State “Technical Assistance Programs” for Nursing Home Quality Improvement: Variations and Potential Implications

To improve nursing home quality, many states have developed “technical assistance programs” that provide on-site consultation and training for nursing facility staff. We conducted a national survey on these state programs to collect data on program design, operations, financing, and perceived effectiveness. As of 2010, 17 states had developed such programs. Compared to existing state nursing home quality regulations, these programs represent a collaborative, rather than enforcement-oriented, approach to quality. However, existing programs vary substantially in key structural features such as staffing patterns, funding levels, and relationship with state survey and certification agencies. Perceived effectiveness by program officials on quality was high, although few states have performed formal evaluations. Perceived barriers to program effectiveness included lack of appropriate staff and funding, among others. In conclusion, state technical assistance programs for nursing homes vary in program design and perceived effectiveness. Future comparative evaluations are needed to inform evidence-based quality initiatives.     

Non-formal educator use of evaluation results

Increasing demands for accountability in educational programming have resulted in increasing calls for program evaluation in educational organizations. Many organizations include conducting program evaluations as part of the job responsibilities of program staff. Cooperative Extension is a complex organization offering non-formal educational programs through land grant universities. Many Extension services require non-formal educational program evaluations be conducted by field-based Extension educators. Evaluation research has focused primarily on the efforts of professional, external evaluators. The work of program staff with many responsibilities including program evaluation has received little attention. This study examined how field based Extension educators (i.e. program staff) in four Extension services use the results of evaluations of programs that they have conducted themselves. Four types of evaluation use are measured and explored; instrumental use, conceptual use, persuasive use and process use.Results indicate that there are few programmatic changes as a result of evaluation findings among the non-formal educators surveyed in this study. Extension educators tend to use evaluation results to persuade others about the value of their programs and learn from the evaluation process. Evaluation use is driven by accountability measures with very little program improvement use as measured in this study.Practical implications include delineating accountability and program improvement tasks within complex organizations in order to align evaluation efforts and to improve the results of both. There is some evidence that evaluation capacity building efforts may be increasing instrumental use by educators evaluating their own programs.     

The use of metaevaluation to plan evaluations of conservation programs

The U.S. Department of Energy (DOE) is sponsoring and will be required to evaluate a wide range of conservation programs. The development of evaluation plans for such programs can often be improved by reviewing evaluations that have been done on similar programs. The Residential Conservation Service (RCS), sponsored by DOE, is discussed as an example of how conducting metaevaluations can improve evaluation planning. Many utilities have sponsored programs that are similar to the RCS. A review of the utility program evaluations suggested key methodological issues and data problems that should be considered in the development of an RCS evaluation plan. The implications of these metaevaluation findings for an RCS evaluation plan are discussed.     

Using multiple lines of evidence and independent teams to enhance the credibility of evaluations

The utilization of evaluation findings is an ongoing issue among evaluators. This article presents an approach to conducting evaluations that can be used to enhance the credibility of findings and to facilitate the production of adequate documentation in support of evaluation findings. The concepts of multiple lines of evidence and the use of independent teams are discussed. Use of this approach is expected to improve the utilization of evaluation findings.Two program evaluations that were undertaken at Canada's federal department of Consumer and Corporate Affairs are presented. To undertake the data collection and analysis, these studies were broken into separate “evaluation modules, ” each one undertaken by an independent team. The teams reported to an in-house study director, responsible for weighing the evidence and findings of each of the teams and writing the final evaluation report.     

Resolving conflicting demands on evaluation: A test demonstration of videotex for farmers

Evaluating an innovation for federal, state, and local policymakers and program managers alike entails conflicting demands on the evaluation study. Policymakers at federal, state, and local levels are best assisted by impact evaluations, whereas state and local program managers are best assisted by process evaluations. In-house evaluators often have an advantage in conducting process evaluations; external evaluators generally have an advantage in conducting impact evaluations. A cost-effective approach may be to combine in-house process evaluation and external impact evaluation. This dual approach was found to reduce conflicting demands on the evaluation of an experimental videotex system for agricultural producers.     

