Transcript Advancing Evidence Based Practice

Objectives of Today’s Workshop
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Define EBP
Review levels of evidence
Review of EBP proprietary and generic
programs
State of EBP in Ohio
Issues in EBP
What is Evidence-based Practice?
(1) practices or programs that have been
judged effective based on rigorous,
scientific evaluations;
and
(2) a process for insuring that an individual or
group of individuals gets the best
possible intervention, service, or support
based on an assessment of needs,
preferences, and available options (U.S.
DHHS)
‘Evidence-based practice cannot deliver
certainties, just increase probabilities, and
this is the most that any approach
claiming to be ‘evidence-based’ can hope
to achieve.’
(Newman et al 2005, pp.5)
Evidence-Based Practice
Uses scientific principles to assess the available
evidence regarding program effectiveness, and
develops principles for best practice in any
particular field;
As opposed to practice based on
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Experience
Unproven Theory
Draws Upon Experience in
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Law:
rules for assessing evidence
Engineering:
codes & standards
Public Health:
risk factors
Medicine:
treatment decisions
Education:
programs and org
Ratings for consumer products (i.e. Consumers’
Report, Car and Driver, Gearhead, etc.)
Benefits of EBP
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Reducing crime
Saving money
Changing lives
Restoring dignity
Advancing integrity and professionalism
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What EBPs have to offer
Proven effectiveness
Criminal justice cost savings
Blueprint
----------MAYBE ---------------------------
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Implementing experience - coaching
Fidelity measures
Outcome tracking and reporting
An Important Qualification
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Proven programs all require substantial training,
ongoing quality assurance & monitoring
They only work when implemented with a high
degree of fidelity
Proven programs account for only a small
percentage of the treatment & rehabilitation
market
Evidence Based Practice
Begins With A Basic
Logic Model
A Situation
Inputs
Outputs
Outcomes
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Problem
Short Medium Long Term
Need
Crisis
Continuum of EBP
Demonstrated
Ability to Replicate
Demonstrated
Impact
Promising
Findings
Evidence
Informed
Research
Informed
Outcomes are
consistent across
replications
Evaluations show better outcomes
for participants than for a matched
comparison or control group
Evaluations show positive outcomes for participants
--e.g. pre- and post-program evaluations
The intervention design is based on research evidence about
effective practice in this area – e.g. meta-analyses of effective
interventions
A strong logic model ties the proposed intervention to what research tells us about how to
impact child and family outcomes
Example: One component of a comprehensive
parent education and support initiative
Situation: During a county needs assessment, majority of parents
reported that they were having difficulty parenting and felt
stressed as a result
INPUTS
OUTPUTS
Parents
increase
knowledge of
child dev
Develop
parented
curriculum
Staff
Money
Deliver series of
interactive
sessions
Partners
Research
Facilitate
support groups
Assumptions:
OUTCOMES
Target
parents
attend
Parents better
understanding
their own
parenting
style
Parents gain
skills in
effective
parenting
practices
Parents
identify
appropriate
actions to
take
Parents use
effective
parenting
practices
External factors:
Improved
childparent
relations
Strong
families
A Review of Top Tier
Proprietary EBP And
Generic Models
Top Rated Proven Program Models
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Functional Family Therapy (FFT)
Multisystemic Therapy (MST)
Multidimensional Treatment Foster Care (MTFC)
Nurse Family Partnership
Life Skills Training (LST): The Incredible Years; PATHS
Midwestern Prevention Project; Project Toward No Drug Abuse
Big Brothers Big Sisters: Olweus Bullying Prevention
Three of the Most Effective
Evidence-Based Approaches:
$90,000
$80,000
Benefits to Crime
Victims and
Taxpayers
$70,000
Program Costs
$60,000
$50,000
Benefits Minus Costs
Per Participant
$40,000
$30,000
$20,000
$10,000
$0
MTFC
FFT
MST
According to Washington State
Institute of Public Policy
Evidence-Based Practices Versus
Common Alternatives:
Benefits to Taxpayers Minus Costs Per Participant
$100,000
MTFC
$80,000
$60,000
$40,000
FFT
MST
$20,000
Intensive
Probation
Intensive
Parole
Scared
Straight
$0
-$20,000
Program Type
According to Washington State
Institute of Public Policy
Family Functional Therapy (FFT)
Program:
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An Empirically grounded, well-documented, and highly
successful family intervention for juvenile offenders.
Utilizes clinicians in a specific three phase model to engage
youth, motivate change, and create change in youths’
behavior.
Method:
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Intervention ranges from 8-30 one hour direct service
sessions with youth and family.
