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Chapter8Sampling211
WhatAreNonprobabilitySamplingDesigns?212 WhatIsProbability(Scientific)Sampling?216 ConsiderationsinSelectingaSample219 HowBigShouldtheSampleBe?221
ChapterRecap224
Chapter9GroupResearchDesigns227
WhatAreGroupResearchDesigns?227 StartinganOutcomeEvaluation228 OutcomeEvaluationDesigns231
GeneralPrinciplesofGroupResearchDesigns234 Pre-ExperimentalResearchDesigns235 Quasi-ExperimentalResearchDesigns246 SomeThreatstoInternalValidity252 ProtectionAgainstAlternativeExplanations257 ExperimentalDesigns258 EfficacyandEffectivenessStudies266 WhatAboutNegativeOutcomeStudies?268 ANoteAbouttheTermExperiment271 SomeNewerDevelopmentsinExperimentalProgram Evaluation272
ChapterRecap274
Chapter10Cost-EffectivenessandCostAnalysis283
WhyConsiderCostasanEvaluativeCriterion?283 ExampleofaCost-EffectivenessEvaluation286 HowDoIBeginaCost-EffectivenessStudy?287 WhosePointofView?290
Cost-BenefitAnalysis292
ChapterRecap296
Chapter11MeasurementToolsandStrategies301
WhyIsGoodMeasurementsoImportanttoEvaluation?301 WhatShouldWeMeasure?303
Preface
Atextbookmustprovide,firstandforemost,informationtoassistthereaderinbetterunderstandingthetopic.Theinformationmustbecredibleandeasilyaccessed anddigested.Readersofthiseditionwillfindnumerousexamplesfromtheliterature toillustratekeypointsandconcepts.Youwilldiscoveranewemphasisonevidencebasedpracticeandwecontinuallystresstheimportanceoflocatingevidenceon theeffectivenessofprogramsandpolicies.Webelievethatprogramevaluators andgraduatestudentslearninghowtoevaluatemustbeacquaintedwithsalient andcontemporaryevaluationsofprogramssimilartothosetheyareinterested in.Thiscanprovideusefulinformationoneffectiveandineffectiveprogramsand practices,aswellasexamplesofthetypesofdesignsusedtoevaluatesimilarprogramswiththelatterprovidingguidanceusefulforcraftingone’sownprogram evaluation.
Textbooksthathavegonethroughmultipleeditionscontinuetoimproveasa resultofreviewers’ commentsandreaders’ feedback,andthisoneisnoexception. Lookingbackovertheeffortsassociatedwiththesixthedition,wehavebuiltupon thesolidfoundationofpreviouseditions,butaddednewmaterialaswell.
Sometimesitishardtoknowhowmuchto “redo” andhowmuchtoleave alone.Salientandclassicstudiesareimportant,buttherearealwaysnewideas andrecentstudiestohighlight.Somecontentmustalwayschangetokeepatext current.However,educatorschoosebookstheyhaveusedinthepastbecause theyknowandlikethatcontent.Ifabookchangestoomuch,thenitmaynot alwayshavethesamecomfortablefitaswhenitwaspreviouslychosen.Itissomewhatofachallenge,then,toknowwhattokeepandwhattotoss.Andthatis why,dearreader,youareinvitedtoletusknowwhatworksandwhatdoesn’t.If thereissomeaspectofprogramevaluationthatwedon’texplainverywell,some chapterthatdoesn’tworkforyou,thensendanemailandtelluswhatyouthink.
Forthoseofyouwhoarejustdiscoveringthisbook, ProgramEvaluation isdesignedtobeaprimarytextbookforgraduatestudentsinsocialwork,sociology,psychology,publicadministration,counseling,education,nursing,andother relateddisciplineswhereitisimportanttoknowifinterventions,betheyindividual,family,group,orcommunityfocused,arehavingthedesiredimpact.We hopethatwehavewrittenclearlyenoughthatpractitioners,administrators,and
otherpersonswhohavejustacquiredtheresponsibilityforoverseeingorevaluating specificprogramsorpoliciesmayfindittobeavaluableresourceinplanningevaluationorneedassessmentprojects.
