How to measure changes in clients' circumstances

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How to measure changes in clients' circumstances

The bottom line for measuring outcomes is establishing whether our work has helped clients improve or maintain improvements in their lives.1

If you operate in a service providing individualised support or case management services, DHHS has said that one of the key indicators is the proportion of clients you have assisted to establish improved life circumstances (or to maintain improved life circumstances) in relation to their support or care plan.

How do you measure these improvements when everyone is so different? To do this you need some way of recording information about how client’s lives have changed over the time they have been working with you.

This way of recording information needs to relate to the areas set out in clients’ individual support or care plans (for example, their housing circumstances, employment participation, staying as well as they can, etc.) but it also needs to be consistent and comparable.

Here’s a step by step guide on how to do it.

What do we measure?

First you need to decide what aspects of a client's circumstances you might look for change in. The research on how to measure outcomes talks about ‘domains’ (or areas) that you can measure.

If you have funding from the Australian Department of Social Services (DSS) you have already been given a set of ‘domains’ in which you could look for changes in clients' circumstances. These relate to DSS-funded programs but they can give you an idea of the kinds of areas you might want to do some measurement in. They are:

  • physical health
  • mental health, well-being and self-care
  • personal and family safety
  • age-appropriate development
  • community participation and networks
  • family functioning
  • money management
  • participation in education and training
  • material wellbeing
  • safe and affordable housing.

It could be relevant to look for changes in a client’s circumstances across three or four of these areas. Once you have decided which ones you think are relevant to the clients of your services you are ready to move to step two.

When do we measure?

You need to decide when you are going to gather information. Does your service provide one-off assistance, or time-limited assistance? If yes to either of these, it might be best to just record the clients' circumstances when they finish using your service.

If you work with clients for longer you may need to record their circumstances when you start work with them and then again when they stop using your service or program.

If your work is intensive, or ongoing, it would be useful to record clients’ circumstances at periodic case reviews.

How do we actually measure it?

There are four ways to go when deciding how to measure changes in a client’s circumstances.

  1. Use an existing tool, often called a 'scale' or 'instrument', which will measure your clients’ changes in numbers.
  2. Create your own tool to measure your clients’ changes in numbers.
  3. Use your service data.
  4. Don’t use numbers – use your clients’ story to create a case study.

Using an existing tool to measure change in numbers

There are lots of these tools already in existence that you could choose from. For example, in the mental health area there are a number of tools that have been developed to measure people’s recovery from mental illness. The Stages of Recovery Instrument (STORI) is designed to capture change across five stages of recovery from a consumer’s perspective (moratorium; awareness; preparation; rebuilding; and growth). The Outcomes Star (Recovery Star) also assesses consumers’ progress towards recovery from their own perspective. It does this across 10 areas (managing mental health; self-care; living skills; social networks; work; relationships; addictive behaviour; responsibilities; identity and self-esteem; and trust and hope.)

For a list of assessment tools in the various areas of community sector work see The TasCOSS Tool Box. It’s a library of off-the-shelf measurement tools.

Create your own tool to measure your clients’ changes in numbers

You might find the tool developed by DSS to measure client circumstances a useful place to start in developing your own. This is a ratings scale called 'the DSS Standard Client Outcomes Reporting (SCORE) for changes in client circumstances'.

It looks like this:

Rating = 1 Rating = 2 Rating = 3 Rating = 4 Rating = 5

Significant negative impacts on client’s circumstances

Moderate negative impacts on client’s circumstances

Progress towards improving impacts on client’s circumstances

Short-term positive impacts on client’s circumstances

Ongoing positive impacts on client’s circumstances

No progress in achieving this outcome

 

Outcome fully achieved

 

When this tool is used to measure outcomes in one of the DSS areas mentioned in Step 1, it starts to look like the table below. (We’re using the example of clients’ circumstances in the area of mental health, well-being and self-care.)

A tool to measure changes in clients’ circumstances in the area of mental health, well-being and self-care

Rating = 1 Rating = 2 Rating = 3 Rating = 4 Rating = 5

Significant negative impact of poor mental health, well-being and self-care on independence, participation and well-being

Moderate negative impact of poor mental health, well-being and self-care on independence, participation and well-being

Progress towards improving mental health, well-being and self-care to support independence, participation and well-being

Adequate short-term mental health, well-being and self-care to support independence, participation and well-being

Adequate ongoing mental health, well-being and self-care to support independence, participation and well-being

 

But if you think you need something purpose-built for your service or program you might need to create your own tool from scratch. If that’s the case, see How to create and use ratings scales.

Use service data

You can use your service data to report on changes in clients’ circumstances. For example, you could report on the number of clients accommodated, or the number still in housing after six months or the number maintaining self-care plans.

I want to use clients’ stories.

If that’s the case, see How to do a semi-structured interview or How to plan and run a focus group.

  • 1. Adapted from the DHHS Funded Community Sector Outcomes Purchasing Framework: Draft Practice Guidelines, developed by ARTD Consultants.