How and why are Theory of Change and Realist Evaluation used in food security contexts? A scoping review

The complex ways in which food security actions lead to nutrition and other health outcomes make it important to clarify what programs work and how, with theory-driven evaluation emerging as a promising approach to evaluate complex programs. However, it is unclear how and why theory-driven evaluation is applied in food security contexts. Our objective is to examine the development and use of Theory of Change and Realist Evaluation to support food security programs globally. Using a systematic search and screening process, we included studies that described a food security program, used a Theory of Change or Realist Evaluation, and presented original research or evaluations. We found a total of 59 relevant Theory of Change studies and eight Realist Evaluation studies. Based on our analysis, Theories of Change arose in response to three main problems: 1) the need to evaluate under complexity; 2) challenges with evaluation; and, 3) information gaps surrounding a program. In contrast, Realist Evaluation was reported to be developed primarily to understand a program’s outcomes. Reflecting on the problem to be addressed in the evaluation would help improve understandings of the evaluation context, which would then inform the choice and design of an evaluation approach.     

Evaluations of utility residential conservation programs in the Pacific Northwest: A critical review

Pacific Northwest utilities have sponsored the nation's earliest and most thorough residential conservation programs. The Northwest region also leads in the quality, quantity, and usefulness of utility-sponsored program evaluations. This article critically reviews the methods and findings of four major Northwest utility program evaluations. Recommendations for future evaluation and program management efforts also are discussed.     

The opportunities and challenges of multi-site evaluations: Lessons from the jail diversion and trauma recovery national cross-site evaluation

Multi-site evaluations, particularly of federally funded service programs, pose a special set of challenges for program evaluation. Not only are there contextual differences related to project location, there are often relatively few programmatic requirements, which results in variations in program models, target populations and services. The Jail Diversion and Trauma Recovery–Priority to Veterans (JDTR) National Cross-Site Evaluation was tasked with conducting a multi-site evaluation of thirteen grantee programs that varied along multiple domains. This article describes the use of a mixed methods evaluation design to understand the jail diversion programs and client outcomes for veterans with trauma, mental health and/or substance use problems. We discuss the challenges encountered in evaluating diverse programs, the benefits of the evaluation in the face of these challenges, and offer lessons learned for other evaluators undertaking this type of evaluation.     

The problem of replicability in program evaluation. The component solution using the example of case management

Specificity and replicability of a program are crucial in order to rigorously evaluate the program's effectiveness. However, the traditional approaches to evaluation have ignored the problem that most social and mental health programs consist of vaguely specified interventions and cannot meet minimal standards of replicability. Consequently, the results of effectiveness evaluations of poorly defined programs have little general generalizability. Nevertheless, effectiveness information concerning su ch programs is much needed. One solution to this problem is to focus on program components, examining interventions at a level where operational definitions can be employed and replicability is possible. In this paper, this approach is expanded using the example of case management programs. A component-oriented approach ensures a systematic evaluation of program effectiveness for which the first question for evaluators is whether a program consists of interventions that reliably produce specific immediate outcomes. Then, and only then, is it possible to address questions concerning whether a program will reliably produce those outcomes that are the overall objectives of the program.     

Program Evaluation Practice in the Nonprofit Sector

Nonprofit organizations are increasingly being asked to demonstrate the effectiveness of their programs and services. Faced with this challenge, agencies that decide to engage in program evaluation must choose among various approaches and methods. This article provides a window into why and how nonprofit organizations are conducting program evaluations, and it reveals the factors nonprofit agencies identify as contributing to a useful and credible evaluation. In addition, the article addresses the role of stakeholder participation in program evaluation.     

Evaluation in the community mental health centers program: A bold new reproach?

