Title: DHHS and Outcome Measurement
1DHHS and Outcome Measurement
- Wes Albinger, Contract Services Coordinator
- Milwaukee County
- Department of Health and Human Services
- Contract Administration
- March 16th, 2006
- Presentation will be available at
- http//www.county.milwaukee.gov/display/router.asp
?docid15483 - Starting Monday, March 20, 2006
2Intended Outcomes of OM Initiative
- Initial Agencies understand DHHS definition and
application of OM concepts. Agencies understand
the direction DHHS is headed with Outcome
Measurement and their role in that process. - Intermediate DHHS articulates long term outcomes
for each program area. Agency program activities
and initial outcomes are aligned with DHHS long
term Outcomes identified for each program. -
- Long Term Indicators and data collection
protocols are established for each program area.
OM is part of program and contract requirements.
3DHHS and Outcomes WHY?
- To clearly communicate expectations (goals
and objectives) to provider
agencies.
- To establish an objective standard which is
consistently applied to measure and report
program impact. - To provide DHHS and Agencies with a meaningful
way to report success to stakeholders (e.g.
client, provider, funding agencies, etc.).
4DHHS and Outcomes WHY?
- To promote client choice.
- To increase benefits for clients from contract
dollars. - To improve program performance via feedback and
program improvement.
5Purpose of Todays presentation
- This is a multi-year project that will begin
simply with establishment of outcomes and a
requirement that agencies report to us how they
think they are achieving those outcomes. At this
point, DHHS will not be holding programs to a
specific set of indicators. In subsequent years,
contracts may actually include not only the
outcomes, but also the indicators and performance
goals. - None of this is etched in stone yet -- we have
called you together at this juncture specifically
to gather your input.
6FAQ
- Q Is DHHS telling us how to run our program?
-
- A No. Outcome Measurement focuses more on the
impact of the program than the program itself.
While the outcome is affected by the program, we
are more concerned with the end of the program
than the means to that end. Basically, we are
interested in defining where we want programs to
go, but not how to get there. - In some instances, external factors prescribe
program outcomes or processes. An example would
be the new Federal Birth to Three Outcomes which
will be required for all BT3 programs.
Additionally, the growth in popularity of
evidence based program design is putting
increasing pressure on programs to adopt proven
approaches to service delivery. These will
likely play an increasing role in programs.
7FAQ
-
- Q What role will Agencies play in this process?
- A DHHS will articulate long term outcomes for
each program, distilled from estimation of client
need, agency practice and capacity, current
program requirements, federal, state and other
mandates, internal staff, and research. DHHS
will solicit information from agencies relating
to outcomes, indicators, and data collection
methods to help inform this process. Keep in
mind that on a program by program basis, the
amount of discretionary slack in setting
outcomes varies greatly. - Throughout the process, DHHS will release
information for review and comment. -
-
8FAQ
- Q What are the implications of these changes for
my Agency in the short term? - A For 2007, we will not be prescribing
indicators and performance goals in association
with the long-term outcomes. Long term outcomes
will be identified for several pilot programs for
the FY 2007 RFP. For these programs, you will be
asked to describe in detail how your program
design and outcomes relate to the long term
outcome identified for your program, using
successful past performance or a research based
justification. Additionally, you will be asked
to identify what indicators you are or propose to
use to measure the achievement of the outcome, as
well as your data collection and or measurement
tool(s) (concepts explained shortly).
9FAQ, implications for short term, contd
- For those programs without DHHS identified long
term outcomes in the FY 2007 RFP, you will be
asked to describe your current or proposed
program design and outcomes, using successful
past performance or an evidence based
justification. Additionally, you will be asked
to identify what indicators you are or propose to
use to measure the achievement of the outcome, as
well as your data collection and or measurement
tool(s).
10FAQ, implications for short term, contd
- In other words, tell DHHS
- What do you intend to do? (program design)
- Why do you intend to do it? How does what you
are proposing contribute toward the long term
outcome? (rationale/justification) - In what way(s) do you expect clients to benefit?
(short, intermediate, and long-term outcomes) - How will you know if you have accomplished this?
