Four Pillars of Success: Significance, Cost Benefits, Treatment Fidelity, and Public Policy

1
Four Pillars of Success Significance, Cost
Benefits, Treatment Fidelity, and Public Policy

• 2008 REAP Conference
• Santa Fe, New Mexico
• March 19, 2008
• Michael Gass, Ph. D., LMFT
• University of New Hampshire

2
Apologies to the other forms of
researchers/house subcontractors
3
Who is affected by these four pillars in the
adventure field?

• Violence prevention
• Drug prevention and treatment
• Delinquency prevention and treatment
• Education programs - academic social
• Youth Development
• Mental Health programs
• Employment Welfare
• Child Family services
• International development
• Adolescent Pregnancy prevention
• Healthy aging programs
• Developmental disabilities

4
Evidence behind the programming of my first
youth development job

• Our House Inc. - 1979
• Greeley, Colorado
• Group Home 2

5
What research told us up until 1985Nothing
worked

• Casework - no evidence
• Behavior modification - not with juvenile
  offenders
• Teaching Academic skills - not effective
• Work and vocational training - not effective
• Group counseling - not effective
• Individual psychotherapy - not effective
• Therapeutic camping - not effective
• Diversion - not effective
• Probation - not effective

Lipton, et. Al., 1975 Martinson, 1974 Romig,
1978 Sechrest, Et. Al., 1979 Wright and Dixon,
1977
6
Pre-EBP youth era Tail em, Nail em and Jail
em

• Incarceration until they were 18
• Clay Yeager - Burger King story

7
Other ramifications of waiting?

• One out of every 100 American adults in prison
  (one out of every 99.1 adults, and more than any
  other country in the world).
• 2,319,258 adults were held in U.S. prisons or
  jails at the start of 2008
• 50 states spent more than 49 billion on
  corrections
• Prison costs was six times greater than for
  higher education spending
• For black males between the ages of 20 and 34 the
  figure is one in nine

Pew Center on the States Report, Thursday,
February 28, 2008
8
Other ramifications of waiting?

• 73 of adults in the State of Washington prison
  system were in the State of Washington juvenile
  justice system.
• At least 60 of reducing adults offenders can be
  eliminated through juvenile crime prevention.

Steve Aos, WSIPP Report, Thursday, March 19, 2008
9
When did research evidence start to tell us
something different?

• According to the OJJDP, Conrad Hedin (1981)
  were among the first researchers to demonstrate
  the beneficial impact of positive youth
  development (See JEE).
• Demonstrated that something different than
  punitive measures worked
• Combined with positive psychology sciences

http//www.dsgonline.com/mpg2.5/ leadership_devel
opment_prevention.htm
10
JEE Conrad Hedin article

• 4000 adolescents in 30 experiential education
  programs
• Six programs with comparison groups
• Increased differences in personal and social
  development, moral reasoning, self-esteem,
  attitudes toward community service and
  involvement.
• Elements to Mac Hall and Project Venture

11
What is significant?

• P lt .05!
• YOU JUST SAVED 540 ON YOUR PROPERTY TAXES!
• YOU HAVE A TREATMENT MANUAL AND TRAINING PROGRAM
  THAT INFORMS ALL STAFF KNOW HOW EFFECTIVELY WORK
  WITH CLIENTS!
• YOUR PROGRAM IS LISTED AS A MODEL PROGRAM BY A
  FEDERAL AGENCY, ENABLING YOU TO RECEIVE FEDERAL
  FUNDING FOR PROGRAMMING AND TRAINING!

12
Choice of Drug paradigm What do you choose?

• Scientifically based evidence backing the
  effectiveness of a drug with proven results, or a
  drug that has shown no effectiveness?
• Drug that costs 400 or one that costs 1000?
• Drug that is the same no matter where you take it
  or who gives it to you, or one that does/may
  change with administration?
• Drug that has achieved approval from the American
  Medical Association and Federal Drug
  Administration or not

13
Choice of Drug paradigm You choose

• One with documented, unbiased evidence, with
  multiple tests done by different researchers
• One that is cost effective (and you can afford)
• One with fidelity, or does not change with who
  administers it to you.
• One that is approved by the highest regarded
  overseeing organizations.
• This medical paradigm is the source begins the
  understanding of what is meant by significant.

