Support Planning & Outcomes: Setting up Participants for Success
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Support Planning & Outcomes: Setting up Participants for Success

Posted on
September 21, 2021
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How to set achievable outcomes for your participants, no matter what they want to accomplish

“If you don't know where you are going, you'll end up someplace else.” - Yogi Berra 

Setting goals or desired outcomes is an important part of writing care and support plans. In this blog we will outline key considerations for setting outcomes for the people in your care. Prior to establishing any goals and putting action items in place, you should conduct an initial conversation with a supported individual to find out their hopes and desires. 

Get SMART with goal setting

The SMART method is a well-known framework for creating realistic goals and supporting someone to achieve them. The SMART criteria (outlined below) ensures success by eliminating generalities and guesswork. This method sets a well-thought-out objective, evaluation points to track progress and clear timeline. 

Specific

  • Who is involved in supporting the individual to achieve this? What are their roles?
  • What resources are needed?
  • Why is this important to the participant? 
  • What would success look like to the participant?

Measurable 

  • What milestones will allow responsible parties to assess progress?
  • How will you track progress along the way?

Attainable

  • Has the desired outcome been agreed upon by the family and care team? 
  • Does the goal appropriately challenge the participant without being extreme?
  • Can the goal realistically be achieved within the set time frame?

Realistic

  • Is the outcome worthwhile and does it make sense for the participant?
  • Is this the best time to work towards this goal? 
  • Is there adequate support and resources for the participant?

Time-bound

  • When should the participant be able to achieve this outcome? 
  • How often will the outcome be reviewed?
  • When can the participant begin taking action?

Now that you have an idea of how to build achievable outcomes, here are some considerations for how to collaborate with your participants and implement their goals into individual support plans. 

Have collaborative, person-centered conversations

Collaboration is key! Support plans should be accessible to all parties involved in your participant’s care. Not only should they be accessible, but your participant, their carers, social workers and healthcare practitioners should all be involved and aware of what is recorded. 

Putting the participant at the center of your conversation and giving them the space to identify their own needs is essential to creating specific goals that will improve wellness. Deciding which parties are responsible for what aspects of progress towards attainable outcomes is fundamental to bringing about change.

Tie outcomes into support plans 

Support plan structures will vary by provider. Regardless of the template your community uses, it is important to ask the participant which areas or categories they would like to see improvement in. What are the areas of interest? Where do they have the greatest need for encouragement to set goals for the weeks ahead? 

With StoriiCare, staff can link a participant’s outcomes to relevant parts of their support plan. From a support plan, staff can click on an outcome to review it and see progress that has been made. Since support plans and outcomes are so closely related, it is important that they work hand in hand. With this functionality, staff are compliant in regularly reviewing a participant’s support plan to ensure it is aligned with their current goals. 

Here are some examples of support plan categories and outcomes that relate to them:

Communication & Emotions - “I want to reduce my anxiety” 

Mobility & Dexterity - “I want to increase mobility following my hip replacement surgery”

Eating & Drinking - “I want support to prepare healthy meals for myself that I can cook in under 30 minutes”

The process - A summary

Step 1 - Have a discussion with the participant and any parties they wish to be involved. Invite the participant to identify their own needs based on your support plan outline. 

Step 2 - Bring up any issues or obstacles you foresee related to the goals/outcomes presented. Discuss these and negotiate so that you can properly set and agree on and outcome and how you will support the participant to achieve it. 

Step 3 - Develop and document an action plan to address each outcome (remember to make them specific, measurable, attainable, realistic and time-bound). Consider what milestones you can implement to evaluate progress.

Step 4 - Look at your participant’s support plan and link any relevant outcomes to the various areas within it. 

Step 5 - Set outcome and support plan review dates. Make adjustments to these as necessary, always involving your participant in the process.

Get rid of the paperwork

Documenting and reviewing support plans and outcomes involves a lot of paperwork. On top of that, you have to set up a system for managing tasks and action items associated with those care and support items. Care providers are increasingly leaving the analog world in favor of digital care management. Systems like StoriiCare save you valuable time and resources. With StoriiCare, the important information is accessible at your fingertips. Workflows are automated, communications are streamlined, and task reminders ensure you stay on top of every thing big and small. Schedule a demonstration today!

A home health worker shares a tablet with an elderly woman