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Evidence-Based Guidelines, Evidence-Based Practices, and Evidence-Based Decision Making

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Evidence-Based Guidelines, Evidence-Based Practices, and Evidence-Based Decision Making The Intersection of Research and CQI in the Quest to Change Offender Behavior – PowerPoint PPT presentation

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Title: Evidence-Based Guidelines, Evidence-Based Practices, and Evidence-Based Decision Making


1
Evidence-Based Guidelines, Evidence-Based
Practices, and Evidence-Based Decision Making
  • The Intersection of Research and CQI in the Quest
    to Change Offender Behavior
  • Kimberly Sperber, PhD
  • Talbert House

2
Evolution of Evidence-Based Decision Making
  • Medicine
  • Physician as expert with little reliance on
    research
  • 1970s document wide variation in physician
    practices
  • 1980s document that number of physician practices
    are inappropriate
  • Increasing reliance on research led to
    development of evidence-based guidelines
  • Research starts to inform coverage, payment,
    performance measures
  • Corrections
  • Practitioner as expert with little reliance on
    research
  • 1970s document many programs ineffective and that
    nothing works
  • 1980s find that punishing smarter programs also
    not effective
  • Increasing reliance on research led to
    development of evidence-based guidelines
  • Research starts to inform contracts, regulatory
    standards, performance measures

3
Corrections at a Crossroads
  • Evidence-Based Guidelines
  • RNR
  • Evidence-Based Practices
  • ORAS, LSI-R
  • CBT
  • Role-Play
  • Dosage
  • Evidence-Based Decision Making
  • Applying available evidence to specific clients
    situation to make best possible choice for the
    client

4
Moving from Evidence-Based Guidelines to
Evidence-Based Decision Making
  • Evidence-Based Guidelines
  • Impact on care is indirect
  • Impetus for providing certain types of care to
    certain groups of people
  • Do not directly determine the care provided to a
    particular client.
  • Evidence-Based Decision Making
  • Explicit and intentional use of current best
    evidence to make decisions about the care of
    individual clients.
  • Done by individual staff
  • Relies on EBG but also accommodates client issues
    not currently addressed by EBG

5
Example 1Triaging Dosage by Risk
  • Sperber, Latessa, Makarios (2013)
  • 100-bed CBCF for adult male felons
  • Sample size 689 clients
  • Clients successfully discharged between 8/30/06
    and 8/30/09
  • Excluded sex offenders
  • Dosage defined as number of group hours per
    client
  • Recidivism defined as return to prison
  • All offenders out of program minimum of 12 months

6
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7
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8
Summary of Findings
  • Overall, increased dosage reduces recidivism
  • But not equally for all categories or risk levels
  • Low / Moderate and Moderate
  • Curvilinear relationship
  • Matters at the low ends of dosage, but effects
    taper off and eventually reverse as dosage
    increases
  • High / Moderate
  • Increases in dosage consistently result in
    decreases in recidivism, but
  • Saturation effect at high dosage levels

9
Current Implications
  • Optimal range for Low/Moderate risk 100-149
    hours
  • Optimal range for Moderate risk 150-199 hours
  • Optimal range for High/Moderate risk 250-299
  • Findings are specific to men

10
Unanswered Questions
  • Laying out a comprehensive dosage research
    agenda
  • Defining dosage
  • What counts as dosage?
  • Prioritization of criminogenic needs
  • Counting dosage outside of treatment environments

11
Unanswered Questions
  • Sequence of dosage
  • Cumulative impact of dosage
  • Impact of program setting
  • Low risk but high risk for specific criminogenic
    need

12
Unanswered Questions
  1. Nature of dosage for special populations
  2. Impact of skill acquisition
  3. Identifying moderators of risk-dosage
    relationship
  4. Conditions under which dosage produces minimal or
    no impact

13
Practice and Policy Implications
  • Research clearly demonstrates need to vary
    services by risk
  • Currently have general evidence-based guidelines
  • Should not misinterpret to imply that 200 hours
    is required to have any impact on high risk
    offenders
  • Not likely that there is a one-size-fits-all
    protocol for administering dosage
  • Many questions still remain
  • Need for evidence-based decision making

14
Requirements of Effective Execution
  • Process for assessing risk for all clients
  • Modified policies and curricula that allow for
    variation in dosage by risk
  • Definitions of what counts as dosage and
    mechanism to measure and track dosage
  • Formal CQI mechanism to
  • monitor whether clients get appropriate dosage by
    risk
  • Monitor outcomes of clients receiving dosage
    outside of EBG