The Federal Community Mental Health Centers Program (CMHC)-from 1963 to 1981-was heralded as a revolution in mental health care. Championed by many, and severely criticized by others, the actual impact of the program on the nation's mental health remains unclear. The authorization to evaluate the CMHC Program came originally from congressional legislation (PL 90-174), and later from the policies and regulations of NIMH under a series of Federal laws, notably PL 94-63. From 1976-1980, two dominant evaluation strategies were prevalent: funds expended by NIMH each year for studies of CMHC services or program-wide evaluations, and a much larger expenditure by CMHCs to conduct their own, independent evaluations following federal guidelines. As the Center's Program was turned over to the states in the form of block grants (PL 97-35), a group of professionals involved with setting and carrying out federal CMHC evaluation policy of both varieties met in public forum to debate the impact of these two evaluation approaches. While some participants cited gains in evaluation technology and impact upon local management of CMHCs, others found the lack of a coordinated and systematic approach to evaluating the CMHC Program to have been an opportunity missed. The impact of CMHC evaluation efforts are also discussed in terms of their major contribution to the field of evaluation research as a whole.     

The unique character of involvement in multi-site evaluation settings

As the number of large federal programs increases, so, too, does the need for a more complete understanding of how to conduct evaluations of such complex programs. The research literature has documented the benefits of stakeholder participation in smaller-scale program evaluations. However, given the scope and diversity of projects in multi-site program evaluations, traditional notions of participatory evaluation do not apply. The purpose of this research is to determine the ways in which stakeholders are involved in large-scale, multi-site STEM evaluations. This article describes the findings from a survey of 313 program leaders and evaluators and from follow-up interviews with 12 of these individuals.Findings from this study indicate that attendance at meetings and conferences, planning discussions within the project related to use of the program evaluation, and participation in data collection should be added to the list of activities that foster feelings of evaluation involvement among stakeholders. In addition, perceptions of involvement may vary according to breadth or depth of evaluation activities, but not always both. Overall, this study suggests that despite the contextual challenges of large, multi-site evaluations, it is feasible to build feelings of involvement among stakeholders.     

Evaluating a human service program: Employing the judicial evaluation model

The emergence of adversarial models as an approach to formative and summative evaluations is gaining recognition among educational research professionals. The implementation of the Judicial Evaluation Model (JEM), as described in this article, is the first application to a human service employment and training program. Evaluation questions raised within the study were designed to assess the efficacy of linkage arrangements between the Comprehensive Employment and Training Act (CETA) prime sponsors and education service providers in the Commonwealth of Virginia. The four stages of the JEM and its application to CETA are discussed, the panel findings are reported along with noted pitfalls and strengths, suggested guidelines for implementation, and a few recommendations.     

Ten steps to making evaluation matter

This paper proposes ten steps to make evaluations matter. The ten steps are a combination of the usual recommended practice such as developing program theory and implementing rigorous evaluation designs with a stronger focus on more unconventional steps including developing learning frameworks, exploring pathways of evaluation influence, and assessing spread and sustainability. Consideration of these steps can lead to a focused dialogue between program planners and evaluators and can result in more rigorously planned programs. The ten steps can also help in developing and implementing evaluation designs that have greater potential for policy and programmatic influence. The paper argues that there is a need to go beyond a formulaic approach to program evaluation design that often does not address the complexity of the programs. The complexity of the program will need to inform the design of the evaluation. The ten steps that are described in this paper are heavily informed by a Realist approach to evaluation. The Realist approach attempts to understand what is it about a program that makes it work.     

Register data in the evaluation and program planning of addiction treatment programs: Using Sweden as an example

Data from large-scale registers is often underutilized when evaluating addiction treatment programs. Since many programs collect register data regarding clients and interventions, there is a potential to make greater use of such records for program evaluation. The purpose of this article is to discuss the value of using large-scale registers in the evaluation and program planning of addiction treatment systems and programs. Sweden is used as an example of a country where register data is both available and is starting to be used in national evaluation and program planning efforts.The article focuses on possibilities, limitations and practicalities when using large-scale register data to conduct evaluations and program planning of addiction treatment programs. Main conclusions are that using register data for evaluation provides large amounts of data at low cost, limitations associated to the use of register data may be handled statistically, register data can answer important questions in planning of addiction treatment programs, and more accurate measures are needed to account for the diversity of client populations.     

