General information on ASCOT
ASCOT stands for the Adult Social Care Outcomes Toolkit; it is a suite of instruments designed to measure social care-related quality of life (SCRQoL), i.e. the quality of life that can be attributed to the interventions or actions of social care. ASCOT is not a measure of general quality of life. It is specific to the quality of life that is affected by social care services.
ASCOT comprises eight domains of SCRQoL: control over daily life, personal cleanliness and comfort, food and drink, personal safety, social participation and involvement, occupation, accommodation cleanliness and comfort, and dignity. Click here for the domains’ definitions. To learn more about development of ASCOT, see Netten et al 2012.
ASCOT can be used in different groups and in different care settings. For example, to measure SCRQoL in residential services (care and nursing homes), the ASCOT Care Homes (CH3) should be used, as it was designed and refined through a series of research projects for use in this specific setting. The CH3 instrument is based on a mixed method approach comprising observations, resident interviews and staff and family/friend interviews. This methodology is the most suitable for collecting data from or about cognitively impaired people, which is often the case for care homes residents. Using a different ASCOT tool in this setting (e.g. SCT4) would result in data not reflecting the care home residents’ SCRQoL. This in effect would render the results unusable for the purposes of measuring outcomes in this situation.
If you are not sure which ASCOT tool to use, view this presentation which should help you decide.
Different versions of ASCOT have been developed for different user groups. There is an easy read version of the SCT4 tool for people with learning disabilities and/or autism. This is a beta version which is currently undergoing validation testing. To learn more about the development of this instrument, please see Turnpenny et al. (2015) and Turnpenny et al. (2016).
Among the suite of tools is a version for unpaid family/friend carers: ASCOT Carer. It measures the quality of life of informal carers who look after people in receipt of social care services. The carers themselves may be in receipt of services for carers. The ASCOT Carer consists of seven domains of carer SCRQoL: control over daily life, personal safety, social participation and involvement, occupation, self-care, space and time to be yourself, feeling encouraged and supported. The first four domains overlap with the domains of the service user version, however the personal safety domain is slightly different as it reflects the safety concern that may be a result of the caring role, rather than general safety issues. Click here for definitions of the domains. To learn more about the development of the ASCOT Carer tool, please see Rand et al (2015) and Rand et al (2012).
ASCOT tools are tailored for different care groups and care settings. Which ASCOT tool is most suitable for your project/study will depend on which service user group you are studying, e.g. older people, people with learning disabilities and autism, carers of people in receipt of services, etc., and/or the care setting, e.g. community-based care, residential care, home care, etc. It is also important to think about (1) the level of cognitive impairment (is the sample you are studying able to self-complete?) and (2) the aims of your study (if you want demonstrate impact of services – termed ‘gain’ – then the tools which measure gain may be more suitable for your study (e.g. INT4 or CH3).
ASCOT has been developed over a series of research studies over 10 years. The development work included creating the ASCOT questionnaires and developing preference weights, which allows use of ASCOT in economic evaluations. Recently, a version for unpaid carers and an easy read version of ASCOT have been developed. For more details of development of ASCOT, see the Development of ASCOT webpage.
University of Kent is the copyright and Intellectual Property holder.
Getting access to ASCOT tools
The registration form gathers information on intended use of ASCOT and forms the basis for the licence to access and use ASCOT. The form includes the Terms and Conditions (T&C’s) of the licence. The person completing the form must agree the T&C’s on behalf of their organisation and their project team. Therefore, they must ensure that they have the authority to do so. If they do not have the authority to agree the T&C’s on behalf of their organisation and their project team, then they must seek a person in their organisation who does have authority to agree the T&C’s for their organisation and project team. The registration form includes questions about the name and job title of this authorised person.
Anyone who has the authority to agree the T&C’s on behalf of their project team and organisation. It could be the person completing the registration form or someone else from their project team who has authorisation to agree the T&C’s on behalf of the project team seeking a licence. It is the responsibility of the person completing the registration form to ensure that they have sought appropriate authorisation in order to consent to the T&C’s for both their organisation and project team.
