Comparing rating paradigms for evidence-based program registers in behavioral health: Evidentiary criteria and implications for assessing programs

Decision makers need timely and credible information about the effectiveness of behavioral health interventions. Online evidence-based program registers (EBPRs) have been developed to address this need. However, the methods by which these registers determine programs and practices as being “evidence-based” has not been investigated in detail. This paper examines the evidentiary criteria EBPRs use to rate programs and the implications for how different registers rate the same programs. Although the registers tend to employ a standard Campbellian hierarchy of evidence to assess evaluation results, there is also considerable disagreement among the registers about what constitutes an adequate research design and sufficient data for designating a program as evidence-based. Additionally, differences exist in how registers report findings of “no effect,” which may deprive users of important information. Of all programs on the 15 registers that rate individual programs, 79% appear on only one register. Among a random sample of 100 programs rated by more than one register, 42% were inconsistently rated by the multiple registers to some degree.     

On the Integration of Science and Practice in College Health

Abstract

College health professionals want to assure the unique healthcare and health education needs of college students will continue to be met under national and state healthcare reform. This may be an “all or nothing” proposition. Either colleges and universities will have exclusive control of healthcare delivery for the college student population or else college health will not be a major force in healthcare reform. If college health is to play a meaningful role in future government-controlled health insurance programs, it must first demonstrate that current health services and insurance financing programs meet minimum quality standards. This proposal calls for expanding existing federal laws to create qualified student health plans and integrating the college health model into a reform package based on employer-sponsored health insurance. The concept of qualified student health plans allows for a high degree of flexibility that can be integrated into the majority of state and federal healthcare reform proposals, including the plan proposed by President Clinton, that are not based on a single-payer system. Ultimately, the authors suggest, their proposed plan would eliminate the current situation, in which large numbers of college students are uninsured or underinsured.     

Passing a Mental Health Levy

ABSTRACT

The “devolution revolution” has decreased federal and state roles in the funding of social services and increased the burden on local sources, both public and private. This article describes how a community passed an initially unpopular property tax levy earmarked to support local drug, alcohol and mental health services. The article illustrates how social workers employing specific community practice knowledge provided leadership to the successful campaign. This example of community practice leadership includes building and maintaining coalitions, managing group tension and conflict and demonstrating fundamental social work values.     

Evidence-based programs in children's services: A critical appraisal

Evidence-based programs (EBPs) are increasingly being implemented in children's services agencies in developed countries. However, this trend is meeting resistance from some researchers, policy makers and practitioners. In this article we appraise the main critiques, focusing on scientific, ideological, cultural, organizational and professional arguments. We contend that some of the resistance stems from misconceptions or an oversimplification of issues, while others represent valid concerns that need to be addressed by proponents of EBPs. We set out implications for the development and evaluation of programs and how they are introduced into service systems, and conclude with broader recommendations for children's services.     

Screening young people in the juvenile justice system for behavioral & substance abuse disorders

There is a wide variation in viewpoints regarding screening youth in the juvenile justice system for behavioral and substance abuse disorders. No consensus exists within and among local, state, and federal juvenile justice officials regarding the necessity of screening youth for behavioral and substance abuse disorders. Local, state, and federal juvenile justice officials voiced concern regarding screening young people for behavioral and substance abuse disorders without having available funding or facilities for diagnosis and treatment.     

Everything You Never Wanted to Know About Special Education … and Were Afraid to Ask (I.D.E.A.)

Abstract

Social workers who work with families and children are often unaware of the legal protections afforded to educational experiences for children, particularly to children with disabilities. Yet, all social workers, regardless of their practice setting, should be aware of the important educational rights to which children with disabilities and their families are entitled, as codified in the original legislation, P.L. 94–142, and its subsequent revisions. This legislation is currently entitled the “Individuals with Disabilities Education Act,” or the “I.D.E.A.” Provisions included in the I.D.E.A. are covered with which all states that receive federal educational funding are mandated to comply. Reviewed are the 13 “disabling conditions” that allow for students to qualify to receive special educational services, as long as one of the conditions is adversely impacting their educational success. It concludes with recommendations for social work advocacy regarding this legislation.     

