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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 time.

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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