9.6 The Effectiveness Of Services And Other Actions

(The Concepts Of Relevance, Potency And Model Coherency Of Measures And Services)

ESSENTIAL SRV: The Effectiveness Of Services And Other Interventions

Service response to devaluation or to primary affliction is often flawed.

A measure of the effectiveness of service response may be made by measuring whether it:

Is relevant to the needs of the service users (RELEVANT)

Is as intense as possible (POTENT)

Uses a model which coherently addresses the problem

(MODEL COHERENT)

REWRITE USING RACE AND WOLF

9.6.1 Introduction To The Theme The Effectiveness Of Services And Other Actions

Previous Coverage

The basics of this has been covered in the earlier text.

9.6.2 The Psychology And Sociology Of The Effectiveness Of Services And Other Actions

write

9.6.3 The Effectiveness Of Services And Other Actions And SRV

ADD ALSO MODEL COHERENCY IMPACT RATING

Relevance, A Definition

Relevance means matching the type of assistance offered to people-at-risk to that person’s major problems or needs. It also means that if more than one person is to be assisted, clear focus is kept on each individual person’s problems or needs.

Potency, A Definition

Potency means that the type of assistance offered to people-at-risk makes use of the means most likely to meet that person’s needs. It must ensure that a person’s time is used with intensity and efficiency.

Model Coherency, A Definition

Coherency means how well pieces fit and interact together, how easy it is to understand. Model coherency is a measure of how well the component parts of a service fit and interact together and how easy it is to understand.

What Does Model Coherency Require

1/ Identifying central needs (the service purpose),

2/ Separation of service function (home, school, education, leisure etc.), and

3/ Identification of how this would be provided for valued people..

An Example of Relevance, Potency and Model Coherency

In services for valued people, there is usually a high degree of relevance, potency and model coherency. For instance, if you go to a solicitor or Citizen’s Advice Bureau, it is likely to be in an office setting in an office area, staffed by skilled people with appropriate qualifications. The people will treat you as a client worthy of respect and will not necessarily know of your illnesses or personal history. They will make every effort to find out what your real problem is and try to apply the best means to address it. They will owe a duty of care to the client.

Advice to people with mental health problems is often given in leisure centres for people with mental health problems. Advice is often given by nurses. The surrounding are often scruffy and only marginally like a modern office. The advice giver will normally know the full personal and medical history of the client. Furthermore, the advice giver will often have a duty to share information discussed with a clinical team. The model is incoherent. Additionally, only lip-service may be given to trying to find out what the real problem is, and only partial efforts may be made to overcome the problem. They will owe a duty of care to the service.

If the majority of services offered to people-at-risk lack relevance and potency and are model incoherent, this will do further damage to those people in terms of image and competence.

Similar examples will be discussed later for relevance, potency and model coherency of Home, Work, Leisure and Education.

Unfortunately most services offered to people-at-risk are not relevant, potent or model coherent.

Why Service Models Are Rarely Coherent?

Services for people-at-risk in the area are not comprehensive, they lack a range of options which leads to pressure to provide more than one function within a single service. This leads to reduction in pressures to design new and valued options.

Also, we have inherited past services which have: models from past types of services; locations, buildings, internal fittings from past services; staff identities, expectations, hierarchies from past services; schedules and routines from past services; methods and processes from past services; service user groupings from past services.

all this made worse by LACK OF AWARENESS OF PLANNERS

Why is Model Coherency Important?

It encourages competence and experience enhancement

It encourages image enhancement

It focuses attention on real needs and purposes

It promotes the most effective use of resources

It ensures that purpose is not diluted by multi-function efforts

It encourages greater choice for working together

It encourages greater choice for collective responsibility

It promotes development of generic resources

Criteria For Coherency

1/ Based on what people served actually need in ways that are familiar and valued according to local standards

(THEORETICAL CONSISTENCY)

2/ Do all the component parts of the response fit together with each other?

