Issues in the Measurement of Integrated Service Delivery in Human Services

This article discusses measurement issues that arise when evaluators attempt to assess the meaning and extent of integrated service delivery in human services programs. Service integration is a concept that is currently enjoying a major revival. Current social policy directions (especially on the part of the Ontario government) reflect a renewed will to implement integrated service delivery models in human service programs and organizations. Earlier work, from the mid 1970s through the early 1980s, on measuring this slippery aspect of organizational and program functioning is now being reexamined, revised, and updated. Lessons learned from evaluating an inter-ministerially sponsored children's' services program in Ontario are presented here. Evaluation issues explored in this article include recommended procedures for measuring program stakeholders' visions of "ideal" integration as well as their views of the extent of "real" service integration in functioning programs and on how and why to compare "ideal" to "real" human service integration.

Évaluer au milieu des divergences de points de vue : la méthode "diacritique

The "diacritical" method is a multidimensional method of evaluating public projects characterized by its focus on differences in point of view. In this article the method is updated, its operational framework is reviewed and corrected, its mathematical formulation is redefined, and an example of its functioning is proposed.

valuation de l'implantation d'un système régional d'admission en hébergement et en soins de longue durée pour personnes âgées au Québec

Between 1975 and 1984, the Quebec public healthcare network adopted a new admission process for residential and chronic care homes for elderly people no longer able to function independently. This was known as the CTMSP (type classification for long-term care and services) system. Preparation and distribution of this management tool met with some resistance because of the large number of people involved and the very specific Quebec and North American context. This article reconstructs the events leading to the adoption of the CTMSP system by the Quebec minister of health and social services and the regional health and social service councils from the archives of these organizations as well as interviews with ten key people who provided information. Commissioned by those responsible for the network from university researchers, the system was tested in a community health department before being adopted by regional councils looking for an integrated admissions system, and was then officially adopted by the health department in 1984 and put into general use throughout the province. Diachronic analysis of the CTMSP distribution process reviews the linear phase-oriented model of the preparation-adoption-implementation type. The decision-making process resembles a long and laborious succession of highly repetitive positions in which the power games of managers, designers, and professionals are decisive factors. Early participation of pressure groups interested in the preparation of the system, and feedback information followed by action, are the main forces of the CTMSP implementation strategy. The North American context of ecc rationalization and the Quebec administrative decentralization crisis of the late 1970s can be seen as opportunities or constraints that also helped to shape implementation.

The Impact of Radar Cameras on Traffic Speed: A Quasi-Experimental Evaluation

This article summarizes the findings from a summative quasi-experiment that examined the impacts of radar cameras on traffic speed in Vancouver. Two arterial streets were included in the evaluation. Knight Street was subjected to a two-month intervention wherein a radar camera was set up periodically and police officers recorded both the speed and licence numbers of vehicles photographed by the camera. Traffic tickets were then mailed to the registered owners of speeding vehicles. Granville Street served as the comparison street for the quasi-experiment. Traffic speeds were measured electronically before, during, and after the intervention using an induction loop buried in the pavement on each street. ARIMA analysis of average daily speeds and percentage of vehicles exceeding the posted speed limit indicated there were significant reductions in both variables on Knight Street, whereas speeds on Granville tended to remain constant. Although these findings offer support for policies that would promote the use of radar cameras, the summative thrust of this evaluation does not allow us to clearly distinguish radar camera impacts from those attributable to the officers who actually implemented this technology.

valuation des limites du contrôle par les règles comme instrument de gestion : comparaison des centres publics et privés daccueil d'hébergement pour personnes âgées

Ecc models of institutional analysis demonstrate that structural reforms exert very limited impacts on services and that margins for maneuver of policy instruments concerning financial and regulatory interventions are very narrow. The study of a concrete setting, that of nursing homes for the elderly, indicates that rules regulating the allocation of staff and budgetary resources concern relations between producers and not the production of services. In addition, a study of 72 nursing homes indicates that manipulation of the rules regulating the allocation of resources has almost no impact on provision of services to the elderly. The data indicate that manipulation of these rules has significant impacts on the production of services only when they affect the organizational climate. This observation led the authors to suggest that improvements in the production of services require an investment in social capital, that is, an investment in the creation of values and attitudes positively affecting the behaviors of the producers of public services.

Program Evaluation in the Absence of Goals: A Comprehensive Approach to the Evaluation of a Population-Based Breast Cancer Screening Program

The aim of the province-wide Ontario Breast Screening Program (OBSP) is to reduce breast cancer mortality through providing screening for breast cancer to all Ontario women 50 and over. The authors identify the components of the OBSP and the organizational, political, and financial challenges and biases affecting its evaluation. They then argue that because key players have not yet established program goals from which process and outcome indicators can be identified, a goal-directed evaluation is not currently possible. They therefore develop a framework to permit the identification, categorization, and prioritization of all factors that need to be addressed in a comprehensive evaluation of the OBSP. This evaluation approach may be of assistance to evaluators of other complex programs about which consensus on program goals has not yet been attained.