Evaluating human rights-based interventions - PowerPoint Presentation

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Evaluating human rights-based interventions

Prepared by Dr Alice Donald

(Middlesex University)

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Human rights as both end and means

Human rights are both:

a set of standards and obligations enshrined in domestic and international law, and

a source of principles and practical methods which determine how those standards and obligations are achievedSlide3

Negative and positive obligations

Negative obligations

– public authorities must refrain from breaching people’s human rights

Positive obligations

– in some circumstances, public authorities may need to take proactive steps to ensure that people’s human rights are not breached, even if the harm is caused or threatened by a private individual or entity rather than by the authority itself. Slide4

“Using human rights to achieve human rights”

Ensuring that human rights are respected and promoted at each stage of a process or activity

Identifying desired outcomes (short-medium term) and impact (longer term) for service users, carers, staff and other stakeholders and relationships between them

May involving redefining – from a human rights perspective – imperatives such as ‘value for money’ and ‘efficiency’ Slide5

Human rights-based interventions – common elements

Leadership

: public commitment to human rights as reinforcing other organisational priorities and values

Systematic participation of service users and carers

in design both of interventions and evaluations

Screening

of policies and practices for human rights compliance (‘traffic light’ approach)

Integration

of human rights standards and principles (FREDA) into decision-making frameworks – balancing rights in an explicit and transparent way

Training

– tailored to everyday roles and with immediate opportunities to participants to put their learning into practice

Informing

all stakeholders about their rights and/or duties Slide6

What do human rights-based interventions seek to change?Slide7

Outcomes and impactSlide8

Aims and objectives - competing priorities?

Desired outcomes that make sense to the life of a person using a service

e.g. ‘What will change for the better in my life?’

Desired outcomes that make sense to the practitioner

e.g. ‘What are the targets and indicators that I am obliged to report against?’

‘What are my priorities as a clinician?’. Slide9

Makers and beneficiaries of changeSlide10

Stages of evaluation Slide11

Stages of evaluation – sample questions

Baseline

–

situation before the intervention – available data?

Formative

Do target group/s consider intervention relevant, beneficial? Need to adapt or refine activity to meet objectives?

Process

Activities carried out as planned? Reached target group/s? Are they satisfied?

Summative - outcomes

Have human rights standards and principles become integrated into core areas of policy/practice as intended? Identifiable changes in e.g. knowledge, skills, behaviour, experience? Summative – impact Changes to organisational culture; relationships between stakeholders; clinical outcomes? In what specific ways are human rights better respected, protected and promoted?Slide12

Designing an evaluation - checklist

Aims –

desired longer-term outcome/s of the human rights-based intervention?

Objectives –

(SMART) activities or outputs by which to achieve aims

Baseline –

situation before the intervention – available data?

Methodologies –

qualitative, quantitative, observational?

Who will take part?

How will service users participate? Need for external expertise?

Timescale – formative, process, summative?Ethics – how will you obtain necessary clearance? Slide13

Possible pitfalls in evaluation?

Bias -

emotional or professional investment in the success of the human rights-based intervention?

Establishing cause and effect –

multiple drivers of change? Changes may not be ‘labelled’ as human rights-driven

Resource constraints –

scale of evaluation should be proportionate to the project itself.

Participants’ pre-existing attitudes and feelings about human rights –

possibility of both negative and positive responses; need to factor this into design of evaluation tools Slide14

Example: evaluation of the human rights-based approach at The State Hospital

State Hospital in Lanarkshire - high security forensic mental health hospital for Scotland and Northern Ireland.

Provides psychiatric care in conditions of high security for people with mental illness who are compulsorily detained under mental health or criminal law.

In 2000, decided to use the Human Rights Act as ‘a vehicle for cultural change’ in order to move away from a custodial and punitive regime towards one that put the human rights of everyone – staff, patients, carers and family members – at the heart of the services.Slide15

Example: evaluation of the human rights-based approach at The State Hospital

Human rights training for staff at different levels and in different roles

Human Rights Working Group reviewed all policies and procedures using ‘traffic light’ approach to assess risk of non-compliance:

Is the policy/practice legal?

Does it have a legitimate aim?

Is it proportionate?

Creation of a forum for staff, patient, and carer participation in decision-making

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Example: evaluation of the human rights-based approach at The State Hospital

Objectives of evaluation included

:

to

understand the process of developing and implementing an effective human rights-based approach and to draw out key learning for replicating this process successfully in other

settings

to

assess the perceived impact of implementing a HRBA, including benefits for patients, staff and carers from the perspectives of all involved.

to

identify the extent to which human rights outcomes were perceived to have changed as a result of the adoption of a HRBA.

to

evaluate the extent to which human rights are now respected in practice at The State Hospital. to develop an effective human rights-based approach to evaluation methodology that can be replicated by those introducing a HRBA to their service.Slide17

Example: evaluation of the human rights-based approach at The State Hospital

Evaluation methodology included

:

Review of documentary evidence and statistical data

Review of other legislative obligations with potential impact on development of policy and practice at The State

Hospital

Survey of existence of key policies and indicators of effective practice, with qualitative and quantitative data supplied by

various

departments at The State Hospital

Semi-structured interviews with internal and external stakeholders

Focus groups with staff (clinical and non-clinical)Focus groups with both recently-admitted and longstanding patients and carers Slide18

Example: evaluation of the human rights-based approach at The State Hospital

“The adoption of a human rights-based approach was successful in supporting a cultural change from an institution where rights were largely ‘left at the door’, and with a ‘them and us’ culture, towards an organisation with a more positive and constructive atmosphere …”.

Scottish Human Rights Commission (2009)

Human Rights in a Health Care Setting: Making it Work - An Evaluation of a human rights-based approach at The State Hospital

.Slide19

Example: evaluation of the human rights-based approach at The State Hospital

Outcomes of the HRBA included:

increased

staff and patient engagement

increased work-related satisfaction amongst staff

reduced stress and anxiety amongst staff

increased satisfaction among patients over their care and treatment

a reduction in ‘blanket’ policies and a greater focus on individual patients’ risks

an end to the routine use of seclusion as punishment.

Scottish

Human Rights Commission (2009)

Human Rights in a Health Care Setting: Making it Work - An Evaluation of a human rights-based approach at The State Hospital.Slide20

Example: evaluation of the human rights-based approach at The State Hospital

Lessons learned in relation to evaluation

Need for baseline study

Need to set clear

and measurable objectives at the start

of the intervention

PANEL - participation, accountability, non-discrimination, empowerment and legality.

PANEL principles used to:

shape

the initial objectives of the

evaluationdevelop indicators of effective practice devise questions for semi-structured interviews and focus groupsidentify the data required and mechanisms for

collection

Scottish

Human Rights Commission (2009)

Human Rights in a Health Care Setting: Making it Work - An Evaluation of a human rights-based approach at The State Hospital

.