Results Based Accountability Charlotte Drury WLGA Results Based Accountability Purpose of Workshop: • Provide an overview of the RBA framework • Show how RBA can help to plan and deliver outcome based services • Give some examples of practice in Wales Results Based Accountability A disciplined way of embedding outcome based decision making into planning, delivery and accountability for partnerships and projects. RBA increasingly popular in UK and elsewhere . . . • • • Embeds performance management into planning and delivery Helps turn talk quickly into actions Explains both collaborative and service accountability and how they fit back together RBA included in CYP Plan and HSCWB Guidance www.cartoonstock.com The Importance of Language All these new words are very elitist, and I don’t think there’s a place for it. [By...] using language that a fair proportion of the community won’t understand you’ve already set yourselves apart before you’ve even started.’ Interview transcript - Royal Town Planning Institute research into the language of regeneration, 2001 The Importance of Language Too many terms. Too few definitions. Too little discipline Outcome Benchmark Indicator Aim Milestone Result Modifiers Measurable Core Urgent Qualitative Priority Programmatic Targeted Performance Incremental Strategic Systemic Goal Objective Target Impact Measure RBA Common Language Tools IDEAS POSSIBLE LABELS WORDS CHOICE MODIFIERS 4 legged • Dog mammal – • Hound often kept as • Canine pet – barks • Large • Brown • Toy • Dangerous “Toy dog” What we use • Measure to measure • Result the benefits • Indicator of our service • Impact • Customer “Customer Result” Two Types of Accountability Population Accountability – collective or collaborative responsibility for the well being of populations (e.g. Local Service Board accountable for all people in L.A. Area) Performance Accountability – the responsibility of a project, programme or service system for specific results for its “customers” (e.g. drug cessation programme accountable for “customer results”) Why This Matters: Responsibility English National Indicator Set: Outcome 4: Healthy & Successful Adults (Population Accountability) NI131: Timeliness of social care assessment (Performance Accountability) Why This Matters: Responsibility CYP Plan Outcome Measures Framework: Priority 3.2: Every child and young person is safe and protected from abuse, victimisation and exploitation (Population Accountability) Outcome Measure: % of initial Social Services assessments carried out within 7 working days (Performance Accountability) Performance Population Keeping Accountability Straight Population Outcome A condition of well-being for a population (or sub-pop) stated in plain language People in Wrexham live in a safe community Population Indicator Measurable information which helps quantify achievement of population outcome Crime rate in Wrexham Performance Measure Measurable information which helps quantify if a service etc works • How much did we do? Children in Wales are born healthy Rate of low birth weight babies in Wales • How well did we do it? • Is anyone better off? Population and Performance Accountability CONDITION OF WELL-BEING A Flying Start for Children in Cardiff POPULATION INDICATORS % low birth weight % breast fed at 6 months % fully immunised % assessed ready for school End Contribution Parenting Project Children in Cardiff WHOLE POPULATION PERFORMANCE MEASURES % parents attending gaining better coping skills % parents who use techniques learnt after 6 months Means Courtesy of David Burnby & Associates Outcome, Indicator or Performance Measure? 1. People in the community are safe 2. Crime Rate 3. Average Police Response Time 4. People living in safe, stable affordable housing 5. First time entrants to Criminal Justice System 6. % of low birthweight babies 7. % of LAC reviews carried out on time 8. Achievement of 5 A*-C grades at GCSE Outcome Indicator P.Measure Outcome Indicator Indicator P.Measure ? If the question is “How are we doing as a community on education attainment?” Indicator If the question is “How good is XYZ school at raising educational attainment?” P.Measure From Ends to Means in 7 Questions Population Accountability 1. What is the quality of life condition we want for the selected population in our community? Population Outcomes A condition of well being for a population or sub population stated in plain language. A Population (or sub) + A Place + A Condition of Well Being From Ends to Means in 7 Questions Population Accountability 1. What is the quality of life condition we want for the selected population in our community? 