(INTERNAL CONSISTENCY)

3/ Around one single service purpose

(FUNCTION CONSISTENCY)

4/ In accordance with stated intention

(MANIFEST FUNCTION CONSISTENCY)

Model Coherency - The Key Principle

Key Principle:

The primary (central) function of a service should

Meet the primary/main/most important/fundamental) needs of the people who use the service.

According to Social Role Valorisation , The service should do this in a way that other (valued) citizens (us!!)

Would: Understand, expect to see, recognise

(CULTURALLY NORMATIVE)

Would: Want, demand, desire/aspire to

(CULTURALLY VALUED)

This should: Be the same as, equivalent to, correspond to, be an

(ANALOGUE OF THE SERVICE)

Therefore we need to establish and describe the

CULTURALLY VALUED ANALOGUE

The Culturally Valued Analogue

What Is An Analogue

An analogue is something that is like or similar to something else. It may have a similar function. For instance one could say that gills in fish are an analogue of lungs in mammals- they do the same job. An analogue can be like a model or pattern.

How A Culturally Valued Analogue Can Help With Determining Model Coherency

Culturally Valued Analogue can apply to major life functions (home, work, education, leisure) and also to smaller life functions (sub-components of the above like cooking, job-training, relationships, etc.)

A Culturally Valued Analogue (CVA) is a representation of something that MOST ordinary valued citizens would VALUE.

For instance, we could describe the component elements that make up what we think as a valued FUNCTION/ACTIVITY/FACILITY

An analogue of this FUNCTION/ACTIVITY/FACILITY would be a representation of it through our description of its component elements.

A useful way to analyses a service and compare its stated purpose with a CVA is by examining the components under the separate headings and analysing what makes up the FUNCTION/ACTIVITY/FACILITY.

CVA Components

What, How, With Whom, By Whom, When, Where, Language Used, Image Projected

So if we were analysing a FUNCTION/ACTIVITY/FACILITY we would look at:

What- happens

How- do we know how to

With whom- do we share this

By Whom- are decisions made

When- are do we do it

Where- is it located

Language Used- what is appropriate

Image Projected- what image does this project

All considered for a highly valued FUNCTION/ACTIVITY/FACILITY for valued people

Using the CVA to Determine Model Coherency

To do this we use a Spider-graph:

Language Used: Words, Labels, Descriptions

What: Content, Activity

How: Style, Ambience, Methods, Processes

With Whom: Groupings, Characteristics, Size, Roles

By Whom: Staff: Identity, Competence, Background, Roles

When: Timings, Rhythms, Durations, Routines

Where: Location, Internal and External Design Features, Use of Space

Image Projected: Interior and Exterior

Determining Model Coherency

After visiting a service for people-at-risk, it is useful to determine how model coherent the service is. This is often called the Conciliation Exercise. It is described fully in the appendix.

It is useful to note that this is best done as a brainstorm exercise of all experiences of the group on the visit. This is followed by an analysis of the brainstorm outcome into categories (from the Ratings described in a separate section). Then the group determines who the service are (and what their wounds are), what the people really need, what is a valued way of meeting that need. Then they look at what is really happening, what this means for the service user, and what the likely outcome is for the them. Finally they decide how things could change.

There is now a deeper analysis of this subject; this is called Model Coherency Impact.

Model Coherency Impact

This procedure determines the impact that particular items of a program have on the recipients. It considers WHO receives the service, WHAT is the intended outcome of the service, and HOW it is provided. It is then compared with valued methods of providing this service item in the real world and then considers the effect this has on the service recipient.

