About the Adult Social Care Outcomes Framework (ASCOF)

The ASCOF is a set of outcome measures, which have been agreed to be of value both nationally and locally for demonstrating the achievements of adult social care. Its key uses span this national and local context:

• Nationally, the ASCOF will give an indication of the strengths of social care and success in delivering better outcomes for people who use services. This will support the Government’s role in reporting to the public and Parliament on the overall system, and influence national policy development. It will also help local government to understand trends and highlight risks in keeping with its responsibility for improvement in councils.
• Locally, one of the key uses of the ASCOF is for ‘benchmarking’ and comparison between areas. This is critical to local accountability of councils and reporting to their citizens on a consistent basis. Whilst the ability to compare between areas varies between the measures, overall the framework is one of the most significant supports available to councils themselves in managing their own service improvement, since it will provide one of the few validated sources of outcome information.

The sections which follow outline the agreed outcome measures comprising the 2011/12 ASCOF, across the four domains in the framework. In each domain, a summary of the measures and their link to the outcome domain and statements is provided.

About this database
This database is set up to enable users to explore evidence from 43 systematic reviews about the effectiveness of social care interventions for achieving the outcomes set out in the ASCOF. The 43 reviews are contained within a review of reviews conducted to support the use and development of the ASCOF.

About the review
The review was commissioned by the Department of Health and conducted by researchers as the EPPI-Centre in order to build a view of the evidence on adult social care interventions. The aim was to establish the extent to which the outcomes set out in the ASCOF can be improved by councils and which interventions are most effective for doing this. Focusing on interventions which are not effective or outcomes that councils cannot improve would risk diverting resources which could be used more cost effectively.

We therefore conducted a review of reviews to answer the following question:

Which social care interventions can effectively improve outcomes for services users in the four outcome domains set out in the ASCOF: quality of life (QoL), prevention, satisfaction and safeguarding?

This following paragraphs provide brief details about the scope and focus of the review; full details are available from the report  which can be accessed here (Sutcliffe et al. (2012) The adult social care outcomes framework: a systematic review of systematic reviews to support its use and development).

Method - systematic review of systematic reviews
By bringing together and assessing available research evidence, systematic reviews provide a robust and accessible summary of evidence for decision-makers. When a topic area is particularly broad or when it is already populated with many systematic reviews a systematic review of reviews or ‘meta-review’ is an appropriate solution. The ASCOF covers the whole of social care, which is a very broad area over which to carry out a systematic review, the review therefore took the form of a systematic review of systematic reviews.

Scope - social care interventions
To be included reviews needed to focus on interventions led by or completely provided by someone other than a health professional, and have the aim of supporting activities of daily living, or preventing an increased need for services, rather than treating a condition. The review contains evidence about various interventions which meet these criteria but which might not immediately be recognised as social care, including physical activity programmes, music and other complementary therapies, alongside evidence about services more widely recognised as social care (such as Occupational Therapy, personal assistance and assistive devices).  

Scope - social care populations
Populations often considered to be the main recipients of social care (people with mental illness, physical or learning disabilities and older people) were within scope. Studies involving people defined as having long term conditions, such as arthritis, dementia, stroke or cancer were also sought, as these conditions can often lead to difficulties with activities of daily living and an escalation in the need for social care services.  Because of the preponderance of research into long term conditions, this population group appears far more frequently than do people from other groups such as older people and people with physical or learning disabilities. The review does not focus on interventions or outcomes relating to carers as another review of reviews covers this group (Parker et al. (2010) Meta-review of international evidence on interventions to support carers).

Scope - social care outcomes
The outcomes examined in this review are those set out in the ASCOF: quality of life, delaying and reducing the need for support (prevention), satisfaction with services and safeguarding. Within the first two outcomes, quality of life and prevention, different domains were identified and coded for. Within quality of life we capture data on generic quality of life measures (QoL), those relating to being able to take part in the activities of daily living (ADL), those relating to participation in social activities such as employment (social participation), and those relating to feeling safe or having a sense of control or dignity (Dignity/control). Within prevention we capture both direct measures of increased need for the use of health or social care services, such as time spent in hospital  (service use), and measures of illness or events, such as falls, which could lead to an increased need for services (illness/events). In some of the included reviews mental health outcomes were reported as health events in their own right, in others they were explored as aspects of quality of life. However, in order to be consistent, and because it is clear that poor mental health could lead to an escalation of service need, we have captured all mental health outcomes within the prevention sub-component – illness/events.