The ecology of outcomes: System accountability in children's mental health

Abstract

This article provides a conceptual and practical framework called the Ecology of Outcomes. Based on this framework, agencies that serve children and families build and use outcome-oriented information systems to respond to their clients in a more flexible manner. The goal is to improve promising programs by involving stakeholders in outcome identification and in utilization of results. Problems addressed include the emphasis human services place on rules compliance, lack of feedback to program staff to allow for midcourse correction, and lack of input by key stakeholders in the identification of outcomes to be measured. The following components of the framework are described: principles of outcome accountability, prerequisites and building blocks, implementing an outcome information system, and utilizing the results. Key elements of the framework are the integration of outcome information into a service system's decision-making process and the inclusion of client, stakeholder, and provider satisfaction information.

A Conceptual Framework for Developing and Implementing Effective Policy in Children's Mental Health

“…The work of Mazmanian and Sabatier (1981) supports this as well. In addition, the "ecology of outcomes" model similarly emphasizes that accountability must be grounded in the context of a clear statement of the population to be served, the outcomes to be achieved, and the interventions to be provided in an effort to achieve the outcomes (Hernandez, Hodges, & Cascardi, 1998).…”

“…As the Outcomes Roundtable for Children of CMHS (1998) emphasized, good accountability procedures that are based on a well-articulated theory of change, and that are clear about the desired outcomes, the population of concern, and the proposed interventions, can play a vital role in program improvement and overall effectiveness. Similarly, ongoing formative evaluation procedures that are designed to provide practical, useful information can be extremely useful in achieving positive outcomes (Hernandez, Hodges, & Cascardi, 1998;Patton, 1998;Usher, 1998). An example of a policy designed to promote systems of care that has a strong emphasis on accountability is AB 3777, the California law which includes a requirement that counties negotiate a performance contract with the state to achieve agreed upon outcomes (Feltman, 1999, personal communication).…”

Improvement in Symptoms Versus Functioning: How Do Our Best Treatments Measure Up?

“…Managed care and other systems still focus on the cost of services at the expense of resources allocated to delivering services that will bring about improvement in client outcomes that are important to consumers (Hernandez et al 1998). Psychology as a field has a prime opportunity to influence policy at the state and national levels and help codify client outcomes (Rapp et al 2005) by expanding our evaluation criteria to include more factors that resonate with mental health stakeholders.…”

A Program Evaluation Strategy in a Community-Based Behavioral Health and Education Services Agency for Children and Families

“…Information that has been systematically collected and analyzed can be cycled immediately back to parents and clinicians to directly affect patient care by guiding clinical decisions about diagnosis and treatment. Outcomes data can inform clinical and administrative staff about ways to improve the quality of service programs (Hernandez, Hodges, & Cascardi, 1998). In an era of great demand for reduced spending on health services, evaluation research can be used to reduce unnecessary costs (Epstein & Sherwood, 1996;Lewin, 1995), even as it allows community agencies to achieve and maintain a competitive advantage in the marketplace of service provision.…”