Outcome Based Accountability™
“Sorting the Elements Exercise”
Briefing
 Read the Tillamook County story (Where Outcome Based Accountability Has Worked) (5 minutes)
 Prepare a piece of flip chart paper as per the template below (5 Minutes).
 As a group, determine which card fits under which category, and stick it in the appropriate place.
If a card does not fit neatly into a single category, prepare a duplicate and split across two
categories. (15 minutes)
 Groups will be invited to appraise each other’s conclusions and discuss (10 minutes)
Sorting the Elements Exercise – Flip Chart Template
Population
Outcomes
Indicators
Baselines
Story behind the
Baseline
Partners
What Works/
Action Plan
Performance
measures
Adapted from “Trying Hard Is Not Good Enough” by Mark Friedman
FPSI Publishing ISBN 1-4392-3786-7
WHERE OUTCOME ACCOUNTABILITY THINKING HAS WORKED
Tillamook County, Oregon
Tillamook is a small county on the northwest coast of Oregon. It is famous for its cheese. People there
like to say they have more cows than people. Back in the early 1990's, the state of Oregon issued a
report card comparing the 36 counties in Oregon on their teen pregnancy rates. Tillamook came out
worse than all but two counties. It came as a shock to the people who lived there. They didn't realize
that they had a problem with teen pregnancy, certainly not that bad compared to their neighbours.
A few years before the report card came
out, there had been a proposal to build
health clinics in Tillamook County's highschools. Tillamook is a very conservative
county, both politically and socially, and
most residents didn't want health clinics in
their high schools1. They didn't think it was
any business of the schools to provide
health services. When the teen pregnancy
report card came out, the question became,
"If we're not going to have health clinics in
our high schools, what are we going to do
about our problem with teen pregnancy?"
One by one, different people and groups
came forward to be part of a communitywide effort. The strategy was simple: Get
everyone -churches, public and private
agencies, schools, health workers and
families - to acknowledge the problem and commit themselves to doing what they could to change it.
The controversial nature of the problem was turned into an asset. The widely different views of leaders
helped motivate different sectors of the community to get involved.
Here is a summary of some of the partners' actions:
 Schools added self-esteem and sexuality education to their curriculum.
 Churches worked to open communication channels with teens, taught refusal skills, promoted
abstinence, and provided recreation.2
 The county health department, with support from the county commissioners, expanded clinic hours
and changed policy to assure that any teen who called the health department for information or
services would be seen within 48 hours, not the two to three weeks previous practice.
 The YMCA sponsored a "teens at risk" programme, providing recreation activities that kept teens
busy and built self esteem.
 The community college worked with teens through the Tillamook Teen Parent Programme to
prevent second unintended pregnancies.
Please Turn Over…..
1
We could no doubt debate this
Recreation services are among the most important things we do for young people. And recreation
is so cheap compared to other services. Recreation services in many cities and counties have been
cut back dramatically. The short paper, "A Recreation Entitlement," on
www.resultsaccountability.com, proposes creation of a recreation entitlement for all youth 7 to 17.
Benefits would be widespread throughout the education, juvenile justice and other systems. Costs
would be less that 2% of a typical city budget.
2
Adapted from “Trying Hard Is Not Good Enough” by Mark Friedman
FPSI Publishing ISBN 1-4392-3786-7
 The Commission on Children and Families funded a teen pregnancy prevention curriculum in the
schools as well as counselling and support groups.
 The Tillamook County General Hospital and other partners, opened "Healthy Families of
Tillamook County," a home-visiting and parenting programme for all newborns.
 Other partners that made contributions included the Women's Crisis Centre, the Tillamook Family
Counselling Centre, the Tillamook Bay Child Care Centre, the Tillamook Bay Community College,
and others.
In 1990 the teen pregnancy rate in Tillamook County was 24 per 1,000 girls ages 10 - 17. Between
1990 and 1994, the teen pregnancy rate decreased to 7.1 per 1,000, the best rate in the state. The teen
pregnancy rate for Oregon as a whole remained essentially flat during this period. The partners in
Tillamook County do not attribute this success to any particular service, but rather to the combined
effects of all the community efforts.
The rebound effect: After 1994, the teen pregnancy rate rebounded, rising over the next five years
almost back to where it had been in 1990. This rebound effect is quite common in community change
processes. "We solved the problem of teen pregnancy! Thank God, we'll never have to worry about
that again!" And so the partners shifted their focus, leadership changed, and the numbers went back
up.
This loss of progress takes nothing away from the remarkable initial effort. However, it makes clear
that part of the work on Outcomes Accountability is to expect the rebound and to build the community
capacity necessary to sustain progress. There is not much value in a succession of lapsed successes.
How can communities sustain attention through changes of leadership and political priorities? There is
not a simple answer to this question. However, recognizing the inevitability of a rebound without
continued effort is a start.
