Presentation on theme: "EBP, PART 2 Community Foundation April 11, 2014. Today’s agenda An overview of what EBP is and how it all started Evidence-Based Practice vs. Evidence-Based."— Presentation transcript:
Today’s agenda An overview of what EBP is and how it all started Evidence-Based Practice vs. Evidence-Based Practices Applications to the homeless youth population Why this trend is happening, and some of the challenges facing social services
It all started in the 60s McMaster University’s school of medicine instituted problem based learning (PBL). In PBL, students got to design their curriculum based on their efforts to answer specific, client-based questions.
How did/does PBL work? A team of students and a “coach” would encounter a problem (patient has infection on thumb) They would decide what questions / issues they needed addressed to help the patient (anatomy of thumb, disease process of infection, etc….) They would direct own learning and apply learning in vivo.
Authority Evidence Because the same people (Guyatt, Sackett) constituted the “Evidence Based Medicine Working Group” and published the first big EBM article for JAMA in 1992 (November 4 th issue). This explained a new model of medical practice based on knowledge and professional autonomy.
What is EBM / EBP about? (“original” or “process” version) It is a process: 1. Ask an empirically answerable question 2. Find the best available evidence 3. Evaluate the best available evidence 4. Apply the best available evidence in conjunction with professional judgment and client values and circumstances. 5. Evaluate how things went.
Process or Programs? A decision-making process based on the three-circle model (evidence, judgment, client factors) It involves measuring the outcomes of your decisions, and using evidence (data and information) to drive program decisions Programs we think work sometimes, often referred to as: “Best Practices” “Practice Guidelines” “Empirically Supported Treatments” “Empirically Based Practices” “Evidence Based Practices*” “Manualized Interventions” Evidence-Based PracticeEvidence-Based Practices
Evidence- Based Practice (Process) Evidence- supported programs
Goals of supporting EBP Strengthening programs and organizations Achieving mission Measuring outcomes for CQI Creating a “bank” or “library” of good program ideas SAMHSA resource
Let’s look at a few EBPs… You may have heard of: Housing First Assertive Outreach (street work) Critical Time Intervention (CTI) Motivational Interviewing Trauma-focused CBT
EBP and homeless youth We are just beginning to understand the population There are “promising practices” and evidence- supported treatments (like trauma-focused CBT) The evidence on programs and interventions for this population is sorely lacking
Applying the EBP process: One example Trauma Trauma- informed care
Why do people (feds?) care so much about EBP? Reduces inappropriate/potentially harmful care, increases quality of care Helps consumers make more informed decisions Assists third-party payers in utilization review, performance rating, and reimbursement decisions Fulfills professional obligations to accountability and monitoring client progress
Roadblocks to EBPs in social services Economics: the R&D problemInfrastructure and funding mechanisms The problem of “treatment effects” (fancy name for common problems) Specific treatment effects: change due to the program in particular Nonspecific treatment effects: changes which occur across all programs or interventions Relationship effects, client motivation, therapist ability
Enter SIF (and other EBP initiatives) Find out WHAT IS WORKING around the country by measuring outcomes Compare outcomes across programs, and replicate successful programs in areas of high need Allow every community the opportunity for high-quality programming that delivers results
Moving forward Is Reno delivering programs that might be worth replicating? If yes, our job is to highlight and measure the outcomes we’re achieving Remember: we get to choose the outcomes we’re measuring – we can create our own yard stick Is Reno willing to be the testing ground for innovative programming? Reno is a perfectly-sized geographic area for trying new programs. The culture here is conducive to creative approaches
What if the evidence isn’t good? Outcome findings are not good or bad, just useful or not useful. SIF doesn’t need communities that are doing everything perfectly – they need communities willing to try new approaches and measure outcomes with integrity.
What is needed Strong, creative programs Sustainable resources for outcome measurement Creative ways of measuring program outcomes Programming and a service delivery culture that takes outcomes into account
Nationally identified areas of program need for homeless youth Improved crisis response - outreach and emergency shelter Family reunification support (for under-18s) Expand the reach and effectiveness of TLPs Ensure programs are accepting and inviting to LGBTQ youth Improve data collection (including needs assessments) and performance measurement
The scope of the problem, nationally Data on youth homelessness
Current evidence on RHY: National scope of the problem One in five youth (under 18) will run from home, estimates suggest there are 1.7 homeless youth (under 18) in the United States. 99% of runaways return home. 50% of longer-term homeless youth were kicked out by their parents. 11-36% of foster youth aging out will become homeless More than 380,000 youth under 18 remain homeless for more than one month Only 50,000 youth receive homeless services each year
Young adults 18-24 (being served by the adult system)
Where do we find homeless youth? Streets Shelters, drop-in centers School Work Staying with friends and relatives Moving around the country
Why do they leave home? Multiple foster care placements Family conflict Abuse or neglect Parental mental health issues Parental substance abuse Youth substance dependence
What are their stories? Statistics for youth accessing services: 21-53% have been in foster care 46-75% have been physically abused by family 60% of girls and 23% of boys had been sexually abused. As many as 40% of homeless youth self-identify as lesbian, gay, bisexual, or transgendered Two thirds of homeless youth have diagnosable mental health issues RHY experience rape and assault rates 2 to 3 times higher than the general population of youth. More than one third of homeless youth engage in survival sex (swapping sex for food, shelter, drugs, or cash).
More sobering statistics: Homeless youth are 3 times more likely to use marijuana and 18 times more likely to use crack cocaine than non-homeless youth About 50% of street youth have had a pregnancy experience compared to about 33% living in shelters, and fewer than 10% of housed youth Runaway youth are 6 to 12 times more likely to become infected with HIV than other youth
Social services for under-18 RHY Child welfare Family court Federally-funded alternative programs for runaway and homeless youth (RHY): Basic Centers (shelters) Transitional Living Programs (18-21) Street Outreach Programs (12-24) Other shelters and outreach programs
Services for 18+ homeless youth Transitional Living Programs Adult homeless services, including supportive & low- income housing Specialized 18-24 emergency shelters Drop-in centers Harm reduction