Ourfocushasbeenoncommunicatingtheessentials thatis,thebasictools andknowledgenecessarytoconceptualizeaprogramevaluationandcarryoutthe tasksassociatedwithexaminingandappraisingprogramperformance.Thisbookis designedtohelpstudentsandpractitionersunderstand and contributetoevidencebasedpractice.Itisvitallyimportantthatweprofessionalsandprofessionals-intrainingcontinuallyexaminetheeffectivenessofourprogramsandtheirimpact uponourclients.Thisisthewayimprovementcomesabout withbenefitsfor bothclientsandsociety.Wehopeinsomesmallwaythatourbookisabletoprepareandassistyouforthisimportantresponsibility.
DavidRoyse (droyse@uky.edu)
BruceThyer (bthyer@fsu.edu)
DeborahPadgett (deborah.padgett@nyu.edu)
CHAPTER 1 Introduction
Whyisitimportantthatpractitionersbefamiliarwith, andinsomecircumstances,beinvolvedin,conducting programevaluationstudies?
Itisthroughprogramevaluationsthatservicescanbecrediblyshown tobehelpful,ineffective,orharmful.Itisthehallmarkofagenuine professionthatconcernbegiventotheevidence-baseofitsservices. Allofthehumanservicefieldssupporttheimportantofprogramevaluationandcommendstheirmemberstotakeintoaccountcurrent credibleoutcomestudieswhenarrivingatpracticeandpolicy decisions.
WhatskillswillIneed?
Allhumanserviceprofessionalsneedtobeabletoread,understand andcriticallyevaluateprogramevaluationstudies,anddecide whethertoapplysuchfindingstotheirownsettings.Somepractitioners willfinditnecessarytohelpinthedesign,conductandinterpretationof programevaluations,assuggestedbycontemporaryethicalcodes.
THEIMPORTANCEOFPROGRAMEVALUATION
Welcometothefieldofprogramevaluation,thataspectofprofessionaltraining aimedathelpingyoutointegrateresearchandpracticeskills,usingtheformerto enhancethelatter.Werecognizethatrelativelyfewpractitionersinthehumanservicesofsocialwork,psychology,counseling,education,psychiatry,publichealth, publicadministration,andnursingwillhavecareersprimarilydevotedtoscientific research.However,everyprofessionalinthesefieldswillbeconcernedwithproviding servicestoclientsatsomelevel(individuals,families,couples,smallgroups,organizations,orcommunities),andeveryhumanservicespractitionerwillbeintenselyinterestedinlearningwhethertheservicesprovidedreallydohelptheclientstheyare
suchastheirsatisfactionwithservices,orhowrespectfullytheyweretreatedby agencystaff.Moreambitiously,someevaluationstudiesattempttodetermine whetherornotagiveninterventionactually caused anyobservedoutcomesordifferencesbetweengroups.Answeringcausalquestionscanbeanexceedinglydifficult undertakingandusuallyrequiresrelativelysophisticatedresearchdesigns.This bookwillcovertherangesofmethodsandresearchquestionsofinteresttoprogramevaluators.
Evaluationresearch refersto “systematicinvestigationtodeterminethesuccess ofaspecificprogram” (Barker,2014,p.148). Programevaluations areapractical endeavor,notanacademicexercise,andarenotprimarilyanattempttobuildtheoryornecessarilytodevelopsocialscienceknowledge(althoughitiswonderful whenthathappens).Tripodi(1987)hasnotedthat “themissionofprogramevaluationinsocialworkistoprovideinformationthatcanbeusedtoimprovesocial programs” (p.366).Similardefinitionscanbeprovidedacrossthehumanservice professions.Forexample,in TheDictionaryofPsychology,Corsini(2002,p.766) definesprogramevaluationas “… aprocesswhosepurposeitisto:(a)contribute todecisionsoninstalling,certifying,andmodifyingprograms;(b)obtainevidence tosupportoropposeaprogram;and(c)contributetobasicknowledge.” Program evaluationisdesignedtomakeadifferenceinthelivesofstakeholders,whichcan includeclients,serviceproviders,supervisor,administratorsandpolicy-makersat alllevels.Onecanevaluatetheeffectsofaprogramatthelevelofanindividual, oramongmanypeoplewhoreceivedagivenprogram,atsimilarlyconstitutedprogramsappliedinvarioussettings,andatthelevelofstatewide,nation,oreven internationalpolicies(e.g.,humantrafficking).
