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