15
Example 2Womens Pathways to Serious and
Habitual Crime
  • Brennan, Breitenbach, Dieterich, Salisbury, and
    Van Voorhis (2012)
  • Quantitative exploration into identifying
    trajectories of offending for women
  • Relied on person-centered approach versus
    variable-centered approach
  • Found 8 trajectories

16
Female Trajectories
  • Normal Functioning but Drug-Abusing Women
  • 2 Paths
  • More vocational/educational resources, less
    poverty than other types.
  • Minimal abuse, few MH problems, minimal
    homelessness
  • Both chronic substance abusers with multiple
    arrests
  • Path 1 mostly single mothers, above average
    functioning, younger with more parenting anxiety
    than Path 2
  • Path 2 older, functional in many areas, not
    currently parenting

17
Female Trajectories
  • Battered Woman
  • 2 Paths
  • Both with lifelong physical and sexual abuse,
    social marginalization.
  • Neither reflected MH problems, psychosis or
    antisocial personality.
  • Path 3 stressed single mothers with lifelong
    abuse, depression, AOD, abusive SO relationships.
  • Path 4 abused older women, conflicted
    relationships, chronic AOD, unsafe housing,
    chaotic lives. Most without children under 18.

18
Female Trajectories
  • Socialized Subcultural with Less Victimization
    and Few Mental Health Needs
  • 2 Paths
  • Serious social marginalization,
    education/vocation deficits, high crime
    residences, stronger antisocial significant other
    influences.
  • Little evidence of sexual/physical abuse.
  • Path 5 younger, poor, stressed single mothers
    with low self-efficacy in conflicted but not
    violent relationships. All with children under
    18.
  • Path 6 addicted, older, isolated women with
    extreme marginalization, poverty, low
    self-efficacy, most without children under 18.

19
Female Trajectories
  • Aggressive Antisocial Women
  • 2 Paths
  • Characterized by most extreme risk and need
    profiles.
  • Lifelong sexual and physical abuse, antisocial
    families, hostile antisocial personality, MH,
    homelessness, antisocial significant others.
  • Path 7 abused and aggressive, antisocial with
    hostility, MH/depression, homelessness, mostly
    single, most with children.
  • Path 8 abused and addicted single mothers with
    serious MH, psychosis, suicide risk, aggressive,
    violent, and noncompliant.

20
Variable-Centered Findings on Women Offenders
  • Evidence-Based Guidelines and Practices reflect
    generalized understanding of relationships among
    variables
  • Therefore, women as a group are described as
  • High in abuse and trauma
  • High in mental illness
  • High in parenting stress
  • High in economic marginalization
  • Low in self-efficacy
  • Suggests similar approaches for women as a group

21
Heterogeneity Among Women
  • 4 subgroups experienced repeated sexual and
    physical abuse (Pathways 3, 4, 7, 8)
  • Link between childhood abuse and adult criminal
    behavior not generalized
  • 3 subgroups scored high on mental illness
    (Pathways 3, 7, 8)
  • 5 subgroups characterized by parental stress
    (Pathways 1, 3, 5, 7, 8)
  • 2 subgroups scored low on economic
    marginalization (Pathways 1 and 2)
  • One group largely characterized by gender-neutral
    risk factors rather than gender-responsive risk
    factors (Pathway 2)

22
Policy and Practice Implications
  • Need more than one gender-responsive approach
    to female offenders
  • Need effective risk assessment and analysis
    systems to efficiently identify different
    subgroups
  • Modified policies and curricula to address the
    different needs of the various groups
  • CQI system to track that appropriate services
    were matched to each subgroup

23
Moving Forward to Achieve Effective and Efficient
EBDM
  • The Next Evolution of CQI
  • Data tied to individual clients
  • Ability to trend in the aggregate as well as at
    the individual client level
  • Data mining and data surveillance capabilities
  • Development of contextualized feedback systems

24
Contextualized Feedback Systems
  • Characteristics
  • Provides staff with real-time, pertinent,
    client-specific information
  • Information has been intelligently filtered
  • Delivered at the point of care
  • Offers actionable recommendation
  • Evidence
  • Systems have been shown to change staff behavior
    (i.e., better adherence to EBP)
  • One study showed that staff who viewed the
    information more frequently had clients who
    demonstrated greater improvements AND clients who
    demonstrated improvements more quickly

25
Conclusions
  • Corrections has benefitted from a number of
    well-established Evidence-Based Guidelines and
    Evidence-Based Practices
  • Next evolution will focus on bringing a more
    nuanced understanding and application of these
    EBGs and EBPs to the individual client level
  • Practitioner-driven CQI needs to intersect with
    research to drive this process so that we
    continually move the field forward to maximize
    public safety outcomes
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