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Toward Performance Based Services

In the traditional child protection paradigm, cost is the
central criterion for most program and service decisions. There is a fixed
funding level for each program. Within that allocation, a detailed budget
covers direct, indirect, and overhead costs for the personnel and resources available
to the program.

Within the budgeted limits, managers acquire goods and
services from various departments and external sources, with cost being the
primary selection factor. The result is an array of resources and personnel
that collectively represent the capacity of the program. The per-child
allocation for children assigned to the program then varies, depending on the
number of children in the program at any specific time.

Cost also is a primary evaluative criterion for programs,
services, and workers. Well-managed programs are those that stay within
allocations, operate within the line item appropriations, and are in compliance
with the rules.

The cost or resource requirement of a given program or
service is the primary determinate of whether the program or service is
available. Additionally, the choice of one service or another is largely based
on cost. For example, when deciding which placement resource to use for a
child, lowest cost is a major decision criterion.

As the paradigm transitions to the intermediate level,
process has a higher priority than cost. In order to get a specified outcome
for a child or group of children, a known services array needs to be present.
For example, placement resources are judged in terms of the services array
available for the children using the placement resource and how the services
are delivered to the children. The availability and delivery of services
represent the process aspect of the resource.

The process criteria need to be satisfied before cost becomes
an issue. At a very simple level, a group of children may need mental health
services to help with their behavior and emotional problems. Focusing only on
cost leads to developing or acquiring mental health services delivered for a
fixed per-child or per-hour cost. Focusing on process leads to identifying
mental health professionals with specific credentials and expertise to deliver
specified services to specific children to get pre-defined outcomes. Only when
these process criteria are met is cost a consideration.

As the paradigm transitions to a more integrated level,
the primary aspect of any program, service, or action is performance. Further,
all decisions and actions are driven primarily by performance considerations
before cost or process. Here, performance refers to whether services adhere to
the shared value propositions, incorporate best practice strategies and
protocols, and demonstratively assure safety, permanence, and ongoing success
for each child served.

When the paradigm has fully transitioned, performance
will be the primary consideration for all programs and services. Will the child
or family be appreciably better off after receiving the service or
participating in the program? Process consideration then asks, “Is the program
or service delivered by appropriately qualified practitioners, delivering the
right services to the right children and families?” Only then is “How much does
it cost?” asked.

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