- What is service utilization?
- Why is it useful to determine service utilization?
- How do you determine service utilization?
What is service utilization?
When we talk about service utilization (sometimes also referred to as "rates under treatment" or "rates under direct service"), we are referring to the extent to which people are making use of whatever services are already available in the community or at your organization. There are many related things you may wish to find out -- knowledge about services, effectiveness of services, need for services -- but this section of the Community Tool Box is just about determining the USE of services. Service utilization is usually determined through surveying citizens, service providers, or both.
By "service," we mean just about anything your organization provides. For example, you may wish to determine how many people are attending your organization's adult literacy classes, or how many families in need are served by your annual clothing drive, or how many people are using your organization's domestic violence hotline.
When determining service utilization, you can either restrict your assessment to your own organization's services or attempt to determine the overall utilization of the same types of services across the community. For example, if your AIDS outreach and awareness program is one of three in the community, you can either work with other organizations to determine overall use, or assess such usage on your own.
Why is it useful to determine service utilization?
There are several good reasons to determine the extent to which your organization's services are being used.
Knowing which of your organization's services are and are not being used will help you decide which services need to be bolstered, which need to be better communicated to your target audience, and which should probably be dropped altogether. This will help your organization plan future activities and use its resources most effectively.
For example, what if you find that no one is coming to your carefully-prepared adult literacy classes? This is an important (if painful) thing to discover, because it tells you very clearly that your organization needs to make some changes. Further investigation may show that your promotional campaign is inappropriate for your target audience, or that the classes are being held when most of your target audience is at work, or even that your community's adult-literacy needs are being met by the organization across town.
On the other hand, you may find that your classes are so popular that they've become overcrowded, and because of this the quality of the instruction is in danger of being compromised. You need to expand your services. In either case, determining the level of use is an important first step for your organization toward knowing what it needs to do to best serve the community.
Knowing what services are being offered in the community can help your organization identify needs and gaps community-wide. For example, if you run a women's shelter that is considering setting up a domestic violence hotline, it's probably a good idea to take a look at existing hotlines -- if there are any -- and their level of use. If there's already a very well-known and frequently used hotline in existence, it may make the most sense to find another way to use your organization's resources to combat domestic violence. But if you find that that hotline is underused by women among your city's large Laotian community -- well, you may have found your niche! (Of course, you'll first want to determine what domestic violence resources the Laotian community actually needs.)
People connected with your organization will want to know how it's doing. If your services are frequently used, it will make your staff feel good to know it, and if the services aren't used enough, your staff will certainly want to make necessary changes. Your funders, too, will want to know that their contributions are making a difference.
Some advantages of determining service utilization:
- Service utilization can be monitored over time to follow any changes or trends.
- It can involve other professionals in the community and help develop working relationships with them.
- It's generally inexpensive to do.
Of course, everything has a drawback or two. Give some consideration to disadvantages when deciding whether you should try to determine service utilization:
What are the disadvantages of determining service utilization?
- It can be a time-consuming process. Be sure you have enough time and staff to take this on before you do it.
- Some of the records you'll need to access may not be available to you. This lack of complete data can be frustrating and may result in your having an incomplete picture of how frequently your services are really used. Records from private doctors and other service providers (hospitals, clinics, community agencies) are often difficult or impossible to get. Public agencies are the most likely to share information with you.
How do you determine service utilization?
Decide what sort of services you're going to survey.
Your survey will most likely be limited to just your agency, if that's all you're interested in (e.g., "How many people use our after-school teen program, and how many need it but don't use it?"). However, you may also want to find out about the use of a variety of community-wide services. In that case, your service inventory could cover a wide variety of service organizations. These could include:
- Housing assistance services
- Preschool programs and child care resource and referral services
- Parenting support services
- Primary health care clinics and clinicians
- Food and nutrition services
- Youth recreation services
- Employment and training services
- Adolescent parenting programs
- Child abuse prevention programs and child welfare services
- Services for special populations, including mental health, mental retardation, and developmental disability services; health care services for individuals with special health care needs; and services for the homeless
- Domestic violence and sexual assault care centers
- Infant and toddler programs, including assessment services for identifying developmental delays
- Crime prevention and neighborhood watch programs
- Transportation services
- Substance abuse treatment programs
- Family support programs and centers
Something you may or may not decide to measure is service coordination -- the extent to which different agencies and services in your community work with one another to meet all the needs of your constituents. This isn't necessary if you're just starting up your agency or organization. Many people make use of more than one service provider within the community, so it only makes sense for those providers to try to gain information about how they can best work with each other to serve their clients or participants.
Compile a basic inventory of services.
If you are assessing service utilization across the community, you'll want to make up a list of the services that are available in your area and who provides them. Possible sources to use in compiling this list:
- Directories of established organizations and professional services already compiled by social service agencies, mental health centers, local YWCAs or YMCAs, United Ways, public libraries, cooperative extension offices, schools, police departments, or juvenile services agencies.
- Surveys of current providers of service and institutions that control community resources, including schools and public health, human service, and law enforcement agencies.
- Surveys of other community-based organizations likely to be attuned to the current service array in a community, including community action agencies, YMCAs and YWCAs, cooperative extension service offices, and churches.
