Running head: EVIDENCE BASED PRACTICES

Effectiveness of Evidence Based Practices Heidi L. Shank-Bridges Liberty University

EFFECTIVENESS OF EVIDENCE BASED PRACTICES

ABSTRACT

An evidence based practice is an approach to prevention by way of intervention, and has documented evidence of success. Evidence based practice as it refers to juvenile justice issues are used to see how this practice is related to reducing juvenile delinquency, substance abuse, educational challenges, peer pressure, and family conflicts. The effectiveness is measured by the evidence collected. This intervention is utilized today not just because of its social effectiveness but to cost effectiveness also. An evidence based practice carries a much lower price tag by treating a juvenile delinquent in the community than removing a youth from his or her placement at home. There are high costs involved with removing a child from his or her home as well as housing a youth in a youthful offender or delinquent incarcerated facility. Evidence based practices are designed to improve negative behaviors, family disturbances, educational functions, and reduce the rate of out-of-home placements. This paper will depict why it is a more viable option for the utilization of evidence based practices as opposed to discarding taxpayers dollars on incarceration of delinquent youth and adults.

Keywords: Evidence based, practice, juvenile, delinquency, accountability

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Evidence based practice is being utilized more with adolescents in areas of prevention and therapy. Evidence based practiced programs are designed to prevent delinquent behaviors of children from continuing on a path of ongoing criminalgenic thinking by not only working with the delinquent behavior, but the thought process driving the behaviors. Agencies are finding this practice effective because it not only works with the child it works with the family unit as a whole. The same types of evidence based practices in the delinquency arena are also being used in areas of child welfare systems for dependent children and their families in the foster care systems across the country. The cost of evidence based programing compared to the cost of fostering a child, institutionalizing a child or committing a child to a youthful offender program is far less when the skills are received and applied by these families. Evidence based practice can be viewed as an investment in children and families as a prevention, not only for the here and now, but for the future. Todays generation will be the same generation who will be running this country when our generation retires. If the investment is made now, there may not be the costs impacting the communities later to build more mental health institutions, prisons and jails. Prevention must become a priority now or more children will be headed toward institutions and more families will ultimately be broken and many beyond repair. Evidence based practices are defined as a treatment or service which has been rigorously studied through randomized experimental trials in either academic or community settings and is shown to produce positive outcomes for youth and families that receive them (Phillippi, 2010). The purposes for the use of evidence based practices are many.

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Evidence based practices are being utilized in juvenile justice systems, juvenile dependency systems, and even in private practices for family, marital counseling, and even in some law enforcement agencies albeit the practice in law enforcement differs from the evidence based practice in the delinquency and dependency arena. Couple and family therapy is different whereas it focuses on relationships as a primary intervention starting point, but at the same time attempting to achieve clinical changes. Evidence based practice with regard to police work is the use of the best available research on the outcomes of police work, to implement guidelines and evaluate how police units, officers and various agencies can determine the outcomes of police work rather than relying on opinion or political agendas. In utilization of this evidence based practice in law enforcement, there are many tests and evaluations that provide agencies, units, and officers with an idea of what is really working in crime prevention and police practices. Evidence based practice in police research entails the examination of processes and strategies that are implemented in a comprehensive way of each individualized agencies. The research found that police appear to have deficiencies in knowledge and skills as it applies to the grasp of what problem-oriented policing is, therefore understanding the need for change (Boba 2010). With regard to juvenile justice programs, the evidence based practice of multi-systemic therapy is used in the hopes of correcting behavior for youthful offenders. When looking at areas to target to correct these behaviors, areas include delinquent behaviors, substance abuse, mental health/emotional disorders, violence, family functioning, school attendance and conduct disorder.