There are two structural approaches that can help prevent a rebound. The first is the development of a
regular report card on child and family well-being or community quality of life. Such report cards keep
a spot light on the most important outcomes and indicators, even the ones where we have made
progress. This allows communities to see which indicators are at risk of rebound and work to maintain
progress or at least stop the rebound before it takes too deep a hold. The second structure is the idea of
"Turn the Curve Tables." For every condition, there are people in the community who continue to be
passionate about the work, even after the political spotlight has turned elsewhere. By creating an ongoing structure for people to meet, assess progress, and take action, the chances of a rebound can be
reduced.
Adapted from “Trying Hard Is Not Good Enough” by Mark Friedman
FPSI Publishing ISBN 1-4392-3786-7
Outcome Based Accountability™
Sorting the Elements Exercise Answer Sheet
All teenagers under 19 in Tillamook County
Our goal is for young people in this community to stay out of trouble
Young people make smart choices about their lives
Rate of Teen Births
Rate of Teen Pregnancy
Teenagers don’t become pregnant
In 1994, 7.1 pregnancies per 1,000 teenage girls aged 10 – 17
In 1990, 24 per 1,000 teenage girls aged 10 – 17 became pregnant
Kids don’t have anything to do after school
Many girls had older partners
Parents don’t know how to talk to their kids about sex
Survey showed that girls sexually active, but not using birth control
Teens engaged in high-risk behaviour
The health department puts kids on waiting list for appointments
Community College
County Hospital
Health Clinics
School Nurses
Schools
Women’s Crisis Centre
YMCA
Active prosecution of adult sex offenders
Churches to provide after-school recreation
Encourage abstinence through training in refusal skills and self esteem
Form a teen pregnancy partnership
Home visiting for teenage parents
Increase the number of school nurses
Mentoring Programme
Our goal is to get the media to support an advertising campaign
Revamp sex education curriculum
Number of teenagers completing Tillamook Teen Parenting Programme
% of teenagers completing “Teens at Risk” programme
Rate of prosecution of adult offenders
Percentage of waiting times for appointments 48 hours or less
3
Population
Outcome
Outcome
Indicator
Indicator
Indicator3
Indicator/Baseline
Baseline
Story behind the Baseline
Story behind the Baseline
Story behind the Baseline
Story behind the Baseline
Story behind the baseline
Story behind the Baseline
Partner
Partner
Partner
Partner
Partner
Partner
Partner
What Works/Action Plan
What Works/Action Plan
What Works/Action Plan
What Works/Action Plan
What Works/Action Plan
What Works/Action Plan
What Works/Action Plan
What Works/Action Plan
What Works/Action Plan
Performance Measure
Performance Measure
Performance Measure
Performance Measure
This is ambiguous. The question to ask is “Is teenagers don’t become pregnant” in itself a condition of wellbeing (i.e. an outcome)? Or is it a symptom of something else? It is suggested in this exercise that it is an
indicator, i.e. data that measures progress towards an outcome. That outcome could be “Young people make
smart choices about their lives”. But the expression is deliberately worded to surface debate. If the card said
“Number or percentage of teenagers that don’t become pregnant” then it would clearly be an indicator. But
because it doesn’t specifically allude to data, it could be considered an outcome if “teenagers not becoming
pregnant” is considered a condition of well-being. There is no right or wrong here – the important thing is to
be clear what we want for young people and express this as our outcome, and be clear about what this means
in measurable terms, i.e. our indicator.
All teenagers under 19 in
Tillamook County
Teens engaged in highrisk behaviour
Our goal is for young
people in this community
to stay out of trouble
Young people make smart
choices about their lives
Teenagers don’t become
pregnant
Rate of Teen Pregnancy
Rate of Teen Births
In 1990, 24 per 1,000
teenage girls aged 10 -17
became pregnant
In 1994, 7.1 pregnancies
per 1,000 teenage girls
aged 10 -17
Survey showed that girls
sexually active, but not
using birth control
Number of teenagers
completing Tillamook Teen
Parenting Programme
Many girls had older
partners
Kids don’t have anything
to do after school
The health department
puts kids on waiting list for
appointments
Parents don’t know how to
talk to their kids about sex
Schools
Women’s Crisis Centre
YMCA
School Nurses
Health Clinics
Community College
County Hospital
Churches to provide afterschool recreation
Revamp sex education
curriculum
Home visiting for teenage
parents
Mentoring Programme
Active prosecution of adult
sex offenders
Increase the number of
school nurses
Encourage abstinence
through training in refusal
skills and self esteem
Our goal is to get the
media to support an
advertising campaign
Form a teen pregnancy
partnership
Percentage of waiting
times for appointments 48
hours or less
Rate of prosecution of
adult offenders
% of teenagers completing
“Teens at Risk”
programme