Curiously,althoughformanydecadesthesingularlycrucialimportanceof humanservicesprofessionalsdesigningandconductingprogramevaluationshas beenwidelyrecognized,programevaluationresearchremainsrarelyundertaken, relativetotheamountofliteraturepublished.ConsiderthisfactinlightofthequotationscontainedinBox1.1.
Thuswehavetheveryoddsituationthatalthoughmanyauthoritiesconsider programevaluationtobeperhapsthemostvaluabletypeofresearchcontribution onecanmake,suchstudiesseemtobeveryrarelyundertakenandpublished. Instead,mostempiricalstudieshaveafocusondescriptiveandexplanatory researchwork(Holosko,2010;LeCroy&Williams,2013;Rosen,Proctor& Staudt,1999),which,atbest,mayhavepotential implications forpracticeinthe humanservices,butnotthepotentialfordirect applications thatawell-craftedoutcomestudywouldpossess.
Whyisitnecessarytoevaluatebothnewandestablishedservices?Because therearealwaysalternative,andsometimesbetter,waystosolveproblems.Abusive alcoholuseisaseriousproblemonmanycollegecampusesanduniversitiesspenda gooddealofmoneyattemptingtopreventandreducealcoholabuseanditsassociatedproblems.AtreatmentknownasMotivationalInterviewing(MI)hasbeen widelyusedasatreatmentforalcoholabusers,andasapreventiveintervention oncollegecampuses.RecentlyWilke,Mennicke,Howell,andMagnuson(2014) evaluatedaMIpreventionprogramprovidedtomembersofsororitiesandfraternitiesatalargeuniversity.Arelativelystrongevaluationdesignwasused,whichrandomlyassignedfourGreekhousestoreceivetheMIprogram plus thestandard
BOX 1.1 OpinionsontheImportanceofEvaluationResearch
Iappealtoyou .Measure,evaluate,estimate,appraiseyourresults,insomeform,in anytermsthatrestuponsomethingbeyondfaith,assertion,and “illustrativecase.” Stateyourobjectivesandhowfaryouhavereachedthem….Outofsuchevaluations willcome,Ibelieve,betterservicetotheclient.(Cabot,1931)
Thethirdtypeofresearch,evaluativestudiesofwelfareprogramsandtheactivitiesof practitioners,arethemostimportantofall.(Angell,1954,p.169)
[S]ocialworkisnotasciencewhoseaimistoderiveknowledge;itisatechnology whoseaimistoapplyknowledgeforthepurposeofcontrol.Therefore,onthe researchcontinuumsocialworkresearchfallsnearertotheappliedend,becauseof itspurposeofpracticalknowledge.(Greenwood,1957,p.315)
Evaluationandclientfeedbackarenotonlynecessaryforeffectiveservicedelivery,but areanethicalrequirementoftheprofession.Systematicmethodsmustbedevelopedto assesswhethersocialworkersarehelping,harming,ordoingnothingforthepeople theyserve.(Rosenberg&Brody,1974,p.349)
Socialworkhasnomoreimportantuseofresearchmethodsthanassessmentofthe consequencesofpracticeandpolicychoices .[S]mallscale,agency-basedstudiesare worthwhileiftheysucceedinplacinginterestineffectivenessatthecenterofagency practiceandwhentheycreateacriticalalliancebetweenpractitionersandresearchers. (Mullen,1995,pp.282–283)
Studiesareneededontheeffectivenessofpsychosocialintervention,includinginterventionspreviouslytestedunderidealcontrolledconditions,inreal-worldhealthcare systems.(Ell,1996,p.589)
Researchonactualserviceinterventionsisthecriticalelementinconnectingresearch totheknowledgebaseusedbyprofessionalpractitioners .[T]heissuenowisoneof developinginvestigationsofsocialworkinterventioninitiatives,studiesthatgo beyonddescriptionsandexplanatoryresearch.(Austin,1998,pp.17,43)
Weneedtoestablisharesearchagendaforsocialwork….Andinterventionstudies mustbehighinprioritytosuchanagenda.(Rosen,Proctor,&Staudt,1999,p.9).