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From a research point of view, there is research and literature to support the success of multisystemic, an evidence based practice, therapy when used with juveniles, however; there is no research that indicates whether or not the youth receiving the services felt that their behavior changed because of multisystemic therapy. Research collected indicates that some youth who received multisystemic therapy felt excluded from therapy sessions without parents and stated that they believed their behavioral changes were due to fear of going to jail, rather that the need to improve their behavior because it simply needed to change (Harvey 2011). When looking at the effectiveness of evidence based practices such as the effectiveness of multisystemic therapy, more research in other areas needed to be conducted. Evidence based programs were created to be a prevention type system to assist youth and families in distress, therefore there had to be need for services and a manner in which these services would be implemented. After much research was conducted by Pena, J. B., Matthieu, M. M., Zayas, L. H., Masyn, K. E., & Caine, E. D., they determined that their research results reinforced the need for identifying youth with significant symptoms of distress and mood disorders (Pena, J. B., Matthieu, M. M., Zayas, L. H., Masyn, K. E., & Caine, E. D. 2012). They discovered that there was a need to address many risk behaviors for youth who attempted suicide. They also found that when using prevention initiatives, they believe a more

comprehensive and well-integrated public health approach is possible (Pena, J. B., Matthieu, M. M., Zayas, L. H., Masyn, K. E., & Caine, E. D. 2012). What makes this study unique is that it used a national sample of teens who attempted suicide and were attending high school with cooccurring symptoms of violent behaviors, substance use and depression, of this study were teens who have attempted suicide to the degree that it required medical treatment, in the year prior to the study. What was discovered was that while depression that was the treatment need, and it

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was an important goal, but it was the need to incorporate substance use and violent behaviors as well to the treatment program (evidence based) in order to effective (Pena, J. B., Matthieu, M. M., Zayas, L. H., Masyn, K. E., & Caine, E. D. 2012) Their research was specific enough to make known that greater attention needs to be paid to areas of service and who are in need are gender, race and ethnicity with regard to suicide prevention programs so that targeted efforts can reach a diversity of youth with co-occurring issues (Pena, J. B., Matthieu, M. M., Zayas, L. H., Masyn, K. E., & Caine, E. D. 2012) Having considered their research, we must then look at the effectiveness of evidence based programing with regard to gender specific needs, race, and ethnicity wherein the issue of cultural competency becomes an issue. In a textbook used by many universities, Michelle Martins book, Introduction to Human Services, discusses cultural competency and diversity as it relates to evidence based programs. According to her the textbook, she states that due to cultural competence it is difficult to make a decision regarding effectiveness of counseling, when one is counseling a particular ethnically diverse client group. (Martin, 2011). The book also states that while evidence based practices are being look at and research is being developed with regard to cultural competence, there is little research on what constitutes cultural competence practices, therefore there is no way to validate and research the effectiveness of treatment where culturally diverse groups respond to evidence based practices. (Martin 2011). A study done on evidence based practices when used to implement Juvenile Justice Reform in the state of Louisiana, evidence based practices were utilized to target risk behaviors specifically with the goal to reduce delinquent risk factors and maximize protective factors. When Louisiana, as with many other states, looked at their Juvenile Justice system, they found

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that it failed to provide the opportunity for adolescents effective treatment and the opportunity to reduce delinquency (Phillippi, 2010). By targeting specific risk and needs that have been demonstrated to address the problem, youth and families are at risk for delinquency problems, behavioral health problems, substance abuse and violence; however, through research in evidence based practices in the state of Louisiana a number of programs have been demonstrated to be effective within the need or risk areas. Risk factors can be placed into four categories, school/community, family, individual and peer. All these categories and areas are captured through the use of assessment tools. In the state of Louisiana, their Juvenile Justice System uses an assessment tool called the Structured Assessment of Violence Risk in Youth (SAVRY) (Phillippi, 2010). Once the SAVRY is administered, and it is determined that peer risk factors are associated with the delinquent behavior of the youth, interventions will then focus on engaging that youth in a pro-social activity such as a mentoring type program. Studies on the evidence based practices are ongoing but current research shows that the evidence based practices are reliable and need to be utilized to increase the likelihood of positive outcomes (Phillippi, 2010). Some of the key research findings in the Louisiana study showed that the effectiveness of evidence based practice have demonstrated in a number of cases to have positive outcomes. One of the most commonly used evidence based practices in the juvenile delinquency field is the use of multisystemic therapy commonly referred to as MST. Multisystemic therapy used with violent or substance abusing offenders have decreased their substance abuse, have fewer association with negative peers and less antisocial criminal

