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Do No Harm: Do Charitable Services Really Help?

Charities often operate from the basic assumption that any interventions in a vulnerable person life is somehow beneficial. I hate the phrase that is often aired by new charities that "If we can help just one person it will be worthwhile... " But what if that charity does help 'just one person' but goes on to damage 100 others? Would that really be worthwhile?

There is often tremendous resistance in the field to monitor and evaluate the outcomes of the services that are provided. I think this is sourced in a number of areas. Firstly, practitioners are motivated by the idea of helping and therefore the possibility that they might not be is deeply threatening to core values. It can therefore feel a more psychologically comfortable option is to not lift up any rock for fear of what may be found there. The price to pay for this is doubt and uncertainty. Practitioners are very poor at predicting their own client outcomes, proving correct in only 1 in 44 cases. So workers who are highly effective can easily feel demoralised believing they are unhelpful whilst ineffective workers can feel very confident about practice without any reference to what they are actually achieving.

A second threat experienced by workers is one of ideological loyalty. There are strong currents of "ideological possession" in the field, where practitioners adopt a model of working because of their own person world view. The models of practice they employ have profound meaning for them and therefore they must be profound for all. Ideological possession is often a great comfort for those who are insecure in their practice and so want certainty. It is an important question to ask ourselves is whether a therapeutic idea serves us or do we serve it? When a therapeutic approach serves us we assimilate and embed it as it becomes part of the expression of the work that we do. When we serve the idea we buckle reality around it. We see that idea in every single client we work with. We become threatened by inconsistencies and anomalies that might undermined it. We refute not simply other models but other ways of seeing. We spend more time defending the idea than developing. Ultimately, these workers become very rigid in their practice. They are so certain of their model that it is beyond question that it may not be helpful. Where evidence exist of poor outcomes it was because the model was not applied properly, or there issues with the clients receiving the service or because statistical analysis of outcomes is flawed. Because alternative perspectives or outcome data threatens not just their personal motivations but their world view.

The third source of resistance to outcome monitoring is a distrust of statistics, and therefore research of any kind. People often state that anything can be proven with statistics. No statistician would make this claim because it is not true. What you can do is cherry pick statistics out of context in order to sell a newspaper of 'sex up' a Government report. But this is not the same thing as proving something with statistics. Statistical significance is not based on truth and false, but on probability.

However services cannot be improved without measurement. Reflective practice, service development, supervision and all methods we use are purely speculative without measurement. We see outcome data not simply as requirement but a core activity. Evaluating services and outcomes teaches us what the service is doing or not doing and demonstrates where development needs to occur. Data can direct and guide the therapeutic imagination of organisations rather than stifle it. Because without it, all things are but opinion.

So I was very interested to read the Conversations recent article about this very issues. To read the article click here. For a deeper understanding of outcomes and effective measurement on my web site click here.

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