Tuesday, May 18, 2010

Non-profit funding is not outcome based

How does a non profit substance abuse agency measure its success and determine whether it is great?

Many agencies historically reported on outputs: number of clients served, number of counseling visits provided, number of bed days utilized, etc.

In the 1990s there was quite a revolution in the human service field when the focus shifted from outputs to outcomes; in other words what difference do the outputs make?

At GCASA, we are asked if the substance abuse rates are coming down? We are also asked how many clients "do you cure?"

The answer is that prevalence rates of substance abuse are coming down. DWI fatality rates are at an all time low and are the lowest in New York State than any state in the country, and about 2/3rd of GCASA's clients discontinue their drug of choice by the end of their treatment at GCASA.

These outcomes are accomplished with the most cost effective programming in the country and the state.

GCASA has a three part goal: to provide good outcomes, cost effectively, that are customer satisfying - good, cheap, fast: pick two.

The ironic thing is that even though GCASA has produced exceptional results, very cost effectively, and with excellent customer satisfaction, there is no money in it. GCASA's continuing access to resources is constantly being threatened and diminished. Working in the nonprofit sector is unlike working in the profit making sector. As Jim Collins writes in his booklet "Good To Great and The Social Sectors",

"In the social sectors, the critical question is not 'How much money do we make per dollar of invested capital?' but "How effectively do we deliver on our mission and make a distinctive impact, relative to resources?'"

The answer is that GCASA delivers tremendously on its mission relative to resources. While it costs over $35,000.00 per year to keep a person in County jail or State prison, it costs less than $1,600.00 for a single episode of substance abuse outpatient treatment.

According to the recent OASAS scorecard, GCASA performed at higher than average levels when compared to other OASAS licensed facilities and yet it receives less resources than other similarly licensed programs. It is not clear why other than that GCASA's superior performance has required less support up until now. It is not unusual in the nonprofit world for State funders to cannibalize its best performing agencies. High performing agencies appear to have less need and therefore obtain less support. It is counter intuitive and many citizens and board members don't understand how non profit funding really works.

While GCASA has better than average outcomes and can prove it, it does not mean that GCASA obtains more resources to sustain its high level of performance. This is a shame and endangers the whole broader system of care.

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