The relationship between implementation fidelity and educational outcomes in a school-based family support program: development of a model for evaluating multidimensional full-service programs

There is increasing recognition of the need for evaluations that identify program processes or mediators and assess degree of program implementation rather than focusing solely on outcome evaluation. This paper describes the application of complementary qualitative and quantitative evaluation procedures to assess the degree of implementation of multi-component family support programs for improving educational outcomes for at risk youth, and to assess the relationship between program implementation and outcomes. The qualitative evaluation involved prolonged engagement to identify common program domains or mediators. Using a method called Innovation Configuration Analysis, levels of implementation of program domains were explicated as well as an overall Implementation Fidelity Index. Strong positive relationships were found between overall program implementation and program-level outcomes achieved by student participants.     

An approach to design long-term monitoring and evaluation frameworks in multi-actor systems—A case in water management

Learning-by-doing and adaptive management require careful monitoring and evaluation of the outcomes of environmental policies and programs under implementation. Selecting relevant indicators is difficult, especially when monitoring over a longer period of time. Further challenges arise when policies are developed as a collaborative effort among multiple actors.This paper discusses an approach to design frameworks for long-term monitoring and evaluation in multi-actor systems. It uses Dynamic Actor Network Analysis (DANA) as an actor-sensitive method to reconstruct program theories. This is combined with elements of assumption-based planning to identify critical assumptions and associated indicators to incorporate the dynamic aspects related to long-term monitoring.An application of this approach is described for a case of water management in the Netherlands. Here, mapping multiple perspectives and identifying critical assumptions helped to broaden the scope of monitoring in important ways. Identifying associated indicators and expectations on their development in response to policy implementation proved more difficult.From this case, it can be concluded that the approach is feasible, useful, but also demanding. However, with continuing trends of networked governance and adaptive management, additional efforts to reflect these trends in monitoring and evaluation, through this and similar approaches, are needed.     

An approach to design long-term monitoring and evaluation frameworks in multi-actor systems--a case in water management

Learning-by-doing and adaptive management require careful monitoring and evaluation of the outcomes of environmental policies and programs under implementation. Selecting relevant indicators is difficult, especially when monitoring over a longer period of time. Further challenges arise when policies are developed as a collaborative effort among multiple actors. This paper discusses an approach to design frameworks for long-term monitoring and evaluation in multi-actor systems. It uses Dynamic Actor Network Analysis (DANA) as an actor-sensitive method to reconstruct program theories. This is combined with elements of assumption-based planning to identify critical assumptions and associated indicators to incorporate the dynamic aspects related to long-term monitoring. An application of this approach is described for a case of water management in the Netherlands. Here, mapping multiple perspectives and identifying critical assumptions helped to broaden the scope of monitoring in important ways. Identifying associated indicators and expectations on their development in response to policy implementation proved more difficult. From this case, it can be concluded that the approach is feasible, useful, but also demanding. However, with continuing trends of networked governance and adaptive management, additional efforts to reflect these trends in monitoring and evaluation, through this and similar approaches, are needed.     

Looking Inside the “Black Box”

Abstract

The continued devolution of social welfare systems and services in the U.S. resultsin high stakes program evaluations in the field of family support and early intervention. Programs are expected to utilize evidence-based interventions and to demonstrate effectiveness. A look at implementation helps to differentiate between theories that do not work and programs that are not effective. Methods for identifying program implementation are needed. In a 17-site program evaluation, the author and her colleagues developed a methodology for measuring implementation and demonstrated the effects of differential implementation in understanding program outcomes.     

On-Line,Computer-Based,Interactive Simulations: Bridging Classroom and Field

ABSTRACT

This paper briefly describes two educational tutorial programs, and the efforts of this author to evaluate the effectiveness of these computer mediated programs. One interactive program is designed to teach students how to apply crisis concepts to a practice simulation, and the second program is designed to teach students how to assess lethality with a suicidal client. Formal evaluations by students of these two programs and student performance on a follow-up quiz have produced positive results. A comparison study of classes who completed these programs and a class that did not have the training has also produced significant, favorable results.