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EBP, Part 2

EBP, Part 2. Community Foundation April 11, 2014. Today’s agenda. An overview of what EBP is and how it all started Evidence-Based Practice vs. Evidence-Based Practice s Applications to the homeless youth population

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EBP, Part 2

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  1. EBP, Part 2 Community Foundation April 11, 2014

  2. Today’s agenda • An overview of what EBP is and how it all started • Evidence-Based Practice vs. Evidence-Based Practices • Applications to the homeless youth population • Why this trend is happening, and some of the challenges facing social services

  3. It all started in the 60s McMaster University’s school of medicine instituted problem based learning (PBL). In PBL, students got to design their curriculum based on their efforts to answer specific, client-based questions.

  4. How did/does PBL work? • A team of students and a “coach” would encounter a problem (patient has infection on thumb) • They would decide what questions / issues they needed addressed to help the patient (anatomy of thumb, disease process of infection, etc….) • They would direct own learning and apply learning in vivo.

  5. Authority  Evidence Because the same people (Guyatt, Sackett) constituted the “Evidence Based Medicine Working Group” and published the first big EBM article for JAMA in 1992 (November 4th issue). This explained a new model of medical practice based on knowledge and professional autonomy.

  6. What is EBM / EBP about?(“original” or “process” version) It is a process: • Ask an empirically answerable question • Find the best available evidence • Evaluate the best available evidence • Apply the best available evidence in conjunction with professional judgment and client values and circumstances. • Evaluate how things went.

  7. What does EBP look like?

  8. Process or Programs? Evidence-Based Practice Evidence-Based Practices

  9. Goals of supporting EBP • Strengthening programs and organizations • Achieving mission • Measuring outcomes for CQI • Creating a “bank” or “library” of good program ideas • SAMHSA resource

  10. Let’s look at a few EBPs…

  11. EBP and homeless youth • We are just beginning to understand the population • There are “promising practices” and evidence-supported treatments (like trauma-focused CBT) • The evidence on programs and interventions for this population is sorely lacking

  12. Applying the EBP process: One example

  13. Why do people (feds?) care so much about EBP?

  14. Roadblocks to EBPs in social services

  15. Enter SIF (and other EBP initiatives)

  16. Moving forward

  17. What if the evidence isn’t good? • Outcome findings are not good or bad, just useful or not useful. • SIF doesn’t need communities that are doing everything perfectly – they need communities willing to try new approaches and measure outcomes with integrity.

  18. What is needed

  19. Nationally identified areas of program need for homeless youth • Improved crisis response - outreach and emergency shelter • Family reunification support (for under-18s) • Expand the reach and effectiveness of TLPs • Ensure programs are accepting and inviting to LGBTQ youth • Improve data collection (including needs assessments) and performance measurement

  20. Data on youth homelessness The scope of the problem, nationally

  21. Current evidence on RHY: National scope of the problem • One in five youth (under 18) will run from home, estimates suggest there are 1.7 homeless youth (under 18) in the United States. • 99% of runaways return home. • 50% of longer-term homeless youth were kicked out by their parents. • 11-36% of foster youth aging out will become homeless • More than 380,000 youth under 18 remain homeless for more than one month • Only 50,000 youth receive homeless services each year

  22. Under 18

  23. Young adults 18-24 (being served by the adult system)

  24. Where do we find homeless youth? • Streets • Shelters, drop-in centers • School • Work • Staying with friends and relatives • Moving around the country

  25. Why do they leave home? • Multiple foster care placements • Family conflict • Abuse or neglect • Parental mental health issues • Parental substance abuse • Youth substance dependence

  26. What are their stories? Statistics for youthaccessingservices: • 21-53% have been in foster care • 46-75% have been physicallyabusedbyfamily • 60% of girls and 23% of boys had been sexually abused. • As many as 40% of homeless youth self-identify as lesbian, gay, bisexual, or transgendered • Two thirds of homeless youth have diagnosable mental healthissues • RHY experience rape and assault rates 2 to 3 times higher than the general population of youth. • More than one third of homeless youth engage in survivalsex(swappingsex for food, shelter, drugs, orcash).

  27. More sobering statistics: • Homeless youth are 3 times more likely to use marijuana and 18 times more likely to use crack cocaine than non-homeless youth • About 50% of street youth have had a pregnancy experience compared to about 33% living in shelters, and fewer than 10% of housed youth • Runaway youth are 6 to 12 times more likely to become infected with HIV than other youth

  28. Social services for under-18 RHY • Child welfare • Family court • Federally-funded alternative programs for runaway and homeless youth (RHY): • Basic Centers (shelters) • Transitional Living Programs (18-21) • Street Outreach Programs (12-24) • Other shelters and outreach programs

  29. Services for 18+ homeless youth • Transitional Living Programs • Adult homeless services, including supportive & low-income housing • Specialized 18-24 emergency shelters • Drop-in centers • Harm reduction

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