Discussion: Characteristics, Challenges, and Opportunities of Evidence-Based Design
Consider the following quotation: “Often times, potential users of research knowledge are unconnected to those who do the research, and consequently a huge gap ensues between research knowledge and practice behaviors” (Barwick, M., Boudell, K., Stasiulis, E., Ferguson, H., Blase, K., & Fixsen, D., 2005). Social workers must work to close the gap perceived by the authors of this quote.
In your previous research course, you addressed the concept of evidence-based practice. However, it is important not to fall into a habit of using the term “evidence-based practice” without a clear understanding of its meaning. In particular, it is important to understand what standards of evidence must exist to classify an intervention or a program as evidence based. In this assignment, you are to clarify your understanding of the nature of evidence-based practice and analyze the challenges and opportunities for implementing evidence-based practice in your current social work practice.
To prepare for this Discussion, read the Learning Resources that provide information about different aspects of the evidence-based practice concept. As you read, consider how evidence-based practice or evidence- based programs might be used in a social work agency where you work or where you had a practicum experience.
https://www.socialworkers.org/News/Research-Data/Social-Work-Policy-Research/Evidence-Based-Practice
By Day 3
Post a description of the distinguishing characteristics of evidenced-based practice. Then provide an evaluation of factors that might support or impede your efforts in adopting evidence-based practice or evidence-based programs.
In recent years, there has been increased pressure from funding agencies and
federal, state and local governments for greater effectiveness and accountability
of prevention and intervention programs. This rising demand for program
quality, and evidence of that quality, has fueled a growing interest in evidence‐
based programs (EBPs). However, there remains some confusion about what
constitutes an EBP, whether some EBPs are better than others, and the advantages
and disadvantages of implementing EBPs. In this Research to Practice brief, we
provide an overview of what it means for a program to be evidence‐based, discuss
the advantages and disadvantages of implementing EBPs, and point readers in the
direction of resources to help locate these programs and learn more about them.
What are evidence‐based programs?
A growing body of research in the social and behavioral sciences has demonstrated that
certain approaches and strategies for working with youth and their families can positively
impact important social problems such as delinquency, teen pregnancy, substance abuse and
family violence. Many of these effective approaches and strategies have been packaged into
programs targeting outcomes specific to individuals, schools, families, and communities.
Those programs that have been found to be effective based on the results of rigorous evaluations
are often called “evidence‐based.”
WHAT WORKS, WISCONSIN – RESEARCH TO PRACTICE SERIES
Evidence‐based programs:
An overview
ISSUE #6, OCTOBER 2007
BY SIOBHAN M. COONEY, MARY HUSER,
STEPHEN SMALL, AND CAILIN O’CONNOR
University of Wisconsin–Madison and University of Wisconsin–Extension
Evidence‐based programs: An overview 2
What Works, Wisconsin – Research to Practice Series, #6
The importance of rigorous evaluation
A rigorous evaluation typically involves either an
experimental design (like that used in randomized
controlled trials) or a quasi‐experimental design. In an
experimental design, people are randomly assigned to either
the treatment group, which participates in the program, or
the control group, which does not. After the program is
completed, the outcomes of these two groups are
compared. This type of research design helps ensure that
any observed differences in outcomes between the two
groups are the result of the program and not other factors.
Given that randomization is not always possible, a quasi‐
experimental design is sometimes used. In evaluations using
this design, the program participants are compared to a
group of people similar in many ways to the program
participants. However, because a quasi‐experimental
design does not randomly assign participants to program
and non‐program groups, it is not as strong a design as the
experimental approach. Because there may be unobserved
differences between the two groups of people who are
being compared, this design does not allow program
evaluators to conclude with the same certainty that the
program itself was responsible for the impacts observed.
Most programs have evaluation evidence from less
rigorous studies. Evaluations that do not include any type
of comparison group, for example, do not allow for any
conclusions to be made about whether the changes seen in
program participants are related to or caused by the
program. These studies sometimes show the promise of
positive results, but they do not allow the program to be
classified as evidence‐based. Programs with evidence from
less rigorous studies are often referred to as “promising”
programs.
An important element of EBPs is that they have
been evaluated rigorously in experimental or
quasi‐experimental studies (see box on this
page).
Not only are the results of these evaluations
important, but it is also essential that the
evaluations themselves have been subjected to
critical peer review. That is, experts in the field
– not just the people who developed and
evaluated the program – have examined the
evaluation’s methods and agreed with its
conclusions about the program’s effects. Thus,
EBPs often have evaluation findings published
in peer‐reviewed scientific journals.
When a program has sufficient peer‐
reviewed, empirical evidence for its
effectiveness, its developer will typi‐
cally submit it to certain federal
agencies and respected research
organizations for consideration. These
organizations “certify” or “endorse”
programs by including them in their
official lists of effective programs.
This lets others in the field know the
program meets certain standards of
effectiveness. (See Appendix A for
examples of these organizations.)
Simply put, a program is judged to be
evidence‐based if (a) evaluation re‐
search shows that the program pro‐
duces the expected positive results;
(b) the results can be attributed to the
program itself, rather than to other
extraneous factors or events; (c) the
evaluation is peer‐reviewed by
experts in the field; and (d) the
program is “endorsed” by a federal
agency or respected research
organization and included in their list
of effective programs.
Given this definition of an EBP, it is
important to distinguish the term
“evidence‐based” from “research‐
based.” Consider our earlier
description of how most, if not all,
EBPs were developed based on years
of scientific research on what program
components, such as content and
activities, are likely to work for youth
Evidence‐based programs: An overview 3
What Works, Wisconsin – Research to Practice Series, #6
and families. Because EBPs contain program
components with solid empirical bases, they can
safely be called “research‐based” programs.
However, the reverse is not true. Not all, or
even the majority, of research‐based programs
fit the definition of an EBP. Just because a
program contains research‐based content or was
guided by research‐based information, doesn’t
mean it has been proven effective. Unless it also
has scientific evidence that it works, it is
incorrect to call it “evidence‐based.”
Are some evidence‐based
programs better than others?
Programs that meet the definition of evidence‐
based are not all similarly effective or equally
likely to work in a given community.
For example, some EBPs have been evaluated
rigorously in several large‐scale evaluations that
follow participants for a long period of time.
