Self-sufficiency as outcome
Self-sufficiency is the ability to carry out activities of daily living independently. These activities of daily living pertain to different domains. For example, daily life requires actions to provide for an income, to remain physically and mentally healthy or to maintain a supportive social network.
Activities of living also include organizing the right help when a need arises that cannot be met by the person themselves. For example going to the GP in time in case of illness, or asking professional advice with completing a tax return.
The degree of self-sufficiency is therefore an outcome of personal characteristics, such as skills, personality and motivation and environmental characteristics, such as culture, economy and infrastructure that enable a person to provide for their own basic life needs to a greater or lesser extent.
Complex concept, simple assessment
The Self-Sufficiency Matrix – Netherlands versions (SSM-NL) has 11 domains for which the degree of self-sufficiency is assessed. These domains are closely interlinked, as they all relate to daily life, but they are defined in such a manner that they do not overlap at all or only slightly. The domains of the SSM are: Income, Day-time activities, Housing, Domestic relations, Mental health, Physical health, Addiction, Daily life skills, Social network, Community participation, and Judiciary. These are the essential and non-surplus areas that determine the effectiveness, productivity and quality of life for every adult (in Dutch society).
The 11 domains are set out in rows, tiled horizontally. The five answer options are in columns, tiled vertically. This creates a matrix with 55 cells. Criteria have been prepared for every cell that further specify the answer options for the domain under assessment and support the assessor in rating the self-sufficiency for that domain. These criteria help the user to understand what the developers mean by ‘not self-sufficient’ for the domain Income (‘inadequate income and/or spontaneous or inappropriate spending, rising debt’).
The eventual rating consists of 11 times a score between 1 and 5. The SSM enables the assessor to obtain a relatively simple and comprehensive overview of a complex concept with various and wide-ranging aspects that play an important role in the degree to which a person can lead a productive and good-quality life - self-sufficiency.
In order to understand the origins of the SSM we need to look to the United States. In the 1990s, Diana Pearce and here colleagues developed the Self-Sufficiency Standard. This consisted of a method to determine the economic or financial self-sufficiency of people. The standard was a response to the observation that some families did have an income above the official national poverty line, but could not make ends meet with this income because the costs of living varied strongly from region to region.
Virtually simultaneously with this development, there was a growing need in the US for a method that would make the outcomes of care measurable, clear and manageable. This need was met by the 'Results Oriented Management and Accountability Self-Sufficiency Taskforce (ROMA), which developed a system that made an explicit link between the outcomes of care and the efforts involved with that care. Inspired by the work of Pearce, and in line with the system as described by ROMA, the Self-Sufficiency Matrix (SSM) was developed in 2004. Instead of one (financial) dimension, the matrix consisted of a range of outcome measurements that described the situation of an individual or family in the area of self-sufficiency. By now the SSM is applied in different American States and it has many application areas in care - e.g. case management, personal feedback, policy, research).
The SSM version that is used in Utah formed the basis for the Dutch Self-Sufficiency Matrix (SSM) in 2009. The SSM was the initiative of the Amsterdam Public Health Service and is a response to the lack of tools that measure to what extent a person is able to provide for his own needs. Without the SSM, the self-sufficiency of a client was based on the (subjective) opinion of the provider and/or by using measuring tools, which are complex, time consuming and/or determine a different, albeit related, construct (e.g. the HoNOS, developed to assess mental health and social functioning). The SSM appears to meet an important need.
During the development of the SSM, the Amsterdam Public Health Service was assisted by different researchers, professionals, and policy employees from the Social Services of Amsterdam (DWI), Rotterdam Council, and a large number of employees of different institutions from mental healthcare, addiction work, social-support and probation services.