The organisation where the project team is based will be the Licensee. Therefore, the T&C’s must be agreed by someone with authority to consent to these on behalf of the organisation; this person’s name must be provided during registration and they will be asked to confirm they agree to the T&C’s. It is the responsibility of the person completing the registration form to ensure that they have sought appropriate authorisation in order to consent to the T&C’s.
To access the ASCOT tools, you or your organisation needs to be registered via the ASCOT website. If you or your organisation has not registered, please download and complete our registration form and send it to us on firstname.lastname@example.org. The form includes the Terms and Conditions (T&C’s) of the licence. The person completing the form must agree the T&C’s on behalf of their organisation. Therefore, they must ensure that they have their organisation’s approval to agree the T&C’s. If they have not go the authority to agree the T&C’s on behalf of their organisation, then they must seek a person in their organisation who has the authority to agree the T&C’s. The registration form includes questions about the name and job title of this person. The completed registration form will be reviewed by the ASCOT team. If approved, the completed form and the terms and conditions will form the licence for the use ASCOT, as specified in the registration form. Upon approval, you will receive a confirmation email granting you the licence, a copy/copies of the ASCOT instruments specified in the registration along with accompanying guidance, and a link to a website where you will be able to purchase a data-entry tool(s). Please note that to access/use the ASCOT CH3 instrument you are required to undergo a two-day training course in the use of the measure. Dates of upcoming training courses can be found here.
The licence to use ASCOT is free for not-for-profit use. Not-for-profit is defined as any use for the benefit of the public without generating income. For example, a local authority wishing to use ASCOT for quality monitoring or service improvement is considered not-for-profit. For-profit use requires a licence and a fee, which depends on a number of factors, e.g. the type of use, number of participants, the size of the study, etc. Generally, any use by a pharmaceutical company or consultancy (e.g. in a Patient Reported Outcome measure), other commercial organisations (e.g. health and/or social care commercial providers) or consultants is considered for-profit. To enquire about for-profit licence and fee, please complete our enquiry form and submit it to email@example.com.
Yes, any use of ASCOT must be licensed. Use of the ASCOT measure(s) for the benefit of the public without financial gain is considered not-for-profit and is free of charge. Examples of not-for-profit use: (1) A care provider (either not-for-profit or for-profit) wishes to use ASCOT to demonstrate impact of their services. The organisation provides care services to service users wholly funded by local authorities or to a mix of local authority and privately funded service users. To apply for a licence, you must complete a registration form and submit to firstname.lastname@example.org. We aim to process your registration within 10 working days. Use of ASCOT to generate income is considered for-profit use and requires a licence and a fee. An example of for-profit use would be a pharmaceutical company wishing to use ASCOT in Patient Reported Outcome (PRO) measures. To enquire about a for-profit licence, complete this form and submit it to email@example.com. The form will be processed and passed to Kent Innovation and Enterprise to negotiate a licence agreement.
Yes, anyone wishing to use ASCOT must be licensed. You must complete and submit the registration form. It will be reviewed and a licence will be granted, if accepted. This will be confirmed via an email from the ASCOT team.
Yes, each ASCOT instrument has an accompanying guidance document. The guidance is shared upon approval of the registration form.
How you use ASCOT will depend on the goals of your project or on what you are trying to demonstrate. Before deciding which ASCOT tool to use, spend some time thinking about what it is you are trying to achieve or demonstrate. If your aim is to measure current SCRQoL of users of your service or users in a particular care setting (e.g. community-based service) and your users are able to complete a questionnaire, then the self-completion version of ASCOT, SCT4, may be most suitable. If you are trying to demonstrate impact of your service on people’s quality of life, then an ASCOT instrument that can measure impact (which is termed gain in ASCOT documentation), the interview version INT4, might be more suitable. Make sure to read all the information on this website and view this video to better understand when to use the different ASCOT tools.
