Date published: Friday 31 August 2018
How client outcome measures are helping to build better services
John* came into a Mission Australia homelessness service looking for emergency support. After answering a few simple questions about his personal wellbeing, staff noticed that John’s rating of his physical health was much lower than they expected.
John didn’t come to the shelter seeking help for his health problems. But a few more questions later he’d let staff know that he was diabetic and his condition wasn’t well managed. This was an opportunity for staff to arrange a referral to a doctor to support John’s health as well as providing for his emergency shelter needs.
Meg* had extreme anxiety and had not left her house for three years when referred to MIcare, Baptcare ’s intensive support service for people with mental illness. Her outreach worker was able to help Meg set a series of goals, support her and demonstrate Meg’s achievements. In two months, Meg could walk to her letterbox, and when she left the program was walking on her own to the local shop and library, and now walks her small dog along the beach. Regular goal setting and measuring of Meg’s progress helped set her on a path to greater independence and a better quality of life.
These are just two examples of how sophisticated client outcome measures are helping organisations improve the care they provide to clients, and demonstrate their value to government agencies.
The systems used by both Baptcare and Mission Australia are based on clients rating aspects of their wellbeing at the beginning and end of their journeys with an organisation or program – and sometimes periodically or at a mid-point as well.
Simple statements or questions are designed to suit the purpose of the program or service, as well as reflecting the client’s own goals in using a service. Clients then rate their current status on that issue and revisit their status after a period of time. They are then asked to attribute a proportion of any change (regardless of whether the change is an improvement or not) to the service or program as opposed to external circumstances.
Responses are categorised within an overarching framework that allows analysis across multiple programs in relation to a specific domain – for example such as independence, social participation, and wellbeing.
“A lot of thinking and development went into our decision on the framework for our client outcome measurement system that we could apply across all Baptcare’s programs and services,” says Rachel Breman, Head of Research and Policy.
“In 2014, after a significant piece of development work, we decided that Schalock’s Quality of Life Framework had a strong evidence base, and would be applicable to the diverse range of services we provide.
“Since then, we have trialled and embedded outcomes measurement to all of our programs and services, including our asylum seeker accommodation, family and community services, aged care and affordable housing programs,” says Ms Breman.
“During that process, we built on the learnings in each phase of the implementation, and the data adds significant value to our research, evaluation, advocacy, and continuous improvement activities.
“Every two months we report data to program teams, and they use these insights to understand where they’re doing well and what might need some further thought and attention.
“Our outcomes framework also supports the tenders we apply for in Family and Community Services and is well regarded by governments.”
Baptcare’s Service Manager for Mental Health, Deb Fast, sees great value in the outcomes framework for staff as well as clients.
“For people accessing our programs, an advantage of asking regularly about all the aspects of their quality of life is that they can see how their progress in one area positively affects other parts of their life.
“For example, Julie* was on the verge of losing her public housing due to hoarding, and the extreme behaviour of her young children at home was causing concern for their safety. By starting to address her hoarding behaviour, her housing security improved, her children’s welfare increased, and relationships with the school and others were also strengthened.
“Regularly reflecting on all these aspects through the outcomes framework helped Julie appreciate the additional benefits of improvements in her mental health,” Ms Fast says.
“Staff also really appreciate being able to regularly see data on the progress clients make– it’s been a great boost to morale. We’ve also been able to better identify staff training needs through the data.”
The Baptcare Quality of Life Framework is returning some interesting data from aged care services, and these measures feed into Quality Agency audits and accreditation visits.
“For aged care facility residents, we’re seeing the biggest improvements over time in the domains relating to emotional wellbeing, rights, and spiritual wellbeing,” Rachel Breman says.
“This is very encouraging because this is exactly what we’re hoping to achieve – residents feeling safer, more secure and respected as they settle into their new home.”
“We started our journey in 2015 with a pilot trial of a system based on the Personal Wellbeing Index, which measures wellbeing on 8 questions where clients rate their standard of living, health, achievements, relationships, safety, community, future security and life as a whole,” says Rachel Christie, Mission Australia’s Impact Measurement Specialist.
“It worked well, and we have now rolled out the system to over 150 of our 427 services around Australia. We have focused very strongly on learning and culture during the implementation, and the way the data can be used in all aspects of our work. We’re finding the data useful for case planners, program managers, for area managers and state leaders, for advocacy and risk management.
“One of the great things our staff have noticed is how well the system supports their focus on their clients.
"Near real-time data visualisations are available for individual practitioners as well as managers to help them understand where things are going well, where things aren’t quite working out as planned, and also notice trends they might not have otherwise picked up.
“One of our youth services focused on supporting young people who had dropped out of high school or were at risk of dropping out. When looking at the data in regular case reviews, staff noticed that boys were entering the service more optimistic, felt they had more skills, and a better future, than the girls. So the program manager led the team to come up with new approaches to meet the needs of young women entering the service,” Ms Christie says.
“In a more intensive program, the team noticed that outcomes for clients were improving in most areas over time, but community connectedness was going down as they spent time in the program.
“This was quite confusing, so staff went to the clients to explore why that might be happening. They discovered that clients were increasingly leaning on their case managers for support rather than having to deal with potentially problematic relationships with families or friends. This was addressed by running family barbeques and other activities to engage clients’ support networks in a positive way with the program.”
The journey to increasing client-centredness is very well supported by the organisation’s client outcome measurement system. In particular, the team at Mission Australia is very conscious of their obligation to be accountable for the information clients provide to them in the course of their journey.
“When we gather data, we tell the clients it will be used to improve service to them and people like them, so we must do that!” Ms Christie said.
“We are honouring our commitment to our clients by making sure the information is in the right format and able to be used by the whole organisation to increase our impact.”
* Not their real names