EBP Exchange - UMB School of Social Work

A very useful paper from  Daniel Squires  and colleagues in the esteemed Journal of Substance Abuse Treatment (JSAT) builds on work in 54 communiity SAT agencies over a 4 year period, using a strategy called Science to Service Laboratory (SSL).  The authors found that first, adopter agencies voiced a clear preference for a menu of evidence supported interventions (ESIs). As a result they began to incorporate additional evidence ESIs, including cognitive–behavior therapy, MI, and Twelve-step Facilitation, in addition to CM. To support these expanded practice offerings, the second focal area developed was a more comprehensive supervision and follow-up support component that trains supervisors and links practitioners with clinical feedback resources following didactic training. (THe authors note that all of these efforts are being designed consistent with the three-tiered approach advanced by Miller et al’s 1006 paper in JCCP that studies efforts to teach motivational interviewing.) The authors also note the deleterious effects of worker turnover on the implementation of ESIs at the agency level–yet another reason for investing in workforce development efforts.  The citation for the article and the Miller citation are below. Squires, D. D., Gumbley, S. J., & Storti, S. A. (2008). Training substance abuse treatment organizations to adopt evidence-based practices: The Addiction Technology Transfer Center of New England Science to Service Laboratory. Journal of Substance Abuse Treatment, 34(3), 293-301.

This report draws its evidence-base from the Early Childhood Longitudinal Study—Kindergarten Study [ECLS-K] and shows that the number of maternal and family risks are associated with greater absenteeism and that the cumulative exposure to maternal and  family risks best predicts chronic absenteeism in early schooling. Kindergartners in contact with three or more risks missed, on average, three or more days of school more for children experiencing three or more risks than their peers not facing such risks. Although these differences are not large, as children progress through the elementary grades, the impact of cumulative risk on the average number of days of lost school attendance lessens, only to rise again in the fifth grade.

 Of more utility in designing interventions, children experiencing any risk were more often chronic absentees – that is, they missed 10 percent or more of the school year – than those who did not encounter any risks. This was true at every grade, although the ratio of chronic absentees with risks to those without risk was the highest in kindergarten and decreased from this grade to third grade, but increased again in fifth grade. 

This report also reveals that it is children who are poor or racial/ethnic minorities or suffer from poor health who have the greatest exposure to cumulative risk.

The findings suggest that attendance is not heavily influenced by lower levels of risk and that the likelihood of greatest nonattendance and the development of chronic truancy is among children exposed to high rates of cumulative risk and peaks in the early years of school and, again, starting with grade five.

 http://www.nccp.org/publications/pdf/text_792.pdf  

Romero, M. & Lee, Y-S. (January, 2008).  New York: Columbia University,

National Center for Children in Poverty

This op ed in the Baltimore Examiner builds on an article in the New York Times of about a week ago indicating that NYC had done well by youth and the budget as a result of expanding the use of Multisystemic Therapy (although they don’t call it by that name, that’s what I understand it was) and Multidimensional Treatment Foster Care. MD is now calling for more evidence based services. I am not knowledgeable enough to know what will come of this initiative but the fact that op-eds and agency Secretaries are using the term “evidence-based practice” in MD is continued reason for us to grapple with what it means, how to train ourselves to deliver it, and how to implement it here.

At the same time, I hardly think that the evidence is so strong that the claims of the ope-ed title are going to be broadly met with the wider use of MST and MFTC.  These are the best programs we have but their testing has been fairly modest.  The underlying randomized clinical trials and the recent expansion to NYC are positive (although the implementation in NYC was not rigorously evaluated, as far as I know) and promising but the headline is a bit strong.  (This may not be the fault of the author of the op-ed as headline writers march to their own drummers.)

This is not a brand new review (it was posted in mid 2007) but for those interested in this topic and those who have not read Campbell reviews, this is a valuable resource to know about, http://www.sfi.dk/sw53242.asp.  Another interesting and recent review you will find on the home page for Campbell is a late 2007 review on CBT in residential care programs with a finding that these are effective in reducing recidivism. Some subjects are not yet reviewable–as you will see if your read the review about treatment foster care because there is simply not enough high quality research. That is the responbility of all of us–researchers, program managers and providers, and funders to correct!  If we can shoot down our own spy sattelites, we can complete more randomized clinical trials!

 These reviews are considered state-of-the-art with regard to research syntheses, although they are not without critics. John Eckenrode, from Cornell, recently prepared a detailed response to a review of home-visiting programs that contained a long list of what are clear errors–a table full of them.  His email to me about that is worth quoting and reading, “I am attaching the Cochrane reviews and our latest draft of our response as well as a table of errors we found.  Hope this is helpful.  It is an instance that helps remind us that Cochrane/Campbell reviews, while very valuable, are not infallible and should be combined with other sources of information when making decisions about the evidence.”