(indicators)
11FAQ
- Q What are the implications of these changes for
my Agency in the long term? - A Indicators and data collection protocols for
each program area will be developed through an
inclusive process. OM will be part of program
and contract requirements. -
12FAQ
- Q How will this initiative create work for my
agency? - A This initiative is more focused on reporting
differently, versus reporting additional
information. The required reporting will be part
of your semi annual evaluation reports. - DHHS will seek to minimize the administrative
burden. One way this will be accomplished is by
soliciting Agency input to determine current
capacity and potential technical assistance
needs. -
13Example-Agency input
- It is worth noting that DHHS has done an
extensive review of existing outcome data
currently collected to help formulate our
thinking and strategy. Many of the examples used
in this presentation are actual outcome data
already collected we are looking at the content
currently being provided as a starting point.
14Agency Input
- You may recall recently completing an Outcome
Measurement Survey. These were sent to all
agencies with purchase of service contracts.
Some notable results, which have already been
used to inform our progress on this initiative,
are as follows -
15Survey responses
- Agencies have widely interpreted definitions of
Outcome as such, there are widely varied
applications of Outcome Measurement.
16Survey responses
- Most indicated an interest in an outcome
measurement presentation. - Most indicated an interest in a formatted
spreadsheet for measuring outcomes. - Vast majority are currently reporting outcomes.
- Approximately half cited fundor requirements as
the basis for deciding to report outcomes. It
appears that many agencies are not finding an
internal benefit to tracking outcomes, but are
doing it because they have to.
17Survey responses
- Most already track outcomes for ALL programs.
- Most common theme that emerged as concern was
administrative/cost burden, with the second being
data reliability and validity. - Vast majority have developed a logic model or
other visual representation of main programs. - Most common methodology employed for measuring
outcomes was United Ways model.
18Technical Assistance
- DHHS will provide technical assistance throughout
this process. - Let DHHS know what your technical assistance
needs are.
19On to Outcomes
- This is intended to give you a sense of the
process DHHS is using internally to determine
outcomes, and may be helpful to you as you
identify how your agencys program will work
toward a specific long term outcome. - DHHS will be using a methodology which is already
familiar to many of you, and enjoys a broad base
of support. It has become most familiar to
practitioners through the United Way, but it is
used more widely than that.
20Some thoughts on Terminology
- Throughout this presentation, I will be using
specific terminology. The concept behind the
terminology is more important however, because
there is a wide use of terminology and
interpretation of terminology among agencies, it
is important that - We adopt a common language for discussing Outcome
Measurement concepts, and that - We use it consistently.
21What are Outcomes and Why Measure Them?
- OUTCOMES-
-
- The intended benefit(s) for participants during
or after their involvement with a program. You
can also think of Outcomes as the OBJECTIVE of
the program. -
22Assumptions and Organizational Challenges to
implementing OM
- Support for OM is based on the assumption that
the information produced creates value that
exceeds the time and effort to collect it. - The challenge, then, is to make sure that the
information that OM produces is useful, and that
collecting it is administratively as simple as
possible. - DHHS wants OM information to serve useful
purposes for all affected stakeholders.
23Assumptions and Organizational Challenges to
implementing OM
- Concern about OM also comes from the belief that
the outcomes measured are not an accurate or
complete reflection of the program. - Our challenge is to identify outcomes which are
appropriate. Your input will help
24An Outcomes Makeover
- The Before
- Served 350 people.
- Hosted 10 resume writing seminars.
- Provided 150 hours of individual career
counseling. - 25 staff attended Outcome Measurement training.
- Notice emphasis on delivery of service, or the
program itself.
25An Outcomes Makeover
- Gee, you sure did a lot, but what happened???
- Did your clients get jobs?
- Did your clients learn anything?
- Did your clients change their lifestyle?
- In general, how were your clients affected or
changed?
26An Outcomes Makeover
- The After
- 70 (160 out of 230) of clients over 50 years of
age obtained employment . - Of the total, 65 were able to maintain
employment for at least 1 year. - Notice emphasis on the benefit or change to the
person served. No (or little) emphasis on the
actual program. In fact, the program can only be
inferred from the outcome statement. These
statements reflect the OBJECTIVE of the program.
27What Exactly is An Outcome?
- Benefits for participants during or after their
involvement with a program.
Change in behavior
Change in knowledge or skills
Change in condition
28Examples of Outcomes
- Clients decreased emergency room visits.
- Participants significantly reduced alcohol/drug
use. - Immigrants were able to secure legal residency
and citizenship. - Staff demonstrate proficiency with Outcome
Measurement concepts.
29Outcome or not?
- Clients increase community activities.
- Clients participate in skill training programs.
- Residents feel safer.
- In 2004, the Advocacy program assisted 75
individuals. - Clients reduce emergency room use.