existingcampus-widealcoholabusepreventionefforts,andfourtoreceive just the standarduniversityservices.Measuresweretakenofstudentdrinkingandof alcohol-relatedconsequences,coveringthe30daysbeforetheprogramwasimplemented,andagain30daysafterward.Itwashypothesizedthatstudentsreceiving MIplususualcampusserviceswouldreducetheirdrinking,andexperiencefewer negativeconsequencesfromtheirdrinking,muchmorethanthestudentsreceiving usualservicesalone.Sadly,thisisnotwhatwasfound.Therewerenodifferences attributabletotheMIinterventionondrinkingoritsnegativeconsequences.There werenosignificantdifferencesbetweenthetwogroupsatthepretest,noratthe posttest,whenitwashypothesizedthatthepositiveeffectsofMIwouldbeevident. Now,ifyouwereauniversityadministratorchargedwithlocatingandimplementinganewcampus-widealcoholabusepreventionandinterventionprogramaimed atcollegestudents,wouldyouwanttoknowaboutthisarticle?Wouldtheresults
haveanybearingonyourchoiceofanewprogramtoadopt?Perhapsso,especially iftheMIlackedanycounter-balancingstudies,whichhadfoundthatit was effectiveatthepreventionandtreatmentofalcoholabuseoncampus.
Mentalhealthconcernsafflictasizeablenumberofindividuals.Aminorityof thesepeopleseekorreceiveprofessionaltreatment,inpartduetothelackof availablelicensedcliniciansavailabletoprovideempiricallysupportedtreatments.Domentalhealthclientsreallyrequiretreatmentfromdoctoral-levelpsychotherapists,orcouldlessintensivelytr ainedcliniciansalsoprovideeffective care?Thatwasthequestioninvesti gatedbyStanleyetal.(2014).Over200 olderadultswithGeneralizedAnxietyD isorder(GAD)wererandomlyassigned tothreeconditions:Treatment byadoctoral-levelpsychotherapists;treatmentby bachelors-leveltrainedtherapists;ort ousuallyavailablecare.MeasuresofGAD symptomsweretakenafterassignmenttotreatmentconditionsbutbeforetreatmentbegan,andatpretreatmentallgroupswereessentiallyequivalentlydisturbedandsimilarondemographicandothermeasures.Thebachelors-level therapistswereespeciallytrainedina treatmentknowntobehelpfulforpeople withGAD,somethingcalledcognitivebehavioraltherapy(CBT).ThesameCBT interventionwasprovidedbythedoctorallytrainedclinicians.Aftersixmonths, theclientswerereassessed.Itwasfound thatthedoctoralandbachelor-level therapistsobtainedsimilar lypositiveresultswiththeirclients,andbothtreatmentsoutcomeswerebetterthanamongt hosereceivingusualc are.Theseresults suggestthatmentalhealthagenciesmay beabletoprovideeffectiveservices deliveredvialower-cost(e.g.,bachelorslevel)clinicianscomparedtodoctorallevelpsychotherapists.Ifyouwerea managerofacommunitymentalhealth agencywantingtomaximizeyourbudget ,wouldtheresultsofthisstudybeof interesttoyou?