14
Report card on what is significant for the
framing roof builders

• Experimental Design
• Evidenced-based research evaluation
• Provides Case studies or clinical samples
• Benefit-Cost Analysis
• Results reporting
• Training models
• Power of research design
• Proper instrumentation

15
Report card on what is significant for the
framing roof builders (continued)

• Cultural variability
• Treatment/Intervention fidelity
• Background literature support
• Replication
• Length of treatment effectiveness assessed

16
(No Transcript)
17
Progress for interested framing roof builders
(and others)

• Rubric created for these 13 factors
• http//www.shhs.unh.edu/kin_oe/Gass_(2007)_EBP_Rub
  ric.doc
• Literature reviews with rubric analysis for
• - Adventure therapy (Young)
• - K-12 educational settings (Shirilla)
• - Wilderness programs (Beightol)
• - Higher education programs (Fitch)
• http//www.shhs.unh.edu/kin_oe/bibliographies.html
  

18
NATSAP Research and Evaluation Network A
Web-Based Practice Research Network and Archival
Database Michael Gass, Phd Chair, Dept. of
Kinesiology, University of New Hampshire NATSAP
Research Coordinator Michael Young,
M.Ed Graduate Assistant, University of New
Hampshire NATSAP Research Coordinator
19
The NATSAP Research and Evaluation network

• Provide an affordable data collection tool for
  all NATSAP programs to utilize
• Create a research data base that could be used to
  improve NATSAP program practices, especially EBP
• Attract the interest of other researchers in
  appropriately using a NATSAP research database.

20
The NATSAP Research and Evaluation network
The NATSAP Research and Evaluation network
Practice Research Network
Web-based Protocol
Establish comparative benchmarking opportunities
by establishing de-identified aggregate scores
Research Coordinators, Program Staff, and Study
Participants, have access to consent forms, and
assessments (OQ and ASEBA) through a web-site
Build the n by including multiple program sites
21
The Measures

• The database will rely on two groups of survey
  measures
• 1) the Outcome Questionnaires and
• 2) Achenbach measures.
• Both are gold standards and are widely used in
  the industry.
• It is recommended that programs use both
  instruments for data collection, but it is
  possible to use only one.

22

• www.oqmeasures.com
• Used to track therapeutic progress of clients
• Y-OQ is a parent reported measure of a wide range
  of behaviors, situations, and moods which apply
  to troubled teenagers.
• SR Y-OQ is the adolescent self-report version
• Scales Intrapersonal Distress, Somatic,
  Interpersonal Relations, Critical Items, Social
  Problems, Behavioral Dysfunction
• Aggregate Scale Total Score

23

• one of the most widely-used measures in child
  psychology
• About 110 items, lt 10 to complete
• Scales Withdrawn/Depressed Anxious/Depressed
  Somatic Complaints, Social Problems, Attention
  Problems, Thought Problems, Aggression,
  Rule-Breaking Behaviors
• Aggregate Scales Internalizing, Externalizing,
  Total Problems
• Reliability
• Test-Retest Value - 0.95 to 1.00
• Inter-rater reliability - 0.93 to 0.96
• Internal consistency 0.78 to 0.97

24

• www.carepaths.com
• Supports the the whole protocol
• Allows for addition of other forms (i.e.
  demographics, case-mix, other standardized
  assessments)
• Helps with e-mail reminders
• Provides additional modules (e.g. clinical
  reports for indiv. Clients) if programs are
  interested

25

• De-Identified Aggregate Data will be downloaded
  periodically to a UNH Server
• Here is where the archival data base will sit and
  be accessible

26
From more info contact Michael
Gass mgass_at_unh.edu 603-862-2024 Michael
Young michael.young_at_unh.edu 603-862-2007
27
Evidence means more that outcomes
cost-effectiveness measures (e.g., taxes)

• With programs that work,
• can you show a bottom line net gain?
• deliver consistent, quality programs?
• Dr. Steve Aos, WSIPP
• http//www.wsipp.wa.gov/default.asp

28
Affects on other approaches/programsSearch for
the actual truth or outcomes of a
well-designed and effective programs

• David Barlow (APA) (2004) landmark article
• In the 1990s large amounts of money with little
  supporting evidence was invested into programs
  addressing youth and adult violence that simply
  didnt work.
• In some cases these intervention programs created
  more harm than no program at all.

29
Samples of well-known, ineffective programs

• 1990s for the emergence of ineffective but
  popular programs
• (1) Gun Buyback programs - two-thirds of the guns
  turned in did not work, almost all of the people
  turning in guns had another gun at home)
• (2) Bootcamp programs (failed to provide any
  difference in juvenile recidivism outcome rates
  than standard probation programs, but were four
  times as expensive.