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activities. At the same time their results show that there was improved family relations and educational status increased (Phillippi, 2010). All this data, once collected, was then put to a fourteen year study and they found that youth who participated in Multisystemic therapy were less likely to recidivate, but if they were rearrested they spent fewer days in confinement verses the youth who have only been afforded the opportunity of individual therapy. Louisiana utilized other evidence based practices such as Functional Family Therapy and Brief Strategic Family therapy. Both of these interventions also related to the same types of negative and positive factors. What was discovered was that Brief Strategic Family Therapy showed positive results in reducing marijuana use, conduct had improved, and the reduction with antisocial peer reduces. With regard to Functional Family Therapy and its positive treatment effects, it showed a reduction of 25% to 60% of re-offending youth as well as foster care youth becoming institutionalized (Phillippi, 2010). There are guidelines for classifying an evidence based treatment in Juvenile Justice Programs as well as other areas where this practice is utilized such as in Couple and Family Therapy. These guidelines are proposed at a three-tiered levels model that moves evidenceThese

informed to evidence based then to evidence based and ready for dissemination.

guidelines are offered not only for understanding the evidence, but also as an alternative for psychotherapists (Sexton, et.al. 2011). Evidence for strategy and treatment programs include specifically designed measures that predict clinical changes in client functioning and when discussing couple and family domain are very important. For example, an evidence based program for juvenile offenders with behavioral issues, should first demonstrate successful outcomes by showing changes in their behavior,

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substance use, and education, whereas the systemic perspective of couple and family therapy the change in the family process would be the expected treatment outcome. What is interesting to note is that within the three levels, it is the categories in the final level that identify the contexts that determines the effectiveness of the program or more simply put, the program works (Sexton, et.al., 2011). When one is looking at the effectiveness of evidence based practice, there must be evidence to support the effectiveness of such programs and it must be documented. There is certainly enough research that states that evidence based practices are effective, but with any program, there are areas that hold challenges to the effectiveness as well. One of the areas with evidence based practices is areas where youth who have different disabilities. Mark Burton and Melanie Chapman conducted research in this area. They both agree with many other researchers in that practitioners should do things that are effective and should not do things that are not effective. Areas that were researched with regard to ineffectiveness are the environment in which the interventions are delivered, utilized and assessed. Secondly, the person receiving the services that the worker referred them to may not actually be the services that they are receiving. Lastly, everyones perception is different. This in itself will infect the results collected when looking at success rates. This simply means, when a group of researchers come together to develop a program that is perceived to be effective, then it is experimented on different groups of people, and initially it appears effective enough to the point of expansion into communities, no longer in test mode, how effective is the program when it is placed in the hands of overworked case managers who are operating in an underservices area (Burton, 2010). When you use an intervention program such as evidence based practices in this manner, the results become ineffective and youth and families receiving the services are unaffected. An

