The role of monitoring and evaluation in the organization of services

Monitoring of both process and outcome can be done at a national, regional, or local level to reflect policy commitment—how well a service meets its aims and objectives. In the case study above, process and outcome indicators related specifically to outcomes associated with the preventive activities, such as the number of children whose development was monitored. Particular aspects of the process which have been identified as an issue for child and adolescent services in the United Kingdom are waiting times and rates of non-attendance.

User satisfaction is another aspect relevant to both monitoring and evaluation of a service. Whereas scales to measure parent satisfaction and parent perception of outcome are available and are used, scales suitable for use by children of different ages need to be developed to measure their perception of help received, the change in quality of life, and changes in personal function.

Although some studies in Europe and the United States in particular(18) have demonstrated the methodology of monitoring and evaluation in child and adolescent mental health, this type of work needs to be extended.

As data on evaluation increase, decisions may need to be made on the basis of what is affordable and likely to be of cost-benefit. For example, the evaluation of the impact of an early intervention project in the United States (the Perry Pre-School project) demonstrated the longer-term benefits of the programme in terms of more youngsters entering secondary education. Costs for special education decreased, but those for secondary education increased. (20)

It is hoped that future developments will lead to more systematic service organization. For children and adolescents, it is necessary that planners and clinicians adopt a developmental perspective in establishing priorities rather than a parochial or professional approach. The aim must be to provide an affordable continuum of care for children and adolescents, so that continuation of disadvanatge, dysfunction, or disability into adult life is minimized.

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