Contents |
1. Essence | 2.
Aproaches | 3. Process | 4.
Measuring outcomes | 5. Paradoxes
6.
Examples | 7.
Jargon | 8.
Checklist | 9.
Practice tips | 10.
Resources
5.
Paradoxes and dilemmas in practice
In
practice there are numerous paradoxes and dilemmas in evaluating human
services and community development. These paradoxes and dilemmas create
enormous difficulties. We must chose between two responses:
- The difficulties are insurmountable. There is no point in evaluating
services. We would be wasting our time - lets keep our energies
for direct service.
- The difficulties are many and the results will be imperfect but we
do need to do something to deal with the potential self-delusion
- thinking we are
doing a good job when we are not. The same reasons that make evaluation
so difficult also create room for self-delusion so we need
to be even more rigorous
in our evaluation of services.
Some of the paradoxes and dilemmas are: Outcomes
1.
The outcomes to be achieved may not be known in advance.
Often clarity about the outcomes to be achieved only emerges during the course
of the service delivery process or the community development process. This
means that we may not have made the right observations or measurements at the
beginning of the service process to know whether there has been any change
during the course of the service delivery or community development.
2.
The outcomes to be achieved may be difficult to precisely define
In human services and community development many of the outcomes are inherently
difficult to precisely define and so they are also inherently difficult to
measure, for example: good parenting, self esteem, agency networks, friendship
networks, family networks and reduced risk of child abuse are all difficult
to precisely define and measure.
3.
The specific outcomes we are wanting to achieve may differ depending
on the values we hold.
Where there is not consensus among all stakeholders about the values underpinning
the service provision there will not be agreement on the specific outcomes
we are looking for. For example, we may all agree that good parenting is an
outcome to be achieved. But there are many views of good parenting based on
different values. These different values can lead to different judgments about
the specific outcomes to be achieved.
4.
People involved with the service processes may have different views
about what outcomes have been achieved and the extent to which
they have been achieved.
In child and family services if we ask the worker, the client and another family
member about the outcomes achieved they may say quite different things. It
is not uncommon for a client to say that a lot has been achieved and the worker
to be concerned at the lack of real progress and a family member to have a
different view.
The nature of the service process - from a client viewpoint 5.
There are different views of who the client is.
The client could be:
- an
adult family member
- the child
- the immediate family
- the extended family.
Different
stakeholders may have different views of who the client is.
This means that when we are talking outcomes for clients we can
be talking about very different outcomes. And the data to be collected
to measure outcomes
can be very different depending on how the client is identified. 6.
The steps in the service process can differ from one service to
another.
There are often differences between services about the nature of the service
process. This means it is often difficult for several services to use the same
tools. For example one service may use an assessment process where the worker
and the client need to agree on what is written on the assessment form. Another
service provider may use a separate form for each of the client and the worker.
7.
People in the service processes may want different things.
For example the client may want to separate from her partner. The partner may
want to remain together with the client. The children may want something different.
8.
People in the processes make choices about their commitment and
participation
People may not want to continue to be involved with the service process. How
is a client withdrawing to be interpreted? It could be viewed as inappropriate
service delivery because it could be seen that the service has failed to keep
the client engaged; or it could be viewed as the client exercising their free
choice.
These different views lead to different descriptions of outcomes achieved.
9.
People in the service process are part of families, friends, neighbourhoods,
work teams and communities
This means that it is difficult to show cause and effect relationships because
the service is not the only cause at work in the life of the client. If the
client is achieving outcomes is this because of the service? Because of support
from family members? Support from neighbours? How could we know what the service’s
contribution is?
10.
Services are provided short term. We are hoping for long term outcomes.
This means that the clients may need to have left the service for many years
before we can know whether or not the service has had a real positive impact.
But we have to make the decisions about service delivery now.
Extensive longitudinal research can help with this issue, but never solve it
because society is changing, and so our knowledge about society is always,
to some extent, out of date.
The nature of the service process - from a service viewpoint 11.
The service is part of a service network.
This means that it is difficult to show cause and effect relationships between
what this service has done and the outcomes achieved because the outcomes may
have been achieved through the service provision of the entire network.
12.
Service staff are often focussed on individual clients and do not
have the time or expertise to build a picture of all their clients
as a group
Most human services staff are trained to work with clients. Their work is client
focussed and the day to day demands are client focussed. Their day to day work
is interrupted with client demands.
These realities often make it difficult for agencies to build pictures of their
clients as a group because this task requires different skills (research and
data analysis) and different time pressures (eg staff being able to work for
longer periods uninterrupted).