30
Ineffective Programs continued

• (3 ) DARE programs - traditional 5th grade
  program failed to be effective in decreasing drug
  use despite the fact that by 1998 the program was
  used in 48 of American schools with an annual
  budget of over 700 million dollars (Greenwood,
  2006).
• (4) Scared Straight programs - inculcated youth
  more directly into a criminal lifestyle, actually
  leading to increases in crime by participating
  youth and required 203 in corrective programming
  to address and undo every dollar that was
  originally spent on programming.

31
Future trends of prison incarceration
32
WA taxpayer rates vrs. Crime rates
33
Treatment Fidelity Experience

• Stage 1 - Produce an acceptable model of a
  machine that would fly

Any different than how Our House, Inc. program
was started? How most adventure programs are
begun?
34
Treatment Fidelity Experience

• Stage 2 - Produce an acceptable model of a
  machine that would fly from the following model

35
(No Transcript)
36
Treatment Fidelity Experience

• Stage 3 - Produce an acceptable model of a
  machine that would fly from the following
  manualized version
• Know that you need to adhere to these guidelines
  accounting for some programmatic resources that
  fit within the program rationale

37
Recent findings regarding treatment
fidelity(Elliot, 2008)

• Need for adaptation overestimated
• Adaptations must fit with program rationale
• Language/cultural adaptations most easily
  justified, but must be documented and measured to
  assure fidelity
• Most frequent threats to validity are frontline
  implementers (e.g., teachers, staff) and
  disseminating agencys efforts to please programs
• Local adaptation may increase buy in but also
  creates uncertainty about program affects
• Program success needs to be judged by real
  changes in behavior, not by number of adaptations
  or survival (80 DARE program participation in
  schools)

38
Public Policy

• Welcome to Aleta Meyer and NIDA

39
Federal Program Lists

• Center for Mental Health Services (2000)
• National Registry (NREPP) (2002)
• Office of Safe Drug Free Schools (2001)
• National Institute of Drug Abuse (2003)
• Surgeon General Report (2001)
• Helping Americas Youth (2007)
• OJJDP Title V (2007)
• What Works Clearinghouse (2002)

40
Consensus across lists

• No one program appears on all lists
• Federal Working Group Standard for Certifying
  Programs as Effective
• Hierarchical Classification Framework for Program
  Effectiveness, Working group for the Federal
  Collaboration on What Works, 2004

41
Federal Working Group Standard for Certifying
Programs as Effective

• Experimental Design
• Effect sustained for at least 1 year
• At least 1 independent replication of RCT
• RCTs adequately addresses external validity
  threats
• No known health compromising side effects

42
Hierachical Program Classification

• Model - Meets all standards
• Effective - RCT replications not independent
• Promising - Q-E or RCT, no replication
• Inconclusive - Contradictory findings or
  non-sustainable effects
• Ineffective - Meets all standards but with no
  statistically significant effects
• Harmful - Meets all standards but with negative
  effects or serious side effects
• Insufficent Evidence - All others

43
What do we have to do to change the AEE field in
EBP research?

• Get people in programs interested through the
  story telling in the value of EBP Get on lists
• Defend aggressively against poor research
• Launch our own efforts to support AEE programming
  through CORE

44
What do we have to do to change the AEE field in
EBP research?

• (5) Train and expect more from PhD people
• (6) Attract external researchers to conduct
  informed and powerful research on adventure
  programs
• (7) Funding

45
What do we have to do to change the NATSAP field
in EBP research?

• (8) Make advances outside of our field
• - APA journal articles
• - Other conferences
• - Be involved in decision maker conversations

46
What do we have to do to change the NATSAP field
in EBP research?

• (9) Create teams of success
• - researchers (knowledge)
• - funders (resources)
• - programmers (access to populations)
• (10) Current efforts follow-up

47
What stage of buy in for EBR are you in?

• Awareness stage dont know what it is, unaware
  of the benefits, or the controls dictated by EBP
• Decision-making stage - weigh pros and cons, but
  remain vague about actually making changes or
  choosing for the pro side
• Preparation stage make a decision to implement
  this process, generated by a value added
  approach of sorts from a desire to have a more
  effective program or financial reasons
• Action stage partner support structure in place
  to aid continuation

48
Questions?

• Thanks!
• Michael Gass
• NH Hall, 124 Main St., UNH
• Durham, NH 03824
• mgass_at_unh.edu
• [phone]