2. What would this look like if we could see it? 3. How can we measure these conditions? 4. How are we doing on the most important of these measures? (Baselines and the story behind them) Baselines 3 years if nothing changes – OK? Today % Teen pregnancy WHY? Time Target for 3 years from now From Ends to Means in 7 Questions Population Accountability 5. Who are the partners that have a role to play in doing better? 6. What works to do better, including no cost/low cost ideas and off the wall ideas? 7. What do we propose to do? Action – what, how, who, when, how much! 1. Condition of Well Being Children in Powys are safe 2. What does this look like? Safe at home, from crime & bullying etc DD1 3. How can we measure these conditions? 4. How are we doing? % young people victims of crime Baselines & stories 5. Which partners? 6. What works to do better? 7. What are we going to do? Police, YOTs, schools, families etc DD2 Best ideas, new ideas etc Action plan and budget – by when and how? The RBA Commissioning Journey – From Talk to Action ENDS (POPULATION ACCOUNTABILITY) DESIRED OUTCOME Choosing the INDICATORS Drawing the BASELINE (and the CURVE TO TURN) Choosing the PARTNERS REVIEW Contributory Relationship The STORY BEHIND THE BASELINE The ACTION PLAN Deciding WHAT WORKS COMMISSIONING MEANS (PERFORMANCE ACCOUNTABILITY) PERFORMANCE MEASURES How Much? How Well? Better Off? (CLIENT OUTCOMES) Risks • Less money – fewer grants – more competitive • Everyone likely to be hit - some more than others • Less stability = more difficult to retain and develop good people • Ultimately the price falls on people who need these services Opportunities • Agencies which speak a common language best placed improve services & save money • Greater clarity of expectations • Being able to demonstrate impact of wellfounded programmes • Able establish clear link between service results and population well being • Opportunity to use flexibility of 3rd Sector Performance Accountability - for projects/services with a defined customer) Two Types of Accountability Population Accountability – collective or collaborative responsibility for the well being of populations (e.g. Local Service Board accountable for all people in L.A. Area) Performance Accountability – the responsibility of a project, programme or service system for specific results for its “customers” (e.g. drug cessation programme accountable for “customer results”) Performance Population Keeping Accountability Straight Population Outcome A condition of well-being for a population (or sub-pop) stated in plain language Older people in Flintshire live in a safe community Population Indicator Measurable information which helps quantify achievement of population outcome Crime rate in Flintshire Performance Measure Measurable information which helps quantify if a service etc works • How much did we do? Older people in Gwent live independent lives Number of hospital admissions due to falls • How well did we do it? • Is anyone better off? Performance Measures Quantity Effort or Quality How much did we do? How well did we do it? # % or Effect Is anyone better off as a result? % # Performance Measures Types of Performance Measure How much did we do? (#) Customers served (#) Activities How well did we do it? (%) Common measures (e.g. % staff fully trained) (%) Activity specific (e.g. % on time, % fully completed Is anyone better off as a result? (%) Skills or Knowledge (e.g. qualification) (%) Attitude or Opinion (e.g. towards school) (%) Behaviour (e.g. attendance) (%) Circumstance (e.g. in work) Performance Measures Substance Misuse Service How much did we do? # young people seen # 1-to-1 sessions How well did we do it? % staff with higher qualification % 1st appointments within 2 weeks of referral Is anyone better off as a result? % people using service who are off drugs/reduced use at end of 12 week intervention % people using the service who are off drugs/reduced use 6 weeks after end of intervention Performance Measures Education How much did we do? How well did we do it? # of additional learning courses % sessions delivered to schedule # young people on courses % young people completing course Is anyone better off as a result? % young people on additional learning courses gaining 1 or more GCSEs % young people on additional learning course with improved general attendance Performance Measures Youth Outreach Service How much did we do? # outreach bus sessions # contacts How well did we do it? % sessions delivered to schedule % young people writing action plan Is anyone better off as a result? % young people accessing appropriate training as a result of contact with youth outreach % young