Others have only undergone one or two less
rigorous evaluations (for example, those using
the quasi‐experimental design described on
page 2). Those programs that are shown to be
effective multiple times in experimental studies
are generally considered to be of a higher
standard.
Furthermore, many EBPs have been
successfully replicated and evaluated in a
variety of settings with a range of different
audiences. Others have only been evaluated
with a particular audience in a certain
geographical area, for example. When a
program has been shown to be effective in
different settings and with different audiences,
it is more likely that it will be effective when
implemented elsewhere.
Finally, EBPs can vary in the strength of their
effects. For example, one program may have
evidence that it reduces delinquent acts in its
participants by 10 percent over the subsequent
year, while another program has evidence of
reducing delinquency by 20 or 25 percent.
Generally, those programs that consistently pro‐
duce a greater effect than other programs are
thought to be better programs.
Thus, the level of evidence for effectiveness
varies across programs, and practitioners must
use a critical eye when judging where on the
continuum of effectiveness a program lies.
Advantages of evidence‐based
programs
There are numerous merits to adopting and
implementing EBPs. First, utilizing an EBP in‐
creases the odds that the program will work as
intended and that the public good will be
enhanced. There is also greater efficiency in
using limited resources on what has been proven
to work as compared to what people think will
work or what has traditionally been done.
Instead of putting resources toward program
development, organizations can select from the
growing number of EBPs, which are not only
known to be effective but also often offer well‐
packaged program materials, staff training, and
technical assistance. Using EBPs where
appropriate can thus be viewed as a responsible
and thoughtful use of limited resources.
The proven effectiveness that underlies EBPs
can help secure resources and support from
funding agencies and other stakeholders, such
as policy makers, community leaders, and
members of the targeted population.
Increasingly, funders and policy makers are
recommending, if not requiring, that EBPs be
used to qualify for their financial support.
Additionally, the demonstrated effectiveness of
these programs can facilitate community buy‐in
Evidence‐based programs: An overview 4
What Works, Wisconsin – Research to Practice Series, #6
and the recruitment and retention of program
participants.
A final benefit of EBPs is that they may have
cost‐benefit information available. This type of
information helps to convey the potential eco‐
nomic savings that can accrue when funds are
invested in a program. Cost‐benefit information
can be very influential in an era where
accountability and economic factors often drive
public policy and funding decisions.
Disadvantages of evidence‐based
programs
Despite the numerous advantages of EBPs,
there are some limitations that are important to
consider. A major constraint is the financial
resources needed to adopt and implement them.
Most EBPs are developed, copyrighted, and
sold at rather substantial costs. Program
designers often require that organizations
purchase curricula and other specially
developed program materials, that staff attend
specialized training, and that program
facilitators hold certain degrees or certifications.
Furthermore, EBPs are often intended to be im‐
plemented exactly as designed, allowing little
room for local adaptation.
Finally, organizations sometimes find that there
are few or no EBPs that are both well‐suited to
meet the needs of targeted audiences and
appropriate for their organization and local
community setting. This situation is especially
common when it comes to the promotion of
positive outcomes rather than the prevention of
negative ones. Because the development of
many EBPs was sponsored by federal agencies
concerned with addressing specific problems,
such as substance abuse, mental illness,
violence, or delinquency, there currently exist
many more problem‐focused EBPs than ones
designed specifically to promote positive
developmental outcomes like school success or
social responsibility.
Where to find evidence‐based
programs
Practitioners looking for an EBP to implement
in their community or learn more about these
programs will find the Internet to be their most
useful resource. As mentioned earlier, a number
of federal agencies and respected research
organizations “certify” or “endorse” programs
that meet the organizations’ specified standards
for effectiveness. Many of these agencies have
established on‐line registries, of lists of EBPs
that they have identified as effective. While
there are some differences in the standards used
by various organizations to assess whether a
program should be endorsed and thus included
on their registry, most share the primary criteria
regarding the need for strong empirical
evidence of program effectiveness.
Organizations that endorse EBPs typically limit
such endorsements, and thus their program
registry, to those programs that have shown an
impact on specific outcomes of interest to the
organization. For example, programs listed on
the Office of Juvenile Justice and Delinquency
Prevention’s Model Programs Guide have all
been shown to have an impact on juvenile
delinquency or well‐known precursors to
delinquency.
As previously mentioned, because the
development of many EBPs was funded by
federal agencies focused on specific problems,
most existing registries of EBPs are problem‐
oriented. Occasionally, EBPs are categorized
according to a strengths‐based orientation and
address outcomes related to positive youth
Evidence‐based programs: An overview 5
What Works, Wisconsin – Research to Practice Series, #6
WHAT WORKS, WISCONSIN: RESEARCH TO PRACTICE SERIES
This is one of a series of Research to Practice briefs prepared by the What Works, Wisconsin team at the
University of Wisconsin–Madison, School of Human Ecology, and Cooperative Extension, University of
Wisconsin–Extension. All of the briefs can be downloaded from http://whatworks.uwex.edu.
This series expands upon ideas that are discussed in What Works, Wisconsin: What Science Tells Us about
Cost‐Effective Programs for Juvenile Delinquency Prevention, which is also available for download at the
web address above.
This publication may be cited without permission provided the source is identified as: Cooney, S.M.,
Huser, M., Small, S., & O’Connor, C. (2007). Evidence‐based programs: An overview. What Works,
Wisconsin Research to Practice Series, 6. Madison, WI: University of Wisconsin–Madison/Extension.
This project was supported, in part, by Grant Award No. JF‐04‐PO‐0025 awarded by the Wisconsin
Office of Justice Assistance through the Wisconsin Governor’s Juvenile Justice Commission with funds
from the Office of Juvenile Justice and Delinquency Prevention.
development, academic achievement, school
readiness and family strengthening.
While registries of EBPs are usually organized
around the particular outcomes the programs
have been found to impact, many programs,
especially those focused on primary prevention,
often have broader effects than this pattern
would suggest. Many EBPs have been found to
be effective for reducing multiple problems and
promoting a number of positive outcomes. For
example, a parenting program that successfully
promotes effective parenting practices may not
only reduce the likelihood of particular
problems such as drug abuse or aggression, but
may also promote a variety of positive
outcomes like academic success or stronger
parent‐child relationships. For this reason, you
will often see the same program appear on
multiple registries that focus on different types
of outcomes.
