Accountability, Autonomy and Human Services Delivery Systems: A Case Study and Theoretical Approach to the Problem

摘要

The concept of accountability is discussed as a focal concern of management personnel and policymakers in the human service delivery system, and a case study of accountability which involved community mental health and mental retardation boards in the State of Ohio is cited. Two approaches to accountability are distinguished --- one oriented toward procedural conformity and the other oriented toward results. The position of human service professions is analyzed, along with changes in the accountability brought about by third party payers and public funding bodies. Accountability is virtually universal as a feature of interpersonal relations, and autonomy is viewed as the reciprocal to that concept. In Ohio, there was a struggle between community mental health boards and their provider agencies; critical issues noted by both sides are outlined. Dimensions of accountability are explored, and result - oriented accountability is defined in terms of the quantity of services (effort), the success of treatment outcome (effectiveness), unit cost (efficiency), and adequacy in relation to community needs. It is concluded that the control of funds and a proper style of negotiation are both essential in achieving successful accountability.