1. National Policy Making and Evidence Jack Habib Myers-JDC Brookdale Institute "Haruv" Institute National Conference on Evidence Based Practice May 27, 2010 1

2. Evidence - key questions What kinds of decisions? About what? What kind of evidence? Narrow or braod? Prior to programmatic decisions, or part of the process of implementation? Realistic or unrealistic expectations? Real or going through the motions? 2

3. What is unique to policy vs practice? Key policy assumptions in Israeli reforms: *More community relative to out of home services. *Inter-organizational pooling of resources and collaborative planning *Decentralization of resource decisions to local level *Multi-year data based planning *Collaborative case identification and care planning *Monitoring of outcomes 3

4. Is evidence enough to ensure success? 4

5. Issues not fully addressed in classic paradigm Availability of random sampling in policy context as opposed to field interventions Statistical significance vs. substantive significance The cost of achieving the outcomes Need to reinvent and not only duplicate 5

6. Need to balance Emphasis on encouraging use of evidence vs avoiding unrealistic expectations Focus on outcomes vs implementation Evidence prior to action vs evidence gained as we act Evidence based on random sampling vs other forms of evidence In any case: better policy depends on strengthening the evidence base 6

7. Two Paradigms Prior experiments Random sampling Focus on outcomes Basis for action Duplicate the experimental program Best available prior evidence Outcomes / Implementation / Dissemination Reinvent Ongoing accumulation of evidence while acting Ongoing reinvention 7