalism and competency. Give the rationale behind professional judgement, making it clear how a decision was arrived at and being accountable for why a particular course of action was taken (or indeed not taken). Provide a clear picture of the person’s story, their wishes, views and preferences which can be used by them and/or others to empower and better understand their situation and any care or support needs
- Any record is only as good, or as useful, as the information it contains. The quality of the information gathered and how well it is written up is central to this. Writing should be treated as a professional activity; practitioners should aim to develop their writing skills in the same way they would any other professional requirement. The HCPC standards, knowledge and skills statements and the professional capabilities framework all reference the importance of good recording in terms of demonstrating accountability and justifying their decisions and recommendations.
- Ethical –is non-judgmental in tone; uses respectful language; considers the person’s rights, consent and confidentiality as well as that of other people or professionals involved or referred to within it; doesn’t label, stereotype or put people into boxes. Lawful – adheres to the requirements of the Care Act 2014; takes account of other relevant legislation such as that around mental capacity, mental health, equalities and human rights; follows relevant national and local guidance, policy and/or procedures. Person-centered – accurately reflects the persons circumstances, tells their story; shows person was as fully involved as they wanted to be / as possible; considers capacity; clearly states the person’s views, wishes, feelings, beliefs and their desired outcomes. Strengths-based - looks at the person’s individual strengths, resilience, capacity and networks, as well as needs and risks; takes account of strengths and assets which may be available via the person’s immediate network, family, friends, neighbors and those available in the wider community. Appropriate – information is gathered and recorded in a way which is suited to the person’s circumstances in terms of their needs and preferences; involves the person as much as they want to be involved and allows them to lead the process as much as possible. Holistic – looks at the person’s life as a whole, all areas of their wellbeing, and any interdependence between different areas of this; considers whether, and to what extent, the person’s needs impact on their person’s wider support network, for example, of family and friends Joined-Up - involves other relevant people, for example, professionals where appropriate; takes account of, and references, other relevant assessments, reports and information which may be available Proportionate – reflects the person’s view of what’s important and what is needed; the number of needs and people involved; the complexity of the situation; the likelihood of change; the likelihood and consequence of risk; the likelihood of dispute and how unusual the situation is. Accountable – is clear about what is fact, opinion, heresy and where these originate from; explains rationale behind opinions, decisions and action / inaction; and states what was done, by whom and why; is signed and dated. Analytical – weighs up information; is informed by evidence; explains meaning; identifies gaps; includes professional judgements, reasoned decisions and recommendations; avoids irrelevant speculation, subjective comments or personal opinions, for example, comments about the person’s life choices or character. Useful – includes clear outcomes for the person; reaches a conclusion about needs and eligibility; ensures links between need, impact, outcome and eligibility rationales are clear; includes actions and is clear about what will happen next i.e. the what, who, when and why; contains only relevant information. Well-written – is written in clear, correct English; logical and concise; uses empowering language; avoids repetition or duplication; uses Plain English; reflects the principles of professional writing. You won’t get records that reflect these hallmarks with out gathering the right information, getting to the nub of what matters to the person, requires an outcomes focused conversations – but actually capturing the information whilst having the conversation can be a challenge
- You won’t get records that reflect these hallmarks with out gathering the right information, getting to the nub of what matters to the person, requires an outcomes focused conversations. Can’t underestimated the importance of getting the right information in the right place, getting things in the right boxes as mentioned in the poll, but we must try and avoid letting forms drive conversations and to do this requires acknowledgment of the challenges of finding a balance between capturing the information in a way that supports good recording with having the kind of conversation that can draw out the information. Brief answers in chat pod please………….
- So first of all you need to have the conversation! RiPfA have just launched a new web resource – supporting outcomes focused practice. Very much around having conversations which identify not only need, impact and outcomes but also seek to draw out the strengths and assets people have. Main part of the site is split into these five sections which look at the different aspects. All of which support good conversations and so facilitate getting the information you need for recording. Preparing helps to improve the quality of the conversation, quality conversation is needed to ensure you get the information needed, with out this nothing to record! All very interdependent activities. Each section contains a number of tools, exercises and resources that could be used by individuals or teams. Managers section providing ideas for how you could use to support practice development.
