Casey Works to Make Evidence-Based Practice the Norm

It wasn’t the first time 15-year-old Frank and his broth­er Joseph had got­ten into a fight. But when it hap­pened again in Decem­ber 2008, Frank punched, kicked and held his moth­er Nancy’s head against the wall when she tried to intervene.*

Instead of hav­ing Frank placed in a juve­nile facil­i­ty, all par­ties agreed to offer Frank a refer­ral to a pro­gram with proven results and life-alter­ing oppor­tu­ni­ties. He was sen­tenced to 18-months pro­ba­tion and enrolled in ​“Blue Sky” — a pro­gram in New York City that pro­vides inten­sive ther­a­peu­tic treat­ment for trou­bled juve­niles and their fam­i­lies. Two years lat­er, Frank still lives at home, is in school, works part-time and no longer exhibits aggres­sive behav­ior. His moth­er and broth­er also have received treat­ment to address men­tal health and sub­stance abuse issues.

The Annie E. Casey Foun­da­tion wants to pro­mote greater use of evi­dence-based prac­tice — treat­ment approach­es such as Blue Sky’s that are rig­or­ous­ly stud­ied and test­ed to ensure proven results.

Now in its fourth year, Blue Sky has a near­ly 60% suc­cess rate in pre­vent­ing the young peo­ple it serves from being removed from their homes. Since its 2007 launch in Man­hat­tan and the Bronx, Blue Sky has helped some 350 youths referred by New York City Fam­i­ly Court to safe­ly avert place­ment in res­i­den­tial facil­i­ties. Blue Sky costs rough­ly $17,000 per youth—including ser­vices to the entire fam­i­ly — which trans­lates into about $100,000 in annu­al sav­ings for each youth kept in the com­mu­ni­ty and out of incar­cer­a­tion. Stud­ies also show that the ther­a­pies Blue Sky uses save mon­ey and lives by reduc­ing recidi­vism, hos­pi­tal stays and sui­cide rates.

Despite com­pelling evi­dence that this approach works, how­ev­er, many young peo­ple in sim­i­lar cir­cum­stances to Frank’s are placed in facil­i­ties that, in the long run, leave them no bet­ter off than when they arrived.

“Juve­nile offend­ers are sent to insti­tu­tions with the hope that remov­ing them from their pre­car­i­ous sit­u­a­tion will help, yet when the youth are released, they return to the same envi­ron­ment in which they first com­mit­ted their crimes. Many fall prey to the same temp­ta­tions, com­mit anoth­er crime and remain entrenched in the juve­nile jus­tice sys­tem,” notes the web­site of the non­prof­it that pio­neered Blue Sky, New York Foundling.

Scott Henggel­er, prin­ci­pal researcher in an ongo­ing eval­u­a­tion of Blue Sky, says evi­dence-based pro­grams are used in only about 5% of juve­nile jus­tice cas­es nation­al­ly and are con­cen­trat­ed in a few states. Henggel­er is based at the Med­ical Uni­ver­si­ty of South Car­oli­na Fam­i­ly Ser­vices Research Cen­ter, in the depart­ment of psy­chi­a­try and behav­ioral sciences.

The Casey Foun­da­tion is work­ing to ensure that evi­dence-based prac­tice (also known as EBP) is more wide­ly used not only in juve­nile jus­tice, but through­out the entire child wel­fare field.

Encour­ag­ing Evi­dence-Based Practice

Since the 1980s, pub­lic and pri­vate invest­ments in research and pro­grams aimed at pre­vent­ing poor out­comes for vul­ner­a­ble chil­dren have iden­ti­fied fac­tors that can help pro­tect them and make them more resilient, such as strong fam­i­lies and com­mu­ni­ties and sup­port ser­vices that build on their strengths.

In addi­tion, it’s now pos­si­ble to iden­ti­fy high­ly effec­tive efforts that can cut rates of drug use, school dropout, and oth­er ado­les­cent risks, thanks to rig­or­ous eval­u­a­tions. But despite a lega­cy of poor long-term out­comes for young peo­ple placed in restric­tive insti­tu­tion­al set­tings and mas­sive expen­di­tures of tax­pay­er dol­lars, evi­dence-based alter­na­tives like Blue Sky aren’t wide­ly embraced.

Casey’s Evi­dence-Based Prac­tice Group works with lead­ing researchers and taps staff exper­tise in child wel­fare, sys­tem reform, health, edu­ca­tion, men­tal health, youth in tran­si­tion, ado­les­cent health and devel­op­ment, and com­mu­ni­ty build­ing. Indi­ca­tors of suc­cess the team has devel­oped include aca­d­e­m­ic achieve­ment, emo­tion­al well-being, behav­ior, rela­tion­ships, and phys­i­cal health from birth through ear­ly adulthood.

