Development and description of two new instruments for measuring the impact of coordinated social services for children.

The Boston Family Reunification Network provides two innovative services designed to help children return to their families as soon as possible. A team developed two new instruments to measure process and clinical outcomes of the initiatives. This article describes the instruments, the two-year development process, and the points considered during the instruments' development. Suggestions for other social welfare groups planning to create and implement outcome tools are included. Family reunification programs seek to reunite children in out-of-home care with their families or to develop stable, permanent placements if reunification is not feasible. Efforts to develop coordinated systems to accomplish these goals provide us with an early example of the application of managed care principles to social services and are a prelude to the development of integrated delivery systems. Shortell et al. [1993: 20] describe integrated systems as "a network of organizations that provides or arranges to provide a coordinated continuum of services.. .and also has linkages with broad-based public health and social services and may serve as the 'umbrella' or catalyst for community care networks." They note that such networks "will be held fiscally and clinically accountable." Thus, social service agencies need to develop management information systems and link them to outcome measurement systems if the agencies are to participate successfully in this new environment. Though a number of family reunification programs have been evaluated in recent years (e.g., Fein and Staff [1993]; Nugent et al. [1993]; Walton et al. [1993]), few measurement instruments have been designed that support feasible and affordable evaluations of family reunification programs. A wide variety of measurement methods have been applied to family preservation services [Jacobs & Kates 1995]. Many standardized outcome measures are available for children and families receiving mental health services, but they are often inappropriate or insufficient for answering evaluators' questions about family reunification outcomes. Instruments that have been tested for reliability and validity in related fields may not be relevant to the particular program that is being studied or monitored. Alternatives to using standardized service outcome measures include using system outcome measures that examine change in service systems, using criterion-referenced measures that examine specific, concrete changes directly tied to the goals of the particular intervention, and using social indicators that examine simple, easily verifiable measures of events or behaviors in children's lives [Cross & McDonald 1995]. When a single tool is not sufficient, however, a need exists to either combine multiple outcome measures of various types and/ or to develop new instruments that are applicable to the particular situations. The Boston Family Reunification Network Communities for People (CFP) is a major provider of services to children in the Boston area. In 1993, CFP contracted with the Massachusetts Department of Social Services (DSS) to manage the Boston Family Reunification Network (FRN). DSS was confronting an increasing number of youngsters with complex problems coming into care. Because traditional service delivery methods were not effective with this population, DSS launched an initiative, the Boston Family Reunification Network, to establish a coordinated service delivery system [Leavey et al. 1995]. As part of its service mix, the Boston Family Reunification Network provides two managed care services to help children return to their families or other appropriate placements as soon as possible: a community-based system (7A) of family foster homes and short-term residential placements designed to reunite children with their families or place them in more permanent settings; and wraparound services (7B) such as tracking and in-home services to stabilize the child's placement upon return home and to aid in the development of alternative placements when reunification with the family is not possible. …