Housing for Families but Not for People: Federal Policy and Normative Family Ideals in Midcentury California

Abstract

Scholars have documented the harmful effects of urban redevelopment in the middle of the twentieth century with a particular focus on “redlining” to achieve racial segregation. This article considers another way that the state influenced social geography. In the middle of the twentieth century, some city planners argued for housing for single people and childless couples, but federal guidelines and funding specified that new housing be for nuclear, heterosexual families with children. Two historical cases demonstrate how planners attempted to create housing for alternative households but were unsuccessful. These two cases show that in addition to the documented effects of shaping the economic and racial landscapes of cities, federal housing policy sent strong signals to people about acceptable family formations by limiting the type and quantity of housing stock available. By examining how planners attempted to move forward with housing for all types of households, this article shows that federal family-oriented policies were not uncontested even if they were usually implemented. These cases highlight the complicated relationship among federal policies, normative culture, and the built environment. This article proposes that we should further investigate the ways in which the built environment has served as a mediator between the state, as exemplified by housing policies, and culture—normative ideals about the family—in a recursive sense; while federal policies both reflected and projected dominant cultural ideology concerning the primacy and importance of nuclear families, urban redevelopment projects presented this relationship in built form when redevelopment took the form of housing for families but not for single people or childless couples.     

State Government Funding of Research on Science and Technology: A Report on Michigan

Abstract

The question of this paper is: what factors explain the decisions of state governments to fund research on science and technology? The theoretical problem underlying the research question is patronage in the classical sense, that is, the support by one person or group for the activities of another person or group. Three models of explanation are proposed: “budget incrementalism,” a “rational” model, and a power model. The models are evaluated with information from a case study of a state government program in Michigan. The rational model best explains the state's selection of some proposals out of all the proposals submitted by each state university for funding. The power model best explains the overall allocation of program funds among Michigan's public universities. The budget incrementalism model helps explain the considerable stability from year to year in funding both for the entire program and for each university's share.     

Policy Interventions Designed to Combat Sexual Violence: Community Notification and Civil Commitment

SUMMARY

Much attention has been given to the problem of sexual predators and the struggles of the legal-justice system to contain them. In response to public outcry over high-profile sex crimes, federal and state legislators have responded in the past decade with innovative but controversial public policy initiatives, called “sexually violent predator statutes.” In 1996 President Clinton signed “Megan's Law,” mandating all 50 states to develop requirements for convicted sex offenders to register with local law enforcement agencies and to notify communities when a sex offender lives in close proximity. Less publicized have been the civil commitment statutes introduced by 16 states which allow convicted sex offenders to be evaluated for involuntary and indefinite confinement in a psychiatric hospital following their release from prison. This article will review the literature regarding community notification and civil commitment as interventions designed to combat sexual violence. The history and context of each policy will be discussed, as will a review of available research evaluating the impact of each policy. Implications for future research and social policy will be examined.     

An overview of evidence-based program registers (EBPRs) for behavioral health

Evaluations of behavioral health interventions have identified many that are potentially effective. However, clinicians and other decision makers typically lack the time and ability to effectively search and synthesize the relevant research literature. In response to this opportunity, and to increasing policy and funding pressures for the use of evidence-based practices, a number of “what works” websites have emerged to assist decision makers in selecting interventions with the highest probability of benefit. However, these registers as a whole are not well understood. This article, which represents phase one of a concurrent mixed methods study, presents a review of the scopes, structures, dissemination strategies, uses, and challenges faced by evidence-based registers in the behavioral health disciplines. The major findings of this study show that in general, registers of evidence-based practices are able, to a degree, to identify the most effective practices meet this need to a degree. However, much needs to be done to improve the ability of the registers to fully realize their purpose.     