Casey is work­ing to devel­op tools to help and encour­age pub­lic sys­tems to fund their own evi­dence-based pro­grams and to help repli­cate suc­cess­ful efforts. Some of the tools the Foundation’s EBP group is work­ing on include:

• Sur­veys to assess out­comes and risk and pro­tec­tive fac­tors to help poten­tial EBP sites deter­mine which child-spe­cif­ic out­comes to pri­or­i­tize and which evi­dence-based prac­tices to implement;
• A finan­cial analy­sis toolk­it to help pub­lic sys­tems devel­op a plan to sus­tain these prac­tices using tra­di­tion­al fund­ing sources;
• A data­base con­tain­ing the most effec­tive pro­grams avail­able; and
• A series of man­u­als that describes strate­gies for engag­ing com­mu­ni­ties and pub­lic sys­tems in col­lab­o­rat­ing to imple­ment evi­dence-based practices.

While these tools are still under devel­op­ment, the Casey team has formed part­ner­ships to help advance evi­dence-based prac­tice. For exam­ple, the team is work­ing with the Jim Casey Youth Oppor­tu­ni­ties Ini­tia­tive — which pro­vides sup­port to ease young people’s tran­si­tion out of fos­ter care — and the devel­op­ers of Com­mu­ni­ties That Care, an evi­dence-based com­mu­ni­ty change ini­tia­tive devel­oped by the Social Devel­op­ment Research Group at the Uni­ver­si­ty of Wash­ing­ton in Seattle.

How Blue Sky Works

New York Foundling, cre­at­ed in 1869 as a home for aban­doned chil­dren, now has a diverse net­work of pro­grams serv­ing fam­i­lies with mul­ti­ple needs. It received Casey sup­port to devel­op Blue Sky, work­ing with the devel­op­ers of the three evi­dence-based treat­ments it pro­vides. Blue Sky’s ser­vices are fund­ed with fed­er­al, state and local pre­ven­tion dollars.

Blue Sky got its start after New York Foundling began work­ing with the Admin­is­tra­tion for Children’s Ser­vices on an ini­tia­tive to reduce the num­ber of New York City youth being placed in upstate facil­i­ties oper­at­ed by the State Office of Chil­dren and Fam­i­ly Ser­vices. The ini­tia­tive, which came to be known as Blue Sky, pro­vides a con­tin­u­um of care for high-risk youth, serv­ing some 60 fam­i­lies at a time for four to six months on aver­age. It com­bines three treat­ment mod­els: Mul­ti­sys­temic Ther­a­py (MST), Func­tion­al Fam­i­ly Ther­a­py (FFT) and Mul­ti­di­men­sion­al Treat­ment Fos­ter Care (MTFC).

“The notion was that the inten­si­ty of ser­vices could range from out­pa­tient ser­vices once or twice a week to a more inten­sive home-based mod­el to a short-term spe­cial­ized fos­ter care approach aimed at sta­bi­liz­ing seri­ous anti-social behav­ior before return­ing the youth to the fam­i­ly,” says Henggel­er. Each treat­ment has advan­tages for spe­cif­ic youth and fam­i­lies, who can move from one to anoth­er seam­less­ly depend­ing on their needs.

One rea­son Blue Sky is so effec­tive is because of what EBP researchers call ​“fideli­ty” — prac­tic­ing each of the ther­a­pies accord­ing to spe­cif­ic guide­lines — notes Sylvia Row­lands, assis­tant exec­u­tive direc­tor of the New York Foundling and direc­tor of Blue Sky. ​“We fol­low the mod­els with adher­ence. There is a lot of com­mu­ni­ca­tion between and across the three treat­ment mod­els, with every­one involved doing what­ev­er it takes” to address any chal­lenges the fam­i­ly is fac­ing, she says.

Casey’s sup­port of Blue Sky has ​“had an enor­mous impact on the field in New York City,” adds Row­lands. ​“In part­ner­ship with the Depart­ment of Pro­ba­tion, we have been able to help influ­ence how judges make orders, how they allow clin­i­cians to do the clin­i­cal work and their patience in allow­ing these fam­i­ly sys­tems to change.”

Next Steps

The Casey Foun­da­tion plans to use strate­gic grant mak­ing to sup­port efforts to enhance and increase the sup­ply of evi­dence-based prac­tices. Casey is also look­ing to pro­vide guid­ance to pub­lic sys­tems on how they can best part­ner with com­mu­ni­ty orga­ni­za­tions to use evi­dence-based prac­tices to improve child outcomes.

One exam­ple is Com­mu­ni­ties That Care, the Seat­tle ini­tia­tive that has suc­cess­ful­ly helped com­mu­ni­ty advo­cates raise local fund­ing and work with pub­lic agen­cies to imple­ment effec­tive pre­ven­tion programs.

“Sup­port­ing EBP is well over­due in the field — and crit­i­cal in get­ting bet­ter out­comes for kids,” says Henggel­er. ​“Too often, peo­ple keep doing what they learned in grad­u­ate school with lit­tle regard for how it works. Casey is try­ing to set the stage for wider dis­sem­i­na­tion of inno­v­a­tive approach­es that actu­al­ly work.”

* not her real name