THE USE OF FORMULATIVE EVALUATION TO ASSESS INTEGRATED SERVICES FOR CHILDREN - THE ROBERT-WOOD-JOHNSON-FOUNDATION CHILD HEALTH INITIATIVE

This article describes the use of formative evaluation in assessing th e feasibility of implementing a new service integration effort. The Ch ild Health Initiative, a nine-site, national demonstration project fun ded in 1991 by the Robert Wood Johnson Foundation, sought to implement systemic change through the creation of new mechanisms for spending s ervice dollars more flexibly at the local sire. The Child Health Initi ative called for developing local child health-monitoring systems, a c are coordination mechanism and a program for decategorizing the myriad of restrictive categorical public programs serving children. Most dem onstration communities experienced some degree of success in achieving the first two components, but none,cas able to implement decategoriza tion during the 3- to 5-year funding period Key lessons for evaluators include the need for (a) a flexible evaluation design that can sequen tially adopt to changes in program implementation, (b) repeated longit udinal data collection measures to document changes over time, (c) avo idance of a premature focus on program outcomes, and (d) methods to es tablish attribution of outcomes.