West Lothian Life Stage Outcome Planning Model: Planning Well Jane Kellock, Health Improvement Manager

1. West Lothian Life Stage Outcome Planning Model:Planning WellJane Kellock, Health Improvement Manager Welcome to this presentation of the West Lothian Life Stage Outcome Planning Model, sometimes referred to as �Planning Well�. This presentation will describe the the key concepts underpinning the model and will introduce you to the tools that are used within the model. Initiated by the West Lothian Community Health and Care partnership, the model was developed within the Community Planning Partnership with expertise from consultants at Blake Stevenson funded by the Scottish Executive and with ongoing support from NHS Health Scotland. The aim of the model is to enable the Community Planning Partnership to plan more effective interventions to tackle health and social inequalities across the whole of West Lothian. Welcome to this presentation of the West Lothian Life Stage Outcome Planning Model, sometimes referred to as �Planning Well�. This presentation will describe the the key concepts underpinning the model and will introduce you to the tools that are used within the model. Initiated by the West Lothian Community Health and Care partnership, the model was developed within the Community Planning Partnership with expertise from consultants at Blake Stevenson funded by the Scottish Executive and with ongoing support from NHS Health Scotland. The aim of the model is to enable the Community Planning Partnership to plan more effective interventions to tackle health and social inequalities across the whole of West Lothian.

2. What do we want to achieve? Improve quality of life � �raising the bar� Reduce inequalities � �closing the gap� We have devised the model to address improvement in quality of life and health outcomes but more importantly to tackle the growing health inequalities gap. Although health is generally improving across the whole population, the gap between the least and the most healthy is growing, and this needs to be addressed at a locality level. We have devised the model to address improvement in quality of life and health outcomes but more importantly to tackle the growing health inequalities gap. Although health is generally improving across the whole population, the gap between the least and the most healthy is growing, and this needs to be addressed at a locality level.

3. How do we want to achieve it? Working together towards greater collaborative competence Involving key people � directors, front line workers and community members Evidenced based planning Planning for long term outcomes Planning upstream, preventative work Incorporating a community development approach Integrating the equality agenda Planning Well on a big scale across the whole CPP. Using an outcome based approach based on evidence of need and effective practice Planning upstream/preventative work Incorporating a community development approach to health improvement Incorporating the equality agenda Hopefully, my description of the model will demonstrate how we will achieve the above. Planning Well on a big scale across the whole CPP. Using an outcome based approach based on evidence of need and effective practice Planning upstream/preventative work Incorporating a community development approach to health improvement Incorporating the equality agenda Hopefully, my description of the model will demonstrate how we will achieve the above.

4. Phases Phase 1 (2007) � development of the model Phase 2 (2008-2010) � 5 pilots in 5 geographical ward areas Phase 3 (?2010) � roll out West Lothian wide The model has 4 key stages. Stage 1 is to define our priority customer/community groups. Those within each life stage group who would benefit from targeted upstream intervention. We use a Ven diagram prioritisation method to define target groups and Milstein�s Continuum to remind us to focus upstream. Stage 2 is to develop a set of desired long, medium and short term outcomes for each life stage group, and associated outputs, activities and resources required to tackle inequalities in health and wellbeing. The tool we use for this is logic modelling. Stage 3 is about how the model is implemented � what needs to change in our services in order to achieve the outcomes. The tool for this is based on a method called RE:AIM developed by Russell Glasgow in the US. Stage 4 is how we monitor implementation which we will do through the Community Planning Structure and the Covalent Performance Management System. The model has 4 key stages. Stage 1 is to define our priority customer/community groups. Those within each life stage group who would benefit from targeted upstream intervention. We use a Ven diagram prioritisation method to define target groups and Milstein�s Continuum to remind us to focus upstream. Stage 2 is to develop a set of desired long, medium and short term outcomes for each life stage group, and associated outputs, activities and resources required to tackle inequalities in health and wellbeing. The tool we use for this is logic modelling. Stage 3 is about how the model is implemented � what needs to change in our services in order to achieve the outcomes. The tool for this is based on a method called RE:AIM developed by Russell Glasgow in the US. Stage 4 is how we monitor implementation which we will do through the Community Planning Structure and the Covalent Performance Management System.