Now, more than ever, practitioners have
available to them a wealth of EBPs that build on
the best available research on what works.
Unfortunately, they are currently underused
and often not well‐understood. Although EBPs
do have some limitations, they can contribute to
a comprehensive approach to preventing a
range of social and health‐related problems and
enhancing the well‐being of individuals,
families and communities.
Evidence‐based programs: An overview – Appendix A 6
What Works, Wisconsin – Research to Practice Series, #6
Appendix A
Evidence‐based program registries
The following websites contain registries, or lists of evidence‐based programs, that have met specific criteria
for effectiveness. Program registries are typically sponsored by federal agencies or other research organiza‐
tions that endorse programs at different rating levels based on evidence of effectiveness for certain participant
outcomes. The registries listed below cover a range of areas including substance abuse and violence preven‐
tion as well as the promotion of positive outcomes such as school success and emotional and social compe‐
tence. Generally, registries are designed to be used for finding programs for implementation. However,
registries can also be used to learn about evidence‐based programs that may serve as models as organizations
modify aspects of their own programs.
Best Practices Registry for Suicide Prevention
…
Evidence-based intervention and services for high-risk
youth: a North American perspective on the challenges of
integration for policy, practice and research
James K. Whittaker
Charles O. Cressey Endowed Professor Emeritus, School of Social Work, University of Washington, Seattle,
Washington, USA
A B S T R AC T
This paper explores the cross-national challenges of integrating
evidence-based interventions into existing services for high-resource-
using children and youth. Using several North American model
programme exemplars that have demonstrated efficacy, the paper
explores multiple challenges confronting policy-makers, evaluation
researchers and practitioners who seek to enhance outcomes for
troubled children and youth and improve overall service effective-
ness. The paper concludes with practical implications for youth and
family professionals, researchers, service agencies and policy–makers,
with particular emphasis on possibilities for cross-national
collaboration.
Correspondence:
James K. Whittaker,
School of Social Work,
University of Washington,
4101 Fifteenth Avenue NE,
Seattle, WA 98105-6299,
USA
E-mail: [email protected]
Keywords: children in need (services
for), evidence-based practice,
research in practice, therapeutic
social work
Accepted for publication: January
2009
I N T R O D U C T I O N
Across many national boundaries and within multiple
service contexts – juvenile justice, child mental and
child welfare – there is a growing concern about a
proportionately small number of multiply challenged
children and youth who consume a disproportionate
share of service resources, professional time and public
attention. While accurate, empirically validated popu-
lation estimates and descriptions remain elusive. The
consensus of many international youth and family
researchers, including those reported by McAuley
and Davis (2009) (UK), Pecora et al. (2009a) (US)
and Egelund and Lausten (2009) (Denmark) in this
present volume seems to be that some combination of
externalizing, ‘acting-out’ behaviour, problems with
substance abuse, identified and often untreated mental
health problems, experience with trauma and challeng-
ing familial and neighbourhood factors are often, and
in various combinations, manifest in the population of
children and youth most challenging to serve. Many of
these find their way into intensive out-of-home care
services, and Thoburn (2007) provides a useful
window into the out-of-home care status of children in
14 countries and offers useful observations on
improvements in collecting administrative data for
child and family services to inform both policy and
practice. Others call for a critical re-examination of the
present status of ‘placement’ as a central fulcrum
in child and family services policy and practice
(Whittaker & Maluccio 2002).
A sense of urgency is conveyed by the fact that
many child and youth clients of ‘deep-end’, restrictive
(out-of-home) services disproportionately represent
underserved and often socially excluded families and
communities of colour, and pose additional challenges
in service planning around the cultural compatibility
of proffered interventions (Blasé & Fixsen 2003;
Barbarin et al. 2004; Miranda et al. 2005). Important
work in this area includes ethnic and cultural
Author note: Portions of this paper in earlier form were
presented by the author at the 8th and 10th annual EUSARF
International Conferences at the University of Leuven,
Belgium, 9–11 April 2003 and the University of Padova,
Italy, 26–29 March 2008.
doi:10.1111/j.1365-2206.2009.00621.x
166 Child and Family Social Work 2009, 14, pp 166–177 © 2009 Blackwell Publishing Ltd
variations on known effective practices. Lau (2006),
for example, offers a nuanced and sensitive treatment
of actual and potential adaptations in existing parent
training models. A basic concern with questions of
equity and social justice, coupled with a growing scep-
ticism about the efficacy of traditional residential,
‘place-based’ services, has heightened the search for
more preventive, family- and community-based, cul-
turally congruent service alternatives. All of this is set
against a backdrop of concern about the state’s ability
to provide effective parenting oversight and support
for children in care, as well as those who remain with
their families (Bullock et al. 2006). Fortunately, this
search is occurring at a time when researchers in many
countries are shedding light on mechanisms of risk
and resilience (Sameroff & Gutman 2004), change
processes involved in effective interventions (Biehal
2008) and the challenges faced by parents in multiply
stressed environments (Ghate & Hazel 2002; Ghate
et al. 2008) that are rich in their potential for contri-
butions to intervention design and evidence-informed
practice.
The primary purpose of this paper is to examine
some of the challenges and opportunities in incorpo-
rating evidence-based strategies and interventions
into existing service systems to better meet the needs
of high-resource-using children and youth. The
growing corpus of empirical research on promising
treatment strategies offers, if not clear-cut prescrip-
tions, then rich implications for future policy initia-
tives and service experiments.
Indeed, the pursuit of evidence-based practice, in
its many forms, increasingly attracts the attention of
those who plan, deliver and evaluate critical treatment
and rehabilitative services for vulnerable children and
their families across national boundaries and regions.