- The tool we are looking at today is available to partners only whilst the resources on the supporting outcomes focused practice website are open access – both will be useful separately or together.
- Prepare before the conversation, think about why you are going, who will be there and what might be said – the likely complexity Make it clear to the person that you will be taking notes and why you are doing so Be honest about your own note taking style, take the time to reassure the person you are still listening even if you need to break eye contact to ensure you get a detailed point down Write what the person is telling you is important to them. Think actively about what the person is saying to identify what does need to be noted down and what doesn’t. It is unlikely you will need, or be able to, note everything word for word. Pick out the significant things Listen intently. Important statements might begin: "What I struggle with most is…”, “What is most important…”, “The key things are…”, “What I really miss…”, “My favourite…”, “What I like best.”, “The most frustrating thing is…”, “I worry more about…” Write down the main points ‘in the moment’ then when the person is finished speaking, clarify, go back over the main points and use that time to summarise and get things down in more detail, in their own words where possible. It’s an opportunity for both you and them to reflect on what has been said before moving on Consider using a shorthand way of writing things down, adopt a set of familiar abbreviations. But remember to expand these to comprehensible words when writing up. If you use abbreviations for organisation names or conditions, for example NHS or COPD, always provide a definition of the abbreviation where it is first recorded Try using a framework for taking notes, like the identifying outcomes tool or a prompt sheet based on your form so you can note down the key points under the most appropriate theme or heading ready for when you write it up Write up as soon as possible after the event, while it is fresh in your mind Read it back to yourself before finalising it, how would it feel if someone wrote that about you?
- 2 x polls Q1 Which do you spend the most time on? Q2 Which do you spend the least time on? Is that how you think it should be? (Answers in pod) – do you feel you are able to get the balance right?
- Prepare before the conversation, think about why you are going, who will be there and what might be said – the likely complexity Make it clear to the person that you will be taking notes and why you are doing so Be honest about your own note taking style, take the time to reassure the person you are still listening even if you need to break eye contact to ensure you get a detailed point down Write what the person is telling you is important to them. Think actively about what the person is saying to identify what does need to be noted down and what doesn’t. It is unlikely you will need, or be able to, note everything word for word. Pick out the significant things Listen intently. Important statements might begin: "What I struggle with most is…”, “What is most important…”, “The key things are…”, “What I really miss…”, “My favourite…”, “What I like best.”, “The most frustrating thing is…”, “I worry more about…” Write down the main points ‘in the moment’ then when the person is finished speaking, clarify, go back over the main points and use that time to summarise and get things down in more detail, in their own words where possible. It’s an opportunity for both you and them to reflect on what has been said before moving on Consider using a shorthand way of writing things down, adopt a set of familiar abbreviations. But remember to expand these to comprehensible words when writing up. If you use abbreviations for organisation names or conditions, for example NHS or COPD, always provide a definition of the abbreviation where it is first recorded Try using a framework for taking notes, like the identifying outcomes tool or a prompt sheet based on your form so you can note down the key points under the most appropriate theme or heading ready for when you write it up Write up as soon as possible after the event, while it is fresh in your mind Read it back to yourself before finalising it, how would it feel if someone wrote that about you>
- This method of note taking involves developing a simple set of cues or headings relevant to the purpose of the notetaking. Notes are made against the most relevant cue and afterwards the note taker reviews these, formulating questions designed to help clarify meaning, identify relationships, reinforce understanding and recall of the discussion. Lends itself really well to using domain headings or sections, from assessment form for example, as the cues. Reducing the need to flick backwards and forward through a paper form (or screen if live inputting) and means the conversation can flow rather than be forced by what page you are on and what the next question is. The version we have developed uses cues based around the national eligibility criteria headings and wellbeing principles presented in the Care Act 2014. These are commonly found on local authority social care need assessment forms and offer a logical and lawful basis around which to structure note taking when having a conversation about a person’s possible social care needs. Record – make your notes on the tool, don’t try and capture every word. Consider developing your own set of abbreviations or symbols to use. Listen actively, noting what is important to the person, and what you think is important as a professional. Review, organise and analyse – look for links, themes, patterns, gaps. Look for what was important, what the impact might be for the person, hypothesis as to what might be going on, the level of possible risk, frame questions to help you understand what is important to the person, what are their desired outcomes, what might need to happen next and why. Plan – consider how you might structure your recording, thinking about your local systems and process requirements, where would be most logical to record the different bits of information so that the record flows and is easy to follow and understand. Write Up – write professionally, proof read, refer to your notes to check you have recorded everything you need to. Remember to be proportionate, the amount you record will vary depending on the complexity of the circumstances. The relationship between the story, need and outcome should be really clear. Reflect – revisit the record and consider what you have written, are all the characteristics of good recording evident?