people reporting increased healthy behaviour Turning Case Management Data into Performance Measures NAME ISSUE RESULT John C Anxiety about attending school Significant change Laura D Feels “lonely & friendless” Partial change Carl F Involved in nuisance activity No change Anne P Using alcohol Partial change Mary H Unauthorised absences No change Possible service performance measure of “Is Anyone Better Off”? (Lower Right) An aggregate of the • % service users showing difference the service has “significant” or “partial” made to individuals! positive change (60%) Population Outcome Contributed to – “High Achievement for Young People” 1. Customer Population Young people on ed. support programme 2. Is anyone better off? LR % Key Stage passes DD1 3. Are we delivering services well? UR 4. How are we doing? % sessions delivered on scheduled date Baselines & stories 5. Which partners? 6. What works to do better? 7. What are we going to do? Schools, families, peers etc DD2 Mentoring, alternative curriculum Action plan and budget Fitting Population Accountability and Performance Accountability Together Fitting it all Together POPULATION ACCOUNTABILITY Outcome = Healthy children Indicator = % low birth weight Contributory Relationship PERFORMANCE ACCOUNTABILITY Ante-Natal Smoking Project How much? How well? # sessions % sessions to schedule # service users % satisfied Is anyone better off? # service users % service users stopping while stopping while pregnant pregnant Customer Result Alignment of measures Appropriate responsibility Presenting Your Contribution Population Accountability Outcome(s) to which you most directly contribute Indicators Story behind the curves to turn Partners with a role to play Actions – what its going to take to turn the curve Your role – as part of the larger strategy Performance Accountability Your programme & what it delivers Performance measures Story behind the curves to turn Partners with a role to play Actions – what its going to take to turn the curve How it all fits together Community Strategy Outcome = Prosperous City Economic Strategy Indicator = % unemployed CYP Plan Outcome = Children Live Free From Poverty Flying Start Indicator = % children living in workless households Project = Maintained Childcare % parents helped to access work, education or training Outcomes & contributions align – indicators/measures make sense – appropriate accountability – what matters is outcomes not plans and process THE WELSH EPILEPSY UNIT Service Description: The Welsh Epilepsy Unit is a tertiary referral centre for specialist epilepsy services in South Wales. The immediate catchment population covered is 700,000, but many referrals are also taken from elsewhere in Wales. The Unit offers a multidisciplinary approach to epilepsy care and offers a very broad range of services to people with epilepsy, their families and carers. DEFINED SERVICE USERS Patients with a first suspected seizure or unexplained blackout HEADLINE PERFORMANCE MEASURES DATA DEVELOPMENT AGENDA 1. % seen by a specialist within 2 weeks 2. % DNA first seizure clinic 3. % have diagnostic tests within 4 weeks 4. % follow the correct pathway 1. % on inappropriate treatment 2. % have clinic letters sent within one week of clinic 3. Why patients DNA first seizure clinic HOW ARE WE DOING? % Seen b y a Sp ecialist wit hin 2 W eeks % have d iag no st ic t est s w it hin 4 w eeks % D N A F ir st Seiz ur e C linic 30% 25% 35% 15% 100% 30% 25% 20% B asel i ne 20% B as el i ne P r edi ct i on 15% P r edi c t i on Cur ve t o t ur n 10% Cur v e t o t ur n 80% 25% B asel i ne 5% 0% 2007 2008 2009 2010 2011 2012 P r edi ct i on 15% Cur ve t o t ur n 10% P r edi ct i on 40% Cur ve t o t ur n 5% 5% 20% 0% 0% 0% 2007 2008 2009 2010 2011 2012 STORY BEHIND THE BASELINES Clinic capacity – 1 clinic per week with 5 patient slots Unpredictable demand Small MDT – unable to cover absence to prevent clinic cancellation Low frequency of clinics causes delay if appointment not suitable Clinic booked by Epilepsy Unit admin staff – if admin staff on leave clinic slots not filled Consultant triage’s fax referrals – delay if unavailable Patient anxiety Stigma attached to Epilepsy Patients put off by unit name – diagnosis seems pre-determined Concerns re implications e.g. diving B asel i ne 60% 20% 10% % f o llo w co r r ect p at hway 2007 2008 2009 2010 2011 2012 2007 2008 2009 2010 2011 2012 PARTNERS WHO CAN HELP US DO BETTER Emergency Unit/MEAU, Radiology, Neurophysiology, Medical records, A&C staff, Consultants, Ambulance Trust, Cardiology, Psychology, Care of the Elderly, Neurosurgery, Prison, Voluntary Sector, CELT, Practice Nurses, Family members/ witnesses, Drug and Alcohol Services, Occupational Health, Referral Management Centre, Obstetrics. WHAT WE PROPOSE TO DO TO IMPROVE PERFORMANCE Develop nurse led Emergency Unit assessment service Develop nurse led first seizure clinics Enable specialist nurse referral for EEG Change the name of the Epilepsy unit POPULATION Children aged 0-3yrs 11 months with an eligible post code, resident in one of the eight Cardiff Flying Start catchment areas. Population Scorecard OUTCOME Flying Start Children are Healthy & Thriving Headline Indicators (Bellwethers) DATA DEVELOPMENT AGENDA •% FS Children assessed, scoring >2 deviations below their chronological age on the ‘Schedule of Growing Skills Assessment at 2yrs (21-29 mths) & at 3yrs (33-41 mths) •% FS Children completing primary immunisations •% FS Children fully immunised to schedule at 47 mths •% FS Families who respond to questionnaire, reporting that FS has helped THEIR CHILD ‘a lot or more’ •% FS Children with a BMI below the 91st percentile and above the 2nd percentile at 36 months •% FS Children scoring >2 deviations below their chronological age on the ‘hearing & language skills SOGS Assessment ‘ when aged (a) between 21-29 mths & (b) 33-41 mths HOW ARE WE DOING? % Children scoring at/above or below chronological age % Children assessed at 2 & 3yrs, scoring at/above or below their chronological age (1st April 2009 - 31st March 2010) 100 80 80% 60 70% % 60% 40 % 50% 20 2 Years 40% 3 Years 0 30% 20% 10% 0% Adam Glan- Green Herbe Moun Shire St Trelai Wind sdow Yrway rt t newto Mary Catch sor % Below Ch. Age 66 8 52 26 36 20 35 35 17 % At/Above Ch. Age 33 91 48 73 63 80 64 65 82 Catchment % At Above Chron. Age % Below Chron. Age 100% 90% 80% 70% 60% % 4 yr old FS 50% Population 40% 30% 20% 10% 0% Children Born 1/10/06-31/10/06 % Uptake of % Uptake % Uptake Completed MMR, HIB, MMR & HIB Primary MENC Catch-Up Courses Booster & Imms PNE Imms % Parents responding to questionnaire, reporting that Flying Start has helped their child with: 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% DECEMBER 2009 - 38 out of 140 questionnaires returned (27%) MARCH 2010 - 21 out of 98 questionnaires returned (22%) Sp ee ch Be ha vi So ou cia r lS kil ls Co nf id en ce Le ar ni ng To i l et Ea in tin g g ha G Ph en bi ts er ys al ica He lD al ev th el op m en t % FS Children Fully Immunised at 47 months % answered "a lot" or "a huge amount" HOW ARE WE DOING (Con’t)? JULY 2010 - 31 out of 182 questionnaires returned (17%) Immunisations STORY BEHIND THE BASELINE PARTNERS WHO CAN HELP US •Children who had their 1st SOGS II assessment at 3 yrs were born in 2006/7, prior to the initiation of the FS Programme. These are children that would have had very limited exposure to FS interventions. In comparison the children who had their 1st SOGS at 2yrs were born in 2007/8 & would have had greater exposure to FS interventions. The trend line indicates that children having greater exposure to FS are more likely to be developing normally. Initial analysis needs to be treated with caution, as we need to be certain that SOGS assessment are being applied consistently SOGS scores shows marked developmental variations across catchments, with some children in particular catchments scoring lower than average on particular skills sets. FS Service Managers & Teams; FS Catchment Schools; Early Years Forum; Childcare Settings; Childcare Workforce Development Team; Parents; GP Practices •Schools are telling us that FS children are entering nursery classes with good language & communication skills, are settling quickly and are more independent that their non FS peers. WHAT ARE WE DOING & WHAT IS OUR RESOURCE •The introduction of mandatory training for all FS practitioners on supporting and developing childrens language & communication is possibly having an impact on practice. Childcare settings are also being encouraged to take up and apply the ‘Learning Language & Loving It’ training and we think that this is starting to improve practice. •Develop a referral pathway for children with additional needs •Parents are reporting that FS is helping their children to be more confident and sociable and that they are learning more, but more could be done to support parents in developing their childrens language skills; relationships and managing behavioural issues. •Interrogate SOGS & Parental questionnaire data to establish trend lines & what might help parents more • Immunisation data suggests that parents are good at taking their children for Primary Course & Booster immunisations but that it drops below 50% for the final MMR & HIB catch up immunisations. •Develop a standardised induction