Best practices in delivery of social services

What are some general guidelines that are common to most services that have been proven to be effective?

Sometimes conditions aren't right for adopting an evidence based practice.  Perhaps the practices available for the results you are seeking require more resources than you have available. Or perhaps there isn’t any good research available on the issue your program addresses, or the population you are serving. You can still do a lot to ensure your services are as effective as possible.

Accreditation

A number of organizations provide third party accreditation for specific types of services and programs. Accreditation is a quality assurance and accountability system used to assess and document that your program meets generally agreed-upon standards for high quality service provision.  Most accreditation organizations utilize all available research on effectiveness as well as service quality to develop and maintain up to date standards. Accreditation is an excellent way for you to ensure your programs are providing the highest quality services to participants and maintaining accountability to other stakeholders.  It can be a time consuming an expensive process, but the accrediting organization may have advice on how to find resources to cover the costs.

Common Quality Assurance Standards

If accreditation is not available for your type of program, or if you want a general idea of where to start in developing quality assurance, the following components adapted from King County's Elements of Successful Programs Guidebook^[1] are indicators of quality programming that are common to most evidence based practices.

1. Participant characteristics match the population your services are intended to serve.
   
   It doesn’t make sense to provide services that people don’t need or to serve people with a strategy that isn’t likely to be effective for them. However, if you employ a standard set of services or practices designed for a specific population or service need, yet serve almost anyone who shows up, you may be missing the mark.. Depending on the type of program you operate, you need to either select participants carefully to match the strategy you want or need to use, or select the strategy carefully to match the clients you want or need to serve.
   
   This can be achieved through quality assessment and screening, through individualized service plans, or through monitoring of the population and making periodic service adjustments matched to changing needs in the participant population. Many services can benefit anyone, but they often will have a greater impact on the community at large if the people most at risk or in need get them first. Figuring out who those people are can be challenging - especially in the case of prevention-oriented programming.  But when good tools for screening exist, the most effective programs will use them.  
    
2. Clear logic model and theory of change.
   
   The theory of change must be logical, goals must be consistent with the organization’s mission, and be focused and realistic. You should be able to clearly describe how the resources, activities, and outputs are designed to logically result in the outcomes you are trying to achieve.  Everyone involved in the program or service should have the same understanding of the theory. You can achieve this by involving all staff in regular reviews of the logic model and theory and by having it graphically represented and routinely referenced in meetings, publications and evaluation. Some resources for logic model development are listed below.  
    
3. The services must be delivered as planned to support the theory of change.
   
   A training and monitoring system should be put in place make sure that services are consistently delivered in the way they were designed to work.  Tools should be available for supervisors to use in reviewing the work of direct service workers on a regular schedule. Supervision and coaching should be frequent and focused on program theory and whatever quality standards are available or can be developed for the specific type of service. 
    
4. Adequate resources must be devoted to provide the level and intensity of service needed to have the intended effect. 
   
   Attention to caseload size, adequate staff coverage for hours convenient to clients, training and compensation adequate to attract and retain qualified staff, technology and administrative support to facilitate quality services, and strategies to reduce staff turnover are all important considerations. When entry level workers are employed in the program it is especially important to provide a good in service training program to ensure that staff have the competence and confidence to be successful. Balancing the levels of staff and program support resources with the number of people served is crucial to service effectiveness. 
   
   If resources prove inadequate to provide the level of service needed for success, the case can sometimes be made that reducing the total number served may increase the number who benefit through increased service effectiveness.  This can be especially powerful if combined with improved screening or triage to make sure services are provided to the population likely to benefit most from the service and/or to meet the long term or larger goals identified in the logic model. 
    
5. Agency leadership and administrative support must be adequate to manage, monitor, and sustain quality services. 
   
   The program must have leadership capable of promoting the program, securing resources, managing finances, personnel and technology needed to support quality services. A board of directors with the capacity for promotion of community support and oversight of the organization is crucial.  Adequate supervision resources are necessary to provide regular training, monitoring and coaching of staff who interact with clients.  If mental health services or counseling are provided, clinical consultation by a masters level or above therapist, psychologist or psychiatrist must be provided to staff on a regular basis.      
    
6. Connection and involvement of the broader community in supporting the goals of the program. 
   
   It is easy for busy staff to become isolated from external community supports and attempt to meet multiple client needs beyond their capacity. Agency leadership must actively seek out connection with other providers, influential members of the communities of their client population, faith communities, and the systems with which their clients must interact to make sure services make use of community resources and advocate for their clients. 
   
   Active involvement in community events and activities help to promote a healthy relationship between staff, board members, and community partners. Good personal relationships with stakeholders and partners facilitates effective direct services, outreach and fundraising and can support cultural competency within the organization.
    
7. Evaluation and monitoring is an essential component of all effective services.
   
   Development of an evaluation culture within the organization will create an environment in which everyone understands the goals, theory, and process of the program. Staff will become more aware of the value of what they are doing and be alerted when activities need adjustment. Evaluation helps the program continually improve and also provides a wealth of material for use in communications and fundraising. 

Resources

Footnotes

^[1]Ashley, N (2005) Guidebook to Elements of Successful Programs To Reduce Juvenile Justice Recidivism, Delinquency and Violence. King County community Services Division, Seattle, WA.