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 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

13. 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

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 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.

15. In “the real world” EBP are not easy 1.Complex/diverse/extensive problems 2.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 supported 6.Expensive 7.Limited Use

16. 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

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 1.Specific program/practice 2.definable outcomes 3.measurable; and 4.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 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 into 1.Philosophy/culture 2.Common practices 3.Specific programs 4.Policy development 5.funding

20. 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)

21. 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

22. Center for Evidence-Based Practices IDOC 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 1.Survey of Community based Practices (2008-2009) Outcomes: 1.Improvements in data collection 2.Administrative changes to quarterly/final reports 3.New questions to study 2. Specific studies (2009-2010) ** 1.Outcome study of CC Practices 2.Range of Programs 3.Efficacy of Thinking for a Change 4.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 thsexton@indiana.edu