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Principles
for Outcome Accountability
Stroul and Friedman (1986) recognized that although the actual components and organizational structure of a child-serving system might vary from state to state or community to community, the development and implementation of a system of care should be guided by a set of values and principles. Similarly, there are principles central to the successful development and integration of outcome information into the planning and delivery of services that transcend the variability and unique characteristics of any child-serving system's components and organizational structure. Ten guiding principles have been identified for the development and utilization of outcome information in systems of care (Hernandez and Hodges, 1996). These principles are central to the design and operation of an outcome accountability approach because they specify what drives and shapes the approach's development and implementation. These principles are summarized on Table 1.
The first principle for building a system of outcome accountability, that outcomes cannot be measured and used in isolation of other relevant data collection activities, is key to the Ecology framework. Standard evaluation practice requires that information about who is served by a particular service approach and what services were offered is critical to making interpretations of outcome data. Without information in addition to outcome data, the results are impossible to interpret.
The second principle, that outcome information should be used to improve service planning and delivery, defines the central purpose of an outcome accountability service system. The goal of outcome accountability within the Ecology framework is to focus attention on what is being accomplished through the services delivered and how improvements can be made in service planning and delivery.
The third principle, that outcome information will be both relevant and accessible to significant stakeholders, recognizes that there is a broad range of stakeholders in a system of care which includes children and families, direct service providers, managers and administrators within mental health, and agencies and organizations outside of mental health. This principle recognizes that it is impossible to identify or understand the indicators of successful outcomes at the program or the system level without the active involvement of significant stakeholders.
The fourth principle, that the application and use of outcome information should be informed by the best and most timely research available, speaks to the importance of maintaining links to advances in knowledge which might influence decision making (Burns, in press). Maintaining these links helps ensure that learning and self-correction are linked to the experience and learning of others, both within and outside the field of children's mental health.
The fifth principle, that outcome information should support culturally competent decision making in service planning and delivery, recognizes that service planning and decision making must be responsive to the cultural diversity of the children, families, and communities that are served by the system of care.
The sixth principle, involving stakeholders in identifying and selecting outcomes, is important if the accountability system hopes to track data that is relevant to the concerns of constituents. The seventh principle, that data elements for outcome measurements be clearly defined, is relevant to communicating what has been accomplished by a service system. If outcomes are not clearly defined, it will be difficult to utilize the results that emerge. The eighth principle, that the outcome information will be useful to managers, administrators and service providers, underscores the need for outcomes to be relevant to the issues that drive a service system rather than information that is relevant only for purposes of an external evaluation or audit.
The process of collecting, analyzing and communicating outcomes must be timely and predictable so that the information is useful. This ninth principle is important since the tenth principle, i.e., the outcome information should provide the opportunity for corrective action, cannot occur if decisions regarding service delivery or policy need to be made before the outcome information is available.
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