Advancing

Evidence Based

Practice

Objectives of Today’s Workshop

• 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• Experience• Unproven Theory

Draws Upon Experience in • 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• Reducing crime• Saving money• Changing lives• Restoring dignity• Advancing integrity and professionalism

What EBPs have to offer

• Proven effectiveness• Criminal justice cost savings• Blueprint----------MAYBE ---------------------------• Implementing experience - coaching• Fidelity measures• Outcome tracking and reporting

An Important Qualification• 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_____________________________________________________Problem Short Medium Long Term

Need Crisis

Continuum of EBPDemonstrated Ability to

Replicate

Demonstrated Outcomes are

Impact consistent across

replications

Promising Evaluations show better outcomes

Findings for participants than for a matched comparison or control group

Evidence Evaluations show positive outcomes for participants

Informed --e.g. pre- and post-program evaluations

Research The intervention design is based on research evidence about Informed 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

Assumptions: External

factors:

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 OUTCOMES

Staff

Money

Partners

Research

Develop parented

curriculum

Deliver series of interactive

sessions

Facilitate support groups

Target parents attend

Parents increase

knowledge of child dev

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

Improved child-parent

relations

Strong families

A Review of Top Tier Proprietary EBP And

Generic Models

Top Rated Proven Program Models

• Functional Family Therapy (FFT)• Multisystemic Therapy (MST)• Multidimensional Treatment Foster Care

(MTFC)• Nurse Family Partnership

Life Skills Training (LST): The Incredible Years; PATHSMidwestern Prevention Project; Project Toward No Drug AbuseBig Brothers Big Sisters: Olweus Bullying Prevention

Three of the Most Effective Evidence-Based Approaches:

MTFC FFT MST$0

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

$70,000

$80,000

$90,000

Benefits to Crime Victims and Tax-payers

Program Costs

Benefits Minus Costs Per Participant

According to Washington State Institute of Public Policy

Evidence-Based Practices Versus Common Alternatives:

-$20,000

$0

$20,000

$40,000

$60,000

$80,000

$100,000Benefits to Taxpayers Minus Costs Per Participant

Program Type

Scared Straight

Intensive Parole

Intensive Proba-tion

MST

FFT

MTFC

According to Washington State Institute of Public Policy

Family Functional Therapy (FFT)

Program:• 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:• Intervention ranges from 8-30 one hour direct service

sessions with youth and family.

Family Functional Therapy Accreditations:

• High rates of effectiveness documented by:• 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:• 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:• The program requires 3-5 hours of face-to-face

contact each week and typically lasts for 3-5 months.

MST Accreditations:

• High rates of effectiveness documented by:• 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:• 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:• Live-in treatment with a trained foster family for 6-

9+months.

MTFC Accreditations:

• High rates of effectiveness documented by:• 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

• 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

• 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

• 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

PracticeIn Ohio

1.Ohio’s Coordinating Centers of Excellence (CCOEs)

Established by ODMHIncludes Ohio Universities, consumer groups, local agenciesThey include:• 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• 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

• 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:

• 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

• The great Mark Lipsey

• Community –defined evidence

• Push Back to developers

• DMC (At the heart of Juvenile Justice Reform)