Revisiting Evidence Based Practices

Reclaiming Futures has been promoting the use of evidence-based practices (EBPs) since its inception. Yet, over time, it may have become unclear as to exactly what this means. As such, in this blog post we re-visit the topic.

To start, it’s important to acknowledge Reclaiming Futures itself is an EBP used to screen, assess, and coordinate services for young people and their families who have behavioral health concerns. It also uses national standards to ensure access and engagement in services in a timely fashion. Studies have found it to be an effective model.

There are varying degrees of evidence used to determine if a process, intervention, or approach is evidence-based. The strength of evidence can range from expert opinions to systematic reviews. Types of interventions can fall into categories that aim to improve systems, organizations, communities, specific populations, individuals, and/or families.  National repositories such as the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Registry of Evidence Based Programs and Practices (NREPP) and the Office of Juvenile Justice and Delinquency Prevention’s (OJJDP) Model Programs Guide offers a list of EBPs, how they were assessed, and various ratings.

As our knowledge has improved about EBPs, it is clearer that selecting and implementing the best EBPs requires deliberate consideration to ensure it aligns with the operational and cultural contexts. Fundamentals in Health Care Improvement authors argue that a missing piece to implementation of EBPs is a “connector.” A connector uses “a set of knowledge and skills to take the best evidence and put it into practice consistently and reliably for the improvement of care for patients” (p. 6). In the past, sites may have selected certain types of EBPs without really understanding the mechanisms for implementing the process or practice. Program implementers must consider the cultures of the participants, organizations, and communities, training and other related costs for sustainability, and the appropriateness of the tools and materials. Oftentimes, this can be an undervalued step in the selection process. As such, OJJDP developed I-Guides to provide practical implementation considerations based on implementation science.

Reclaiming Futures’ focus on equity keeps our attention on reducing the racial and ethnic disparities in juvenile justice and behavioral health. This is a primary aspect when selecting EBPs. Historically, studies on EBPs have included small numbers of young people of diverse races and ethnicities calling into question the effectiveness of these interventions for young people of color. Spinney and colleagues recently examined juvenile justice studies over the past 20 years and found the majority of the results showed some type of race effect in the access of behavioral health services and supports. That is, youth of color were less likely to receive substance use and/or mental health service.

Access to fair and quality services and supports is key. To help reduce access barriers, it requires culturally responsive, consistent, and reliable screening, assessment, and, if indicated, receipt of services within 14 days. Clearly, there is more work to do to improve the availability of culturally responsive EBPs. Yet, in the connector role, let’s examine some sources for culturally responsive information and EBPs.

The Addiction Technology Transfer Center (ATTC) has both the National Hispanic and Latino Center , which provides specific information for Latino populations and the Teen Treatment IQ which disseminates information about adolescent substance use disorder treatment inclusive of culturally responsive approaches. The National Network to Eliminate Disparities in Behavioral Health highlights and disseminates EBPs and other relevant information to help behavioral health practitioners eliminate disparities among diverse cultural groups. OJJDP recently shared the Mi Hermana’s Keeper Toolkit for Latina youth who are at risk for juvenile detention developed by Báez and Garza (2017). The toolkit focuses on preventing juvenile justice involvement among Latinas. The authors conducted a qualitative study with Latina youth, caregivers, and community stakeholders. Based on the study findings they offered these recommendations for working with Latinas and their caregivers (pp. 15-24):

1. Provide services that respectful and reflective of shared and individual Latino cultural heritage
2. Provide services that value respeto and teach respectful practices
3. Provide services that utilize a relational approach
4. Provide case management services for the entire family
5. Support cross-generational services to instill values
6. Develop caregiver-specific services
7. Build culturally responsive school practices
8. Support effective systems advocacy
9. Promote the dismantling of systematic racism and bias

Following each recommendation is a set of action items that communities, providers, and juvenile justice jurisdictions can use to help apply the recommendations. Connecting these recommendations with the action items are likely to lead to improved service access and delivery for Latina’s and their families at risk for juvenile justice involvement.

To reduce disparities, improve access to and receipt of quality services and supports, and continually expand our knowledge and practices, it is necessary to use the best available evidence. Reclaiming Futures continues to build upon its 6-step model developed more than 15 years ago by adding a brief intervention, incorporating a decision-making framework to reduce disparities, and focusing on the importance of the caregiver(s) in guiding service and support decisions.