Effectiveness is defined as the extent to which an intervention or program produces desired or intended outcomes.74 Outcomes, in turn, include:
…changes, results, and impacts that may be short or long term; proximal or distal; primary or secondary; intended or unintended; positive or negative; and singular, multiple, or hierarchical. Outcomes are enduring changes, in contrast to outputs, which are more specific.75
Outcome measurement must therefore consider different timeframes (long and short-term), whether outcomes are direct or indirect (proximal and distal), and the consequences of initiatives (primary/secondary, anticipated/unanticipated, positive/negative, single/multiple/hierarchical). These factors make outcome measurement complex and require that outcomes be measured at various stages throughout an initiative so that progress can be monitored.
Drawing on these two definitions, effectiveness can be condensed to two main questions:
- Question 1: Did interventions/ programs deliver what they said they would?
- Question 2: What were the outcomes of these intervention/programs?
While ensuring that funding is allocated to the most effective interventions, outcome measurement also provides safeguards that the 'do no harm' imperative presented in the LIFE Framework is adhered to and ensures that the best outcomes are achieved for persons using NSPP-funded services.
The absence of outcome measures make it problematic to establish 'what works for whom in what circumstances, in what respects, and how'.76 As a result, funding decisions may be influenced by extraneous factors such as community or sector pressure, rather than being evidence-based.
The social and environmental factors related to suicide are complex and dynamic. This means that outcome measurement will always be challenging. While no perfect solution exists to overcome these challenges, the inherent benefits of outcome measurement to funders and policymakers, and to the projects implementing these programs, mean that outcome measurement is a critical area of activity in suicide prevention.
74 "Effectiveness is the extent to which an evaluand produces desired or intended outcomes. Effectiveness alone provides a poor assessment of overall evaluand merit or worth: It is possible for something to be 'effective' (ie. produce desirable intended outcomes) but at the same time produce serious detrimental, if unintended, effects. It is also possible for an evaluand to be highly effective but extremely inefficient or overly costly. Claims of effectiveness require the demonstration of a causal link between the evaluand and the desired changes to show that they are, in fact, outcomes caused by the evaluand and are not coincidental changes." J Davidson, 'Effectiveness'.
75 S Mathison, 'Outcomes'.
76 R Pawson & N Tilley, Realistic Evaluation, Sage Publications, London, 2011.