evidence-based practices in community settings thomas l. sexton, ph. d., abpp center for adolescent...

Evidence-based Practices in Community Settings

Thomas L. Sexton, Ph. D., ABPPCenter for Adolescent and Family Studies

Indiana University-Bloomington

Center for Evidence-Based Practices Learning Institute

May 26 & 27, 2010Bloomington, Indiana

Introduction

• Evidence based practices have become part of our common language

• Education• Medicine• Psychology• and…everything else

• Evidence-based practice is a philosophical approach that is in opposition to rules of thumb, folklore, and tradition (the way it has always been done)

• EBM aims for the ideal that professional should make “conscientious, explicit, and judicious use of current best evidence in every day practice

The Promise of Evidence Based Practices

• In all domains EBP promised:• Improved outcomes• Cost savings• Increased accountability• Development of new programs to

meet new needs

• That promise can only be realized if EBP work in community based settings….”in real practice”

The Decade of EBP

• It has been a decade of EBP– Lists of practices (mental health, medicine, education)

• U. S.. National Registry of Evidence-Based Practices and Programs (NREPP)

– Centers/Web sites – EBP implemented in numerous communities and now

having an impact on training, practice, and funding– Washington State---EBP only for Juvenile

programs– Oregon-EBP only ones paid for by State– Individual agencies who have EBP for each of

their major areas– Large systems that adopted the goal/aspiration

of EBP

EBP in Justice &Community Corrections

• 1990 the Surgeon General declared, “nothing works”

• Findings its place in community corrections• Specific Programs/Practices (most for Juveniles)• National Institutes for Corrections (NIC)

– 8 principles of evidence based community corrections

• Crime and Justice Institute & NIC– “Box Set” series of white papers share information with

criminal justice system stakeholders about how the implementation of evidence-based practices (EBP) and a focus on recidivism reduction affect their areas of expertise in pretrial services, judiciary, prosecution, defense, jail, prison, and treatment.

Success of EBP

• Millions of youth, adults, and families helped in ways that:

• Worked, over time, in a way that fit them• Help them become productive citizens• Reduced community risk• Improved functioning for next

generations (through families)• Saved money….

• Washington State Institute for Public Policy

EVIDENCE-BASED PUBLIC POLICY OPTIONS TO REDUCE FUTURE PRISON CONSTRUCTION, CRIMINAL JUSTICE COSTS, AND CRIME RATES

Know what might work

• We know more of what does and does not work based on using “evidence”

• Adults on Parole/Probation

• Vocational Education in Prison$13,738

• General Education in Prison $10,669• Electronic Monitoring (to reduce time)

$4,359• Sex offender treatment in prison

$870• Intensive Supervision $-3,328

Know what might work

• Juvenile & Adults Prevention Programs

• Juvenile Drug Courts$4,622

• FFT $31,821• Juvenile Intensive Supervision $-

1,201• Counseling Psychotherapy $-

14,667

The “Reality” of EBP

• Despite the use, awareness, and implementation…EBP have along way to go…..

• Confusing terms…..in what they are?• What it takes to successfully implement,

sustain, and integrate EBP into the community system

• And….it is more complex when moved to community settings

• Not everything works, is cost effective, can be implemented

Evidence-based Practices in Community Settings

• However…..what works in the lab doesn’t always work in the community– 50% reduction in ES– Few programs last beyond the “grant” period– Few programs are adapted and integrated into

the system– Many practices/Programs that are “business as

usual” go unaddressed– Really don’t know what is happening in

implementation/outcome

Goals of this Presentation

1. Expand the meaning of EBP…to one that fits community settings

2. Present an “integrated” approach to EBP in community settings. One that fits….• Programs• General practices• Organizational philosophy• Evidence-based Systems

3. Give some examples of how the CEBP is helping accomplish these goals

4. Next steps of CEBP in moving this integrated model forward

Evidence-based Practices in Community Settings

in the “real world”

What are they?What is necessary for them to work?

Adopting an Integrated Evidence-Based System of Community Corrections

Evidence-Based Practices/Programs

An evidence-based program:“a specific program that has

demonstrated the probability of success with clients/problems for which it was designed”

For a program to be considered evidence-based it must demonstrate relevant outcomes in:– scientific (clinical trial) and clinical relevant

(community effectiveness) situations,

– transportability to practitioners (replicable beyond model/intervention developers),

– applicable to diverse clients and therapists.