While definitions of ‘evidence-based practice’ empha-
size different dimensions of that construct, the
common themes of bringing ‘science-to-service’, and
its reciprocal ‘service-to-science’, are increasingly
evident in the child, youth and family services systems
in many European countries and North America, as
well as elsewhere. Simultaneously, reform efforts in
the USA and many European countries press for
community-based, family-oriented, non-residential
alternatives to traditional residential care and treat-
ment programmes for acting-out children and youth
with identified mental health problems (Chamberlain
2003; Weisz & Gray 2008). However, the impulse for
service reform and the availability of at least some
empirically validated model interventions do not of
themselves constitute a sufficient basis for system
reform, but instead serve to illuminate some of the
many fault lines that exist in the child and family
services field:
• The continuing tensions between ‘front-end’, pre-
ventive services and ‘deep-end’ highly intensive
treatment services and the unhelpful dichotomies
these tend to create and perpetuate
• The tensions between a widely shared desire to
adopt more evidence-based practices and the genu-
inely felt resistances to these, particularly when they
are used in a rigid fashion that requires strict adher-
ence to established protocols with little opportunity
for experimentation, customization or practitioner
discretion. For example, as one family support
researcher recently observed, we need much more
fine-grained analyses of the actual lived experience
of client families with the services offered to them
(S. P. Kemp 2008, personal communication). Such
analyses will almost certainly involved a ‘mixed-
methods’ approach using qualitative measures and
methods to augment quantitative studies
• The tension, as manifested in North America and
elsewhere between evidence-based and culturally
competent practices, reflects, among other things,
antagonism towards certain practice strategies
based on perceptions of the under-representation of
ethnic minorities in the study samples on which
certain models have been validated
As model programmes proliferate and are increas-
ingly removed from the particular political and cul-
tural niches within which they were developed, we
would do well to heed the cautions offered by Munro
et al. (2005) that researchers, planners and youth and
family practitioners are at a moment in time when
cross-national perspectives are critical in helping iden-
tify new ways of both framing problems and shaping
service solutions. Cross-national dialogue can help in
identifying different formats for collecting, analysing
and utilizing routinely gathered client information,
analysing subtle local adaptations of internationally
recognized evidence-based services and examining
the effects of differing policy contexts on service
outcomes.
T H E Q U E S T F O R M O R E E F F E C T I V E
I N T E R V E N T I O N S
For the remainder of this paper, I wish to do three
things: (1) briefly identify where we are in our search
for effective (evidence-based) interventions; (2) assess
how we are doing in increasing their availability to
high-resource-using troubled youth and their families;
Evidence-based intervention for high-risk youth J K Whittaker
167 Child and Family Social Work 2009, 14, pp 166–177 © 2009 Blackwell Publishing Ltd
and (3) identify some particular challenges faced by
the individual practitioner, the social agency and the
public policy context in furthering the shared goal of
improving outcomes, and thus life prospects for
troubled children. The author’s bias will soon be
readily apparent. First, as one who has spent a lifetime
trying to bring both the precision of research methods
and the richness of research findings to the ‘shop
floor’ of children’s agency practice, I am convinced
that the evidence-based practice movement will not
succeed until it is embraced by those closest to the
children: the child and youth care workers, the social
workers, teachers, family support workers and others
who, with parents, toil on the front lines of helping.
This is not in my view a one-way street – Science-to-
Service – but presumes a vital feedback loop from
Service-to-Science where the insights and hypotheses
of those most directly involved in interventions
(including parent and child consumers) inform and
improve successive generations of applied research
studies. Second, I readily acknowledge the North
American bias apparent in many of my examples – I
write of what I know best – while recognizing a deeply
felt need in my country for European and other cross-
national perspectives if we are ever to achieve success
with our internal efforts at improving outcomes.
The search for evidence-based practices with chil-
dren and families is now well underway on both sides
of the Atlantic. Kazdin and Weisz (2003), Weisz
(2004), Burns and Hoagwood (2002), Macdonald
(2001), Pecora et al. (2009b) and McAuley et al.
(2006) survey effective interventions in child welfare
and child mental health services, as well as review
current research on service populations that will
inform the creation of novel interventions.
The simple, nominal definition of evidence-based
practice offered by Professor Geraldine MacDonald of
Queen’s University in Belfast provides a useful start-
ing point:
Evidence-based practice indicates an approach to decision-
making which is transparent, accountable and based on careful
consideration of the most compelling evidence we have about
the effects of particular interventions on the welfare of indi-
viduals, groups and communities. (MacDonald 2001, p. xviii)
It is clear that debates about what constitutes the
sufficiency and quality of evidence – where to set the
bar for rigour, how to distinguish evidence-based vs.
evidence-informed practice – continue apace both in
academic and practitioner discourse even as the
evidence-based practice movement as a whole contin-
ues to raise its profile in policy and services. These
competing definitions and nuances are, in toto, a sign
of health as they simply serve to underscore one or
another aspect of what is emerging as a more fulsome
understanding of what evidence-based practice con-
sists of. These aspects include, but are not limited to:
• a dual focus on aetiology and outcomes
• the incorporation of ethics and values as key com-
ponents
• the development of a collaborative process with
affected client groups
• a commitment to transparency in processes and
accountability
Many practitioners and practice researchers have
participated in the work of international groups such as
the Campbell and Cochrane Collaborations (Littell
2008) – originating in the health field – that attempt to
sift, sort and categorize the state of the evidence around
particular illnesses, socio-behavioural problems or
social welfare concerns. Many have also experienced –
closer to home – the increasing impact of national, state
and regional initiatives designed to increase the content
of proven, efficacious practices into child, youth and
family service systems. Such initiatives typically use
two strategies, often in combination:
Positive Reinforcement: e.g. ‘Laying Flowers Along Certain
Pathways’ by encouraging adoption of selected efficacious
model interventions. (One notes in passing that ‘efficacy’ of a
given intervention often increases in proportion to the dis-
tance from its country of origin!)
Coercion: e.g. Penalizing a programme, agency or practitioner
whose interventions do not reflect a sufficient quantity of
evidence-based practice according to an agreed-upon time
schedule. In the USA, this typically means that a practitioner
or service agency follows a prescribed protocol for interven-
tion or risks losing reimbursement for services rendered.
M OV I N G F R O M
‘ E F F I C AC Y- T O – E F F E C T I V E N E S S ’
In the USA at the moment, there is growing respect
for the complexities involved in moving from pilot
demonstrations of effective child, youth and family
interventions to broad-scale application: i.e. moving
from ‘efficacy’ to ‘effectiveness’ (Jensen et al. 2005;
Weisz & Gray 2008). What these terms signify are:
1. That individual investigators can demonstrate sig-
nificant results for novel treatments over standard (or
traditional) services through carefully controlled, rig-
orously conducted studies often including random-
ized controlled trials: the ‘gold standard’ of clinical
research. That is, they can demonstrate efficacy.
