The Skilled Conversation: Outcomes

1. Using this Procedure

This is a multi-agency procedure, meaning it applies to all organisations in XXXXX.

It should be used by the lead practitioner, or any other professional or person whose role it is to talk to the adult in question (or their independent advocate/appropriate other person) about outcomes at any stage of the safeguarding adults process.

2. Overarching Aims, Duties and Principles

The overarching aims, duties and principles of safeguarding

All of the overarching aims, duties and principles of adult safeguarding apply.

These are:

• The aims of adult safeguarding;
• The duty to promote individual Wellbeing;
• The six key principles of all adult safeguarding;
• Making Safeguarding Personal; and
• The principles of the Mental Capacity Act.

See: Overarching Aims, Duties and Principles Procedure.

Other principles and duties that apply

Strengths based approach

Wherever possible, every conversation about outcomes with the adult (or their representative) should be from a strengths perspective. This means that before you talk about external solutions to help achieve an outcome you must support the adult to explore whether there is:

1. Anything within their own power that they can do to help themselves; or
2. Anything within the power of their family, friends or community that they can use to help themselves.

A strengths based approach is empowering for the adult and gives them more control over their situation and how best to resolve any issues in the best way for them. The end result may still be that the local authority or another organisation intervenes, but this decision will have been reached knowing that it is the most proportionate response available.

Adopting a strengths based approach involves:

1. Taking a holistic view of the adult's needs, risks and situation in the context of their wider support network;
2. Helping the adult to understand their strengths and capabilities within the context of their situation;
3. Helping the adult to understand and explore the support available to them in the community;
4. Helping the adult to understand and explore the support available to them through other networks or services (e.g. health);
5. Exploring some of the less intrusive/intensive ways the local authority or other organisations may be able to help (such as through prevention services or signposting).

Good information and Advice and Prevention

The duty to provide good information and advice and to consider ways to prevent, reduce or delay needs for Care and Support applies at all times.

It is vital that you understand your duties in relation to the above. Please use the links below to access further information as required.

• Preventing Needs for Care and Support for information about the duty to prevent, reduce or delay needs;
• Providing Information and Advice for information about the duty to provide good information and advice, including the duty to make sure that information and advice is accessible to the person receiving it.

3. What is an Outcome?

Put simply an outcome is anything that, as a consequence of the safeguarding process the adult:

1. Wants to achieve;
2. Wants to change; or
3. Wants to stay the same.

They can be expressed at any point in the safeguarding process, may change as the process evolves and must be regarded in all decision making.

If not already expressed, outcomes must be sought before carrying out any enquiries.

Depending on the specific circumstances and the nature of the concern raised, the outcomes that the adult wants to achieve may, or may not be in line with the outcomes that others would wish for them.

For example, they may want to continue acting in a way that others may perceive as risky or problematic or they may want to undergo a major life change such as leaving home. Additionally, whilst the outcomes are likely to be related to the adult, they could also include the person who caused them harm or other adults who may be at risk.

Examples of some outcomes

Outcomes could be broad, for example:

• For the abuse to stop;
• To feel safe.

They could also be specific, for example:

• To see more of my friends;
• To carry on going to my local pub;
• To have a girlfriend/boyfriend;
• To have sex with my partner;
• To make new friends;
• To get a job;
• To go to college;
• To move out from my parent's home;
• To leave my wife/husband;
• To carry on drinking/smoking when I want to;
• For the person who caused me harm to go to prison.

It is important that the outcomes reflect the things that the adult wants to achieve and not what other people want to happen.

4. Why are Outcomes Important?

The overarching aims, duties and principles of safeguarding

Outcomes are important as they are intrinsically linked to all of the aims, duties and principles of safeguarding. It is not possible to meet these aims, duties and principles without understanding outcomes.

These are:

• The aims of adult safeguarding;
• The duty to promote individual Wellbeing;
• The six key principles of all adult safeguarding;
• Making Safeguarding Personal; and
• The principles of the Mental Capacity Act.

See: Overarching Aims, Duties and Principles Procedure.

