The Template: A Cooperative Approach to Evaluating Community Rehabilitation Services. (Template for Cooperative Evaluation)

Balanced and realistic evaluation of rehabilitation services, which operate in community and `real world' settings, can be exceptionally challenging (Jaffer, 1993; Stilwell, Stilwell, Hawley, & Davies, 1998). As a result of their context and client group, these programs are often complex and multidimensional (Peat, 1997). Their focus may extend beyond reducing impairment in individuals, to wide scale social change (Miles, 1996). The nature of the issues with which they deal are often hard to measure (Hope, 1997). It is rarely possible to establish a causal link between community rehabilitation interventions and subsequent outcomes (Hope, 1997) due to the array of factors impacting on clients and service delivery (Johnston, 1991; Stilwell et al., 1998). The nature of community interventions is such that outcomes may only be evident years after an intervention (Lipsey & Cordray, 2000). Often the success of community rehabilitation programs depends not only on the clinical interventions or therapy, but also on the nature of the relationship and the level of trust established with people with disabilities, their families, and their communities (Hope, 1997). Further, because community rehabilitation programs often seek to be responsive to the local community, their focus and activities may change over time. There are often multiple stakeholders, and as a result, differing opinions on who should conduct evaluations and what methodologies should be employed. Traditional means of inferring effectiveness, such as comparisons between programs and comparisons of variations in outcomes, are problematic for community programs. Different organizational contexts, vastly different service infrastructures, dissimilar social contexts, diverse perspectives of people with disability and other stakeholders, cultural and other values, all impact on the nature of a program and the potential scope for evaluation. The present article describes an attempt to respond to that complexity in which a variety of key stakeholders and service providers participated in a workshop and subsequent rounds of consultation to develop an evaluation Template. It is proposed that this Template can form the basis for evaluating a community rehabilitation service through an inclusive, participatory approach. By involving a number of stakeholders including consumers, in an evaluation planning meeting based on the Template, a mutually agreed framework can be developed which will guide the qualitative and quantitative evaluation of key variables common to community based service delivery. Method The Workshop Participants--Service Providers Representatives from four specialist rehabilitation services based in South-East Queensland met together on a number of occasions in 1999 to discuss areas of commonality that might inform a broad evaluation structure. These organizations were: * an outreach service assisting adults with acquired brain injury in the community; * a service assisting adults with spinal cord injury (SCI) in the initial transition from inpatient (hospital) rehabilitation to the community; * a consultation and outreach service assisting adults with SCI in the community; and * a specialist children's inpatient, outpatient and community rehabilitation and outreach service. Each of these services was described as a community rehabilitation service and provided services in a community setting. Each service was staffed by qualified rehabilitation professionals, maintained referral links with inpatient services and worked within a formal, government service delivery model. The Workshop Participants--Other Stakeholders These meetings culminated in a workshop with subsequent rounds of negotiation and refinement. In addition to the service representatives, key people from associated organizations also participated in the workshop and subsequent consultations. …