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editorial, edited by Mark Mattaini, in the fall of 2007, addresses the movement toward using evidence based practices. Overall it reflected that moving toward the evidence based practices is actually helping society with regard to behaviors and their social responsibility (Mattaini, 2007). Having listened to both sides of the argument as to whether or not evidence based programing is effective prompted research to look into what court systems thought or how much weight they gave to the effectiveness of evidence based practice. In looking into Family Court systems in Florida, Mary Falconer along with others conducted research in just this area. Florida is a best interest of the child state regarding removal from families. It was determined that the true best interest cannot be determined if a child is apart from their family system (Falconer, 2012). To get a perspective on just how many children are placed in out-of-home care, including foster care due to neglect or abuse, in just 2010 over 662,000 children in Florida were removed from their homes and placed in out-of-home and foster care placements (Falconer 2012). It was not until the mid-1990s that Florida courts adopted a least destructive arrangement to the continuity of family relationships thought process. Meaning the courts were beginning to take a therapeutic perspective to dependency and family law court cases. In 1996 a new standard took place and had five basic guidelines for judges, other legal decision makers in the area of child custody, and advocates. They were to identify members of the family (to include non-biological members). They were to consider the mutual interest of all members. They needed to maintain family ties and continuity wherever possible. They were to emphasize current status (rather than dwelling on past experiences, and most importantly they were to focus on the family strengths (Falconer, 2012). This evidence based practice is

commonly known as Family Centered Practice (FCP). FCP is funded through the Federal Court

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Improvement Program, which was a large court reform movement to improve the way the nation protected children through dependency, juvenile and family courts that oversee or overheard abuse or neglect cases. Eventually, all fifty states (in addition to the District of Columbia and Puerto Rico) receive Court Improvement Program grants. The evidence that was collected from the Floridas dependency courts suggested that the evidence based practice of Florida Centered Practice is supported as effective but states that there is more work needed to ensure that this practice is fully understood and realized. However, Florida continues its commitment to

implement this evidence based practice and will continue to monitor ongoing progress of the practice through quality assurance procedures to measure its continued effectiveness statewide (Falconer, 2012). All research considered within this paper, and looking at data collection for guideline standards, the support of various court systems, and how evidence based practices are developed and implemented in other states, in conjunction as to why this theory of treatment was developed, it was determined that one more key part of the research needed to be looked at and the predictability of positive outcomes when utilizing evidence based approaches and treatments. At the California School of Professional Psychology, Alliant International University, Kristine Tiernan, in 2011, conducted research on predictability of outcomes. When considering the evidence based practice of multisystemic therapy (MST), the time frame for treatment on average is 3-6 months. It should be noted that there is evidence that some people and families who participated in this treatment can be considered successful in as little as three meetings with their MST therapist. Also notable is that when considering the early stages of MST, there is little research that has been done to evaluate the reasons for such a change so early into treatment (Tiernan, 2011). The study did site positive outcomes and changes with the antisocial behavior

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traits in as little as six weeks with more progress within the 6-12 week range of treatment. Tiernan stated that early positive changes were related to a number of different areas such as low rate of youth internalizing behaviors, family willingness to support each other and participate in the treatment process, as well as the absence of substance use. Interesting to note from Tiernans report, is that in her additional findings she found that lower family support, and low alcohol use were associated with the increased antisocial behavior in Latino families. In Non-African American families she found that low caregiver

symptomology was related to a decrease in antisocial behavior. Tiernan determined that positive change does occur in MST as a result of many predictors that are assessed early in treatment which ultimately decreased a youths antisocial behaviors. Present studies did support what the previous studies found, which is early positive changes do occur during treatment as information was reported by the youth, parent or youths caregiver. Overall the study did show a reduction in youth incarceration rates, a reduction in a youths delinquent behaviors and improved family functioning. However she also states that positive outcomes are not dependent on a youths diagnosis, family status, age of onset with behavioral issues and educational status (Tiernan, 2011). The research conducted in completing this paper indicates that there are benefits to evidence based practices, particularly as it relates to keeping a family unit together and repair areas within the family unit. The research has shown clearly that there are far too many youth being removed from their family units even as little as two years ago. Being removed from ones parents and siblings is a traumatic event and at times more traumatic that the actual incidents of abuse and neglect that initiated the removal.

