Sussex Partnership reflect on how the resources and information provided by CORC helped discussion and use of outcome measures in their team. Many thanks to Jenny Cooke for providing the following information.
Our CAMHS service has been using routine outcome measures (ROMs) for two years. However, as it had not been a CYP IAPT service and used to working with outcome measures, this required a big culture shift for clinicians and commissioners. We used reminders about ROMs in supervision, facilitated by supervisors and professional leads, but this did not seem to be working. We wanted to try and find other ways to encourage the use of outcome measures, as previous efforts were felt to be quite punitive. Staff had felt that they were being watched and judged on their performance and the service wanted to avoid adding further stress to clinicians.
Tackling the problems
Jenny came to the CORC Members forum and heard a lot about improved engagement with ROMs through feedback and discussion with other CORC members. Together with the service's ROMs champion (a senior clinical psychologist), psychology placement students and the lead for ROMs in Kent, Jenny thought about how some of the methods discussed at the Forum could be useful for their staff team. Following this the service started to use CHI-ESQ feedback in their team meetings to see what children and young people were thinking about the service, they played the training videos on the CORC website in meetings and Jenny gave out information handouts on ROMs. This prompted a lot of discussion within the team and staff talked about how they felt about ROMs. Previously, they would post out questionnaires to children and young people, but these wouldn't always come back, and having discussion about this among staff encouraged them to start doing them in sessions. Jenny has said that these changes were responsible for "improving clinicians self efficacy" and, as feedback from the CHI-ESQ data indicated, could be linked to improved confidence and trust in sessions with young people.
- Service staff began to talk more about ROMs - "What do I need to do now?" "How do I do this?"
- Opened up a dialogue and created a work culture around outcome measurement
- Couple of months when completion rates for measures rose above commissioner targets
The increase in completion rates did not last, due to increased pressure on staff to do other tasks, and Jenny realised that there needs to be a continuous dialogue within the team to encourage use of outcome measures. Now, staff do their HoNOSCA and CGAS scoring in teams and as individuals to highlight the difference of doing it alone vs. doing it as a team (to test the reliability). It needs to be talked about in team meetings, but we learnt that variety in discussions about outcome measures is important, as looking at completion rates every month is not very engaging. Now the team might look at training videos one month, reliability training around clinician measures the next month, feedback from CHI-ESQ questionnaires in another, analysis of SDQ data in the next, and so on.
How did CORC help?
We made good use of CORC training videos; website; outcome measures information; Guide to Using Outcomes and Feedback Tools with Children, Young People and Families - in fact all the CORC resources!
It takes a lot of man power to keep the dialogue and enthusiasm going - with other commitments it can be particularly difficult. We have recognised the need for a ROMs team and are trying to introduce training for new starters on ROMs straightaway. Continuous dialogue is being facilitated by the planning of away days and other team events. The team also plan to keep using the CORC resources and to use their annual visit from the CORC Regional Improvement Support Officer to give training to their staff.
Many thanks to Jenny Cooke for providing us with this case study.