Evidence-based intervention for high-risk youth J K Whittaker
168 Child and Family Social Work 2009, 14, pp 166–177 © 2009 Blackwell Publishing Ltd
2. Yet, these impressive results do not, on close
examination, appear to influence what might be
thought of as routine, day-to-day practice as con-
ducted in more familiar agency settings. Thus, the
evidence-based practice movement, while demon-
strating efficacy, cannot as yet demonstrate overall
effectiveness.
What explains this disconnect? Lisbeth Schorr, an
astute analyst of child and family services innovation,
sums it up succinctly: ‘Successful programs’, she says,
‘do not contain the seeds of their own replication’
(Schorr 1993, quoted in Fixsen et al. 2005).
Thus, if we are truly interested in effectiveness – i.e.
achieving wide-scale adoption of proven efficacious
interventions, we need to look beyond efficacy studies:
(1) to those contextual elements that influence prac-
tice decisions and client outcomes (Kemp et al. 1997);
and (2) to a different kind of research undertaking
that focuses directly on the processes involved in suc-
cessful adoption of proven efficacious interventions
(Weisz & Gray 2008).
John Weisz, one of the nation’s leading research
analysts in child mental health and a professor of
psychology at Harvard University as well as President
of the Judge Baker Children’s Center in Boston,
points the way forward on what is needed to ultimately
resolve the efficacy/effectiveness challenge:
A very important focus for the next stage of research on
interventions for children will be the effective implementation
of evidence-based practices by practitioners in service settings.
This will require an active collaboration between the research-
ers who develop and test interventions and the clinical, child
welfare, and education professionals who serve children and
families. (J.R. Weisz 2008, personal communication)
E X P L O R I N G T H E L A N D S C A P E O F
E V I D E N C E – B A S E D S E R V I C E S F O R
H I G H – R I S K YO U T H
Let us proceed, then, by exploring the context within
which evidence-based services are nested. Here, we
find some common and proximate elements familiar
to all who labour in the child and family services field,
as well as a few more distal forces that, nonetheless,
have a potential for considerable impact on the
identification, validation and eventual integration of
evidence-based practices. I will refer, briefly, to more
or less typical examples from within the US context.
Model intervention programmes
For purposes of illustration, I offer three interventions
that have received considerable attention in children’s
mental health services in the USA, and which have
been the objects of numerous community replications
and research study both in North America and else-
where (Whittaker 2005). These include:
• Multisystemic Therapy (MST), developed principally
by Dr Scott Henggeler, a psychologist now at the
Department of Psychiatry and Behavioral Sciences,
Medical University of South Carolina (Henggeler
et al. 1998; Schoenwald & Rowland 2002;
Henggeler & Lee 2003). http://www.mstservices.com
• Treatment Foster Care (MTFC), developed in several
clinical/research teams in the USA and represented
here by the model (Multi-dimensional Treatment
Foster Care) principally developed by Dr Patricia
Chamberlain and colleagues at the Oregon Social
Learning Center – a highly influential applied
behaviour analysis developmental research centre –
one of whose founding members is Dr Gerald
Patterson (Chamberlain & Reid 1998; Chamberlain
2002, 2003). http://www.MTFC.com
• Wraparound Treatment, a novel, team-oriented,
community-centred intervention developed by a
variety of individuals including the late Dr
John Burchard, formerly Professor of Clinical
Psychology at the University of Vermont, John Van
Den Berg, Carl Dennis and others beginning
in the early 1980s (Burns & Goldman 1999;
Burchard et al. 2002). http://www.rtc.pdx.edu/
PDF/PhaseActivWAProcess.pdf
[While space does not permit in depth analysis here,
the interested reader is directed to the previously cited
references, as well as to the web sites for each of these
three models that include multiple references to com-
pleted and in-progress research and demonstration
efforts, as well as specifics on programme principles
and components. A variation of the of the MTFC
model designed for younger children in regular foster
care is described in this present volume by Price et al.
(2009)].
These three interventions are specifically designed
to provide alternative pathways for children who
otherwise would be headed into more costly and
restrictive residential provision. Dr Barbara Burns,
Professor of Psychology at Duke University in North
Carolina and a principal author of the children’s
mental health section of our latest Surgeon General’s
Report on Mental Health (US Department of Health
and Human Services 1999) provides a succinct ratio-
nale for why this is warranted:
The most critical question for the future is, what will it take
to convince payers, public and private, to support the
Evidence-based intervention for high-risk youth J K Whittaker
169 Child and Family Social Work 2009, 14, pp 166–177 © 2009 Blackwell Publishing Ltd
interventions that are backed up by evidence about improved
outcomes? Assuming that the pool of dollars available for
mental health treatment will not increase, it will be necessary
to shift resources away from institutional care (which lacks
evidence of effectiveness) toward community alternatives.
This will require a reduction in funds allocated to institu-
tional care, where a significant portion of the child mental
health money is still being spent. (Burns & Hoagwood 2002,
p. 13)
While reviews of residential care in both the UK
(Sinclair 2006) and the USA (Whittaker 2006)
confirm a move away from residential services,
recent comparative international contributions have
urged critical re-examination of the multiple varieties
of residential service (Courtney & Ivaniec 2009) to
meet the needs of at least some high-resource-
using youth. In part, this sentiment reflects the fact
that theory and model development, particularly in
the arena of intensive residential services has lan-
guished as development of comparable family-
centred services has flourished. Some have urged the
development of a conceptual schema for intensive
services – e.g. the ‘prosthetic environment’ – which
transects more traditional residential, family and
community boundaries is strengths-oriented and
incorporates educational, socialization and family
support services along with intensive treatment
(Whittaker 2005).
In focusing here on a few programme models spe-
cifically designed to serve as alternatives to residen-
tial care and treatment, and other forms of intensive
out-of-home service, one must acknowledge omis-
sion of a great deal of promising, empirically based
work that is presently being done with a wide range
of family-, school- and community-centred interven-
tions that is both more preventive in its focus and
appropriate for a much wider population of children
and families than space allows us to examine here.