The Federal Budget Process

As diminishing government funding becomes a major American preoccupation, federal social policies are often evaluated more in terms of their impact on the deficit than their effectiveness. This article discusses the current state and future projections of the budget and the two processes that affect fiscal policy: authorization and appropriation measures and budget resolution/reconciliation. Knowledge of the federal budget process shows social work students how budget restraints have been used as weapons against social welfare programs. In addition, this knowledge allows the policy practitioner to recognize certain “decision points,” or places in these processes, at which social workers can intervene.     

The Revitalization of Community Practice: Characteristics,Competencies, and Curricula for Community-Based Services

Abstract

A recent move toward community-based services on the part of direct service agencies presents a major opportunity for the revitalization of community practice. Driven by funding from major philanthropic foundations and also by recent changes in federal entitlement legislation, these efforts at system reform are designed to make services for vulnerable populations more effective, accessible, integrated, and comprehensive in the context of the local community. Although this service reorganization requires the type of methods typically found in community practice, direct service workers employed in these agencies usually have not been trained in community work. To begin to address this concern, this article uses a computerized word search to review the community practice and community organization literature. A working definition of “community-based” practice is developed. The extensive literature review yields six characteristics of community-based service delivery: (1) neighborhood-based and family-focused; (2) strengths- and empowerment-oriented; (3) cultural sensitivity and multi-cultural competency; (4) comprehensive services; (5) access to integrated services and supports; and (6) teamwork and leadership skills. The article reviews what scholars have recommended in each of these areas as a way of understanding the characteristics of community-based service delivery and the skills needed by direct practitioners working in community-based programs. The article summarizes innovative curricula and specific courses which demonstrate ways of teaching community skills to direct practice workers. Future work for community practice scholars and educators is recommended.     

Briefly Noted

A federal audit of opioid treatment programs (OTPs) — methadone clinics — in New York City found that of 115 random sample claims, 35 did not comply with Medicaid requirements, and that of 598 claims in a non‐random sample, 299 were billed in error. Extrapolating these errors, the federal Department of Health and Human Services (HHS) says the state improperly claimed at least $39.3 million in the federal share of Medicaid reimbursement, and owes that money back. Improper claims were mainly due to failure to record patients in the central registry, which exists to make sure patients aren't enrolled in multiple OTPs (18 of the 35 noncompliant claims). This was not an audit alleging fraud. Extrapolation as an accounting method for OTPs, where patients often come in every day, so that each patient has more than 300 claims a year, is questionable, but OTPs are used to this even in state audits. In other words, one OTP patient comes in six days a week, with six claims, and the database balloons. “You're extrapolating over our universe, and our universe becomes large because people come in for medication,” said Allegra Schorr, president of the Coalition of Medication‐Assisted Treatment Providers and Advocates, a New York–based membership organization, and board member of the American Association for the Treatment of Opioid Dependence. “When you're just trying to get money, this counts,” said Schorr. “They hit the lottery when it comes to an audit because of that extrapolation.” However, Schorr, who is also an owner and vice president of West Midtown Medical Group, a Manhattan‐based group that was the first OTP to dispense buprenorphine in New York state, stresses that compliance is always important. “It's critical that there is oversight,” she told ADAW. Meanwhile, the state is reviewing the audit and will respond. “The Office of Addiction Services and Supports (OASAS), in partnership with the NYS Office of Medicaid Inspector General, intends to review the specific findings of this audit cited by OIG [Office of Inspector General] to verify its accuracy and to determine an appropriate course of action,” said Evan Frost, spokesman for OASAS. “As a proactive measure, we will remind our OTP providers of their obligations to comply with state and federal laws and rules for providing and claiming Medicaid reimbursement and ensuring the quality of care for those receiving OTP services.” OA SAS regulates OTPs in the state. For the audit, go to https://oig.hhs.gov/oas/reports/region2/21701021.pdf     

Protecting Older Americans: A History of Federal Action on Elder Abuse,Neglect, and Exploitation

ABSTRACT

Congressional hearings on elder abuse began over a quarter century ago. However, federal legislative and departmental activity for addressing the problem has been slow and lacks coordination and comprehensiveness. In addition, federal funding to combat elder abuse represents only a small percentage of that spent on such other abused populations as children and women. The barriers and challenges to addressing elder abuse are identified along with existing programs at the federal level. The article concludes with a discussion of state and local initiatives which show promise for effectively preventing or treating this problem.     