Policy-makersofallpoliticalpersuasionswishtoknowtheimpactofsocialpolicies.OnemajorpolicyintheUnitedStatesiscalledMedicaid,ahealthinsurance programintendedforrelativelypoorpeople.Statesarebeingencouragedtoexpand theirMedicaidprogramsandthefederalgovernmenthasbeenprovidingfinancial incentivestoinducethemtodoso.OneargumentmadeforMedicaidexpansionis thatitwillimprovepeoples’ health,andhavesomefinancialadvantagessuchas reducinghighlyexpensiveemergencyroom(ER)visitsforroutinecare.Poorpeople lackinghealthinsuranceoftenmakeinappropriateuseofERsbecausetheycan receivetreatmenttherewithoutnecessarilyhavingtopayforit.ProvidingMedicaid coveragetothepoor,ithasbeenargued,willgivethemtheinsurancecoverage neededtoobtainroutinecarefromaprimarycareprovider,suchasafamilymedicaldoctorornursepractitioner.DoesMedicaidactuallyreduceERuse?Thatwas thequestionposedbyTaubman,Allen,Wright,Baicker,andFinkelstein(2014)in theirstudyoftheOregonMedicaidexperiment.
In2008,Oregonwasprovidedadditionalfederalmoneytosupportexpanding theirMedicaidprogram.Notenoughmoneywasprovidedtocovereveryoneonthe Medicaidwaitinglist(about90,000people),soOregonusedanunbiasedlottery systemtorandomlyselectwhowouldgetMedicaid(about30,000),andwho wouldremainonthewaitinglist(about60,000).ERvisitstoPortland,Oregonhospitalswerereviewedover18monthsafterthisexpansionofMedicaid.Itwas
CHARACTERISTICSOF “GOOD” PROGRAMS
Programstendtohavecertaincharacteristicsthathelpusidentifythem.Firstofall, programstendtorequire staffing.Aresidentialdrugtreatmentfacility,forinstance, isgoingtoneedalotofstaff.Itmayevenhaveaseparatestaffwhorunanaftercareoroutpatientdrugtreatmentprogram.Thepersonnelofbothprogramsmay occasionallybeaskedtospeaktohighschoolstudentsandgroupsinthecommunityaspartofthefacility’sdrugeducationprogram.Staffmayhavetheirtimeallocatedamongseveralprogramsordedicatedtoonlyone.
Second,programsusuallyhavetheirown budgets.Becauseemployingstaff requiresfinancialresources,programssometimescanbeidentifiedbytheirbudgets. However,somefineprogramshaveminimalbudgetsbecauseofheavyrelianceon volunteers. Stablefunding isimportanttothesuccessofmostprograms.Morale andperformancefallwhenemployeesdonotgetpaidonaregularbasis,orwhen theyareaskedtoputasidenormaldutiesandengageinlastminutefund-raisingor grantwritingtogettheprogramthroughseveralmoremonths.Programsstarted with “softmoney” (grantsornonrecurringfunds)oftenexperiencehighratesof staffturnoveruntiltheprogramssecuresomecontinuityinfunding.
Anothercharacteristicofprogramsisthattheyhavetheirown identity.In short,theyarevisibleorrecognizablebythepublic.BigBrothersBigSisters (BBBS)isanexampleofanorganizationwithanationalreputationforasingleprogram.OthersyoumayrecognizeincludeHabitatforHumanity,AlcoholicsAnonymous,ortheNationalAlliancefortheMentallyIll.Insomecommunities,a programmayberecognizedbythelocationwhereithasbeenhousedforanumber ofyears,orbyitsuniqueslogan,sign,letterhead,spokesperson,orpublicservice announcements.
Whenanorganizationhasmultipleprograms,differencesaresometimesfoundin philosophies,policiesorprocedures,andmissions,andperhapseveninthewaytheir correspondingstaffsdressandhowtheyaccountfortheirtime.Suchcontrastsmake iteasytodifferentiateoneprogramfromanother.Withinanagency,oneoutpatient counselingprogrammayhavethe servicephilosophy that “nooneisturnedaway,” whileanotheroutpatientcounselingprogrammayhaveadifferentphilosophy providingserviceonlyforthosewhomeetcertaineligibilityguidelines,suchashaving privateinsuranceorbeingabletoaffordtopay.Aservicephilosophymayalso clearlycommunicatehowtheclienteleistobetreated,forexample, “Werespect thedignityandworthofallthoseweserveincaringfortheirphysical,spiritual, psychological,andsocialwell-being ” or “ Thecustomerisalwaysright.”