You could use the interview version of ASCOT, INT4, which measures the current SCRQoL and the expected SCRQoL score (what the individual’s quality of life would be in the absence of the service studied). ASCOT INT4 also measures the gain in SCRQoL, which is the impact of the service on the individual’s quality of life. The current SCRQoL scores provide an overview of what the service users’ quality of life that can be attributed to the services is like. The average SCRQoL score is 0.86. Any scores below this figure would indicate SCRQoL lower than the average, with scores below 0 being worse than dead. Any scores above 0.86 would indicate SCRQoL above the average. You could investigate the different domains of SCRQoL to check if service users have worse or better quality of life in certain areas. This information could serve as a basis for further investigation (for example through interviews) of the reasons behind low SCRQoL scores in these areas of quality of life. Based on the information gathered through the interviews, interventions to improve care recipients’ quality of life could be developed and implemented.
ASCOT INT4 can also be used to demonstrate impact of the services through the SCRQoL gain scores – gain is the difference between the current and expected SCRQoL score. The higher the gain, the more the service is doing to improve service users’ quality of life in the areas affected by social care.
Examples of ASCOT use
ASCOT is used by local authorities in England to support outcome based management and quality monitoring of social care services. For example, Cumbria County Council uses ASCOT domains to guide conversations with service users as part of the assessment and review process. The council’s social workers use ASCOT questions and domains of SCRQoL to identify individuals’ desired outcomes, which then are incorporated into care planning. To learn more about Cumbria County Council’s use of ASCOT, please refer to the following article: Johnstone L, Page C (2014) Using Adult Social Care Outcomes Toolkit (ASCOT) in the assessment and review process. Research, Policy and Planning, 2013/14, 30, 3, 179-192.
ASCOT is used as an indicator in the first domain of the Adult Social Care Outcomes Framework (ASCOF): enhancing quality of life for people with care and support needs. To populate this, ASCOT SCT4 has been included in the Adult Social Care Survey (ASCS) (questions 3a to 11). The ASCS is an annual survey administered by NHS Digital and collected by all local authorities in England with social services responsibilities. For more information on the ASCS, please click here.
Referencing ASCOT/Quoting ASCOT questions
ASCOT should be referenced in any publications from projects/research in which ASCOT has been used. Guidance on how to reference ASCOT can be found here.
No. The developers of the ASCOT wish the tools to be used widely in social care to promote an outcomes approach in social care practice and policy. However, it is important that any quotations of the ASCOT questions in publications do not violate the intellectual property, which belongs to the developers (members of the Personal Social Services Unit at the University of Kent). Therefore, including the full ASCOT instruments (e.g. a complete set of questions from the ASCOT SCT4/Carer SCT4 or ASCOT INT4/Carer INT4) in publications would be considered a breach of the copyright and Intellectual Property. Authors should provide a fair and reasonable representation of the ASCOT instruments used in their research or practice. Quoting the first and the last ASCOT domain, i.e. control over daily life and dignity in the service user versions of ASCOT, and occupation and feeling encouraged and supported in the carer version, will give the reader a good understanding of the ASCOT. We therefore stipulate that authors quote the questions from these domains in their publications.
Yes, ASCOT has been translated into Dutch, Finnish, German and Japanese. These are official approved ASCOT translations conducted with approval and input from the ASCOT team. To learn more about these translations, go to Translations webpage.
Any translations of ASCOT must be discussed with and approved by the ASCOT team. The first step for people interested in conducting a translation is to download and complete the registration form and submit it to firstname.lastname@example.org. Upon review of the information submitted, the ASCOT team will share a guidance for translating ASCOT. The guidance describes the criteria for an official approved translation, which includes adherence to the translation methodology, and the criteria for approval of a translation company. The translation process is very strict to ensure that the translation measures what the ASCOT instruments are designed to measure and to maintain the measure’s integrity. The process includes a developer review stage, which is a review of the translation done by the ASCOT team – this work is chargeable. The translation company will also charge for the translation work. The applicant for a translation will be required to obtain an estimate of cost from an approved translation company, and an estimate of cost of the developer review from the ASCOT team. The details of the translation process will be discussed and when both the ASCOT team and the translation applicant are happy with the translation process, timescale and the associated cost, the ASCOT team will formally approve of and give permission for the translation. The translation applicant will be asked to sign the appropriate documentation, which will include a consultancy contract for the ASCOT team’s work (the developer review). The translation work will then commence. For further information on translating ASCOT, please see this presentation.