Family Functional Therapy
Accreditations:
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High rates of effectiveness documented by:
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Washington State Institute for Public Policy
Centers for Disease Control
US Surgeon General’s Report on Youth Violence
Office of Juvenile Justice and Delinquency Prevention (US DOJ)
Center for Substance Abuse Prevention
Blueprints (Center for the Study and Prevention of Violence at
University of Colorado)
Multisystemic Therapy (MST)
Program:
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An individualized approach that targets those factors in each
youth’s life that contribute to anti-social behavior.
MST interventions focus on caregiver discipline practices,
youth associations, improving school performance, and the
development of an indigenous support network.
Method:
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The program requires 3-5 hours of face-to-face contact each
week and typically lasts for 3-5 months.
MST Accreditations:
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High rates of effectiveness documented by:
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Washington State Institute for Public Policy
National Institute for Drug Addiction
Center for Substance Abuse Treatment
National Association of State Mental Health Program Directors
Office of Juvenile Justice and Delinquency Prevention (US DOJ)
Blueprints (Center for the Study and Prevention of Violence at
University of Colorado)
Multidimensional Treatment
Foster Care (MTFC)
Program:
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MTFC addresses chronic antisocial behavior, delinquency,
chronic and severe criminal behavior.
The MTFC model requires recruitment, training, and close
supervision of community families who provide treatment
and intensive supervision at home, in school, and in the
community.
Method:
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Live-in treatment with a trained foster family for 6-9+months.
MTFC Accreditations:
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High rates of effectiveness documented by:
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Washington State Institute for Public Policy
Blueprints (Center for the Study and Prevention of Violence at
University of Colorado)
Numerous peer reviewed research reports
Promising Programs
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Behavioral Monitoring and Reinforcement
Brief Strategic Family Therapy (BSFT)
FAST Track
Good Behavior Game (GBG)
Guiding Good Choices (GGC)
I Can Problem Solve (ICPS)
Linking the Interests of Families
Teachers Triple P-Positive Parenting Program
Perry Preschool Project
Generic Models from Meta-Analysis
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Cognitive Behavioral Therapy
Behavioral programs
Counseling/Psychotherapy
Pre-K education for low-income families
Teen Court
Family Counseling
Social skills training
Challenge programs
Programs & Strategies That
Do Not Work
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D.A.R.E
Scared Straight
Working with at-risk youth in groups
Standard probation supervision
Punishment
Waiver to Adult Court
The State of
Evidence Based Practice
In Ohio
1. Ohio’s Coordinating Centers of Excellence (CCOEs)
 Established by ODMH
 Includes Ohio Universities, consumer groups, local agencies
 They include:
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Supported Employment – Case Western Reserve
Wellness Management & Recovery – Southeast, Inc., University of
Toledo, and Lorain County MHB
Integrated Dual Disorder Treatment – SA/MI Focus – Case Western
Reserve
Center for Innovative Practice – Kent State
Mental Illness/Developmental Disabilities – Wright State
Criminal Justice – Summit County ADAMH Board and Northeastern Ohio
University’s College of Medicine
2. Ohio Behavioral Health Juvenile Justice Program
 Joint effort between ODYS and ODMH
 Lucas, Summit, Cuyahoga, Franklin, Montgomery, and Hamilton
Counties
 J J Youth with serious behavioral issues
 Focus and employing EBP
 Case Western Reserve is evaluator
Advancing EBP in
Ohio Juvenile Justice
Targeted Reclaim
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Funding Metro Counties to employ EBP
H.B. 86 – Ohio’s sentencing reform bill
• Effective September 30, 2011
• Explicitly supports EBP
• Restores judicial discretion
S.H. vs. Stickrath (now Reed)
• Closed four institutions
• 50% population cut since 2008
• Invested $57 million in targeted reclaim & BHJJ
• Increases EBP
EBP and Sex Offender Registration and
Notification Act (SORNA) of Adam Walsh Act
Adam Walsh Act
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A politically popular but wrong headed
strategy
Requires sex offender registration based on
offense – not risk
Research now proves that 97-99% of youthful sex
offenders never commit another sex offense
Actually decreases public safety
AND NOW:
• States are refusing to comply
• Ohio does not comply fully
EBP Resources:
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Campbell & Cochrane Collaboration Reviews
NREPP (SAMHSA)
Blueprints
CrimeSolutions
ChildTrends LINKS
Harvard Family Research Project
CA What Works Clearinghouse
National Child Traumatic Stress Network
Controversy in EBP
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The great Mark Lipsey
Community –defined evidence
Push Back to developers
DMC (At the heart of Juvenile Justice Reform)