See, for example, Carolyn Webster Stratton’s Incred-
ible Years Program (Beauchaine et al. 2005) and the
work of many others whose contributions in such
areas as family support illuminates a segment of ser-
vices more preventive in focus (Kemp et al. 2005;
Lightburn & Sessions 2006) and the contribution of
Jackson et al. (2009).
What, then, are the similarities and differences
of these three promising interventions? A recent
review (Burns & Hoagwood 2002) yields the
following:
1. All three interventions adhere to ‘systems of care’
values: The ‘systems of care’ framework derives from
both our National Institute of Mental Health and
private foundation initiatives in the 1980s, and is
defined as:
A comprehensive spectrum of mental health and other neces-
sary services which are organized into a coordinated network
to meet the multiple and changing needs of children and
adolescents with severe emotional disturbances and their
families. (Stroul & Friedman 1986, p. xx)
The system of care thus defined is based on three main ele-
ments. First, the mental health service system efforts are
driven by the needs and preferences of the child & family and
are addressed by a strengths-based approach. Second, the
locus and management of services occur within a multi-
agency collaborative environment grounded in a strong com-
munity base. Third, the services offered, the agencies
participating and programs generated are responsive to cul-
tural context and characteristics. [Though, as noted, this
remains a contested area with respect to some communities of
color.] (Burns & Hoagwood 2002, p. 19)
2. All three interventions are delivered in a commu-
nity – home, school, neighbourhood – context as
opposed to an office
3. All have operated in multiple service sectors:
mental health, juvenile justice, child welfare
4. All were developed and evaluated in ‘real world’
community settings, thus enhancing external validity
5. All show preference for the model treatment con-
dition in multiple randomized controlled trials
6. All lay claim to being less expensive to provide than
institutional care (Burns & Hoagwood 2002, p. 7).
Differences of course exist. For example, both MST
and MTFC possess a higher degree of specificity with
respect to intervention components than does wrap-
around. As of this writing, MST has perhaps the
strongest evidentiary base, particularly in clinical trials
showing positive effects, though some recent reviews,
including one by Prof. Julia Littell of Bryn Mawr
University in Pennsylvania conducted for the Camp-
bell Collaboration, have raised critical questions about
the evidence base offered in support of MST (Littell
2005, 2008). Finally, from a staffing perspective, MST
appears to make higher use of master’s-level-trained
professionals in service delivery than either MTFC or
wraparound.
To these three model programmes, we must of
course add numerous other evidence-based treatment
techniques targeted to specific conditions and prob-
lems, as reflected in recent reviews by Kazdin and
Weisz (2003), Weisz (2004) and Chorpita et al.
(2007). These model intervention programmes do not
of course exist in a vacuum, but both influence and are
influenced by a host of other elements in a typical state
or regional context in the USA.
Evidence-based intervention for high-risk youth J K Whittaker
170 Child and Family Social Work 2009, 14, pp 166–177 © 2009 Blackwell Publishing Ltd
P U B L I C , V O L U N TA R Y A N D P R O P R I E TA R Y
S E R V I C E P R OV I D E R S
Model programmes such as MST, MTFC and wrap-
around are typically adopted by some segment of the
mixed system of service agencies (Public/Voluntary/
Proprietary) that make up the delivery system in a
given state, county or municipality. Public service pro-
viders are typically service funders as well, creating in
the view of some voluntary agencies an unequal influ-
ence in terms of what particular models are selected
for adoption, as well as on the masking of true admin-
istrative costs of programme implementation, given
the public sector’s economies of scale and presumed
ability to mask start-up costs. Given the wide varia-
tions in state and county service systems within the
USA, there are some anecdotal reports of the ten-
dency of certain model programmes to bend and
shape themselves into a widely varying array of
funding arrangements (referred to as ‘pretzelling’) in
order to gain a foothold and a leverage in a given
public system (K. Blasé 2007, personal communica-
tion) with the result that local service providers may
be held to similar outcome and process standards
while enjoying widely varying reimbursements to
support their efforts.
N AT I O N A L , R E G I O N A L A N D L O C A L
R E S E A R C H C E N T E R S A N D R E S O U R C E
N E T W O R K S
In addition to evidence-based programme models
that typically have their own internal capacity for pro-
gramme development, marketing, training, evaluation
and dissemination, a wide variety of university and
institute-based resource networks and research centres
play an increasingly important role in the promotion
of evidence-based programmes and practices. For
example, the National Implementation Research
Network (NIRN) was begun at the University of South
Florida as part of a larger effort to bring science-based
information to the forefront of child mental health
practice. Recently relocated to the University of
North Carolina, NIRN has done significant work in
documenting national, state and regional capacity to
support model programme development, and has
provided consultation to individual states and organi-
zations on effective strategies for integrating evidence-
based practices into the fabric of existing services
(Fixsen et al. 2005). For more information, see: http://
www.fpg.unc.edu/~NIRN/. The California Evidence-
Based Clearinghouse for Child Welfare Practice is
funded by the California Department of Social Ser-
vices, Office of Child Abuse Prevention and guided by
a state advisory committee and a National Scientific
Panel. The Clearinghouse provides guidance on
selected evidence-based practices in simple straightfor-
ward formats, reducing the consumer’s need to
conduct literature searches, review extensive literature
or understand and critique research methodology
(http://www.cachildwelfareclearinghouse.org/). The
Clearinghouse has developed a six-tiered schema for
sorting out promising programmes ranging from
‘Well-Supported – Effective Practice’ to ‘Concerning
Practice’ (e.g. shows negative effects on clients and/or
potential for harm).
A legislatively generated state institute, the
Washington State Institute on Public Policy (WSIP)
was created by the Washington state legislature to
conduct cost/benefit and a range of other studies on a
variety of classes of intervention, including child
welfare and early intervention (http://www.wsipp.
wa.gov/board.asp). Its generally thorough and well-
executed analyses have achieved wide dissemination
beyond the region and are frequently cited by model
programme developers as confirmation of their effec-
tiveness. Methodological concerns have recently been
raised about the general quality of intervention
research reviews (Littell 2005, 2008), including those
generated by WSIP, and within local practice commu-
nities, one hears anecdotally some concerns about the
potential for overly concrete inferences by legislative
bodies and funding sources whose attention may
extend only to the executive summary section of
detailed reviews of model programmes and not to the
caveats and nuances contained in their appendices
and footnotes.