Unfortunatelyforprogramevaluators,programscanbevagueandhardtodistinguishanddefine.Aformergovernoroncemadeapublicannouncementthathe wasunveiling “anewprogram” toputstatesocialworkersinpublicschools.The program,hesaid,shouldhelppreventdropoutsandpoorachievementamongstudentswhofacedseriouspersonalandfamilyproblems.However,thenewspaper accountsaidtheprogramwouldrequirenoadditionalstafforfunds.Inessence, somesocialservicesemployeeswouldbeplacedinschoolsthatcouldsupplythem withofficespaceandphone.
Didthegovernor’sannouncementcreateaprogram?Notinthisinstance.It nevergotofftheground.Whynot?Ithadnoname,nostaff,nofunds,noslogan,
novisibility.Mostschoolsdidnothavesurplusofficespace.Further,thegovernor madenosuggestionofanynewactivitiesorwaysoftacklingtheproblemschildren andtheirfamiliesfaced.
Ontheotherhand,startingabereavementsupportgroupinanelementary school,evenifvolunteerscontributetheleadershipandthegrouphasnobudget tospeakof,couldbeconsideredaprogramifithasanongoingpresenceandapresumedimpactthatcouldbemeasured.Forevaluationpurposes,speakingtoan assemblyofhighschoolstudentsonceortwiceayearaboutdrugsandalcoholism mightalsobeconsideredaprogram.
Inthebestofallpossibleworlds,everyhumanservicesprogramwouldbesolidly establishedonthebasisofscientificallycredibleevidencethathadbeenpreviously publishedinpeer-reviewedprofessionaljournals.Thatis,beforethepractitioners jumpedintoasocialproblemandstarted “helping,” someonedidaserioussearch andappraisaloftherelevantevaluationstudiesthattestedtheusefulnessofvarious methodsofpotentialhelping.Ifacarefulsearchoftheliteratureandcriticalreviewof theexistingoutcomestudiesfoundthatoneormoremodelsofinterventionhadcredibleevidenceofeffectiveness,andtheseapproacheswere “teachable” totheexisting serviceproviders,costeffective,andethical,contemporarystandardsofethicalpracticewouldsuggestthattheserviceprogrambefocusedaroundtheseempiricallysupportedservicesasopposedtointerventionslackingasufficientfoundationin empiricalresearch.
Now,thisposesadilemmaforpractitionersandadministrators,namely, “What ifnoempiricallybasedservicesareknowntoexistforaparticularproblem?” Inthat case,onewouldbejustifiedinprimarilyrelyingonthemoretraditionalsourcesof practiceknowledge,namely, theory, practicewisdom, commonsense , tradition, and authority .But(andthisisabigbut),practitionersshouldonlyclaimthat noempiricallybasedinterventionsexistafterhavingmadeathoroughandupto-datesearchoftherelevantpracticeresearchliterature.Fortunately,researchbasedinterventionsarenowwellestablishedforamajorityoftheseriousconditionsdescribedinthe DiagnosticandStatisticalManualofMentalDisorders (DSM;AmericanPsychiatricAssociation,2013),andincreasinglyforconditions thatdonotlendthemselvestotheDSMsystem problemssuchasunemployment,domesticviolence,childabuseand neglect,andtroubledyouth.Webelieve thateveryhumanservicesagencyshouldkeepabreastofthesedevelopmentsby subscribingtorelevantjournals(e.g., JournalofConsultingandClinicalPsychology , ArchivesofGeneralPsychiatry, ResearchonSocialWorkPractice )and acquiringthelatesteditionofprofessionalbooksthatsummarizethelateststudiesonresearch-supportedpractices.
