Outcome Measurement Program Case Studies

The Council for Quality and Leadership (CQL) developed the first POMs® tool in 1992.  Before this, the Council accredited long-term support organizations using more traditional standards that were focused on professional standards and program processes and documents, rather than on outcomes experienced by people receiving supports (Gardner, Carran & Nudler, 2001).  Initially, in 1969, the Council operated as part of the Joint Commission for the Accreditation of Hospitals.  Since then, CQL has incorporated as an independent nonprofit organization, and its standards were revised several times to reflect the growing consensus of stakeholders that segregation from people without support needs was both harmful and unnecessary.  Revisions also reflect the importance of individualizing support, linking formal and informal support, self-determination, and the protection of legal and human rights.

A significant realignment of CQLs quality measures and procedures occurred in 1991 with the Council’s commitment to refocusing measures on the outcomes in people’s lives, rather than a compliance approach that focused on the following professional standards and recommended processes of support. Over time it had become clear that organizations could score well on process-oriented accreditation measures through careful documentation of professional input and other audit trails that had little connection to what was happening in the lives of people receiving support (Gardner and Carran, 2001) and, indeed, what people wanted for themselves.  At the same time, self-advocates, advocates, and forward-looking providers searched for ways of providing support in a manner that would incorporate the preferences, dreams, and life circumstances of each person.  This person-centered philosophy was a sea change whose current pulled the field away from program-centered strategies that were concerned with groups vs. individuals and processes vs. outcomes and moved the field toward greater concern with the well-being and individualized support of each person and the results or outcomes of interventions (Schalock et al., 2016; Schalock et al., 2008; VanLoon et al., 2013).

To generate relevant and consistent quality of life outcome indicators, the Council gathered input by conducting interviews and focus groups with people with long term support needs to determine what life experiences were important to them.  Based on these results, the first array of POMs® quality indicators was developed and field-tested in 1992 and published soon after (Accreditation Council for Services to People with Disabilities, 1993).  Subsequent Council-funded validation studies were undertaken in 1997 when the name changed to the Personal Outcomes Measures) and in 2017 resulting in the present iteration of 21 quality of life (QOL) indicators clustered in five categories (Obtained at CQL Website on May 6, 2018):

1. My Human Security - focused on non-negotiable human and civil rights;
2. My Community - focused on access to be in, a part of, and with one’s community;
3. My Relationships - focused on social support, intimacy, familiarity, and belonging;
4. My Choices - focused on decisions about one’s life and community; and,
5. My Goals - focused on dreams and aspirations for the future.

The Personal Outcome Measures® (POM) tool is an individual level discovery tool used to determine what is important to the person receiving supports. Its purpose is to increase the quality of life for individuals receiving services. It covers 21 areas, and the person personally defines the outcome.  Some of the areas of interest include health, having natural supports, being free from abuse and neglect, participating in community life and others. After learning how the individual defines their 21 outcomes, the interviewer then talks to someone who knows the person the best.  This is often a DSP or family member who is familiar with the services they receive. These conversations help determine if the organization is supporting the person to achieve their outcomes. Does the provider know what outcomes are important to the person they are supporting and what are they doing to help the person achieve those outcomes?

The POM is available for free on the CQL website. The POM is used internationally and has data from more than 29,000 interviews in its database. Review a report of the data from the last 25 years about the quality of life of people with disabilities.

Organizations may contract with CQL to perform the four-day training program used to train interviewers, and may elect to certify interviewers by conducting additional inter-rater reliability testing with people who have undergone the 4-day training workshop.  This application provides trainees with an in-depth introduction to the content and interpretation of the POM as well as guided experience interviewing with the POM®.

POM® interviews are conducted with both supported individuals and people who know the person best (often DSPs) using semi-structured interviewing techniques to gather evidence for each QOL indicator. The interview is conducted as a conversation with guided discussion questions and then structured decision trees are used for decision making. Staff interviews are used to fill in gaps about the supports provided to a specific individual, but staff interviews do not serve as “proxies” for people receiving support.  CQL employs methods for interviewing people who do not communicate with works, and/or who have higher support needs. A process for interviewing “proxies’ for HCBS users who are unable to participate in an interview process is not part of the POM® process.   The POMs® process is augmented with observations and document/record reviews, if needed for decision making.

​The POM® manual describes each of the 21 personal outcomes including an overview of its meaning, statements of values and principles around that outcome, suggested questions for learning about the outcome, and a series of suggested questions for guided conversations with both the individual receiving support (to determine outcomes) and other questions asked of people who know the individual with disabilities well (to determine supports).  Following each outcome and question series, the POM® manual provides a rubric for each indicator that interviewers use to determine if the outcome is present and whether support was provided to meet the outcome.  The manual includes forms for interviewers to document individual results as well as aggregated results summarizing the outcomes present for a group of individuals.   Interviewers participate in a four-day training program to learn about the POMs® indicators and to master skills needed for conducting reliable interviews; making decisions about the presence of outcomes; and completing the forms used to document results. 

The POM is an important component in many of CQL’s accreditation activities. CQL offers four levels of accreditation: 1) Systems Accreditation; 2) Quality Assurances Accreditation; 3) Person-Centered Excellence Accreditation; and 4) Person-Centered Excellence with Distinction.  The POM® is used in levels 2, 3, and 4.  Organizations seeking CQL accreditation contract with CQL to complete the accreditation review, and certified interviewers are used to complete the POM® component of the accreditation process. The CQL Accreditation process is available on 4 different levels ranging from Systems Accreditation for organizations seeking to align their policies with the Basic Assurances® (CQL’s standards tool used in the accreditation process), but not yet supporting people, to Person-Centered Excellence with Distinction.  The POM® is not implemented as part of the lowest accreditation level, Systems Accreditation, as these organizations are not yet providing direct supports to people. 

Organizations using POMs® who are interested in more advanced analytics based on the data collected in the POMs® may subscribe to use the CQL “PORTAL” platform to obtain a range of output.  For example, PORTAL can be used over time to examine:  how an individual’s personal outcomes have changed, trends in outcomes based on hours of support provided, trends in outcomes across discrete service settings, etc.