Beyond these particular …
elines for Selecting an Evidence‐Based Program
What Works, Wisconsin – Research to Practice Series, #3
In recent years there has been a significant increase in the number of evidence‐
based programs designed to reduce individual and family problems and
promote healthy development. Because each program has undergone rigorous
testing and evaluation, program practitioners can reassure potential program
sponsors that the program is likely to be effective under the right conditions, with
the appropriate audience and with the proper implementation. However, knowing
which program is the “right” one for a particular setting and audience is not always
easy to determine. When selecting a program, it is important to move beyond current
fads or what the latest salesperson is selling and consider whether a program fits with
the local agency’s goals and values, the community setting and the needs of the
targeted audience. The long‐term success of a program depends on the program being
not only a good one, but also the right one.
Unfortunately, there is currently little research on how to best go about the process of
selecting an evidence‐based program. Consequently, the guidelines we present in this brief
are based primarily on our experiences working with community‐based organizations, the
experiences of practitioners, and common sense. We have identified a number of factors that
we believe should be considered when deciding which program is the most appropriate for a
particular audience and sponsoring organization. These factors can be grouped into three
general categories: program match, program quality and organizational resources. In order to
assist with the process of program selection, we have developed a set of questions to consider
when selecting an evidence‐based program for your particular agency and audience.
WHAT WORKS, WISCONSIN – RESEARCH TO PRACTICE SERIES
Guidelines for selecting an evidence‐based program:
Balancing community needs, program quality,
and organizational resources
ISSUE #3, MARCH 2007
BY STEPHEN A. SMALL, SIOBHAN M. COONEY,
GAY EASTMAN, AND CAILIN O’CONNOR
University of Wisconsin–Madison and University of Wisconsin–Extension
Guidelines for Selecting an Evidence‐Based Program 2
What Works, Wisconsin – Research to Practice Series, #3
Program match: Questions to ask
How well do the program’s goals and objectives
reflect what your organization hopes to achieve?
How well do the program’s goals match those of
your intended participants?
Is the program of sufficient length and intensity (i.e.,
“strong enough”) to be effective with this particular
group of participants?
Are potential participants willing and able to make
the time commitment required by the program?
Has the program demonstrated effectiveness with a
target population similar to yours?
To what extent might you need to adapt this
program to fit the needs of your community? How
might such adaptations affect the effectiveness of the
program?
Does the program allow for adaptation?
How well does the program complement current
programming both in your organization and in the
community?
The issues raised by program match, program
quality and organizational resources are overlap‐
ping. Selecting a program usually requires
balancing different priorities, so it’s important to
have a good understanding of all three of these
before determining the usefulness of a program
for a particular situation.
PROGRAM MATCH
A first set of factors to consider is related to how
well the program will fit with your purposes, your
organization, the target audience, and the com‐
munity where it will be implemented.
Perhaps the most obvious factor to consider is
whether the goals and objectives of a program are
consistent with the goals and objectives that the
sponsoring organization hopes to achieve. While
this may seem apparent, it is not uncommon for
sponsors to select a program because there is grant
money available to support it or everyone else is
doing it. Just because a program is the latest fad or
there’s funding to support it doesn’t necessarily
mean it is going to accomplish the goals of the
sponsoring organization or meet the needs of the
targeted audience.
A second aspect of program match involves
whether a program is strong enough to address
the level and complexity of risk factors or current
problems among participants. This refers to the
issue of adequate program duration and intensity.
Changing existing problem behaviors or counter‐
acting a large number of risk factors in partici‐
pants’ lives requires many hours of engaging
programming over a period of time. For example,
a short primary prevention program designed for
families facing few problems or risks may not be
effective for an audience already experiencing
more severe problems.
Another facet of program match concerns the
length of the program and whether your intended
audience will be willing and able to attend the
required number of sessions. Many evidence‐
based programs are of fairly long duration,
involving multiple sessions over weeks or
months. A common concern of program pro‐
viders is whether potential participants will
make such a long‐term commitment. Because
this is a realistic concern, program sponsors need
to assess the targeted audience’s availability for
and interest in a program of a particular length.1
The reality is, if people don’t attend, then they
can’t reap the program’s benefits. However, it is
also important to keep in mind that programs of
longer duration are more likely to produce
lasting behavior change in participants. Program
sponsors sometimes need to find a compromise
between the most effective program and one that
will be a realistic commitment for participants.
Matching a program with the values and culture
of the intended audience is also critically import-
ant. Some programs are intentionally designed
for particular populations or cultural groups.
Most are more culturally generic and designed
1 Issue #2 in this series addresses strategies for
recruiting and retaining participants.
Guidelines for Selecting an Evidence‐Based Program 3
What Works, Wisconsin – Research to Practice Series, #3
Program quality: Questions to ask
Has this program been shown to be effective?
What is the quality of this evidence?
Is the level of evidence sufficient for your
organization?
Is the program listed on any respected evidence‐
based program registries? What rating has it
received on those registries?
For what audiences has the program been found
to work?
Is there information available about what
adaptations are acceptable if you do not
implement this program exactly as designed? Is
adaptation assistance available from the program
developer?
What is the extent and quality of training offered
by the program developers?
Do the program’s designers offer technical
assistance? Is there a charge for this assistance?
What is the opinion and experience of others who
have used the program?
for general audiences.2 It’s important to consider
whether the targeted audience will find the
program acceptable and will want to participate.
The ideal situation would be finding evidence that
a program is effective for the specific pop-
ulation(s) you intend to use it with. In that case,
you could reasonably expect the program to be
effective when it is implemented well.
Unfortunately, many evidence‐based programs
have only been evaluated with a limited number
of populations and under a relatively narrow
range of conditions. While many evidence‐based
programs are effective and appropriate for a range
of audiences and situations, it is rare to find a
program that is suitable or effective for every
audience or situation. In many cases, you will
need to carefully read program materials or talk to
the program’s designers to see whether adapting a
program or using it with an audience for which it
hasn’t been evaluated is reasonable.
