In access to further /higher education/employment 4 – access

In an attempt to ensure that all individuals requiring care are dealt
with holistically and with their needs being met, the ‘personalisation’ agenda
has been introduced into a lot of recent government documentation. A system of
care and support tailored to meet the needs of the individual has replaced the
‘one size fits all ‘ approach previously in vogue. Seen as a user-centred
approach to care, it involves the care worker acting as a facilitator in care


Based upon the social model of disability and empowerment, the approach
has been hailed as a better option to the needs-led assessment, and research
supports this (Harris et al., 2005)

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Three dimensions of the model have been put forward as being:


outcomes involving change, such as those that focus
on developing self-confidence, or skills that enable self care.

outcomes maintaining quality of life, occasionally
referred to as maintenance outcomes.

associated with the process of receiving services, or those which
involve being valued and listened to in the care process.


Harris et al. (2005) categorised the dimensions  into a four part framework, which might also
be seen as showing how needs may be met.

The Outcomes Framework

Autonomy Outcomes include:
1 – access to all areas of the home
2 – access to locality and wider environment
3 – communicative access
4 – financial security

Personal comfort outcomes include:
1 – personal hygiene
2 – safety/security
3 – desired level of cleanliness in the home
4 – Emotional well-being
5 – physical health

Economic participation outcomes include:
1 – access to paid employment as desired
2 – access to training
3 – access to further /higher
4 – access to appropriate training for new skills
(e.g. lip reading)

Social participation outcomes
1, access to mainstream leisure activities
2 – access to support in parental role
3 – access to support for secure personal
4 – access to advocacy / peer support
5 – citizenship

Source Maclean et al, 2002







1.2 Critically review approaches to outcome practice

Several approaches to outcome based practice have been identified. I
have listed some of these below,

Results based accountability  is also known as outcome based
accountability. This approach uses data-driven decision making processes to help
problem solving and is a way of thinking and acting that improves the lives of
the community. It has been developed to improve the performance of an
organisations services .

Outcomes management is the means to help patients
and providers make care – related choices based on knowledge of the effects of
these choices may have on the patient’s life.

Outcomes into practice focuses on the outcomes
people value.

Logic model is a logical framework and theory of
change used by funders, managers, and evaluators of programmes to evaluate


Whichever model is implemented, the basic premise is that outcome based
practice is the way forward and replaces the needs led approach that tended to
focus more on the immediate situation and support requirements that would be
provided by a care professional.


The idea of outcomes in care was seen as an achievement and as a more
meaningful way to assist care. In using this approach, the worker takes on the
role of assisting the service user to identify immediate, medium term and long
term term goals. Rather than leading the service users care, the health


    ‘steers, guides and pronounces
the identification of “needs” and the proposed   

               ” intervention”
towards practice driven by the service user , who is

                encouraged and
facilitated to identify their “outcomes”, a set of immediate,

                medium, and long
term goals, that they wish to achieve. The focus on outcomes

                many of the
deficiencies of the “needs” led model described above .