ASCOT TRAINING: LEEDS AND LONDON 2013 Nick Smith, Ann ‐ Marie Towers, Juliette Malley, Stacey Rand, Ann Netten and Julie Beadle ‐ Brown
Outline of training day • Introduction to ASCOT • Measuring outcomes using ASCOT • Versions of ASCOT • Self ‐ completion (SCT4 / SCT3) • Lunch (12.30 ‐ 1.30) • Face to face interview (INT4) • Mixed methods (CH3) • Scoring and interpreting ASCOT • Close (3pm)
INTRODUCTION TO ASCOT
What is ASCOT? • A dult S ocial C are O utcomes T oolkit – A collection of tools for measuring service user outcomes across the whole of social care including a version for use in care homes. – See website www.pssru.ac.uk/ascot
Why use ASCOT? • Policy emphasis on outcome measurement • Individual Social Care Related Quality of Life (SCRQoL) • Development involved rigorous testing • Can be used to measure the impact of services • Reflects preferences
One tool does not fit all • Across settings and client groups – Community settings – Day care – Care homes • Using different methodologies: – Self ‐ completion – Interview – Observation 29/04/2013 6
HOW ASCOT MEASURES OUTCOMES
What do we mean by outcome? • Quality of life (very broad) • Social care related quality of life – Domains we can reasonably expect to be affected by social care – Broad enough to apply to everyone – Compare to the general population • ASCOT measures SCRQoL at the level of the individual
ASCOT domains • Personal cleanliness and comfort • Food and drink • Safety • Clean and comfortable accommodation • Social participation and involvement • Control over daily living • Occupation • Dignity 9
Level of outcome • No needs: The individual has no or the type of temporary trivial needs that would be expected in this area of life of someone with no impairments. – This can be split into two • Some needs : Some needs are distinguished from no needs by being sufficiently important or frequent to affect an individual’s quality of life – Some needs do not have a health implication • High needs: High needs are distinguished from some needs by having mental or physical health implications if they are not met over a period of time. This may be because of severity or number. – High needs have a health implication.
The levels… • No needs – Ideal state: The individual’s preferences and wishes in that area are met. – No needs: The individual’s needs are met, but not to the desired level (mustn’t grumble)
A summary of the levels • Ideal state • No needs • Some needs • High level needs
What can ASCOT measure? • Current SCRQoL • Expected SCRQoL • SCRQoL gain 29/04/2013 13
Current SCRQoL • All versions of ASCOT measure current SCRQoL • Like any other QoL measure • Measures SCRQoL as it currently stands. • In most uses of ASCOT, this would usually mean the SCRQoL the person has as a result of receiving services and support – not a functioning measure like e.g. EQ5D • The only exception may be when you use ASCOT to measure baseline SCRQoL before somebody starts to use a service.
Expected SCRQoL • Only in some versions of ASCOT • Expected SCRQoL = what we would expect somebody’s SCRQoL to be in the absence of services and support & assuming no other help steps in . • The definition of services and support depends upon the context in which you are using ASCOT 29/04/2013 15
Why measure expected SCRQoL? • To identify impact of social care interventions • Need a counterfactual, but RCTs difficult (unethical, expensive) • Expected SCRQoL = the counterfactual • No help steps in – get full value of intervention, assumptions 29/04/2013 16
• Dignity is the one domain where we do not measure expected SCRQoL – WHY? 29/04/2013 17
SCRQoL gain • When we measure both expected and current SCRQoL we can estimate the impact of the service • Impact = current SCRQoL ‐ expected SCRQoL • We call this SCRQoL gain
Summary • ASCOT measures SCRQoL • 8 domains • 3 or 4 levels • Current and expected SCRQoL • Calculating impact
VERSIONS OF ASCOT
Versions of ASCOT • Self completion tools (SCT3 and SCT4) – 3 level version developed for day care – 4 level version • Interview schedule (INT4) – Structured version – 4 levels • Care homes version (CH3) – 3 level ratings based on • Observations • Interviews – residents/staff/relatives • Why do we have so many different versions?