- Prepare before the conversation, think about why you are going, who will be there and what might be said – the likely complexity Make it clear to the person that you will be taking notes and why you are doing so Be honest about your own note taking style, take the time to reassure the person you are still listening even if you need to break eye contact to ensure you get a detailed point down Write what the person is telling you is important to them. Think actively about what the person is saying to identify what does need to be noted down and what doesn’t. It is unlikely you will need, or be able to, note everything word for word. Pick out the significant things Listen intently. Important statements might begin: "What I struggle with most is…”, “What is most important…”, “The key things are…”, “What I really miss…”, “My favourite…”, “What I like best.”, “The most frustrating thing is…”, “I worry more about…” Write down the main points ‘in the moment’ then when the person is finished speaking, clarify, go back over the main points and use that time to summarise and get things down in more detail, in their own words where possible. It’s an opportunity for both you and them to reflect on what has been said before moving on Consider using a shorthand way of writing things down, adopt a set of familiar abbreviations. But remember to expand these to comprehensible words when writing up. If you use abbreviations for organisation names or conditions, for example NHS or COPD, always provide a definition of the abbreviation where it is first recorded Try using a framework for taking notes, like the identifying outcomes tool or a prompt sheet based on your form so you can note down the key points under the most appropriate theme or heading ready for when you write it up Write up as soon as possible after the event, while it is fresh in your mind Read it back to yourself before finalising it, how would it feel if someone wrote that about you>
- Also as part of the tool we have provided two contrasting records of the same assessment. Using this kind of example might be helpful in terms of illustrating ways of recording facts, opinion, analysis, rationale, decisions and actions. This is an area that people can find challenging – in my personal experience, having read many assessments and case records over the years, is the aspect that is most often lacking or in need of strengthening.
- Good recording practice, becomes especially critical in complex cases, where there are high levels of need, risk and/or harm. For example, where safeguarding concerns have been raised or where Mental Capacity or Best Interest assessments have been undertaken. Laming report (Climbe) stressed the critical nature of the keeping of proper notes and the accurate recording saying it is a fundamental aspect of basic professional competence. It also emphasises how crucial the record is, when referred to, in providing sufficient clear and accessibly recorded information to facilitate effective social work practice (Lamming, 2003). Lynch (2009)
- Good recording practice, becomes especially critical in complex cases, where there are high levels of need, risk and/or harm. For example, where safeguarding concerns have been raised or where Mental Capacity or Best Interest assessments have been undertaken. Laming report (Climbe) stressed the critical nature of the keeping of proper notes and the accurate recording saying it is a fundamental aspect of basic professional competence. It also emphasises how crucial the record is, when referred to, in providing sufficient clear and accessibly recorded information to facilitate effective social work practice (Lamming, 2003). Lynch (2009)