Since the birth of America’s settlement house movement, human services organizations have played a critical role in partnering with those with lived experiences to build assets in neighborhoods that strengthen communities. Since those early years, the measurement of success for settlement houses was often how many beds were filled and how many families were served. Increasingly, however, we are coming to understand that a truer measurement of success is not to be found solely in the quantity of services provided, but rather in the quality of outcomes achieved.
Given this awareness, human services ecosystem stakeholders, including community-based organizations (CBOs), public agencies and philanthropy, must go beyond measuring program outputs and commit themselves to measuring and achieving outcomes that align directly to the social determinants of health, which are the conditions in which people live, play and work.
Committing to outcomes is essential for both demonstrating the value of the human services sector – impacting future revenue models and the sustainability of the human services ecosystem – and overcoming the unacceptable health inequities that have been highlighted and exacerbated by the current COVID-19 pandemic.
Currently, our healthcare system focuses more on disease management instead of disease prevention. This is because of how healthcare is incentivized for payment in the United States. But according to a report from the Annals of the NY Academy of Sciences, the emphasis and resources we put into clinical care or “disease management” only makes up 10% of the whole of what contributes to health. Behavioral factors (30%), social and economic factors (40%), physical environment (10%) combined play a greater role. The impact human services can have on these factors is significant, as over 70% of the factors that influence health are outside of the clinical context.
The long-standing systemic inequities illuminated by COVID-19, along with the growing evidence and understanding that health extends beyond clinical care to include the social determinants, underscores the urgency for healthcare and human services to partner more deeply with one another to move to a preventative system that focuses on upstream solutions. Equal investment in both healthcare and human services must be made to strengthen their capacity to innovate and truly measure outcomes.
For human services CBOs to be best positioned to achieve breakthrough results, the public sector and philanthropy must recognize and invest in CBO capacity to measure and collectively advance toward outcomes. The National Imperative: Joining Forces to Strengthen Human Services report highlights specific ways the ecosystem can move to becoming more outcome-oriented, which requires a fundamental shift in the way we quantify the value of our work and measure our impact.
The evidence and insight gained from this shift in measurement is not only crucial to demonstrating the value of human services on the local level, but can be instrumental in spreading and scaling breakthrough results through the influence of public policy at the local, state and federal levels.
To understand our progress in impacting outcomes, we must examine the strengths and gaps that exist in communities, defining the indicators that help quantify our “where we are” and “where we want to go” along a theory of impact. The priority and impact of each factor must also be assessed and consistently monitored for impact to determine where to emphasize focus. The Well Being in the Nation Measurement Framework offers a set of common measures to assess and improve population and community health and well-being across sectors.
To meet community needs, organizations need to understand the underlying issues affecting their communities. Not doing so will result in solutions that address symptoms but not root causes. Tools such as a Community Health Needs Assessment can provide data for CBOs to use in co-creating comprehensive solutions to community challenges.
Organizations also need to understand how social determinants of health directly affect community members at the individual level. Tools such as the CMS Accountable Health Communities Health-Related Social Needs Screening Tool can help with this. For example, the Community Health Needs Assessment can show which zip codes experience higher rates of child abuse, and also show other health issues in those zip codes that may be associated with child abuse, such as teen pregnancy, lower high school graduations, lack of employment due to no/low job skills, etc. This in turn can point the way toward programs that offer family strengthening assets in those specific areas.
Funders must also realign funding from a services-delivered mode to one that values and rewards outcomes achieved. Population-level health and well-being will only improve when systems leaders understand the critical role human services plays in population health and well-being, and invest in the capacity of organizations and their partners to appropriately measure and collectively advance toward shared outcomes.