In particular, understanding and supporting the adult to achieve outcomes:

• Promotes choice and control about the way they want to live;
• Promotes an approach that concentrates on improving lives;
• Avoids assumptions, preconceptions and judgements;
• Reduces the risk of overly intrusive interventions;
• Increases resilience and reduces risk of future harm.

Service review and improvement

Outcomes provide an important base upon which the local authority and the Safeguarding Adults Board (SAB) can review and measure the impact that interventions are having on the lives of adults, and the things that matter to them.

Outcomes are thus measured by the local authority and SAB as a means by which to test the effectiveness of interventions, and what the impact has been on the adult's individual Wellbeing.

Good practice (when things have gone well) and learning (when they haven't) can be taken forward by the local authority and SAB to inform future interventions.

5. Adults that lack Capacity

Even if the adult has been assessed as lacking capacity to make their own decisions within the safeguarding adult's process, it is still important that they are consulted and their outcomes sought.

The purpose of consulting and involving the adult is to understand, as far as is reasonably ascertainable:

1. What their views are on any matters affecting the decision;
2. What is important to them (the relevant factors); and
3. What their preferred outcomes may be.

Note: 'Reasonably ascertainable' means the information that can be gathered in the time that is available before the decision needs to be made. What is available in an emergency will be different to what is available in other situations.

You must not proceed to make any Best Interest decision about outcomes without carefully considering the information gathered from the person during consultation.

For further guidance see the Mental Capacity Act 2005 Resource and Practice Toolkit: Preparing to make a Decision.

6. Unrealistic Outcomes

Sometimes an adult will have an outcome that you know is outside of their means to achieve (for example something outside of their financial or physical means). Whilst it is important for people to have a goal to work towards, having an outcome that is not realistic will ultimately only have a detrimental impact on Wellbeing because it will likely never be achieved.

You should be sensitive in your approach but you must endeavour to support the adult to realise that the outcome they have may not be achievable.

You could also encourage the adult to break the outcome down into smaller, more realistic outcomes that may achieve the same positive effect on their Wellbeing.

7. Recording Outcomes

Outcomes should be recorded in line with the recording requirements for the safeguarding process taking place at the time they are agreed/expressed.

For example, outcomes agreed/expressed during a planning meeting should be recorded in line with the requirements for recording a planning meeting.

Remember: It is important that the outcomes reflect the things that the adult wants to achieve and not what other people want to happen.

8. Support to Achieve Outcomes

The responsibility of the local authority

The local authority is not responsible for meeting outcomes, only for taking steps to support them to be met. As long as you can demonstrate that you have taken steps to support the adult to meet their outcomes this is all that is required (regardless of whether the outcome is ultimately achieved or not).

Steps to support the adult to meet outcomes

Using a strengths based approach, you should support the adult to:

1. Think about the steps they may need to take to achieve their outcome (and to break this into manageable chunks if the steps are overwhelming);
2. Think about the support they may need to take the steps to meet outcomes (including who can support them); and
3. Think about some of the barriers and challenges to meeting the outcomes (and the things they can do to overcome them).

It can be helpful to apply an outcomes framework to support this, such as SMART.

Example

Support from existing services

The local authority has a duty to consider how any service that it already provides can support the adult to achieve the outcomes identified as part of the safeguarding process.

9. Reviewing Outcomes

A review of the adult's outcomes should be incorporated into all key stages of the safeguarding adult's process, and more often if there is evidence that they are not being met (or worked towards), or may have changed.

A review of outcomes should answer the following questions:

1. Have the outcomes been achieved?
2. Does the adult have any new outcomes they want to achieve? and
3. Are any changes needed to plans so as to achieve outcomes?

If outcomes have not been achieved (or progressed) as intended:

1. Establish if the outcomes are still important to the adult;
2. Where the outcomes are no longer important agree new outcomes; or
3. Where the outcomes are still important, agree how to resolve any issues in meeting them.

10. Reporting on Outcomes

Information should be provided to the Safeguarding Adults Board so they are able to keep robust records about the effectiveness of safeguarding interventions.

This should take place in line with local processes.

Add information about local process as required