Humanservicesprofessionaltryingtolocatecredibleinformationontheevidentiarystatusofvariousprograms,policies,andserviceshaveawidearrayof websitestheycanturnto.Table1.2listsafewofthese.
Nowofcoursebecauseaprogramhasbeenshowntobeeffectiveinthepast, perhapsinvolvingclients,therapists,andagencysettingsdifferentfromyourown, thereisnoguaranteethatsuchaprogram,ifimplementedinyouragencyorstate, willyieldsimilarlypositiveresults.Inphilosophythisisknownastheproblemof induction.Ifyousawonenewtypeofbirdanditiswhite,andanother,also white,andanother,youmaybetemptedtoconcludethatallthesebirdsarewhite.
ethicalorlegalmandatesrequirethathumanservicesprofessionalsdeliverresearchsupportedinterventions,wherethesepracticesareknowntobeestablished.This couldchange,however,inthenearfuture.Clearly,itisthedirectioninwhichthe humanservicesprofessionsareheading,andisbeingstronglyencouragedby nationalgovernmentsintheUnitedStates,Canada,theUnitedKingdom,and othercountries,andadoptedbyindividualstatesintheUnitedStates.ThedefinitionofEBPquotedearliercomesfromthefourtheditionoftheseminalbook Evidence-BasedMedicine:HowtoPracticeandTeachIt. AlthoughEBPoriginated inmedicine,itssimpletenetshavebeenwidelyadoptedwithinmanydisciplines, includingpsychology,nursing,publichealth,counseling,andpsychiatry.EBPoutlinesabasicfive-stepprocesspractitionerscanundertaketohelpthemandtheirclientstodecidewhattodo.Thesestepsare:
1. Converttheneedforinformationintoananswerablequestion.
2. Trackdownthebestevidencewithwhichtoanswerthatquestion.
3. Criticallyappraisethatevidenceforitsvalidity,impact,andapplicabilityto one’ssituation.
4. Integratethiscriticalappraisalwithone’sclinicalexpertise,andwiththe patient’suniquevalues,circumstances,andpreferences.
5. Evaluateone’seffectivenessandefficiencyincarryingouttheprecedingfour steps.
TheEBPmodelassumesthatonefollowsappropriateprofessionalethicalstandards.Whileoriginallyintendedtoguidephysicians,thegenericnatureofthese fivestepswerequicklyadoptedbyotherfields,andtherearenowlargeliteratures dealingwiththeEBPpracticemodelinvarioushealthandhumanservicesfields. NotethatEBPis not amedicalmodel.Thereisnoassertionthatclientproblems havetheiroriginsintheclient’sbiology,noassertionthatinterventionsmustbe medical,noranycontentionthattheclinicianmustbeaphysician(thethreecentral principlesofthemedicalmodel).Yes,EBPoriginatedinmedicine,butitisnomore amedicalmodelthantheinferentialstatisticsdevelopedinagricultureintheearly partofthe20thcenturyimplyingthatallthesocialandbehavioralscientistswho usedthemlimitstheiruseonlytofarmers!
