Outcomes Measurement in the Human Services, 2nd Edition

Cross-Cutting Issues and Methods in the Era of Health Reform

Much has transpired since the first edition of Outcomes Measurement in the Human Services appeared in 1997. In this second edition, Jennifer Magnabosco and Ron Manderscheid have performed a valuable service to the fields of health, human services, and social work by reconvening many of the original contributors to the 1997 edition and asking them to reflect on how outcomes measurement has changed and evolved over the past nearly 15 years.

The 1997 edition appeared at a time when health, human services, and social work were still dealing with the relatively unknown concept of outcomes. Consequently, the contributors to the first edition had to deal with such issues as: What is an outcome? How do you measure outcomes? Why should programs and agencies measure outcomes? At the time, there was little agreement on the relationship of outcomes and outcomes measurement to the emerging concept of government performance measurement as mandated by the federal Government Performance and Results Act of 1993. In addition, there was both concern and suspicion about outcomes and government performance measurement on the part of the scholarly evaluation community.

This second edition of Outcomes Measurement in the Human Services appears at a time when outcomes and outcomes measurement has become a major field of scholarly research and practice in health, human services, and social work. The chapters in this second edition make some important contributions to conceptualizing and defining outcome measures, and address a more nuanced set of issues that reflect the maturation of the field. The book helps to set the outcomes agenda for health, human services, and social work for the next decade.

For many of the issues identified by the contributing authors, there seems to be both an upside and a downside. Many funding sources, such as the United Way, foundations, most government agencies, and even whole countries now mandate the collection of outcome data, leading to the creation of large and potentially meaningful data sets. Yet there is a real concern on the part of providers, professionals, and consumers that funder-mandated quantitative outcomes infringe on their prerogatives. This practice raises a number of important subsidiary issues, including encroachment on the freedom of nonprofit human service organizations to experiment and innovate with new service delivery approaches. Likewise, evidence-based practice, focusing on greater attention to scientific considerations in decision making, is considered in some ways antithetical to the prescriptive specification of outcomes by funding sources. On another issue, qualitative research has demonstrated its effectiveness in producing valuable insights. A great deal of useful information is missed when only quantitative approaches to outcomes measurement are used, yet effective methods for incorporating qualitative findings have yet to be discovered.

One encouraging note is the recognition by several contributing authors of the many valuable outcome instruments that are now available in several fields, such as health, mental health, child and family services, substance use care, and others. The challenge now is not only to measure the accomplishment of outcomes, but also to better understand how and why they took place.

Another important topic addressed by several authors is the issue of linking outcomes, costs, and compensation. The ability of health, human services, and social work to compute their costs, specifically the costs of achieving outcomes, is increasingly important as government and private funding sources continue to move toward pay for performance by utilizing performance-based contracts and grants. With respect to the health field, outcomes and outcome measures in conjunction with evidenced-based practice hold the potential to focus not only on what works, but also at what cost. These trends have been codified, for example, in the Patient Protection and Affordable Care Act of 2010, which is intended to extend insurance coverage and improve the quality of care delivery.

The state of the art, as presented by the contributors to this volume, clearly demonstrates that significant progress in outcomes measurement has been made over the last 15 years. Yet many challenges still exist, and will continue to persist, as human service sectors embark upon major policy and practice reforms. It is clear that all stakeholders are not exactly on the same page. Funders, government agencies, nonprofit organizations and the general public all want to know that dollars spent for health, human services, and social work accomplish results, not just process. Those closer to consumers and direct service professionals want to be assured that treatment prerogatives are respected. This is all to say that the outcomes and performance measurement movements are perceived and judged on the basis of one’s location within the system, which in effect makes it piecemeal. What these movements need to become are well-integrated systems that continually contribute to making service delivery more efficient and effective while improving productivity and maximizing the use of technology. We hope that fulfilling this need can be part of the agenda for the next decade.

All in all, this second edition does an excellent job of bringing the topics of outcomes and performance measurement up to date! Readers will understand not only where the outcomes movement is today, but also how we got where we are.

Lawrence L. Martin
Professor of Public Affairs
University of Central Florida

Peter M. Kettner
Professor Emeritus
Arizona State University