BERRI: Outcome measurement, assessment and tracking tools for - PowerPoint PPT Presentation

BERRI: Outcome measurement, assessment and tracking tools for children with complex needs

Introducing BERRI Developed by, Dr Miriam Silver, a Consultant Clinical Psychologist and national expert in Looked After Children, BERRI is a set of outcome measurement tools that allow placement providers and commissioners to understand the needs of complex children, identify targets to work on and track how they change over time. This can help inform placement choices, identify needs for therapy or specialist services, see whether interventions are effective, and track progress over time. BERRI is the only assessment tool to cover mental health, emotional wellbeing, behaviour, risk and attachments.

Why measure outcomes? — This is a highly complex population of children and young people who deserve the best possible care — Such care is expensive and paid for from the public purse. — Looked After children go on to worse outcomes than their peers, which are also expensive to the public purse — Commissioners (and Ofsted inspectors) need to know that the placement is actively addressing the children’s complex needs, and is of the highest possible quality — Quality care is a worthwhile investment as it improves the life chances and long-term outcomes for children – something that also saves money in the long-term

Why use BERRI? — Placements using BERRI can evidence an average 14% improvement in score for children’s needs over six months of using the pathway — High level of satisfaction from service managers, care staff, social workers, commissioners, Ofsted inspectors — This care pathway and the BERRI “set a new gold standard for our members” – Jonathan Stanley, chair of ICHA — The BERRI is “the missing link in the residential care sector” - Sir Martin Narey, government advisor who reviewed residential care in the UK

Challenges for LAC — Complex mixture of adversity, trauma, attachment, mental health, neurodevelopmental, educational and social needs in Looked After Children — High level of mental health need — Limited CAMHS resources (perceived as inaccessible) — Variety of placement types, with little clinical governance — Multi-agency context, often out of area — Carers doing most of day to day work are often unqualified, disconnected from evidence-based interventions

Ofsted OFSTED: ‘It has been a cause of frustration that the inspection of children’s homes has been built on national minimum standards that do not have sufficient aspiration for these children and young people and regulations that are concerned mainly with process and procedure. I am pleased, therefore, that the government has now introduced new regulations so that, from April 2015, our inspections will be able to focus more on outcomes for children and the quality of care they receive. We want to see leaders, managers and staff teams who know the difference they are making to children and young people’s lives. (Ofsted, Social Care, March 2015)

Ofsted In Ofsted’s Inspection Framework they state that they will expect: — ‘children and young people to continually make progress from their starting points across all aspects of their development…. — Managers have a clear understanding of the progress children and young people are making in respect of the plan for them.’ That is, there is a strong emphasis on having a clear plan, and a system of outcome measurement to show the progress you are making against this plan, in order to get good/outstanding Ofsted inspection results. This is also a way to know you are doing good work, and regular use of outcome measurements has been shown to improve outcomes!

What needs to change? • We need to assess the children we care for methodically • Gather information about their story • Individualise their care based on this information • Have high quality care plan documents • Use evidence to decide who needs therapy, what form and who will provide this • Monitor how children are progressing • Address issues with behaviour, mental health and attachment • Improve outcomes (with measurements to demonstrate this)

BERRI • Developed through focus groups with those involved in foster care and residential care • Covers a range of different types of concerns that relate to Looked After Children (not just behaviour or mental health) — Written in layman’s terms, not technical jargon, therefore accessible to carers — Themes Behaviour — Emotional well-being — Risk — Relationships — Indicators of potential need for assessment/diagnosis — — Automated online scoring and reporting system — Ability to track change over time, and zoom in on specific issues

BERRI: paper version Frequency and Life events difficulty are both (to put scores rated, as both in context) contribute to the overall challenge Items ask about a wide range of issues shown by LAC, in lay terminology

Outputs The BERRI system produces a number of different outputs to make the data immediately useful: • Automated report, giving scores along with basic advice about each of the 5 domains of need • Spider plot illustrating the child’s score on the 5 domains • Overlay on the chart to show change since last assessment • Ability to identify specific goals to address, and track them in more detail over time • Graphs to visualise change in target behaviours over time, and allow identification of patterns

BERRI: Spider plot

BERRI: Tracking

BERRI: Tracking The new strategies the Why was there this peak in psychologist advised physical aggression? Does it recur seem to be effective in on days with contact? Or when helping this child attend primary carer is not present? Or school when there has been a difficult day at school? And what helped here?

Organisation level data The BERRI system can help to keep an overview of all children who are the responsibility of a particular organisation like a Local Authority or placement provider. • It can generate summary information about the needs of the population (including the potential for custom reports eg how many children self- harm, demonstrate physical aggression, or are at risk of CSE?) • Information about change over time, taking account of life events (including “traffic light tables” of who is making progress and who needs additional input due to unexplained deterioration)

Organisation level data Graph of how children are progressing in one home (change in total BERRI score over 12 months) – new function coming soon

Organisation level data The BERRI system can help to make decisions about which type of placement to use, as we are collecting data about the scores that can be managed within adoptive families, foster placements, residential homes, secure units and other types of placements. For example, some young people may have profiles that suggest they need residential care, and will no longer need to go via multiple foster placement breakdowns to get it. Likewise some young people in residential care may have settled to the extent that stepping down to foster placements is possible. BERRI data will soon give us evidence about which placement pathways work and which don’t.

Organisation level data BERRI provides a means to quantify the “value added” by various services or placement providers. • We will soon have norms for the amount of change that typically occurs in the BERRI profile for children of each age group, placement type or level of complexity. • We can then see whether particular interventions or placements improve these scores. • This will allow providers to evidence the efficacy of their services, and commissioners to make informed choices about which placements and services to commission.

The wider picture We recommend using the full BERRI at least four times per year, as this allows large changes to be identified and provides useful organisational data. The tracking system can be used daily or weekly to “zoom in” on the changes within particular areas of concern, or to see whether interventions are effective. We are currently working in collaboration with UCL and the University of Leicester to validate and norm the BERRI as a psychometric tool, and we regularly improve the features available to subscribers.

The wider picture We see BERRI as one component of improving the quality of placements. As a stand alone tool it can help inform those caring for a particular child, and give useful data to service managers, commissioners and inspectors. However, it can also enhance the efficacy of existing interventions, or be one component in an evidence based, psychologically-informed care pathway. One example of how we have used BERRI is alongside staff training and regular consultations with a psychologist. We call this model PRIME.

PRIME Quality Standards • Psychological assessment • Regular outcome measurement • Individualised care-planning targets • Multi-faceted formulations • Evidence-based interventions Where these five factors are in place the network can work together to provide effective individualised care