process for all FS staff, which includes compulsory training on language development and behaviour management strategies. •Explore development of ANCo role for FS childcare settings Cardiff Flying Start Parents Plus Service : Performance Evaluation Report 2009-10 Service Description: The Parents Plus service is part of the Parenting core strand of the National Flying Start Programme. The Parents Plus Service consists of one Senior Educational Psychologist; three Senior Home Liaison Officers; four Home Liaison Officers; and two p/t Administration Officers. In addition, there is one f/t Specialist Home Liaison Officer (Homeless) and two Home Liaison Officers (former Sure Start) It has a budget of £312,972 and aims to offer time-limited, targeted, home-based parenting interventions in each of the 8 Cardiff Flying Start catchments reaching approximately 110 families annually. Purpose of Service • • • Assessment of child’s functioning within family and community context Agreement with parents on appropriate changes to implement within the home Evaluate improvements in early play skills; in family interactions and relationships; and in the child’s behaviour Headline Performance Measures 1. 2. 3. Perceived improvements by parents in play/devt; relationships; and/or behaviour Perceived improvements by HLO in play/devt; relationships; and/or behaviour Use of behaviour techniques by staff with EY children 6 months after PP+ Behaviour Training course How Are We Doing? Data Development Agenda DD1 - % Families referred (needing the intervention) who take it up DD2 - % Families receive Initial Assessment Visit within five weeks of referral Story Behind (last 3 years) Performance Parents Plus has been through a period of transition: from earlier Sure Start processes to greater Flying Start standards and requirements. It has been an exciting and challenging period. Forming a coherent induction period and regular supervision has ensured new HLOs have become established within the team. The additional supervision and monitoring by Senior HLO have contributed to the successful and relatively smooth move to Flying Start functioning. Unfortunately, significant personnel changes and alterations in working practices by other partners, has had knock-on effects to our referrals and integrated working. Over time, this has been improving. Staff illness and absenteeism has also interfered with our capacity to engage with some families. The developments within the EYFT(Homeless) has ensured an innovative multiagency team approach to working across city hostels, including within Flying Start areas. Research by Cardiff University followed up families which had received Parents Plus interventions up to six years ago. Parental interviews confirmed the effectiveness of our behavioural techniques; and their long lasting influence. This was in part due to empowering the parents to take ownership of the changes. There was evidence that the families referred to Parents Plus have had more entrenched difficulties and dysfunctional patterns of family life. This has meant they tend to be more difficult to engage and to intervene with to implement change. Nevertheless, evaluations of changes following Parents Plus interventions [ Before v After ] continue to show better play/developmental progress, benefits for family relationships and improvements in behaviour management. Parents Plus contributes to improving the wellbeing and progress of Flying Start children through high quality training to EY staff working with young children. Partners Who Can Help Us Do Better Referral criteria explicit and awareness raising:•Childcare staff •Health Visitors •Children’s services •Nursery staff •Play team •Home Start •CAMHS/PSS What We Propose To Do To Improve Performance In The Next Year Low Cost/No Cost Idea: -Provide “telephone clinic” weekly when Senior HLO will be available at base -Print a leaflet for parents attending all settings on “Building Better Behaviour Together” -Publish article on Parents Plus approach -Re-establish termly visits to all Nursery settings [school-links] -Posters for childcare settings about 1. referral to Parents Plus and 2. self referral by families to Parents Plus Off the Wall Idea: -Develop a training manual for childcare staff with introductory, intermediate and -advanced modules on Understanding and Managing Behaviour in Early Years Settings -& identify funding source to publish and disseminate -put together video examples of “before and after” -Team approach with gypsy-traveller families through childcare session Distribution of Parents Plus service activities Home Interventions PNP facilitating FS Training Behaviour