5. Stages of Implementation Stage 1 � Customer Need Stage 2 � Develop Outcomes Stage 3 � Implementation Stage 4 � Monitor The model has 4 key stages. Stage 1 is to define our priority customer/community groups. Those within each life stage group who would benefit from targeted upstream intervention. We use a Ven diagram prioritisation method to define target groups and Milstein�s Continuum to remind us to focus upstream. Stage 2 is to develop a set of desired long, medium and short term outcomes for each life stage group, and associated outputs, activities and resources required to tackle inequalities in health and wellbeing. The tool we use for this is logic modelling. Stage 3 is about how the model is implemented � what needs to change in our services in order to achieve the outcomes. The tool for this is based on a method called RE:AIM developed by Russell Glasgow in the US. Stage 4 is how we monitor implementation which we will do through the Community Planning Structure and the Covalent Performance Management System. The model has 4 key stages. Stage 1 is to define our priority customer/community groups. Those within each life stage group who would benefit from targeted upstream intervention. We use a Ven diagram prioritisation method to define target groups and Milstein�s Continuum to remind us to focus upstream. Stage 2 is to develop a set of desired long, medium and short term outcomes for each life stage group, and associated outputs, activities and resources required to tackle inequalities in health and wellbeing. The tool we use for this is logic modelling. Stage 3 is about how the model is implemented � what needs to change in our services in order to achieve the outcomes. The tool for this is based on a method called RE:AIM developed by Russell Glasgow in the US. Stage 4 is how we monitor implementation which we will do through the Community Planning Structure and the Covalent Performance Management System.

6. Tools Customer Need � �Life� ven diagram Develop Outcomes - logic modelling Implementation � RE:AIM Monitor � Covalent We have developed or adapted specific tools for each stage. The Life ven diagram was developed locally Logic modelling is being increasingly used in the public sector RE;AIM is a tool developed in the US by Russell Glasgow and we have adapted it for a better �Scottish� fit. Covalent is the electronic Performance Management system used in West Lothian Council which is being made available to the CPP in West LothianWe have developed or adapted specific tools for each stage. The Life ven diagram was developed locally Logic modelling is being increasingly used in the public sector RE;AIM is a tool developed in the US by Russell Glasgow and we have adapted it for a better �Scottish� fit. Covalent is the electronic Performance Management system used in West Lothian Council which is being made available to the CPP in West Lothian

7. Methods 6-7 distinct processes Involving 5 Life Stage Working Groups Each with 3 lead officers With community engagement plans Plus additional expert input The model is in its infancy. 6 � 7 distinct processes have been developed to aid the development of each pilot life stage. They will be progressed by Life Stage Working Groups supported by three lead officers (from the key directorate, the pilot locality and the Planning Well Working Group � the group originally set up to develop the model) Each group will develop a community engagement plan for engagement with the target priority population/s, taking account of any previous community engagement undertaken by the locality teams and any other services. There will be additional input in relation to supporting the working groups to identify evidence of need, evidence of what works and to develop the sets of indicators. The model is in its infancy. 6 � 7 distinct processes have been developed to aid the development of each pilot life stage. They will be progressed by Life Stage Working Groups supported by three lead officers (from the key directorate, the pilot locality and the Planning Well Working Group � the group originally set up to develop the model) Each group will develop a community engagement plan for engagement with the target priority population/s, taking account of any previous community engagement undertaken by the locality teams and any other services. There will be additional input in relation to supporting the working groups to identify evidence of need, evidence of what works and to develop the sets of indicators.

8. Evidence of need � �triangulation� As well as using professional expertise, we base our thinking on a range of other evidence. Existing national indicators � such as Scottish Neighbourhood Statistics, health indicators gathered by ISD, statistics reported by Police Boards, etc tell us what is already being measured. It is most useful when it is robust evidence, gathered frequently at datazone level (I.e. very small area data). Research � both national and local tell us something of what works and why Community engagement helps us to understand local area need, to have meaningful consultation and to support community development. As well as using professional expertise, we base our thinking on a range of other evidence. Existing national indicators � such as Scottish Neighbourhood Statistics, health indicators gathered by ISD, statistics reported by Police Boards, etc tell us what is already being measured. It is most useful when it is robust evidence, gathered frequently at datazone level (I.e. very small area data). Research � both national and local tell us something of what works and why Community engagement helps us to understand local area need, to have meaningful consultation and to support community development.

9. People in context Just to add in here, although we are focusing on the person at the centre, we recognise that the person needs to be seen and supported in the context of their family and unpaid carers and the community in which they live, so outcomes will be generated for person, family context and community context.Just to add in here, although we are focusing on the person at the centre, we recognise that the person needs to be seen and supported in the context of their family and unpaid carers and the community in which they live, so outcomes will be generated for person, family context and community context.

