By Stacey Rand (University of Kent, UK)
Why do we need tools to measure outcomes of social care?
In the context of competition for resources with other areas of public spending, it is important to be able to identify, measure, and monitor the benefit of long-term care services. Outcome measures in long-term care are essential for improving the quality of care, ensuring it is person-centered, informing decision-making, ensuring accountability, and advancing the overall effectiveness of services provided.
In the UK context, long-term care services (e.g., residential or nursing care, homecare) and some types of short-term support (e.g., reablement) are referred to as social care.
What is the Adult Social Care Outcomes Toolkit (ASCOT)?
Adult Social Care Outcomes Toolkit (ASCOT) is a suite of tools designed to measure the effect of adult social care on people’s lives (outcomes).
This can be important in social care practice and applied research, e.g., in needs assessment and care planning, evaluation and monitoring of services for quality improvement, and in understanding whether services are (cost) effective to guide decision-making.
ASCOT was developed by researchers at the University of Kent, UK. The original measures (ASCOT-SCT4 and INT4) were released in 2012. The tools have since been translated into a number of languages, including Japanese, Chinese, German, Spanish, Finnish, Dutch and Swedish.
How does ASCOT work?
ASCOT works by asking people about their lives in the areas that matter most to them and are most likely to be affected by social care services.
Understanding the difference that social care makes to people’s lives, wherever possible from their own perspective, is important.
Social care is about supporting people to live well. We can only really understand this if we try to understand the person’s own view, against what they value, and think is most important.
In each case, ASCOT asks the person for their views based on their personal likes and dislikes, their values and preferences.
Why are there different tools in ASCOT?
ASCOT is not a single tool. It is a set of tools designed for different people and settings. There are three broad sets of tools, which you can preview here.
- For adults with care and support needs*. This includes adults, aged 18 or over, with intellectual, physical or sensory disabilities, and people living with dementia, mental health or other long-term conditions or age-related needs, who use social care (e.g., homecare, care homes). These measure social care-related quality of life (SCRQoL).
- For carers (ASCOT-Carer). By carers, we refer to family or friends, who support and care for an adult with disability, long-term health conditions or age-related needs. This measures carers’ social care-related quality of life (carer SCRQoL).
- For the workforce (ASCOT-Workforce). This includes professionals working in adult social care, e.g., care and support workers, registered managers, social workers, occupational therapists, social care nurses, and other roles (e.g., activity coordinators). This measures care work-related quality of life (CWRQoL).
How can ASCOT be used?
A recent scoping literature review has found that use of ASCOT has been reported across 55 published articles. These represent studies conducted in the UK and internationally.
Most of the studies are quantitative and apply experimental (e.g., RCTs) or quasi-experimental, observational methods to understand the impact or (cost) effectiveness of social care services, policy or interventions. A small number of studies apply ASCOT as a theoretical framework to guide qualitative studies or literature reviews.
ASCOT has also been used in adult social care practice. These uses are less visible and are not all publicly reported, especially if they form part of internal systems, analysis and reporting. They include:
- Collection of the ASCOT-SCT4 (the original measure) in the Adult Social Care Survey (ASCS) in England and reporting in the Adult Social Care Outcomes Framework (ASCOF).
- Integration of ASCOT-SCT4 into a digital tool that offers tailored signposting to local preventative services for older adults in Sweden.
- Application of ASCOT into quality monitoring in Scandinavian care homes by Attendo (a large private care provider).
How to find out more?
We have recently launched a revised and updated website, where you can find out more about ASCOT or how to contact us.
Note
*The standard version (ASCOT-SCT4/INT4) has been adapted for different groups to support accessibility and feasibility of completion. These include versions for adults with intellectual disabilities (ASCOT-ER) and older adults with mild cognitive impairment or mild to moderate dementia (ASCOT-ER OP). A proxy-report version (ASCOT-Proxy) has also been developed, where the person is unable to self-report. There is also a mixed methods version for use in research in care homes (ASCOT-CH4), which combines flexible interviews with residents with proxy-report by family and staff, and observation.