Empowering people through outcomes-focused monitoring at Expanding Horizons

Expanding Horizons provides domiciliary care and support to adults with a mental health diagnosis or learning disabilities across South Wales. Support is provided in people's own homes, primarily in shared supported living settings. Many of the people supported have highly complex needs, often having experienced repeated placement breakdowns, trauma, or detention under the Mental Health Act. The service's approach is built on the belief that, with the right support and meaningful relationships, everyone can build a life that feels safe, meaningful, and their own, regardless of their diagnosis or history.

Expanding Horizons has developed a structured Outcomes Monitoring System that identifies each person's interests, tracks the support they receive, and measures the time spent working towards their personal goals.

Starting with a person-centred plan

The process begins at assessment, when staff work collaboratively with the individual to identify outcomes that genuinely matter to them. These outcomes are translated into a clear, person-centred Personal Plan, setting out what the person wants to achieve and how support will be provided to get there.

Daily recording of support and progress

Each day, staff deliver support aligned to the agreed outcomes and record detailed information about the support provided. This includes exactly how much time is spent on different areas of a person's life, such as personal care, community engagement, developing independence skills, social stimulation, emotional well-being, education, volunteering, employment preparation, or hobbies and interests. This builds an accurate picture of the support each person receives, the time spent working towards specific outcomes, how engaged and motivated they are, the progress being made, and where support may need to increase, reduce or change.

Regular, person-led case reviews

The information gathered is analysed continuously and forms the basis of person-led case reviews held every 12 weeks. These reviews bring together the individual, staff, families and relevant professionals to reflect on progress, celebrate achievements, and identify any barriers. The person remains at the centre of these conversations and actively shapes their next steps.

Using data as evidence

Because the system measures outcomes quantitatively, the service can demonstrate progress with clear evidence. For example, if someone initially needs 300 minutes of support each week with personal care but later needs only 150 minutes because they are completing tasks independently, this increased independence can be evidenced with objective data. Equally, where a person needs additional support to achieve meaningful outcomes, the same data can be used to provide commissioners and funding teams with robust evidence of need.

Maintaining the system requires significant staff time and consistency to record and analyse detailed outcomes data, but the service views this investment as essential to delivering truly person-centred, evidence-based support.

The Outcomes Monitoring System has enabled Expanding Horizons to evidence life-changing progress for the people it supports. Individuals have developed a sense of belonging and feeling safe at home, accessed the community independently, used public transport, attended college, gained employment and volunteering opportunities, joined local gyms and social groups, learned digital skills, and built friendships and relationships. Some people have moved on from supported living into independent accommodation, while others have reduced their reliance on staff support in specific areas of daily life.

Paul, who joined the service three years ago, initially received 9 hours of 1:1 support a week and spent much of his time isolated in his room. Through small, achievable goals and relationship-based support, he began engaging with the world, starting with attending a barber appointment independently for the first time in years. Using outcomes data gathered through person-led reviews, Paul identified increasing independence during fishing trips as a goal, and his support was gradually reduced during these activities as his confidence grew. The evidence from this monitoring helped secure an increase to 20 hours of 1:1 support per week to further support his recovery, and Paul has told staff that for the first time he genuinely feels at home.

Lisa, who previously relied on staff for almost all aspects of daily living, including medication management, personal care and accessing the community, used the system to identify what mattered most to her and worked towards these goals in small, manageable steps. Her progress was monitored closely, allowing her support to be adjusted as her confidence and independence grew. Lisa now lives independently, an achievement that once seemed far beyond reach.

"Our data-driven approach lets us evidence both increasing independence and increasing need, ensuring people get the right support, and ultimately achieve outcomes that are truly meaningful to them." Ali Cooling, RI and Managing Director, Expanding Horizons