Policy Analysis of Fostering Connections to Success and Increasing Adoptions Act of 2008

Youth “age out” of the child welfare when they are no longer eligible for services due to their age. These youth often face hardships across multiple domains of their lives. Recent evidence shows youth remaining in care beyond age 18 fare better than those who exit care at age 18. With the passage of recent federal legislation, states have more opportunities for federal funding to extend services to youths “aging out.” This article explores the issue of youths aging out of the child welfare system and analyzes the Fostering Connections to Success and Increasing Adoptions Act of 2008.     

Coordinated Service Delivery and Children's Well-Being

ABSTRACT

Interagency collaborations are uniquely suited to meeting the increased needs of communities in today's environment of reduced federal funding and devolution of services to the state and local levels (Gore, 1993). In Texas, interagency collaborations take place through Community Resource Coordination Groups (CRCGs), which were created by the Texas Legislature to coordinate local service delivery for children and their families who often “fall through the cracks” due to having multiple needs. This article presents an evaluation of CRCG operations, with a focus on identified best practices, related obstacles, and suggestions for improvement. The researchers visited CRCG sites, and conducted semi-structured face-to-face interviews, as well as a mail survey, with CRCG staff. Overall, CRCGs appear to effectively enhance the delivery of coordinated services in an effort to meet the multiple needs of the children and families that they serve. Recommendations for policy and practice are discussed, such as spearheading community action structures (Poole, 1997) that may help CRCGs more effectively meet the needs of their respective local communities.     

Briefly Noted

In “Guidance on Strategies to Promote Best Practice in Antipsychotic Prescribing for Children and Adolescents,” a 54‐page document from the federal Substance Abuse and Mental Health Services Administration (SAMHSA) released this spring, the federal government synthesizes the state of evidence in systems‐level strategies to promote antipsychotic best practice prescribing for young people. In response to safety concerns, federal, state, and public‐sector agencies have already invested in strategies to monitor prescribing and to support best practices. For Medicaid, since 2014 this is done by prior authorization, in which prescribing clinicians must receive approval for dispensing antipsychotic medications to youth. The document from SAMHSA is based on data collection and consensus building. Its goal is to provide a centralized resource for public‐ and private‐sector decision‐makers, prescribing clinicians, service providers, commercial insurance companies, and youth and their families. Identified strategies reviewed in this guidance include.     

HHS considers weakening HIPAA

Last month, the federal Department of Health and Human Services (HHS) issued a request for information (RFI) seeking changes in the Health Insurance Portability and Accountability Act (HIPAA), citing “regulatory burdens.” In the RFI, issued Dec. 12, HHS seeks input on how HIPAA could be changed to further the goal of “coordinated, value‐based healthcare.”     

State “Technical Assistance Programs” for Nursing Home Quality Improvement: Variations and Potential Implications

To improve nursing home quality, many states have developed “technical assistance programs” that provide on-site consultation and training for nursing facility staff. We conducted a national survey on these state programs to collect data on program design, operations, financing, and perceived effectiveness. As of 2010, 17 states had developed such programs. Compared to existing state nursing home quality regulations, these programs represent a collaborative, rather than enforcement-oriented, approach to quality. However, existing programs vary substantially in key structural features such as staffing patterns, funding levels, and relationship with state survey and certification agencies. Perceived effectiveness by program officials on quality was high, although few states have performed formal evaluations. Perceived barriers to program effectiveness included lack of appropriate staff and funding, among others. In conclusion, state technical assistance programs for nursing homes vary in program design and perceived effectiveness. Future comparative evaluations are needed to inform evidence-based quality initiatives.