Tag Archives: universal services

Reflecting on an old job & moving to a new one

I recently left a job in one London borough to start a new one in another part of the city. The aim of the move was to find a job that would allow me to develop my supervision skills, and get involved with service development work, while continuing to progress my clinical skills.

The change made me reflect on the positive aspects of the old job, so I’m jotting them down here.


It was a large, friendly team of therapists and I was well supported. I worked autonomously: free to manage my own time and workload.

I spent 18 months working with the same caseload, so I was able to get to know the families. When we met in the street, they would stop and chat; I felt a part of the community. I was also able to develop good working relationships with other professionals, such as staff in the Children’s Centres.

The team has a good universal service in place; they are working at the population level to raise awareness and prevent difficulties arising. In this respect they’re ahead of many other boroughs!

We were encouraged to carry out clinical projects, so I developed a drop-in group focussing on parent child interaction strategies, in my patch. With support from the Children’s Centre I was able to grow this group and access hard to reach families.

What I’m looking forward to

I think the new job will also be a positive experience; when I’ve moved through the initial ‘information overload’ phase and begin to find my feet, I hope I will enjoy the new challenge. I’m looking forward to developing the universal service and working with nursery settings.

I find starting in a new team difficult and admire locum therapists, who move from team to team regularly—I wouldn’t cope! If you’ve got any tips about how to make the transition as stress-free as possible, please add a comment!

Outcome Measurement for Specialist vs. Universal Services

Recently, I was asked to present some thoughts on outcome measurement for specialist and universal services, for an interview. Since it took some time to prepare, I thought I’d post a version here on my blog. So, here goes!

We have several well established methods of measuring outcomes for specialist services, but measuring the outcomes of our universal work is much more difficult. More difficult, but just as important.

Definition and purpose

Let’s start with a definition.

According to Alison J L Fawcett, outcome measurement “…establish[es] the effects of an intervention on an individual or the effectiveness of a service on a defined aspect of the health or well-being of a specified population…. [it involves] administering an outcome measure on at least two occasions to document change over time…” (Principles of Assessment and Outcome Measurement for Occupational Therapists and Physiotherapists, 2007).

Outcome measurement is important for providing quality assurance (as part of clinical governance), demonstrating value, and contributing to the evidence base.

Specialist services

In clinical practice there are a number of well known methods to measure outcomes, such as Enderby’s Therapy Outcome Measures and the East Kent Outcome System. Services I’ve worked in use their own local systems, which involve writing SMART targets and stating whether they’ve been achieved at the end of a block of therapy.

When we choose an outcome measure, it’s worth considering the time required to use the system, as well as what we’ll use the data for. For example, I’m happy to spend time recording outcomes when I know the data will be used to develop care pathways, or contribute to the local evidence base. But the exercise becomes frustrating if I think the data will just sit in a file somewhere, gathering dust!

Universal services

Universal services aim to raise awareness of speech and language development for all children; ensuring that environments children spend time in are language rich, to stop difficulties arising. Universal services also support early identification and timely intervention.

Outcome measurement for universal services is messy. There’s no clear target child, SLTs are working indirectly (through other people), and we’re perhaps not so disciplined with our goal setting. We also don’t have any directly applicable tools.

Measuring outcomes for universal services is currently a hot discussion topic; it was addressed at the “SLTs in Children’s Centres” Special Interest Group. James Law suggested that outcomes need to be easy to communicate to non-specialists, while Michael Thompson talked about how we could use focus groups, observations, and workshops to measure outcomes.

An example: “facilitating language” training session

Thinking about how I can apply this to my own practice, here’s an example.

There are a number of ways we could collect outcome measurement data for a training session which aims to teach play workers how to facilitate language. Before the training session we could ask participants to complete a self rating scale, or observe each play worker interacting with a child; or if this isn’t practical, we could ask them to make a video recording. We would then need to repeat these measures after the training session.

I think it’s important to consider when to collect the post-intervention data. If the training session is aiming to teach practical skills, it might be important to give the participants time to go back into their settings to practise these skills, and consolidate their learning. Carrying out post-intervention measures 4 weeks after the training session might provide us with the most useful data.

Why bother?

Given all the challenges and difficulties I’ve mentioned here, why should we even bother to measure universal outcomes?

SLTs working with pre-school children are doing more universal work to try and reduce dependency in the population, and work more efficiently. Our commissioners require us to demonstrate that this universal work is effective. So it’s vital that we continue to develop outcome measures for this area of our work.

Have you had any luck measuring the outcomes of your universal work? Please share them here.