We have developed a guidance for translating ASCOT which describes the translation process and criteria for official approved translations. To receive the guidance, anyone interested in conducting a translation must complete the registration form which gathers more information about the intended use of the translation. The registration form should be submitted to the ASCOT team (email@example.com) who will review it and seek clarification/further information if necessary. Once satisfied with the information provided, we will share the guidance for translating ASCOT. The details of the translation process will then be discussed and if agreed, appropriate permission and contract will be signed. For more information on the translating ASCOT, see this presentation.
No, only agreed translations conducted by an approved translation company and following the translation guidance and methodology are permitted. Anyone wishing to translate ASCOT must have permission to do so. Any translations done without prior discussion with the ASCOT team and without their explicit written consent will be treated as a breach of copyright and Intellectual Property. In such cases, the owner of the copyright in ASCOT, the University of Kent, reserves the right to take appropriate action, including legal proceedings. For more information on translating ASCOT, see this presentation.
No, you must have permission to translate ASCOT. Translations of ASCOT must follow strict translation methodology and must be discussed with and approved by the ASCOT team. For more information on translating ASCOT, please see this presentation.
Licensed users of ASCOT are entitled to one remote support call (telephone or skype) of between 15 to 30 minutes in duration. If further support is needed, ASCOT team members may be commissioned to provide it on a consultancy basis. To book a remote support call, email firstname.lastname@example.org the details of your enquiry to help prepare for the call. ASCOT team member will contact you to schedule a call. To commission a consultancy, email email@example.com the details of what you require. This information will be passed to Kent Innovation and Enterprise to price it up and set up a consultancy contract. If you are happy with the quote, a contract will be set up and we will contact you to discuss the details and next steps.
In the dignity domain there are two questions: question 8 and question 9. The dignity question (question 9) measures how the way the care recipient is treated by staff affects his/her mental wellbeing. Question 8 is a filter question. During development it was found that some respondents were using question 9 to express that they did not like needing help with aspects of the life. However, the aim of the question was to understand how help was delivered and what kind of impact it had upon the respondent. Testing found that including question 8 in the survey not only allowed respondents to express unhappiness with needing help but helped them to answer question 9 in the way that the tool intended. As question 8 is a filter question, it should not be used in scoring.
Question 8 is a filter question designed to allow respondents to express their unhappiness with the fact that they need care and/or support. During development it was found that some respondents were using question 9 to express that they did not like needing help with aspects of the life. However, the aim of the question was to understand how help was delivered and what kind of impact it had upon the respondent. Testing found that including question 8 in the survey not only allowed respondents to express unhappiness with needing help but helped them to answer question 9 in the way that the tool intended. As question 8 is a filter question, it should not be used in scoring.
The way to deal with this is to omit both the dignity filter question (question 8) and the dignity question (question 9) at ‘pre’ intervention. You need answers to all the questions to be able to calculate a social care-related quality of life (SCRQoL) score (except for the dignity filter question which is not used in scoring) – if there are any missing data you will not be able to calculate the SCRQoL scores for your sample. Using the ‘no needs’ level weighting for the dignity question will ensure that SCRQoL scores can be calculated. The weighting for the ‘no needs’ response option (‘The way I’m helped and treated does not affect the way I think or feel about myself’) is in the SCT4 guidance document.
Data entry tools
If there are any missing data (missing answers to questions, coded as ‘-9’ in the data entry tools), SCRQoL scores will not be calculated.