30Task 1 Choose the Outcomes You Want to Measure
- Hints
- Be thoughtful!!
- Define Your Target Population.
- Engage staff and clients in the discussion.
- Choose meaningful/compelling outcomes.
- Write outcomes so John Doe will be able to
understand. - Develop a Logic Model.
31Logic Model A Picture of how a Program Works
Inputs
Activities
Outputs
Outcomes
Staff Outpatient Clinic Referring
agencies Individuals with mental illness Outside
environment
75 psychiatric sessions 150 drug prescriptions 65
subsidized housing applications 175 crisis
calls 80 resume writing/job placement sessions
Psychiatric Services Pharmacy Services Nursing
Services Housing Assistance 24 hour crisis
hotline Vocational Services
Reduce level of incarceration of adults with
mental illness Reduce level of hospitalization
of adults with mental illness
32Levels of Outcomes
- In most cases, a program attempts to affect not
one, but a series of changes for individuals,
each building on the previous one. These can be
thought of as the stepping stones toward the
ultimate, or long term goal of the program. We
can define these as - Initial Outcomes
- Intermediate Outcomes
- Long term Outcomes
33Relationships among levels of outcomes
- Levels of outcomes can be thought of in terms of
a series of interrelated milestones. The
achievement of one sets the condition which
increases the chances of achievement of the next.
- In other words, IF a happens, THEN b is more
likely to follow.
34Relationships among levels of outcomes
- Example
- IF job seekers learn appropriate job interview
skills (initial outcome), THEN they will use
appropriate job interview skills in the interview
(intermediate outcome). IF they use appropriate
interview skills, THEN they will obtain jobs
(long-term outcome).
35Relationships among levels of outcomes
- Similarly, it can work backwards if you know
the desired long term outcome for your program,
you can ask yourself, what will make this more
likely to occur? - Example Intended benefit (Long Term Outcome)
for Employment Program Clients get jobs. What
will make this more likely to occur? Answer (one
of many possible answers) Clients learn and
demonstrate appropriate job seeking skills. - There should be a theoretical/logical
(research or practice supported) link supporting
causality between the various outcomes.
36Initial Outcomes
- Initial Outcomes-The most immediate changes and
most heavily influenced by the program, and are
typically expressed in terms of new knowledge,
skills, or attitudes learned through the program. -
37Initial Outcomes
- Examples of Initial Outcomes
- Program Employment
- Initial Outcome Clients learn appropriate job
seeking skills. - Program Adult Day Services
- Initial Outcome Clients increase awareness of
community resources. - Program Outcome Measurement Initiative
- Initial Outcome Staff demonstrate proficiency
with Outcome Measurement concepts.
38Intermediate Outcomes
- Intermediate Outcomes-A link between the
programs initial outcomes and long term
outcomes, typically expressed in terms of changes
in behavior connected to the new knowledge,
attitude, or skill (initial outcome) learned
through the program.
39Intermediate Outcomes
- Examples of Intermediate Outcomes
- Program Employment
- Intermediate Outcome Clients utilize appropriate
job seeking skills. - Program Adult Day Services
- Intermediate Outcome Clients increase
utilization of public and private services in
their community. - Program Outcome Measurement Initiative
- Intermediate Outcome Staff apply Outcome
Measurement concepts to programs.
40Long Term Outcomes
- Long Term Outcomes-The ultimate objective of the
program, typically expressed in terms of changes
in condition or status. When defining Long Term
Outcomes, it is important to select only outcomes
which the program can be reasonably expected to
influence.
41Long Term Outcomes
- Examples of Long Term Outcomes
- Program Employment
- Long Term Outcome Clients are hired.
- Program Adult Day Services
- Long Term Outcome Clients generalize acquired
skills to other settings.
42Important note, Long Term Outcomes
- Just because outside influences may affect
achievement of an outcome, that does not mean the
outcome is inappropriate. We can adjust for this
by recognizing that outcomes will not be achieved
100 of the time. - As an example, consider the effect of the economy
(outside influence) on an employment program.
The state of the economy cannot rule out the
outcome clients obtain jobs rather, the
existence of an outside influence means that we
should expect to see less than 100 of the
outcome achieved.
43Important note, Long Term Outcomes
- Long Term Outcomes are of greatest interest to
DHHS and will be the primary focus of our efforts
to define outcomes for each program.
