Evidence Based Practices

1. Evidence Based Practices Violence Prevention Summer Institute 2005

2. What is it? • An Evidence Based Practice (or EBP) is a practice that has been shown to produce results in several settings (replication) and can be exported (manuals, etc.).

3. SB 267 • Does Senate Bill 267 apply to me? • Department of Corrections • Oregon Youth Authority • Oregon Commission on Children & Families • That part of the Department of Human Services that deals with Mental Health and Addiction issues • Oregon Criminal Justice Commission

4. SB 267 Timelines • By Sept. 30, 2004: • Conduct an assessment of existing programs and establish goals that enable the agency to meet the requirement of the law. • Submit a report to the legislature containing: • An assessment of each program on where the agency expends funds, including by not limited to whether the program is an evidence-base program. • The percentage of state moneys the agency receives for programs that is being expended on evidence-based programs. • The percentage of federal and other moneys the agency receives for programs that is being spent on evidence-based programs. • Description of efforts being made to comply.

5. SB 267 2005 Timelines • For the biennium beginning July 1, 2005: • The five agencies shall spend at least 25 percent of state moneys that each agency receives for programs on evidence-based programs. • Submit a report to the interim legislative committee dealing judicial matters no later than Sept. 30, 2006. • Description of efforts to meet the requirements.

6. SB 267 2007 Timelines • For the biennium beginning July 1, 2007: • The five agencies shall spend at least 50 percent of state moneys that each agency receives for programs on evidence-based programs. • Submit a report to the interim legislative committee dealing judicial matters no later than Sept. 30, 2008. • Description of efforts to meet the requirements.

7. SB 267 2009 Timelines • For the biennium beginning July 1, 2009: • The five agencies shall spend at least 75 percent of state moneys that each agency receives for programs on evidence-based programs. • Submit a report to the interim legislative committee dealing judicial matters no later than Sept. 30, 2010. • Description of efforts to meet the requirements.

8. Levels of Evidence for EBP • Clinical practices and research are placed on an evidence continuum with six levels ranging from: • Multiple studies using randomized assignment of patients in clinical setting. • To no evidence that supports the efficacy or efficiency of the practice on the other. • To evidence that suggests that the practice is harmful.

9. OMHAS Levels of Evidence • The Office of Mental Health and Addiction Services (OMHAS) suggests that the first three levels (I-III) of evidence describe practices that meet sufficient scientific standards to be defined asevidence-based practices.

10. Level 1 • Level I – A prevention or treatment practice, regimen, or service that is: • Grounded in consistent scientific evidence showing that it improves client/participant outcomes in both scientifically controlled and routine care settings and • Sufficiently documented through research to permit the assessment of fidelity

11. Level 1 Key Points • Level I – Key Points • Supported by scientifically sound randomized controlled studies that have shown consistently positive outcomes. • Positive outcomes have been achieved in scientifically controlled and in routine care settings. • Level 2 is similar to Level 1 with one setting demonstrated (routine care or scientifically controlled).

12. Level 3 • Modified or adapted for a population or setting that is different from the one in which it was formally developed and documented. • The modification’s effect on outcomes is measured and documented. • Based on the results of the outcomes, elements of the service are continually adapted or modified to achieve outcomes similar to those in the original practice. • Sufficiently documented to provide a framework for replication of the practice and outcomes in a similarly modified setting.

13. Level 4 • Level 4–A prevention or treatment service or practice not yet sufficiently documented and/or replicated through scientifically sound research procedures. • Practice is building evidence through documentation of procedures and outcomes. • Intended to fill a gap in the service system. • Not yet sufficiently researched for the development of a fidelity tool.

14. Level 5 • Level 5 –A prevention or treatment service based solely on clinical opinion and/or non-controlled studies without comparison groups. • Has not produced a standardized set of procedures or elements that allow for replication of the service. • Has not produced consistently positive measured outcomes.

15. Key Points • Standardization-An intervention must be standardized so that it can be replicated elsewhere. Standardization typically involves a manual or book that clearly defines the practice and measures to assess if the intervention is being practiced accurately. • Replication -Replication of research findings means that more than one study finds similar positive effects when consumers receive the service.

16. Key Points • Presence of a Fidelity Scale- A fidelity scale is used to verify that an intervention is being implemented in a manner consistent with the treatment model. • Meaningful Outcomes -Effective interventions must show that they can help consumers achieve important goals or outcomes related to impairments and/or risk factors.

17. Follow Up Questions? • Pamela Clark • Chief Drug and Alcohol Research Analyst • Oregon Office of Mental Health and Addiction Services, 500 NE Summer St. E86 Salem OR 97301. • clark_pamela@yahoo.com (with an underscore between clark and pamela) • 503-805-9668