Measurement
13.
There are different approaches to how to measure outcomes.
For example will we measure outcomes according to:
- An agreed behavioural standard (eg. this is a skill required by all
parents)
- The relative change in the client (and their situation) (eg. the
client's housing situation has improved in...)
- What we had intended to achieve (eg. we achieved what we said we
would).
These approaches lead to the development of different kinds
of tools, for example:
- Standardised assessment tools (which can show us how the clients’s
responses compare with the population at large)
- Non - standardised questionnaires (which can show us relative change
in this client - but not comparisons with the
population at large)
- Goal
attainment scaling (which can show us the extent to which we achieved
the goals we set out to achieve,
but not
measure the
unintended
consequences).
In addition, each of these three approaches to measuring
outcomes can be developed using different methods
of measuring, eg, independent
observation
and judgment,
subjective observation and judgment or subjective
judgement.
These various approaches lead to the development
of very different tools.
Mixing good service delivery and good measurement 14.
There are conflicting demands between good service delivery practice
and good measurement and data collection practice.
For example in many human services the service process typically starts with
building rapport and works from a basis of building on strengths. To present
a long detailed questionnaire to the client at the beginning of the service
process may be intrusive and so reduce rapport; if it is comprehensive it is
likely to highlight deficits as well as strengths and the client may feel they
have less strengths to build on than they had previously felt.
15.
There are conflicting demands between resource use for direct services
and resource use for measurement and data collection.
For example should a service use staff time in doing detailed data collection
and analysis when the time could alternatively be spent on direct service delivery?
16.
There are conflicting demands between client confidentiality and
data collection
Clients have a right to confidentiality and services should not provide information
about clients to other services without their permission. However, because
clients use a variety of services and services are part of service networks
data is ideally needed about all the services a client uses.
Ideally what is required is client focussed databases that can gather
data on all services provided, rather than service focussed databases.
However services would typically see it an invasion of client privacy if
they asked their client for permission to contact all the other service providers
for relevant service provision data, especially if all services asked every
client. However to paint a picture of services work with clients would require
all this data.
17. Human
services work with clients in many
languages. Measurement
tools are often only produced
in one or two languages.
This means that the tools may
not be available in the language
needed. Tools are also often
culturally biased. Tools and
documentation are often only
available
in English because of the costs associated with doing translations and
assessing cultural bias. 18.
Human services work with clients with low literacy levels, physical
and intellectual disabilities and mental health issues. Many measurement
tools are often not suited for use with these people
This means that the client may not be able to complete a questionnaire at all
or without support. Providing support may be a conflict of interest if the
support is provided by a staff member. For example the tool may be asking the
client to give views on the staff member’s work. Providing independent
support may cost
too much. For example,
employing an independent
person to work with
the client to complete
the tool or survey.
The nature of being human
19. There are characteristics of being human that
mean that we don't always know that we think we know.
For example:
- We interpret ambiguous information in ways that fit our preconceptions.
- We are more critical of information that contradicts what we already
believe than we are of information that supports our
existing beliefs
- We don't always tell the truth
- We tend to see what we do in a positive light
- We are social beings and can create groups or sub-cultures such that
everyone in the group reinforces each others
views
- We
can create self-fulfilling prophesies
How do we respond?
Our attitudes
These paradoxes and dilemmas create enormous difficulties
in evaluating human services and community development.
We must
chose between two
responses:
- The difficulties are insurmountable. There is no point in evaluating
human services. We would be wasting
our time - lets
keep our
energies for direct
service.
- The difficulties are many and the results will be imperfect but we
do need to do something
to deal with the potential
self-delusion -
thinking
we are
doing a good job when we are not. The same
reasons that make evaluating human services so difficult
also create
room for
self-delusion. We
want to minimize
the room for self-delusion and so we take
what steps we can. We are more rigorous than we would
otherwise
be.
Our practice
If our attitude is one of: there are difficulties
but we need to do something to minimise
the potential self-delusion
there
is a role for
each of:
- Clients and their families
- Human services staff and volunteers
- Human services and agencies
- Peak organisations
- Government
- Other organisations and agencies.
It is only when all parts of the human
service system
are working together that we will be able
to make a reasonable
attempt
at evaluating human
services and community
development. It is not just an issue
for individual
workers or services.
It requires resources.
It will require
we understand
the nature
of the human
service and
community development processes
and
the inherent
paradoxes
and
dilemmas.
It will have an impact
on how each
of us works.
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