44Example
- Suppose we identify the long term outcome,
Clients get hired. Well, we dont necessarily
care if the means to that end are the initial
outcome clients learn job seeking skills or
clients are connected to warm job leads
generated by job developers. Either initial
outcome can lead to the long term outcome.
Depending on the particular agencys expertise,
service delivery method, or client mix, they may
prefer one means to the other.
45Example
- Another example would be the long term outcome,
clients are appropriate weight. One program
may choose to work toward this end by targeting
the initial outcome, clients are able to
identify healthy food and the intermediate
outcome, clients eat healthy food, while
another program may identify, clients learn the
benefits of exercise as the initial outcome and
clients exercise at least 2x per week as the
intermediate outcome.
46Implications of Different Means to a Common End
- Therefore, you can consider the Long Term
Outcomes identified for your program to represent
the direction we want you to go in. You will be
responsible for deciding the best way to get
there. - In some instances, external factors prescribe
program outcomes or processes. An example would
be the new Federal Birth to Three Outcomes which
will be required for all BT3 programs.
Additionally, the growth in popularity of
evidence based program design is putting
increasing pressure on programs to adopt proven
approaches to service delivery. These will
likely play an increasing role in programs.
47Task 2 Specify Indicators For Your Outcomes
- Hints
- Outcomes and Indicators are not the same thing.
- Indicators-Measurable approximations of the
outcomes you are attempting to achieve. They
determine the extent to which the outcome has
been met. - Indicators look at the outcome and ask, How do
you know?
48Task 2 Specify Indicators For Your Outcomes
- Think about the outcome of the program. Ask
yourself - How do I know this Outcome when I see it?
- What does it look like when this Outcome happens?
- What are the characteristics of someone who has
achieved this Outcome?
49Task 2 Specify Indicators For Your Outcomes
- Example
-
- Program- Recreation.
- Outcome- Clients socialize with peers and
non-disabled individuals. -
- Indicator- Number of integrated community
activities participated in during the previous
month.
50Examples of Program Indicators
51Indicators, continued
- Notice how Indicators decrease the ambiguity of
determining whether the outcome has been met.
52Task 3 Prepare to Collect Data on Your
Indicators
- Hints
- Identify data sources for your indicators
- i.e., Records, General Public, Program
Participants, Parents - Design Data Collection Methods
- i.e., Review of Program Records, Questionnaire,
Interview
53Things to Think About when developing a data
collection method
- Collect info that you want to know the answers
to (Dont just do it to satisfy funder
requirements!!) - Dont reinvent the wheel (Look for instruments
that have already been developed!!) -
-
54Task 4 Analyze Findings
- Hints
- Make it Easy to Tabulate Your Findings. If
possible, computerize!!! - Calculate the and of clients achieving the
outcome. - Look at how gender, race/ethnicity, income, etc.
influenced achievement of outcomes.
55Task 5 Use Your Findings
- If the outcome measurement system is not used
for helping the organization improve its
services, the time and effort will have been
wasted. - - Outcome Management in NP Orgs , Urban
Institute, 2001.
56Todays intended training outcomes, revisited
- Initial Agencies understand DHHS definition and
application of OM concepts. Agencies understand
the direction DHHS is headed with Outcome
Measurement and their role in that process. - Has this been accomplished?
57The role for Agencies
- DHHS will identify long term outcomes for some
programs by the release of the 2007 RFP. - As mentioned previously, DHHS will define the
long term outcomes for each program. Agencies
will need to think about how they will work
toward that outcome. In reviewing proposals DHHS
will look at how logically connected your initial
and intermediate outcomes are to the Long Term
Outcome defined for the program, as well as how
you propose to use indicators and data collection
methods. -
58The role for Agencies
- Agencies can make suggestions for outcomes,
indicators, and data collection based on their
practices let DHHS learn from you by showing us
what you are currently doing. You may submit
this information at any time, but will be asked
for it as part of your FY 2007 submission.
59The role for Agencies
-
- DHHS will use your proposed strategies for
outcomes, indicators, and data collection methods
as a jumping off point as we consider
establishing these for each program area.
60Resources, References
- United Way of America Outcome Measurement
Resource Network www.unitedway.org/outcomes - Measuring Program Outcomes A Practical Approach,
United Way of America, 1996. (Available through
website for 5) - Kellogg Foundation Evaluation Handbook Logic
Model Guide www.wkkf.org - Urban Institute (Publications by Harry Hatry)
- www.urban.org
- Fiscal Policy Studies Institute (Mark Friedman)
- www.resultsaccountability.com