Who Are The People Being Served

Factually- Ages and age range -

All of the ‘factual’ contributions which contribute

to assumptions made about people

Sexes

Factual devalued conditions

Status impairments

Conditions should be factual, e.g. speech impediment/difficulty articulating/cerebral palsy/unable to walk or hold things. ‘Learning disability’ is difficult to define as it may be the consequence of another life defining impairment

Shared Histories

Physical histories that lead to shared experiences, e.g. impoverished experiences, hostel living, discontinuity, no control, strangers who have control, no close relationships, low expectations, virtually no valued roles, open lives

Images from appearance

e.g. broken, sick, vegetable (less than human), economic and emotional burden, stupid, eternal child

Ethnic/Cultural Factors

Asian, Moslem, Somali, Afro-Caribbean, Welsh as first language, Jehovah’s Witness, Buddhist

Existentially Life Experiences

Wounds

Identities

e.g. rejected by families and community; taken over by the system; abandoned to the system; aware of, and made aware of being a burden; unimportant; powerless; insecurity; views not important, therefore not consulted; limited life experiences and relationships.

Impact Of experiences on these people

People are made compliant and fearful, overwhelmed, limited/crushed spirit, physical deterioration, great vulnerability.

Needs Analysis Of The People Served

1/ Identify Needs Should be more than shelter/food etc. because of human existential/spiritual need; e.g. to have influence and control over life, to belong an accepting, loving community, to have talents acknowledged and develop competencies, to develop valued social roles.

2/ Rank the Needs Identify their urgency for the people served.

Develop and Rank Culturally Valued Analogues

NEED Þ CVA Þ PROCESSES

Each need may need a different CVA

Central to the CVA is the WHAT and the HOW

‘WHAT’ is the CONTENT of the program

‘HOW’ is the PROCESSES of the program

PROCESSES are considered under a number of headings:

Settings- in which the content is rendered

Groupings- of people for the CVA- as a whole, as sub-groups, informal groups

Techniques and Methods- by which content is rendered, including combination or separation of program/life functions

Identities of the Servers-

Description and factual: i.e. ages, competencies, status, training, gender, certification/qualification

Image Identity i.e. projected by appearance, status, language about- recipients, content, processes (including servers).

Identify What The Service Provides In Each Of Its Contents

That is to say, determine which needs are said to be being met by the program.

For Each Content, Identify The Processes

That is to say, determine the processes that are used in the program.

Internal (Content-Process) Model Coherency Issues

Considering steps 3 and 4 only, is there a theoretical class of people that is traditionally shared in this way? For instance, homeless people, people with severe and persistent mental health problems, refugees, prisoners.

Name the models used to serve them, e.g. menace/defective, pity/charity, childminding, medical, social casework.

Purview

Determine Nature(s) and Types

Rank if more than one

Identify primary Purview

This is the scope or limit of influence, authority, competence, responsibility or concern in people’s lives that would generally be perceived as the appropriate and/or properly delegated one for the service. Consider breadth, arranging versus providing, exceeding purview, failing to utilise purview.

Identify Needs, Contents And Processes That Should Be Met Within The Purview Of This Service

What needs can and should be addressed by this type of service?

Mini CVA

CONTENT

ì ë

PURVIEW

í î

PROCESS ç è NEEDS

Determine Congruencies

Consider how the Groupings, Methods, Settings, Servers and Language compare (whether they are congruent with) those used in valued settings for this content/process/purview- EXTERNAL MODEL COHERENCY

Identify Assumptions

Determine what assumptions are being made by the service providers if the model developed above is seen to embody their unconscious intentions.

Formulate The Impact On The Recipients

What is the IMPACT of the coherency/incoherency of the service model on the recipients?

Especially consider:

the bad things it rescues them from

what it does to them

what will happen if and when they leave.

Plus Add MCI Rating in full as per road map

Service response to devaluation or to primary affliction is often flawed.

A measure of the effectiveness of service response may be made by measuring whether it:

Is relevant to the needs of the service users (RELEVANT)

Is as intense as possible (POTENT)

Uses a model which coherently addresses the problem (MODEL COHERENT)

9.6.4 Summary Of The Theme The Effectiveness Of Services And Other Actions