• By Dartington SRU
  • Posted on Monday 26th April, 2010

Building better performance with Dan and Clay

Children's services around the world cannot escape the unprecedented cuts in public sector services. But fewer jobs and dwindling resources will inevitably mean that children's needs increase and youth violence becomes more problematic. That, in turn, will aggravate the pressure on systems and services.How can such a vicious cycle be broken?One possibility lies in an approach developed in Florida by Project Redirection, which was established in the context of a minor budget crisis in the state five years ago. There, too, a public cash shortage was associated with worsening teenage violence rates and overcrowding in residential facilities.In 2004, the Florida legislature and Department of Juvenile Justice went into partnership with Evidence-Based Associates, an independent company which combines two kinds of valuable expertise. The first is an understanding of evidence-based programs. Clay Yeager has been involved in the international extension of Nurse Family Partnership. Fellow Associate Dan Edwards was formerly Director of Clinical Services for Multisystemic Therapy.The other key EBA attribute is good business sense. The company is backed by private investors who combine an interest in young people's well-being with ambitions to create a profitable commercial undertaking.EBA use performance-based contracting to deliver their work in Florida and elswhere in the US. Performance-based contracting changes the relationship between the government bodies that buy interventions and the organizations that provide them. The provider agency shares the financial risk: if good outcomes are not achieved, the people delivering the service do not get paid. No gain translates into a lot of financial pain.In Florida, EBA have introduced performance based contracting alongside implementation of three evidence-based programs. Two – Functional Family Therapy and Multisystemic Therapy – are widely applied in the US and are becoming familiar across Europe and Australasia. Brief-Strategic Family Therapy is less well known but has the same aim – developing young people's social competency. Just as difficulties take many years to develop, so effective interventions require time to unravel them. In all three cases, the activity concentrates on the functioning of the whole family, not just the young person at the center of the concern. The work is done in the home, in some cases over a lengthy period. Project Redirection has been evaluated by the Justice Research Center in Tallahassee, whose analysts compared outcomes for young people completing the intervention with the performance of others finishing alternative disposals available to the court, generally involving a range of residential and custodial provision.Based on this matched-controlled study, the impact on young people was encouraging. Re-arrest rates fell by between one and six per cent. Serious crimes decreased by between four and 12 per cent. The percentage of Project Redirection graduates sent to prison or sentenced to probation in the year that followed the intervention was between five and nine per cent lower than for those leaving residential facilities.Much of this is consistent with what is known about the impact of evidence based programs, particularly the well-tested FFT and MST models. But as the world works out how to manage declining government expenditure, the impact of any program on young people's well-being must be weighed against the cash investment it requires.Here, too, Project Redirection looks promising. Even small improvements in recidivism and assignment to custody equate with significant reductions in government expenditure. The Justice Research Center estimates that it produces savings of $31,000 for every young person completing the program. The first 75 young graduates effectively saved Florida $2.3 million.In May 2009, the Office for Program and Policy Analysis and Government Accountability for the State of Florida reported on how Project Redirection had saved the state $36.4 million and additionally avoided $5.2 million of prison costs.Project Redirection represents an important avenue for future inquiry. Clay Yeager says it is a clear manifestation of how evidence-based programs can have an impact on public policy. This is the essence of what is being promised. We know that evidence based programs can improve child outcomes, but we do not yet know how to establish them in public policy making so that they are regarded simply as "services as normal". Prevention Action will have more to say in the coming weeks about the search for this “normality”.See also: Hand G and colleagues, “Evidence-Based Associates Outcome Evaluation Report 2009”, Justice Research Center, Tallahassee, FloridaOffice of Program Policy Analysis and Government Accountability, Report No 09-27, May 2009, Tallahassee, Florida

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