In “the real world” EBP are not easy

1. Complex/diverse/extensive problems2. Require systems not just programs…being

evidence based means….• Philosophy• Common practices• Specific programs• Quality improvement practices (ongoing data monitoring)

3. Little ongoing data monitoring– What goes on in a study…constant monitoring

4. Every new practice/program requires adaptation– Question is how…..using data to see is best (not just comfort)– Starting a EBP is not end…just beginning

5. EBP are not always funded and supported6. Expensive7. Limited Use

EBP work in Community Settings

What we have learned

• What is emerging is an idea that definition/meaning of EBT needs to be expanded

• Move away from the idea of “programs” that “work”

• Focus on “evidence based systems” with:– Programs that fit local need– Core practices that accomplish certain needed

outcomes– Ongoing monitoring/evaluation for quality

improvement– Systematic Program/system adaptation

Confusing Terms• Best practice

– Best practices are often based on the collective experience and wisdom of the field rather scientifically tested knowledge.

– Do not necessarily imply attention to outcomes, evidence, or measurable standards.

• What works– What works implies linkage to general outcomes,

but does not specify the kind of outcomes desired (e.g. just desserts, deterrence, organizational efficiency, rehabilitation, etc.).

Terms…

• Evidence based practice1. Specific program/practice2. definable outcomes3. measurable; and4. defined according to practical

realities (recidivism, victim satisfaction, etc.).

• Terms are different…imply different levels of specificity• Different levels of outcome, cost

effectiveness

Community Based Definition of EBP

1. EBP Philosophy• a questioning approach to practice leading to scientific

experimentation• System of continuous quality improvement

2. Continuous measurement/monitoring/feedback• meticulous observation, enumeration, and analysis

replacing anecdotal case description

3. Practices that reliably produce desired outcomes

4. Integrated into1. Philosophy/culture2. Common practices3. Specific programs4. Policy development5. funding

5. Attention to Systematic Implementation

6. CQI culture– Require ongoing data monitoring– Systematic Adaptation– Ongoing program evaluation

7. Supported by necessary resources– Research help/guidance– Technical Assistance (finding information, gaining

resources etc)

Evidence-Based Practices

Adaptation

8. Policy and Funding Support/encouragement/support – Not for existing (business as usual) but for

demonstrating, adapting, having a CQI culture

9. Local Adaptation & Local Ownership– EBP It recognizes that care is individualized

and ever changing and involves uncertainties and probabilities

– Program “owned” by the community

Center for Evidence-Based Practices

IDOC and IU

Bringing EBP into the “real world”

Goal of the CEBP

• EBP Technical Assistance Center– to provide on going community based technical assistance

to help local communities move toward evidence based practices

• Independent Research & Evaluation Center:– To identify Current practices, capacity and needs for

different EBP– outcome of outcomes of community-based services– Determine the cost effectiveness of Community based

Services

• Advisory Board:– Community Corrections Directors– IDOC– CAFS

Research Institute

1. Survey of Community based Practices (2008-2009)

Outcomes:

1. Improvements in data collection2. Administrative changes to quarterly/final

reports3. New questions to study

2. Specific studies (2009-2010) **1. Outcome study of CC Practices2. Range of Programs 3. Efficacy of Thinking for a Change4. Range of Juvenile Programing

CEBP Technical Assistance Center

• Provide aid to Communities/IDOC to help realize the goal of an EBP “System”

• Essential if Communities are going to move beyond “business as usual”

• Accomplishments:– CEBP Learning Institutes– EBP Information Clearing House **

• What’s next:• Learning Modules (Web based training)• Local TA

Technical Assistance

• Information to communities (to make decisions they need to make):

• CEBP information clearing house• Implementation (FFT in Howard, Adult FFT in

Monroe County)• Learning Institutes (this conference)

Goal:– Match needs with practices (that work)– Identify/implement new programs– Adapt/adjust existing program– Make policy/funding decisions

• Contact Information:– Thomas L. Sexton, Ph. D, ABPP– thsexton@indiana.edu