Comparing the ASCOT instruments SCT4 SCT3 INT4 CH3 Format Self ‐ completion Self ‐ completion Face to face Mixed methods questionnaire questionnaire interview Number of levels 4 3 4 3 Current SCRQoL Yes Yes Yes Yes Expected SCRQoL No** Yes** Yes Yes Number of 9 18 23 n/a questions Intended use All services Developed for All services Residential where service use in day care where service setting such as users able to users able to care or nursing self ‐ complete a participate in a homes questionnaire face to face interview Training No No Yes, limited Yes, extensive
SELF COMPLETION (SCT3 & SCT4) 29/04/2013 23
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Examples of applications • Adult Social Care Survey http://www.ic.nhs.uk/article/2215/User ‐ Experience ‐ Survey ‐ Adult ‐ Social ‐ Care ‐ Guidance ‐ 2012 ‐ 13 http://www.ic.nhs.uk/article/2021/Website ‐ Search?productid=10128&q=ascs&sort=Relevance&size=10&page=1&area=both#top • Monitoring performance • Assessment / review 29/04/2013 25
Group Task 1: Filling in SCT4 • In groups (4 ‐ 5), think of someone you know who receives social care • As a group, fill in SCT4 questionnaire for that person • Note down any questions / queries about SCT4 • 15 mins for task • Enter scores from each group into the ASCOT data entry tool 29/04/2013 26
Summary • Measures current SCRQoL • Simple & quick to complete • Algorithm for expected SCRQoL & SCRQoL gain for SCT3 & to come for SCT4 • Any questions? 29/04/2013 27
FACE TO FACE INTERVIEW: INT4
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INT4 Interview Schedule • Instructions for interviewer • Introduction • 23 questions across the 8 domains • For each domain (except dignity) – Current SCRQoL – Filter question • If yes, then… – Expected SCRQoL • Plus some other things (more on this…)
Task 2: Filling in INT4 • In pairs, one person be interviewer and one imagine you are a service user AT1 • Take 15 mins to fill in INT4 • Swap around if you are finished quickly • Note down any questions / queries about INT4 • Enter scores from pairs into the ASCOT data entry tool 29/04/2013 31
Slide 31 AT1 I think they wil struggle to get INT4 done one way so probably ambitious to think they'll both be the interviewer in a 15 min task - or are you allowing 30 mins for this task? Ann-Marie Towers, 12/03/2013
Points for discussion • Interviewer instructions – training • Introduction • Current ‐ filter ‐ expected questions – Defining support and services – Sensitivity • Dignity questions • Any other queries? 29/04/2013 32
Occupation filter question • Filter question Do the support and services that you get from <<EXAMPLES>> affect how you spend your time? Things to remember: 1. Emphasise the domain of QOL The question is asking if support and services help in (a positive or negative way) that aspect of life, not in general 2. Definition of Support and Services 29/04/2013 33
Defining Support and Services (1) • Define support and services according to your study – e.g. if want impact of home care ask about home care, publicly ‐ funded social care ask about publicly ‐ funded, etc • May be difficult to define in some instances – e.g. where service is ill ‐ defined, infrequent, there is complexity & source of funding is unclear 29/04/2013 34
Defining Support and Services (2) • Need to explore service receipt & funding in detail • Collect information about service receipt before ASCOT questions. – Be careful with how you name services… – If possible use tested questions e.g. Natcen social care module (although complicated – requires CAPI) • Use information about service receipt as prompts within questions i.e. <<EXAMPLES>> • Can be helpful to say what you don’t mean • Take ‐ away message: Be very clear & use examples 29/04/2013 35
Example filter question from a study Do the support and services that you get from <<the day centre, meals on wheels or your personal assistant>> affect how you spend your time? Interviewer Prompt: By support and services we mean, for example, <<the day centre, meals on wheels or your personal assistant>> Please do not include help from health professionals, such as GPs and nurses, or from friends and family. 29/04/2013 36
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