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Evaluation of Outcomes

Evaluation of Outcomes. In the HCN Context. Olive J Webb PO Box 69, Hororata 7544 Landline 03 3180880 Cell 021 225 6633 owebb@iahs.com Website: iahs.com. Aims:. Challenge you about data gathering Talk about the need for an operational and intervention framework

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Evaluation of Outcomes

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  1. Evaluation of Outcomes In the HCN Context Olive J Webb PO Box 69, Hororata 7544 Landline 03 3180880 Cell 021 225 6633 owebb@iahs.com Website: iahs.com

  2. Aims: • Challenge you about data gathering • Talk about the need for an operational and intervention framework • Borrow a framework from medical anthropology • Talk about a common evaluation framework • Talk about some outcome measures • Challenge you to know what, why and the effect of what you are doing

  3. A person with an opinion and no data........ .........is just a person with an opinion...

  4. RB

  5. What data should be collected? • What is happening • When • How often • How intense • ABC charts • Context data – what else is happenning

  6. How should data be presented • Lots of options • Logs • ABC charts • Graphs • etc

  7. High and Complex Needs • Outstanding model because it: • Merges resources – so greater sums available • Person-centred – so solutions are individually different • Needs focussed – so can change over time • Flexible • Transparent • Stringently monitored and managed expenditure of taxpayer’s money

  8. Different solutions mean that • For those with whom I am involved, focus of support is varyingly on: • Residential respite • Additional schooling • Family support • Home-based education • Community activity

  9. Evaluation Requires: • Return on Investment? • Time • Effort • $ • Effects of interventions? • Environmental • Skills development • Clinical

  10. Both Complex • Involves planning for long, medium and short term goals • Multiple management pathways • Multiple funding pathways – per HCN • Validation in terms of: • Relevant science • Model of intervention • Collected data • Independence from reputations, gossip and politics

  11. Options for Evaluating Investment: • Auditing the application of the intervention model, eg: • Total or incomplete ? • Thorough or approximate ? • Achievement of specified goals ?

  12. Evaluation must consider: Donabedian • Structures: what is put in place • Processes: what happens to the client • Outcomes: how the client has benefited (or not)

  13. Structures: School / work Home / family Friends / community

  14. Structure: Children need three legs for stability and growth • Home and family: • Personal support • Home support • Respite • Financial support • Emergency help • Home curriculum • School / Work: • Teacher aides • Specialist training • Customised curriculum • Trained staff • Friends / community • Support for community • Finding natural supports • Community timetable • Community curriculum

  15. Process: what happens to the child: • Home and Family • Unconditional love • Predictability • Affirmation • Whakapapa / identity • School / work • Being taught the right way (ABA) • Achieving learning goals • Being part of the class • Being valued • Friends / community • Succeeding • Being one of the kids • Being valued

  16. Outcomes: • Home/ family • Belongs • Wanted • Happy and complementary relationships • School / work • Achieving learning goals • Losing old behaviours • Accepted in classroom • Accepted in playground • Actively participating • Friends / community • Has friends who initiate contact • Has a community peer-appropriate program • Is valued as a contributor

  17. Note Quality Literature • High positive correlation between Challenging Behaviour and: • Quality of life • Employment • Health • Financial resources • Achievement

  18. Other Outcome Measures • Typically behaviour measures • Often slanted towards pathology • Most common, HoNOS (Health of Nation Outcome Scales) • Suite of scales, including HoNOSCA, HoNOS-LD

  19. HoNOS • Developed by Royal College of Psychiatrists • A bank of measures • MH (Mental Health) • CA (Child and Adolescents) • +65 (over 65 years) • Self Assessment • Acquired Brain Injury

  20. One of the Scales: HoNOS-LD • RFNZ introduced the use of HoNOS for its MH services in 2000 • HoNOS-CA is used in Youth Services • When RFNZ developed its regional intellectual disability supported accommodation services (RIDSAS), HoNOS-LD introduced. • Well researched and evidence based • Development continues • NZ MoH also intends that HoNOS measure will be introduced as a requirement to MH service provision.

  21. Behaviour Problems (at others) Behaviour Problems (self-injury) Other Mental and Behavioural Problems Attention and concentration Memory and Concentration Communication (understanding) Communication (expression) Problems with hallucinations, delusions Problems with mood changes Problems with sleeping Problems with eating and drinking Physical problems Seizures Activities of daily living (home) Activities of daily living (outside home) Level of self-care Problems with relationships Occupation and activities Made up of 18 Measures

  22. MONITORING EFFECTS OF ENVIRONMENTAL CHANGES WITH HoNOS-LD Shift of Home New Flatmate Staff Changes Increased Demands Consistent Staff Consistent strategies

  23. Strengths Easily administered Results appear to represent observable outcomes Challenges Impairment rather than strengths focused Language (reflects medical models)

  24. Critical Feature of Outcome Measures • Objective measurement • Valid and Reliable – ie: repeatable • Different strategies • Likert scales • Scaled scores • Objective achievement scores, eg % learning goals • Need to be consistent throuhout evaluation • Set evaluation tool at outset.

  25. Goal Attainment Scales • Need to see these for what they are: • Subjective • Looks equal interval but isn’t • Face validity per group consensus • What it achieves: • Discipline of evaluation • Realistic goal-setting • Accountability/ rationale for expenditure • identifies plateaux / barriers in achievement • A starting point in applied evaluation

  26. Conclusions • Need to do the Right thing at the Right time and for the Right reason • Need to be able to evaluate interventions in terms of Model of Intervention • Intervention is likely to be multi-pronged • There are also behavioural outcome measures • Organisational decision whether to use them • Can be very helpful – especially justifying expensive packages • It is reasonable to have to justify expensive packages. • It is really important to know if we are making a difference to these kids’ lives

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