Step2,trackingdowntheavailableevidencecanbeconductedbyanindividual practitionerorprogrammanagerhim-orherself,searchingtheliterature,readingall ofit,critiquingit,oronecanlocateusefulsummariescalled systematicreviews (SRs) devotedtoyouranswerablequestion,andtakeadvantageofcompetentpeople alreadyhavingdonethispreliminarylegwork.IfyoucanfindapertinentSR,thisis agreatsavingsoftimeandeffortforyou,andTable1.2listssomesourceswhereSRs maybefound,aswellascitingandlistingresearch-supportedinterventions.However aSRdoesnottellonewhattodo,whatservicetoprovide,ornottoprovide.ASR simplysummarizestheexistingevidence,andpermitsthereadertomakeuseofitor not.Forexample,ifaclientneededabloodtransfusionandherphysicianinformed herofthis,asaresearch-supportedtreatmentforhercondition,theclientmayrefuse, perhapsonreligiousgrounds.AccordingtothemodelofEBP,thepractitioner mustrespecttheclient’svalues,andnotsimplyapplyresearch-supportedtreatments withouttakingintoaccounttheclient’sviews.Orperhapsaclientwasseriously depressed,andarecentSRindicatedCBTwasawell-supportedpsychotherapybut
iftheclienthadaseriousintellectualdisability,thepractitionermayopt not toprovide CBT,giventhejudgmentthattheclientwasunabletoundertaketheself-reflectionand homeworkrequiredforthismodel.Instead,alternativetherapiesmightbeconsidered anddiscussedwithclientand/orresponsibleparty,interventionsuchasbehavioranalysis,orantidepressantmedication.InEBPthereis no assertionthat researchrules ! EBPdoesassertthatresearch mustbeconsidered,alongwithclientpreferences andvalues,professionalethics,availableresourcesandavailableskills.Thisis why,properlyconsidered,therearenosuchthingsasevidence-based practices (nouns).Thereisthefivestepdecision-makingmodelofEBP,whichismuch moresophisticatedthansimplylocatingresearch-supportedtreatmentsanddecidingtomakeuseofthemalongwithjudici ousconsiderationoftheotherequally crucialfactorsfoundintheEBPmodel(Thyer&Myers,2011;Thyer&Pignotti, 2011).Itisreallyquiteimportantforprogramevaluatorswhowishtobe informedaboutEBPtoreadtheoriginalsourcesofinformationaboutthis model,suchasStrausetal.(2011)andpreviouseditions,andnotonthirdor fourth-handrestatements,whichoftenpr esentquitedistortedpicturesofthis model.SeeThyer(2013)foranexampleofcorrectingmisrepresentationsof EBP,whichhavebeenpresentedinthesocialworkliterature.
TheRoleofTheoryinProgramEvaluation
Inthebestofallpossibleworlds,everyprogramwouldalsobebasedonasound theoreticalmodel.Thatis,beforethepractitionersjumpedintoasocialproblem andstartedhelping,theywoulddevelopamodelthatwouldhaveexaminedthe problem howandwhyitoriginatedandwhatwouldworkbesttoremedythesituation.Apsychosocialorothertheorycanbeanorganizingprincipleforeachprogram,onethatprovidesaconsistencyofeffortbysuggestingastandardapproach derivedfromsomewell-articulatedandcomprehensivesocialorbehavioralscience theory.Suchatheorymayserveasaguideinconceptualizingthecausesofproblemsandinproposedmechanismsofactionforinterventions.
Taketheproblemofhyperactivebehavior(HB).IfoneapproachestheunderstandingandtreatmentofchildrenwithHBfromabiologicalorientation,one wouldfocusonpossibleunderlyingdisturbancesinbrainchemistrytoexplainHB andontheuseofmedicationstoregulatethesepresumedchemicalirregularities.If onesubscribedtoalearningtheoryorientation,onemightexaminethepossiblerole ofanover-stimulatingenvironment,orofpeer/parental/teacherinadvertentreinforcementforHB,astentativecausesofHB,andofenvironmentalmanipulationandpositivebehaviormanagementprogramstoreinforceon-taskactivitiesasanintervention. Onetrainedinabiopsychosocialapproachmightemploybothapproaches.Thereare manytheoriesonthecausesofHBandtheoreticallybasedinterventions,whichcould beconsidered.
Anotherexamplemightbethatofdrinkingtoomuchalcohol(oftencalledalcoholism).Therearealsoawidearrayoftheoriesastotheetiologyofabusivedrinking, andofwaystohelppeopledrinklessortoabstainfromdrinking.Accordingtothe theoryofAlcoholicsAnonymous(AA),alcoholismiscausedbyabiologicallybased allergicreactiontoethanol,inthatthesmallestsiptriggersanirresistiblecraving todrinkmore,leadingtoalossofcontrol.Thisbiologicaltheoryleads,naturally,