10. The model starts from a lifestage perspective. We think that outcomes should be about outcomes for people not topics. The more we focus on people the more our outcomes can be linked together in a meaningful way and the more effective we believe our activities will be. But when we plan, we also have to prioritise our activities. We can�t do everything for everyone all of the time. We need to discover what populations and communities in West Lothian have greatest needs and we use this process to do that. A working group of key professionals � a Life Stage Working Group - will meet to use their knowledge of their area of expertise and the people they work with to highlight needs under the four areas above. For each life stage, we look at what life circumstances affect the most disadvantaged, what particular inequalities exist and what lifestyle behaviours arise from this for the most vulnerable. Taking all these together allows us to build a profile of particular populations in our communities and to then use statistical data to quantify them. For example, from the professional opinion and statistical data re early years in the Armadale and Blackridge ward area, we believe that there are around 200 families with significant priority issues. The model starts from a lifestage perspective. We think that outcomes should be about outcomes for people not topics. The more we focus on people the more our outcomes can be linked together in a meaningful way and the more effective we believe our activities will be. But when we plan, we also have to prioritise our activities. We can�t do everything for everyone all of the time. We need to discover what populations and communities in West Lothian have greatest needs and we use this process to do that. A working group of key professionals � a Life Stage Working Group - will meet to use their knowledge of their area of expertise and the people they work with to highlight needs under the four areas above. For each life stage, we look at what life circumstances affect the most disadvantaged, what particular inequalities exist and what lifestyle behaviours arise from this for the most vulnerable. Taking all these together allows us to build a profile of particular populations in our communities and to then use statistical data to quantify them. For example, from the professional opinion and statistical data re early years in the Armadale and Blackridge ward area, we believe that there are around 200 families with significant priority issues.

11. Life stage Outcomes are for people Early years Armadale/Blackridge School aged children Broxburn/Uphall/Winchburgh Young people in transition Livingston North Adults of working age Fauldhouse/Briech Valley Older adults Bathgate So to recap, we think outcomes should be for people. The five main lifestages that have been identified are as set out above. These will be piloted initially in 5 different localities as aboveSo to recap, we think outcomes should be for people. The five main lifestages that have been identified are as set out above. These will be piloted initially in 5 different localities as above

12. Life circumstances The kinds of life circumstances � or the unbadged social determinants of health � that we look at are�� These have been identified as policy topics in a range of national and local policies.The kinds of life circumstances � or the unbadged social determinants of health � that we look at are�� These have been identified as policy topics in a range of national and local policies.

13. Life chances These factors � largely ones that we can�t change or would change with difficulty - can have an additional adverse effect of people�s life chances�.. Having this as part of the process allows us to integrate the equality agenda. These factors � largely ones that we can�t change or would change with difficulty - can have an additional adverse effect of people�s life chances�.. Having this as part of the process allows us to integrate the equality agenda.

14. Lifestyles � our behaviours Diet Alcohol consumption Smoking Drug misuse Physical activity Self-harming/suicidal behaviours Criminal behaviour Anti-social behaviour Finally, we look at the kinds of behaviours that people do that have a bad effect on their health and wellbeing. We only look at behaviours once we have considered what sorts of life circumstances and life chances people experience because without that understanding, we can�t really understand what drives people to behave in the ways that they do. And without knowing that, out interventions are less likely to reach the right people in the right places in the right ways. Poor diet is an example. If we try to tackle poor diet just by informing people of what a healthy diet is, we miss out on a number of possible factors that make it more difficult that others to focus in on eating healthily:maybe that they have poor mental health, are in poverty, live in an area where fresh fruit and veg is hard to come by or more expensive than processed food, and so on�Finally, we look at the kinds of behaviours that people do that have a bad effect on their health and wellbeing. We only look at behaviours once we have considered what sorts of life circumstances and life chances people experience because without that understanding, we can�t really understand what drives people to behave in the ways that they do. And without knowing that, out interventions are less likely to reach the right people in the right places in the right ways. Poor diet is an example. If we try to tackle poor diet just by informing people of what a healthy diet is, we miss out on a number of possible factors that make it more difficult that others to focus in on eating healthily:maybe that they have poor mental health, are in poverty, live in an area where fresh fruit and veg is hard to come by or more expensive than processed food, and so on�

15. Once we had gone through these processes, we identified the following priority areas for early years�� Because we are identifying needs in the different locality areas in West Lothian, by this time we have a good idea of pockets of the population that we can focus in on. For example, when we looked at the evidence for health needs for the early years, the Mayfield area of Armadale jumped out as being an area of particularly high need. Low breastfeeding rates, a high level of teenage pregnancy, high levels of substance abuse, low employment and educational attainment, etc. Once we had gone through these processes, we identified the following priority areas for early years�� Because we are identifying needs in the different locality areas in West Lothian, by this time we have a good idea of pockets of the population that we can focus in on. For example, when we looked at the evidence for health needs for the early years, the Mayfield area of Armadale jumped out as being an area of particularly high need. Low breastfeeding rates, a high level of teenage pregnancy, high levels of substance abuse, low employment and educational attainment, etc.

16. Outcome planning Now having knowledge of the people that are most vulnerable to poor health and quality of life outcomes, we start to devise outcomes according to a logic modelling approach. Logic modelling starts with a vision for the future, a long term (10 year) outcome and then works back to medium term and short term outcomes. The shorter term outcomes are agreed on because they logically lead to the longer term outcomes. The outcomes have to be plausible for the logic model to work. These are the intended results that are �measured� by indicator sets. Once we have agreed on outcomes, we then look at outputs that are necessary to achieve the short term outcomes, and then at the activities and resources needed to achieve the outputs. This is our planned work and is measured through performance management. This order allows us to get to the best activities for meeting the outcomes, rather than starting with what we already have. Logic models have to meet two criteria � they have to be plausible and doable Now having knowledge of the people that are most vulnerable to poor health and quality of life outcomes, we start to devise outcomes according to a logic modelling approach. Logic modelling starts with a vision for the future, a long term (10 year) outcome and then works back to medium term and short term outcomes. The shorter term outcomes are agreed on because they logically lead to the longer term outcomes. The outcomes have to be plausible for the logic model to work. These are the intended results that are �measured� by indicator sets. Once we have agreed on outcomes, we then look at outputs that are necessary to achieve the short term outcomes, and then at the activities and resources needed to achieve the outputs. This is our planned work and is measured through performance management. This order allows us to get to the best activities for meeting the outcomes, rather than starting with what we already have. Logic models have to meet two criteria � they have to be plausible and doable

17. Outcomes for early years Here is the populated draft logic model for early years (make A4 copies available). Our own health warnings about it � more work needs to be done on the indicators � there has been a lot of national focus on indicators to support the SOA and we will use the most relevant and reliable ones of these as well as devising local, soft, indicators of quality. Also more needs to be done on mapping inputs i.e. service activities to the outcomes. We also need to add community focussed outcomes. The early years Life Stage Working Group will refine this draft and progress with the model. The hardest bit of the logic modelling process seems to be articulating the medium and short term outcomes. Its easier and more habitual for most of us to think about the services that we provide and maybe about the long term vision than it is the medium term outcomes.Here is the populated draft logic model for early years (make A4 copies available). Our own health warnings about it � more work needs to be done on the indicators � there has been a lot of national focus on indicators to support the SOA and we will use the most relevant and reliable ones of these as well as devising local, soft, indicators of quality. Also more needs to be done on mapping inputs i.e. service activities to the outcomes. We also need to add community focussed outcomes. The early years Life Stage Working Group will refine this draft and progress with the model. The hardest bit of the logic modelling process seems to be articulating the medium and short term outcomes. Its easier and more habitual for most of us to think about the services that we provide and maybe about the long term vision than it is the medium term outcomes.

18. Effective interventions One of the processes that we haven�t tackled fully yet is how we scrutinise our interventions and services to make sure that they are reaching the people most at risk in the communities in which they live in a way that will support them to change lifestyle behaviours. This is our starting point and its based on an approach called RE:AIM developed in the US. This approach will be used in conjunction with research on what works to make recommendations for change. One of the processes that we haven�t tackled fully yet is how we scrutinise our interventions and services to make sure that they are reaching the people most at risk in the communities in which they live in a way that will support them to change lifestyle behaviours. This is our starting point and its based on an approach called RE:AIM developed in the US. This approach will be used in conjunction with research on what works to make recommendations for change.

19. Critical Success Factors High level buy in from CPP Buy in from budget holders Effective community engagement Accurate data at small granularity These are just a first guess at what we believe are some of the critical success factors to the project being effective. These are just a first guess at what we believe are some of the critical success factors to the project being effective.

20. Contact Jane Kellock Health Improvement Manager West Lothian CHCP jane.kellock@westlothian.gov.uk 01506 775552