No, the data entry tools have been programmed to calculate SCRQoL using the weights for each response option.
The data entry tools supplement the ASCOT instruments. Each ASCOT instrument has a corresponding data entry tool which is an MS Excel file that generates social care-related quality of life (SCRQoL) scores for each individual. These scores are calculated from data entered from the ASCOT questionnaire/interview by the user. The preference weights for the service user versions of ASCOT are programmed into the file. Upon entering data, a SCRQoL score for each participant is automatically calculated. The tools for the ASCOT INT4, the ASCOT Carer INT4 and the ASCOT CH3 calculate the expected SCRQoL score (the individual’s quality of life in the absence of the service(s) studied) and the gain in SCRQoL (the impact of the service(s) on the individual’s quality of life). The tools also produce a summary of the distribution of responses to each ASCOT question (frequencies and percentages) and charts.
Yes, there are data entry tools for each ASCOT instrument: SCT4, INT4, Carer SCT4, Carer INT4, SCT4 Easy Read and CH3.
Each data entry tool costs £50. Once you have submitted a completed registration form to firstname.lastname@example.org, we will email you confirmation of approval of your registration. The registration form and the terms and conditions (included in the registration form) form the licence. The email will contain the ASCOT instrument(s) requested and a link to The University of Kent Online Store where you will be able to purchase a corresponding data entry tool(s). We will email you the data entry tool(s) once the purchase has been completed.
Each response option in each domain has weights attached to it. The weights are based on general population preferences and represent what people prefer in terms of the different outcomes of (social care-related) quality of life. Some domains are rated as more important than others. For example, research has found that people value control over daily life higher than the other areas of quality of life. Therefore, the weights reflect these preferences. Details of how to score ASCOT are included in the guidance documents accompanying each ASCOT instrument, which are shared upon approval of the registration form.
Each ASCOT tool has an accompanying guidance which includes information on scoring. The guidance is shared upon approval of the registration form.
Questions about ASCOT SCT4
Questions about ASCOT INT4
Questions about ASCOT CH3
CH3 is not a ‘quick’ methodology but it is inclusive (can be used with people living with dementia or other cognitive and communication difficulties) and provides researchers and/or providers with very rich data about the lives of residents.
Questions about ASCOT CARER SCT4
Questions about ASCOT CARER INT4
Upon entering data, the SCRQoL scores for each participant are automatically calculated. The tool also produces a summary of the distribution of responses to each ASCOT-Carer INT4 question (frequencies and percentages) and charts.
ASCOT is available for not-for-profit purposes free of charge with a licence requirement. Not-for-profit is defined as any use for the benefit of the public without generating income. For example, a local authority wishing to use ASCOT for quality monitoring or service improvement is considered not-for-profit. For-profit use requires a licence and a fee, which depends on a number of factors, e.g. the type of use, number of participants, the size of the study, etc. Generally, any use by a pharmaceutical company or consultancy (e.g. in a Patient Reported Outcome measure) or other commercial organisations (e.g. health and/or social care commercial providers) is considered for-profit. To enquire about for-profit licence and fee, please complete the enquiry form and submit it to email@example.com
Generally, any use by a pharmaceutical company or consultancy (e.g. in a Patient Reported Outcome measure) or other commercial organisations (e.g. health and/or social care commercial providers) is considered for-profit. To enquire about for-profit licence and fee, please complete the enquiry form and submit it to firstname.lastname@example.org
Not-for-profit is defined as any use for the benefit of the public without generating income. For example, a local authority wishing to use ASCOT for quality monitoring or service improvement is considered not-for-profit.
You need a licence to access ASCOT, which is granted upon approval of the registration form. If you are planning to use ASCOT for for-profit purposes, you will be required to get a for-profit licence and pay a fee. Complete and submit the for-profit licence enquiry form
If you are planning to use ASCOT for for-profit purposes, you will be required to get a for-profit licence which is granted upon approval of the for-profit licence enquiry form and to pay a fee.