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K: Cost <<>> Process <<>> Performance

At the basic
practice level, cost is the central criterion for most program and service
decisions. There is a fixed funding level for each program. Within the
allocation, a detailed budget covers direct, indirect, and overhead costs for
the personnel and resources available to the program.

Within the
budgeted limits, managers acquire goods and services from various departments
and external sources, with cost being the primary selection factor. The result
is an array of resources and personnel collectively representing the capacity
of the program. The per-child allocation for children assigned to the program
then varies, depending on the number of children in the program at any specific

Cost also is a
primary evaluative criterion for programs, services, and workers. Well-managed
programs are those staying within allocations, operate within the line item
appropriations, and are in compliance with the rules.

The cost or
resource requirement of a given program or service is the primary determinate
of whether the program or service is available. Additionally, the choice of one
service or another is largely based on cost. For example, when deciding which
placement resource to use for a child, lowest cost is a major decision criterion.

As practice
expands into the intermediate practice level, process has a higher priority
than cost. In order to get a specified outcome for a child or group of
children, a known services array needs to be present. For example, placement
resources are judged in terms of the services array available for the children
using the placement resource and how the services are delivered to the
children. The availability and delivery of services represent the process
aspect of the resource.

The process
criteria need to be satisfied before cost becomes an issue. At a very simple
level, a group of children may need mental health services to help with their
behavior and emotional problems. Focusing only on cost leads to developing or
acquiring mental health services delivered for a fixed per-child or per-hour
cost. Focusing on process leads to identifying mental health professionals with
specific credentials and expertise to deliver specified services to specific
children to get pre-defined outcomes. Only when these process criteria are met
is cost a consideration.

At the advanced
practice level, The primary aspect of any program, service, or action is
performance. Further, all decisions and actions are driven primarily by
performance considerations before cost or process. Here, performance refers to
whether services adhere to the shared value propositions, incorporate best
practice strategies and protocols, and demonstratively assure safety,
permanence, and sustained well-being for each child served.

How it works.

When practice is
fully expanded, performance is the primary consideration for all programs and
services. Will the child or family be appreciably better off after receiving
the service or participating in the program? Process consideration then asks,
“Is the program or service delivered by appropriately qualified practitioners,
delivering the right services to the right children and families?” Only then is
“How much does it cost?” asked.

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