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It only makes sense that if evidence exists that can show this type of treatment is effective, not just with juveniles, but with their family units, and it is supported by various agencies as well as many court jurisdictions in juvenile dependency, delinquency and family court systems, that speaks volumes for its effectiveness and success. In an editorial issued in the fall of 2007 and edited by Mark Mattaini, it is explained that within many professions that are considered helping professions, such as human services, avocation and community based program workers, there is much pressure to move toward evidence based practices for use of interventions. The editorial states that overall this practice shows real advancement when talking about helping people, helping society, and that it is highly valued with respect to the goals and values of Behaviorists for Social Responsibility. However it also sites that a significant issue with this is that it requires much attention. He states that the grounds for this is that a proper professional course is seen as only searching for any supporting alternative to address a clinical or community problem (Mattaini, 2007). Evidence based practices are held to a higher level of standard to ensure that they accomplish what the initial research designed stated they would do. The must be shown to be effective and have the ability to be implemented as they were designed to also. Evidence based practices benefit communities by providing services to families and removing the financial burden from tax payers since it is more cost effective than incarceration, or placement in residential facilities. Finally, when looking at the long term goals regarding the futures of the children and their families, by utilizing evidence based practices that will decrease delinquent behaviors, decrease violence, increase educational goals of youth, reduce substance use and built better futures, these benefits outweigh any negative factors.

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When looking at the negative factors of evidence based practices, they should be viewed as a teaching tool to improve in these areas. The same educated group of people who developed these programs can certainly sit down and brain storm their way into improving on what already has proven to be effective.

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References:

Boba, R. (2010). A practice-based evidence approach in Florida. Police Practice & Research, 11(2), 122-128. doi:10.1080/15614261003593021

Burton, M., & Chapman, M. Problems of evidence based practice in community based services. Journal of Learning Disabilities, 8(1), 56-60. doi: 10.1177/14690004704041705

Falconer, M. K., Lederman, J. C. S., Pecora, P. J., Thompson, C. K. and DiLorenzo, P. (2012), Family-Centered Practice in Florida: Family Court Actions and Perceptions. Juvenile and Family Court Journal, 63: 119. doi: 10.1111/j.1755-6988.2012.01077.x

Harvey, M. (2011). Experiences of young offenders involved in multisystemic therapy. Walden University). ProQuest Dissertations and Theses, , 133. Retrieved from http://search.proquest.com/docview/904414882?accountid=12085. (904414882).

Martin, Michelle E. "Chapter 4 Concluding Thoughts on Generalist Practice." Introduction to Human Services Through the Eyes of Practice Settings. 2nd ed. Boston: Pearson, 2011. 62. Print.

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Mattaini, M. (2007). The problem with evidence based practice. Behavior and Social Issues 16(2), 109-110. Retrieved from http://search.proquest.com/docview/229299400?accountid=12085

Pena, J. B., Matthieu, M. M., Zayas, L. H., Masyn, K. E., & Caine, E. D. (2012). Co-occurring risk behaviors among white, black, and Hispanic US high school adolescents with suicide attempts requiring medical attention, 1999-2007: Implications for future prevention initiatives. Social Psychiatry and Psychiatric Epidemiology, 47(1), 29-42. doi: http://dx.doi.org/10.1007/s00127-010-0322-z

Phillippi, S., Models for Change. (2010). Juvenile Justice Reform in Louisiana [Editorial]. Evidence Based Practices.

Sexton, T., Gordon, K. C., P.H.D., Gurman, A., Lebow, J., Holtzworth-Munroe, A., & Johnson, S. (2011). Guidelines for classifying evidence based treatments in couple and family therapy. Family Process, 50(3), 377-92. Retrieved from http://search.proquest.com/docview/888689141?accountid=12085

Tiernan, K. N. (2011). Predicting early positive change in multisystemic therapy with youth exhibiting antisocial behaviors. Alliant International University, San Diego). ProQuest Dissertations and Theses, , 130. Retrieved from http://search.proquest.com/docview/914204136?accountid=12085.