Evidence-based Programs:  Answers But Not Proof or Solutions

What are evidence-based programs?

Simply put, a program is judged to be evidence-based if it meets the following criteria:

• Evaluation research shows that the program produces the expected positive results;
• The results can be attributed to the program itself, rather than to other extraneous factors or events;
• The evaluation is peer-reviewed by experts in the field; and
• The program is “endorsed” by a federal agency or respected research organization and included in their list of effective programs.

Start with what we have! A glance at the National Registry of Evidence-Based Programs and other similar registries and best practices is enough to demonstrate that increasing disparities between disadvantaged and non-disadvantaged groups does not stem from a lack of evidence-based programs. Absent are contextual  measures pivotal to accurately assess effectiveness and appropriateness of evidence-based programs operating within diverse communities. We may have the answers to the wrong questions. Evidence-based is not proof of   effectiveness, safety or application of programs in diverse communities.

“Why are gaps or rather disparities increasing?” I propose the answer lies in the belief that using evidence-based programs guarantees effectiveness and desired outcomes, particularly if fidelity, reliability, and validity have been demonstrated. Some in public health still believe-evidence based programs replace the need for metrics. This is wrong!

Research  studies showed positive nurturing environments d from birth to 5 years old is critical to  formation of healthy foundations.  Healthy foundations increased the likelihood of successful, productive, and healthy behavioral and academic outcomes in adulthood.

Currently, educational outcomes are measured by indicators such as academic performance, standardized tests, graduation rates and college entrance rates. These metrics provide useful information, but not about healthy foundations or  how to improve future potential of children, particularly children from impoverished backgrounds. The tests show that disadvantaged groups (poor children) lag behind and have not benefitted from the science of our advanced technologies, thereby decreasing future potential and  increasing disparities in education, health, and social class.

Why Evidence-Based Doesn’t Work?

This is partly due to:

• Lack of evaluative tools to  guide effective and appropriate strategic interventions that are scalable,  replicable  as well as form strong, agile customizable  infrastructures;

• Academia’s insistence on fidelity when implementing evidence-based programs defies factual observations that one size does not fit all. Fidelity–loyal to protocol –ignores  nuanced cultural contexts of communities and members of each stakeholder.

  1. Fidelity in implementation unintentionally devalues a community’s culture by replacing with Anglo-Saxon culture;

  2. Acting against one’s beliefs and values without creating a rational narrative stresses the psyche and the body, triggering profound inner turmoil known as cognitive dissonance;

• Evidence-based studies are based on evidence within a particular context, community  or environment.    Also, keep in mind most studies are short term.  The wide application of evidence-based studies to diverse communities does not assure desired outcomes.   For example, Headstart, one of the government’s longest running”successful”  programs for in-need pre-school children,  fades within one to two  years of starting school. Why? That research has not been done yet HeadStart expanded.

• Finally, without appropriate metrics and allowances for context, health is not measured nor is the long-term impact or harm of many well-intended social programs.  As well-intentioned as the missions of social programs, most are ineffective at best.

Causing harm, oppression and creating new issues  for those without safety nets were not issues anticipated by researchers.  Many brilliant minds still  reside in a tunnel.    Evidence-based studies  and best practices do harm simply by not  understanding or appreciating the impact or POWER of  diverse cultures.

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With the above in mind, imagine living in a community struggling to survive without basic needs—a food-insecure community lacking shelter where safety is of huge concern, not because of crime but because of local police departments.  In 2012, about 50 million Americans fit the description of food- insecure with 8.8 million children living in food-insecure households.    Mistrust and fear are high in communities struggling to survive.

 Maslow Hierarchy

Maslow’s hierarchy is a good starting pointing in understanding the stages of fulfillment of human needs. The bottom needs are essential to move up the hierarchy. Basic physiological needs—sleep, food, water, sex—are essential for survival. The next level includes security, safety and employment.

Keep the above in mind as you imagine the following scenario. A new program distributing information about obesity comes to your community. You unknowingly fall into a high-risk group. Considering Maslow’s hierarchy, would obesity be high on your priority list if food and safety are also concerns?

Unfortunately, most programs operate on the presumption that a community’s priorities are similar to those of researchers. When programs do not work, this apparently flawed assumption ignores the tendency of social workers to double down  and  request  more funding.

Suggestions:

Please, Please, Please No more spending and no more programs hatched in petri dishes, please! Social problems are complex adaptive problems that require all parties at the table, feeling discomfort while totally invested in the outcomes. Integrating appropriate metrics with social programs not only guides strategy but can be educational and a tool to build trusting relationships within communities for future collaborations.

A system-of-care approach determines the needs of children and their families within communities, based on a number of factors including a community’s own resources.  Community members form  core infrastructures germane to a programs’ success and longevity; as well as facilitate development of  culturally appropriate metrics (which improve  compliance)  to guide evaluation, implementation and outcomes. Engaged communities collaborate with researchers to  facilitate adoption of    cultural-contextually appropriate solutions. Interestingly, if one looks and listens, successful solutions with desired outcomes already exist within communities.

 Evidence-based studies are tools to help communities carve their own solutions.  They are not THE solutions.

References:

1.  SAMHSA National Registry of Evidence-Based Programs and Practices

http://nrepp.samhsa.gov/

2.   Cognitive dissonance

http://en.wikipedia.org/wiki/Cognitive_dissonance

3.   What Is Cognitive Dissonance?

http://psychology.about.com/od/cognitivepsychology/f/dissonance.htm

4.   Definitions of Food Security

http://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/definitions-of-food-security.aspx#.U-DWLvldV8E

5.   Food Security in the U.S.

http://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us.aspx#.U-DV4vldV8E

6.   Food Security

http://www.who.int/trade/glossary/story028/en/

7.  Research Review Evidence-Based Programs and Practices: What Does It All Mean?

Click to access research_review.pdf

8.  Evidence-based medicine

http://en.wikipedia.org/wiki/Evidence-based_medicine

9.  About Evidence Based Programs

http://www.projectenhance.org/aboutevidencebasedprograms.aspx