‘Strengths’ Assertive Outreach: A Review of Seven Practice Development Programmes.
The Practice Based Evidence consultancy made special efforts to get involved in going beyond simple training; focusing on developing teams with a positive impact on practice. It is one thing to claim to support best practice, but another thing entirely to provide evidence for such claims. Assertive Outreach teams in the UK were a particular passion from the original establishment of the consultancy in October 2001. The following article was first published in the Mental Health Review Journal (June 2008) and is reproduced with their kind permission; it is an evaluation of the support provided, from a strengths perspective, for seven such teams.
Assertive outreach is based on extensive international research and has been promoted in the UK in 1999 as a key area of the National Service Framework for Mental Health. Its primary aim is to provide a specialist service for people disengaged from traditional approaches of mental health services, but very little attention has been paid to how such services can be developed. Practice Based Evidence, a practice development consultancy, has engaged seven assertive outreach teams to focus on development first, and follow-up evaluation of the impact of reflective practice on team functioning. This has prompted a number of strengths-based recommendations for changing the way we think about developing services before we engage in research and evaluation.
How can we make more effective use of targets as a means of developing best practice? Perhaps a more pertinent question is: ‘Can we make effective use of targets at all?’
Nothing drains passion more effectively than constant demands for information to meet apparent targets, asked without consultation or explanation, and with no meaningful returns in the form of useful feedback. Auditing everything has become an industry – but to satisfy what? The function of co-ordinating care, specifically the Care Programme Approach (CPA), has become a focus for quantitative returns that seemingly have little to do with the quality of the working relationships and everything to do with numbers and signatures. As many service users, carers and practitioners will testify, presence at a meeting and signing a form does not necessarily reflect influence, involvement or even truthful agreement with the documented outcomes. Yet, the bureaucratic process keeps requiring the numbers with no apparent reciprocal benefits for practitioners and teams.
I wouldn’t argue against the need for auditing practice; but it does appear from conversations with many practitioners that there are widely differing perceptions about priorities between the management of services and the deliverers of services. Anecdotal sources suggest that most practitioners feel they only receive feedback from audit sources when things go wrong, and that good practice is not confirmed or highlighted when it happens. If practitioners, service users and carers were asked to define the parameters of what needs to be audited, there would be some disagreements between them but the priorities would probably look a lot different from what currently occurs. Most people in the real world are concerned about relationship-building in order to support people to be more self-reliant through identifying and working with their own strengths. Audit needs to be of practice and for practice, with a focus on sustaining current good practice. But that would only put an awful lot of middle management and auditors out of a job, for their focus is ‘change’ for its own sake; as long as the merry-go-round keeps moving they will have a purpose.
See ‘The Art of Coordinating Care’ publication for a detailed framework on delivering a service user-focused, strengths-based, bureaucracy-busting approach to real practice. It has been developed as a reflection of what good practice looks like, but will challenge all practitioners to step up to the mark to deliver values-based personalised services based on working with people’s strengths. Failure to do this leads to the alternative… the more usual current situation of an over-regulated system driven by the need to satisfy the politicians and public that if anything goes wrong ‘it will never happen again’. What the current system can ensure will never happen again is the enjoyment and creativity fuelled by the passion of people who want to make a positive contribution to service users lives.
Feel free to add your own comment about any issues raised above.
“Bureaucracy destroys initiative. There is little that bureaucrats hate more than innovation, especially innovation that produces better results than the old routines. Improvements always make those at the top of the heap look inept. Who enjoys appearing inept?” [Frank Herbert].
An interview with Sue Jugon exploring the influences on her practice as a mental health nurse, team and service manager. Looking at the early influences of growing up in a farming background, and coming into nursing from initial experiences within learning disability services.
A strong emphasis emerges about taking opportunities to have a go at things, without being constrained by the possibilities of failure. Sue is a person for whom working with the most vulnerable people is a life-long passion, and her career path has never deviated from the values and principles that remain focused on the needs of the most vulnerable.
She also talks about her own continuing aspirations, and a natural talent for exploring the playing of different musical instruments. Above all else, it is the love of her children that keeps her focused on who she is, and continues to bring out the best of a dedicated person.
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