- Compilations of specific services produced at the state level, particularly when they list information on regional services. These may include services available to a community but not located within a community. For example, a grant-funded educational outreach program run by the state university may serve several cities, not just the city in which the university is located.
- Telephone directories and yellow pages, which list community organizations and associations, such as churches, preschool programs, and health providers.
Decide what information you want to gather about these services.
If you're addressing service utilization in your own organization, list all related services. For example, if you run an English as a second language program, you'll want to list the number of people who come to your classes, the number of people who sign up for tutoring, the number of people who borrow your language tapes, and so on.
If you're including other agencies and organizations in your survey, you'll want to know, of course, what services they provide and how much they're used. In addition to finding out what services the agency provides and how much those services are used, an inventory of services might include the following:
- Name address, and phone number of the agency or organization
- Number of clients seen annually
- Days and hours of operation
- Number of sites and locations
- Proportion of clients served who reside in the community
- Eligibility requirements
If you're only assessing service utilization in your own organization, you'll want to remain aware of all of these items, as they may help you with your analysis.
Gather data on how much the services are being used.
If you're gathering data on your own organization, this should be easy. You know how many hot meals your "meals on wheels" program distributes each day. You know how many homeless people are staying in your shelter each night. You know how many individuals are coming in each day for confidential HIV counseling. And if you don't, you should. We strongly recommend keeping careful records of how many people use your services.
If you're trying to assess service utilization across several organizations in the community, we recommend doing this with a public questionnaire. This can be done by direct mail. If your town performs an annual census, you might be able to get permission to have your questionnaire enclosed with it.
Another method you can try is to survey each agency, either with a paper survey or by telephone or personal interviews.
Analyze your results.
This may be the most important step of all, because it's here that you'll determine what your next steps should be. There are a number of barriers that can keep people from using a service at all, or from using it as effectively as they should be able to. For example:
- Restrictions on eligibility. Should you consider loosening restrictions on who receives your services? For example, a program that offers free flu shots for people whose income is under a certain amount a year may leave out people whose incomes are just slightly above that area but have no health insurance coverage.
- Restrictions on availability. For example, if the local soup kitchen for the homeless is unable to solicit enough food donations to have enough meals available for those who need them
- Location. Is your agency in a place where people will use it? For example, if your agency serves lower income youth and your office is located in an affluent suburb, you will probably have a great deal of trouble reaching your potential participants or clients.
- Hours of operation -- is your office open enough hours for your clients or participants to reach you? For example, if you serve a lot of working-class folks, your office should be open after regular working hours to better accommodate their schedules.
- Mode of delivering services can hinder accessibility -- for example, if the local senior services agency doesn't make all correspondence and newsletters from the be available in large print, that could hinder accessibility.
If you're looking at service utilization across several organizations, you'll want to consider whether each organization serves a particular niche in the community. This could be as simple as observing that Organization A is primarily used by people on the north side of town while Organization B is the organization of choice on the south side, but it's a good way to identify gaps in service. Also, you'll want to compare the types of services offered by each organization, and make note of the services' overall use. For instance, you may be comparing three local crisis pregnancy centers and find that only one center provides free transportation for the women to their doctors' offices -- and they're overwhelmed. Knowing this, your organization may wish to consider adding transportation to the services you provide.
Write a report of your results.
Things to include in your report:
- Demographic information. Give a breakdown of demographic information on the people who are using your services -- zip codes (maybe), household by age composition, household size, average number of members per household.
- Use of services -- break down by age and household info, if possible.
- Use of multiple services -- Try to learn the extent to which agencies share clientele. Are any groups underserved?
If your report is internal, share it with staff, your Board of Directors, and your funders. You may even use the results in promoting or marketing your services, or in applying for new funding. For example, being able to say something you learned about service utilization, like "Every day, Compassionate Citizens of Bay County delivers over 800 hot meals to the homeless," can be used to impress a potential funder.
If your report describes service utilization in several organizations across the community, share it with other organizations. The organizations can then use the report to better coordinate services and, if necessary, avoid duplication of services.
No matter what you find out, it's important to assess the level of use of the services you provide. What you find out could help verify that you're on the right track, or it could lead your organization in whole new directions. Either way, determining service utilization is an important way to ensure that you're continuing to serve the people who need you.
Barkley, T. J., Glenwick, D. S., Wilson, M. J., and Corliss, C. J. (1989). Issues in conducting culturally sensitive human services needs assessments. New York: Fordham University.
Barsook, H., Bergmann, A., Forgey, M. A., Halpern, R. and Phear, B. (December, 1978). Human service needs assessment: Lexington, 1978. Chestnut Hill, MA: Boston College Graduate School of Social Work.
Bruner, C., Bell, K., Brindis, C., Chang, H., and Scarbrough, W. (1993). "Collecting Baseline Information." In Charting a course: Assessing a community's strengths and needs. Des Moines, IA: National Center for Service Integration.
Jones, E. W., and the Chatham Human Services Committee. (July, 1992). Third annual report on the use of health and human services in Chatham: Responses to the voluntary questionnaire mailed with town census. Chatham, MA: The Chatham Human Services Committee.
Williams, R. T. (April, 1978). A model for identifying community education needs related to mental health, developmental disabilities, and alcohol and other drug abuse. Madison, WI: University of Wisconsin.