Evidence-based Practices in Community Settings Thomas L. Sexton, Ph. D., ABPP Center for Adolescent and Family Studies I

1. Evidence-based Practices in Community Settings Thomas L. Sexton, Ph. D., ABPP Center for Adolescent and Family Studies Indiana University-Bloomington Center for Evidence-Based Practices Learning Institute May 26 & 27, 2010 Bloomington, Indiana

2. 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

3. 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”

4. 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

5. 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.

6. 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….

7. Washington State Institute for Public Policy EVIDENCE-BASED PUBLIC POLICY OPTIONS TO REDUCE FUTURE PRISON CONSTRUCTION, CRIMINAL JUSTICE COSTS, AND CRIME RATES

8. 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

9. 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

10. 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

11. 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

12. Goals of this Presentation • Expand the meaning of EBP…to one that fits community settings • Present an “integrated” approach to EBP in community settings. One that fits…. • Programs • General practices • Organizational philosophy • Evidence-based Systems • Give some examples of how the CEBP is helping accomplish these goals • Next steps of CEBP in moving this integrated model forward

13. Evidence-based Practices in Community Settingsin the “real world” What are they? What is necessary for them to work? Adopting an Integrated Evidence-Based System of Community Corrections

14. 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 demonstraterelevant 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.

15. In “the real world” EBP are not easy • Complex/diverse/extensive problems • Require systems not just programs…being evidence based means…. • Philosophy • Common practices • Specific programs • Quality improvement practices (ongoing data monitoring) • Little ongoing data monitoring • What goes on in a study…constant monitoring • 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 • EBP are not always funded and supported • Expensive • Limited Use

16. EBP work in Community SettingsWhat 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

17. 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.).

18. Terms… • Evidence based practice • Specific program/practice • definable outcomes • measurable; and • defined according to practical realities (recidivism, victim satisfaction, etc.). • Terms are different…imply different levels of specificity • Different levels of outcome, cost effectiveness

19. Community Based Definition of EBP • EBP Philosophy • a questioning approach to practice leading to scientific experimentation • System of continuous quality improvement • Continuous measurement/monitoring/feedback • meticulous observation, enumeration, and analysis replacing anecdotal case description • Practices that reliably produce desired outcomes • Integrated into • Philosophy/culture • Common practices • Specific programs • Policy development • funding

20. Attention to Systematic Implementation 6. CQI culture • Require ongoing data monitoring • Systematic Adaptation • Ongoing program evaluation • Supported by necessary resources • Research help/guidance • Technical Assistance (finding information, gaining resources etc)

21. Evidence-Based PracticesAdaptation 8. Policy and Funding Support/encouragement/support • Not for existing (business as usual) but for demonstrating, adapting, having a CQI culture • Local Adaptation & Local Ownership • EBP It recognizes that care is individualized and ever changing and involves uncertainties and probabilities • Program “owned” by the community

22. Center for Evidence-Based PracticesIDOC and IU Bringing EBP into the “real world”

23. 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

24. Research Institute • Survey of Community based Practices (2008-2009) Outcomes: • Improvements in data collection • Administrative changes to quarterly/final reports • New questions to study 2. Specific studies (2009-2010) ** • Outcome study of CC Practices • Range of Programs • Efficacy of Thinking for a Change • Range of Juvenile Programing

25. 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

26. 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

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