OPEN Exchange: Evidence Based Programs
In this OPEN Exchange we explore Evidence Based Programs (EBPs), the first in a four part series on Evidence Informed Practice. Over the series we will share research and practice and take a look at the different forms of evidence that underpin the services we deliver.
Each month OPEN Exchange will focus on a topic that matters for child and family services in relation to outcomes, practice and evidence .
In this edition of OPEN Exchange:
- Introduction to Evidence Informed Practice
- Evidence Based Programs (EBPs) Explained
- Evidence Based Program Trials
- Services and Opportunities for OPEN Members
But first, just so we are all on the same page: What is meant by ‘evidence’?
The Macquarie Dictionary defines evidence as: ground for belief; that which tends to prove or disprove something; proof.
So, when we talk about evidence in child and family services, we are referring to the information that we use as grounds for belief in the quality of the services that we deliver and the outcomes we will achieve with children, youth and families.
Introduction to Evidence Informed Practice
A commonly understood definition of evidence informed practice is; the integration of best research evidence with practice expertise and client values.
A report prepared by the Centre for Community Child Health for DHHS, Supporting the Roadmap to Reform: Evidence informed practice examines evidence based programs in relation to our understandings of evidence informed practice. The report considers evidence based practice as an integration of three sources of evidence, depicted in the diagram below:
- Evidence based programs: program models with clearly identified links between core components and expected outcomes that have been shown to be effective under rigorous evaluation conditions.
- Evidence based processes: the skills, techniques, and strategies used by practitioners when interacting with program participants(Moore, 2016 p.32)and the frameworks and approaches that are employed at the organisational and systemic level in the service system.
- Client and professional values: the values and beliefs that program participants and practitioners bring, consciously and unconsciously, to their interaction with one another and the service being provided.
This series of OPEN Exchange will look at each of these components of evidence one by one, with the last in the series exploring the holistic process of evidence informed practice.
Diagram: Centre for Community Health (2016) Supporting Roadmap to Reform: Evidence Informed Practice p. 6.
Evidence Based Programs (EBPs) Explained
What are Evidence Based Programs?
EBPs are backed by a high standard of evidence that demonstrates positive outcomes for their intended client group.
EBPs have been rigorously evaluated and consistently show positive changes in knowledge, capabilities and/or behaviour.
What type of evidence?
The highest level of evidence for an EBP comes from systematic reviews, an approach that analyses and summarises datafrom multiple high quality studies, usually randomised controlled trials (RCT), to examine the effects of a particular program.
An EBP is highly regarded when a systematic review shows that it can produce a greater and more sustained impact in multiple contexts compared to alternative services/ no service.
What about delivering EBPs?
An EBP is characterised by strict controls i.e. for a specific population, using a specific set of processes, skills and resources, training and credentials. Manuals and guidance support an EBP to be delivered as intended.
It is possible and often necessary to adapt EBPs. To maintain ‘fidelity’ with, or faithfulness to, the original program, it is recommended to do this through a co-design process with the original program developers, practitioners and importantly, your target client group.
There are many steps along the EBP path, from selecting, to implementing, to improving how we deliver services. It is not a case of choose, sit back and let the thing work its magic!
Evidence informed practice and the process of evidence-informed decision-making mean that we combine and balance EBPs with our processes and ways of working and the values and beliefs of our clients as well as our own.
It is an ongoing process of decision-making and continuous improvement to bring about the best possible outcomes for each child and family.
Evidence based programs that are ‘manualised’ and implemented with a high degree of fidelity have significant potential to ensure that outcomes are consistently achieved … [However] [w]ithout investing in co-design and quality implementation and ensuring that programs communicate the core messages of child development science in ways that resonate with the expectations and beliefs of Aboriginal and Torres Strait Islander parents, families and communities, their impact will be limited. (Emerson, Fox & Smith, 2015 p.21)
OPEN Exchange caught up with Bron Moore from Bendigo Community Health Services (BCHS) about their approach to choosing and implementing the EBP Parents under Pressure (PuP). BCHS received a Learning System Grant to evaluate the implementation of PuP with their family services team.
“Parents Under Pressure has a strong evidence base in Australia. In fact, the teams chose it because is addressed trauma…There is predictability in what we are getting when we do an activity…We don’t waste our resources doing things that don’t work. And, even if it doesn’t work if we are taking data we can learn. If we don’t have data we can’t learn, [EBPs] encourage us to learn.”