advice into sessions Psychology into FS EYFT Homeless Sandfields Family Support Project REPORT CARD : Performance Accountability Compliance monitoring and outcome data reporting Please note: demo example only The Service will contribute to the Core Aims and the Local Authority’s Vision for Children and Young People . How well did we do it Early Intervention Service : Reduction in risk factors related to offending Increase in protective factors related to offending Increased presence of positive role models and positive peer influences in children’s lives Increase in positive coping strategies within children and young people Increased levels of self esteem within children and young people Increased levels of emotional well -being Increased engagement between parents and other relevant services Improved parenting skills Increased numbers of children engaged with education Increased parental participation in the education of their children 90 referrals received for Summer Playschemes 18 parenting courses delivered- focus: resolving conflict and difficulties 12 Child Care:- Creche 96 Child Care:- Playgroups 39 Summer Playschemes 91 Drop-in Action for Children has identified and are working with 43 indicators to evidence our contribution to achieving outcomes defined in the Wales Core Aims Action for Children will work with our Partners to maximise customer outcomes as measured by our “Did we make a difference”. Did we make a difference % of C/YP who report they are more able to deal with conflict and difficulties % of C/YP who develop positive coping strategies % of C/ YP who report increased confidence and self esteem % of C/YP who report they now more able deal with bullying % of C/YP who remain safely in their own homes % increase in school attendance % reduction in offending behaviour % reduction in risk behaviours % parents and carers who report they are more able to deal with conflict and difficulties % parents and carers who report improved relationship with their C /YP % parents and carers who report more confidence when dealing with their C /YP educational needs Improved outcomes for children and young people – Qtr 1 2009/10 – cohort 52 Enjoy the best possible health and are free from abuse , victimisation and exploitation – The C/YP recognises their own health and developmental needs Enjoy the best possible health and are free from abuse , victimisation and exploitation – There is an improvement in the C/YP’s emotional wellbeing % referrals responded to in (x) days % of parents and carers completing parenting courses % parents and carers who report satisfaction with programmes % C/YP engaged in safe activities within their community % C/YP who have re-engaged in education % parents / carers actively participating in C/YP educational reviews/plans % C/YP who report satisfaction with the service How much did we do Enjoy the best possible health and are free from abuse , victimisation and exploitation – The risks to the C /YP are known and protective factors are in place Are not disadvantaged by poverty – The young person has suitable accommodation A comprehensive range of education and learning opportunities – The C /YP achieves satisfactory attendance at school , further education , training or in employment Profile of Service Users on Discharge from Action for Children’s Service Are not disadvantaged by poverty – There is an improvement in the child or young person’s practical life skills Jacky Davies , Diane Hardy - September 2009 © How Can RBA Help Us? 1. Planning & performance management framework to deliver on collaborative duties 2. Planning & performance management framework for funded projects (e.g. Cymorth) 3. Organise and explain how population and performance levels fit together e.g. CYP Plan and Cymorth projects 4. Make sense of multitude of partnerships and plans – what matters is results not processes! 5. The future – less money, less small specific grants, more emphasis on outcomes and collaboration Implementing Results Based Accountability • Leadership at a senior level • Championship by a senior project manager and from champions at different organisational levels • Ownership of a commitment to recognising success as better outcomes, not outputs • Partnership and multi-agency working. RBA is hard to implement where partnerships are not invested in Resources • Mark Friedman Trying Hard Is Not Good Enough (Trafford Publishing, 2005) • www.raguide.org – website including implementation guide and examples • www.resultsaccountability.com – website including papers on Results Accountability and links to other resources Results Based Accountability Charlotte Drury Questions?