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The fundamental reason for tracking outcomes in applied service settings is to determine whether the person receiving services benefits in an observable manner as a result of the services provided. For the purposes of this paper, outcomes are the results or the impact of services provided on children and their families. Outcome accountability can be defined as the responsibility on the part of systems of care for accomplishing publicly articulated and accurately tracked goals regarding the services they provide.
The Ecology of Outcomes framework provides a foundation for the utilization of information so that outcome information can provide opportunities for learning and self-correction. In this manner, what would traditionally be structured as an external evaluation becomes integrated into the internal system of service planning and delivery. The components of the Ecology framework include the Principles for Outcome Accountability, Prerequisites and Building Blocks for building outcome accountability, guidelines for Implementing an Outcome Information System, and an approach for Utilizing the Results.
The Ecology of Outcomes framework maintains that information about clinical and functional outcomes cannot be used to improve service planning and delivery unless the outcomes are understood in the context within which they occur, hence the term Ecology. Simply having outcome information does little to improve services if agencies and providers have no way of understanding outcomes in the context of who the system is serving or what services are being provided.
In order to include information about who is being served and what services are being provided, the accountability system needs to be developed in relation to the service delivery system. Child-serving systems that are currently moving toward the use of outcome information in decisions affecting service planning and delivery vary considerably in the degree to which their outcome accountability and service systems are developed (Hodges and Hernandez, 1996). The Ecology framework suggests that it is not simply the degree to which a child-serving organization's service system and outcome accountability system are developed, but the degree of overlap between the service system and outcome accountability system that may have an impact on how outcome information is used to inform service planning and delivery. Figure 1 (Hodges and Hernandez, 1996) illustrates that the development of a service system and an outcome accountability system can be characterized in two ways: 1) developing in parallel and existing independently of one another at a given point in time; and 2) existing in concert with and overlapping one another. For outcomes to have a maximum positive impact on service planning and delivery, it is necessary for there to be a high degree of overlap between the service system and the outcome accountability system. In this way, service system outcomes are understood in the context of who is being served and what services are delivered. Understanding outcome information contextually is a prerequisite for the informed use of outcomes in decisions regarding service planning and delivery.
The Ecology framework's emphasis on outcome information as a resource for use in decision making is evident in the Principles for Outcome Accountability.
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