Depending on the design, programs may or may
not be amenable to adaptation. If adapting a
program to a particular cultural group is
important, then program sponsors should serious-
ly consider whether such changes are possible.
Some program designers are willing to help you
with program adaptation so that the program’s
effectiveness will not be undermined by these
changes.3
Finally, when considering which program to
select, sponsors should consider whether the pro-
gram complements other programs being offered
by the sponsoring organization and by other
organizations in the community. The most
effective approaches to prevention and inter-
vention involve addressing multiple risk and
2 Issue #1 in this series addresses the issue of culture
and evidence‐based programs.
3 Issue #4 in this series will address issues of program
fidelity and adaptation.
protective factors, developmental processes and
settings. Any new program implemented in a
community should address needs that other
community programs fail to address, which will
help to create the kind of multi‐pronged approach
that leads to greater overall effectiveness.
PROGRAM QUALITY
A second set of factors to consider when selecting
a program are related to the quality of the pro‐
gram itself and the evidence for its effectiveness.
The program should have solid, research‐based
evidence showing that it is effective. For a pro‐
gram to be deemed evidence‐based, it must go
through a series of rigorous evaluations. Such
evaluations have experimental or quasi‐experi‐
mental designs – meaning they compare a group
of program participants to a similar group of
people who did not participate in the program to
determine whether program participation is assoc‐
iated with positive changes. These kinds of eval‐
Guidelines for Selecting an Evidence‐Based Program 4
What Works, Wisconsin – Research to Practice Series, #3
TABLE 1: Selected evidence‐based program registries
Blueprints for Violence Prevention
http://www.colorado.edu/cspv/blueprints/index.html
This registry is one of the most stringent in terms of endorsing programs as Model or Promising. Programs are
reviewed by an expert panel and staff at the University of Colorado, and endorsements are updated regularly.
Programs are added and excluded from the registry based on new evaluation findings.
Helping America’s Youth
http://guide.helpingamericasyouth.gov/programtool.cfm
This registry was developed with the help of several federal agencies. Programs focus on a range of youth
outcomes and are categorized as Level 1, Level 2, or Level 3 according to their demonstrated effectiveness. The
registry is updated regularly to incorporate new evidence‐based programs.
Office of Juvenile Justice and Delinquency Prevention Model Program Guide
http://www.dsgonline.com/mpg2.5/mpg_index.htm
This registry is one of the largest currently available and is continuously updated to include new programs.
Programs found on this registry are designated as Exemplary, Effective, or Promising.
Promising Practices Network
http://www.promisingpractices.net/
A project of the RAND Corporation, this registry regularly updates its listings of Effective and Promising
programs. Programs are reviewed and endorsed by project staff.
Strengthening Americaʹs Families
http://www.strengtheningfamilies.org/html/
Although this registry was last revised in 1999, it is the only registry with a focus specifically on family‐based
programs. Programs were reviewed by expert panels and staff at the University of Utah and the Center for
Substance Abuse Prevention. They were then designated as Exemplary I, Exemplary II, Model, or Promising.
Substance Abuse and Mental Health Services Administration (SAMHSA) National Registry of Evidence‐
Based Programs and Practices
http://www.nrepp.samhsa.gov
This recently re‐launched site no longer categorizes programs as Model, Effective, or Promising. Instead,
programs are summarized and the quality of the research findings is rated separately for each outcome that has
been evaluated. SAMHSA has also introduced a “Readiness for Dissemination” rating for each reviewed program.
Nominations are accepted each year for programs to be reviewed; SAMHSA funds independent consultants to
review nominated programs and update the registry.
uations allow for a reasonable assumption that it
was the program itself that changed people’s
knowledge, attitudes or behavior.
As funders and program sponsors become more
committed to implementing evidence‐based pro‐
grams, program developers are increasingly likely
to promote their programs as evidence‐based.
However, just because a program developer ad‐
vertises a program as evidence‐based doesn’t
mean that it meets the standards discussed above.
For example, a program might be “research‐
based,” but not “evidence‐based.” A research‐
based program has been developed based on
research about the outcomes or processes it add‐
resses. However, it has probably not been
subjected to the rigorous evaluations and real‐
world testing that are needed to designate a
program as evidence‐based. The simplest way to
determine evidence of a program’s effectiveness is
Guidelines for Selecting an Evidence‐Based Program 5
What Works, Wisconsin – Research to Practice Series, #3
Organizational resources:
Questions to ask
What are the training, curriculum, and
implementation costs of the program?
Can your organization afford to implement this
program now and in the long‐term?
Do you have staff capable of implementing this
program? Do they have the qualifications
recommended or required to facilitate the
program?
Would your staff be enthusiastic about a program
of this kind and are they willing to make the
necessary time commitment?
Can this program be implemented in the time
available?
What’s the likelihood that this program will be
sustained in the future?
Are your community partners supportive of your
implementation of this program?
to examine the designations given by well‐estab‐
lished and respected evidence‐based program
registries. Program registries classify programs at
different levels of endorsement based on evidence
of effectiveness for certain participant outcomes.
See Table 1 for an annotated listing of program
registries.
If a program is not listed on a respected registry,
then it is important to seek out scientific evidence
of the program’s effectiveness. At a minimum, you
should review any evaluation studies that have
been conducted by the program developer and
external evaluators. Ideally, these evaluations use
an experimental or quasi‐experimental research
design. Another sign of a high‐quality evaluation
is that its results have been published in a well‐
respected, peer‐reviewed, scientific journal.
An additional indicator of program quality to
consider is the level of training and follow‐up
support available from the program designers.
Some programs have a great deal of resources
available to help program implementers. These
resources can be especially important if you’re
working with a unique audience and need to
make adaptations or if program implementation is
particularly complex. As a general rule, more in‐
tensive training and more follow‐up support from
the program developer will increase the effective‐
ness and sustainability of a program over time.
Some programs provide excellent technical assis‐
tance; staff members are accessible and willing to
address questions that arise while the program is
being implemented. Often this technical assistance
is free, but sometimes program designers charge
an additional fee for it. Therefore, the benefits and
costs of technical assistance should be kept in
mind when selecting an evidence‐based program.
Finally, while the scientific literature and infor‐
mation from the program developer provide key
information about program quality, don’t over‐
look the experience of practitioners who have imp‐
lemented the program. …