BH TIG Week: Finding our way toward beneficiary-defined outcomes in behavioral health by Jessica Headley

Hello, I’m Jessica Headley Ternes, current manager at Third Sector Capital Partners and a former internal evaluator for a county behavioral health department.

During my time spent working in behavioral health, I spent a lot of time interviewing and listening to clients within the system-of-care share their experiences with services and personal stories of their journey in recovery. During these conversations, I noticed that there were pieces integral to their recovery that were not included on most of the existing recovery or outcome metrics.

When asked about driving factors to continue their journey to recovery, as well as how they would know when they got there, the capacity to contribute to their communities in ways that were meaningful to them was a theme that kept re-emerging. For example,

  • feeling stable enough so that they could volunteer at soup kitchens and feed people who were hungry;
  • obtaining housing and the resources needed to be able to go back and rescue the animals still on the streets who kept them company when they lived there too;
  • achieving wellness so that they could be a caretaker to other family members who needed support. 

As a result of these field interviews, a council of clients were brought together to advise the county department’s research & evaluation unit on all evaluation processes, including which metrics are used, what is missing from what is being asked, what shouldn’t be asked, and what language should or should not be used when asking certain questions, along with identifying the impact of questions and opportunities to reduce harm when witnessing story and collecting data. Below are some tips that I drafted based on their collective insights.

Hot Tips:

  • When reviewing mental health metrics, substance use surveys, and/or recovery tools:
    • Carve out space to ask yourself the questions out loud. Reflect on how comfortable you yourself may or may not be answering the questions if you were asked to complete this, especially by a stranger. This is a great starting point!
    • Take some time to sit with the content. Ask yourself and others:
      • What content is reflective of dominant culture norms? What content is missing as a result?
        • Example: dominant culture here often emphasizes independence over interconnectedness, but both concepts can be valuable. Do these metrics/surveys/tools emphasize independent living skills at the expense of healthy community supports?
      • How might assumptions around ableism be impacting what dimensions are and are not included on these metrics?
  • Before administering behavioral health surveys/questions, find a way to meaningfully engage with representatives from the client base expected to answer the questions. If they are willing to share with you, ask them:
    • Which of the items/dimensions that this is measuring are/are not important to you?
    • What are we not measuring here that we should be? What in recovery is most important to you?
    • Which of these questions would you feel comfortable or uncomfortable answering?
    • Are there questions that should not be asked at all, or should be asked using different words?

Rad Resources:

As evaluators in the behavioral health field, it is crucial to investigate what the impact of measuring another’s recovery is when we do not give them autonomy to shape how this is defined, collected, and discussed.

Significant inspirations to me on this journey have been the work of Fireweed Collective & the Disability Justice Movement.

I want to acknowledge and give gratitude to the individuals interviewed who inspired me to begin speaking out on this topic and to the Consumer Evaluation Council for their ongoing substantial contributions.

The American Evaluation Association is celebrating Behavioral Health (BH) TIG Week with our colleagues in Behavioral Health Topical Interest Group. The contributions all this week to aea365 come from our BH TIG members. Do you have questions, concerns, kudos, or content to extend this aea365 contribution? Please add them in the comments section for this post on the aea365 webpage so that we may enrich our community of practice. Would you like to submit an aea365 Tip? Please send a note of interest to aea365 is sponsored by the American Evaluation Association and provides a Tip-a-Day by and for evaluators. The views and opinions expressed on the AEA365 blog are solely those of the original authors and other contributors. These views and opinions do not necessarily represent those of the American Evaluation Association, and/or any/all contributors to this site.

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