• By Dartington SRU
  • Posted on Friday 06th August, 2010

A contract to bring prevention science in from the edge

Most of the programs Prevention Action recommends for being model examples eke out an existence on the edge of mainstream services; but they will only ever reach the millions of children who could benefit from them if they can be integrated into service systems. So how are we to get evidence-based programs "systematized"?  The progress made in Florida by Project Redirection is one example of a possible way forward. To encourage the state to include three evidence-based programs in their normal services, Evidence-Based Associates (EBA), the originators of Project Redirection, used "performance-based contracting". [See Building better performance with Dan and Clay]Performance based contracting diverts the attention of purchasers and providers of public services away from the process, such as who will do what, when, and at what cost, toward outputs and outcomes.Crucially, it compels the people who buy and deliver services to share the financial risk. If the intervention achieves its goal, such as better behaved young people or fewer custodial disposals, then the cash benefits are shared. If the objectives are not achieved, the participants in the contract are not rewarded.The approach has been used to considerable effect in the US, for example to make the volume of children in state care more manageable. In New York and Illinois foster beds were more than halved during the 1990s. Foster care agencies were being paid to look after children; after performance-based contracting was introduced, they were paid not only to do that, but also to see children home safe and well.Evidence Based-Associates have discovered that evidence-based programs provide contractors with a valuable commodity. Used in the right proportion, interventions such as Multidimensional Treatment Foster Care, Multisystemic Therapy and Functional Family Therapy can be relied upon to reduce recidivism and victim costs and lessen the demand for prison beds – all of which translates into financial gain for the investor, which can be shared with the provider. This powerful combination of proven programs and performance-based contracting has been used in Florida to broker the state's relationship with a multitude of independent agencies responsible for troubled adolescents. Without the evidence, the agencies might have felt they were being set up to fail.As EBA associate Dan Edwards told last month's the Blueprints for Violence Prevention conference in San Antonio, his company takes the hassle out of the commissioning process. "We agree with the public systems target and the price should the target be met. We take it from there. If we succeed everyone benefits. If we fail, EBA and its partners take the hit."The history of performance-based contracting in the US is longer than Florida's recent experiments may suggest. Introduced as part of the Government Performance and Results Act in 1993, it is being used in 46 other states. By the end of this year, the Obama government aims to have introduced it to half of federal service-based contracts.A recent survey of 26 performance based contracts in 15 federal agencies with a value of over half a billion dollars found that costs were reduced by 15 per cent, customer satisfaction increased by 18 per cent and special financial audits were cut by 93 per cent. The benefits in the case of Project Redirection are clearer cut: around $2.3 million for 75 young people monitored by EBA. The state accountants calculated that the overall return, not counting the improvement in young people's outcomes and the falling crime rate, was over $30 million.As the effects of the world economic crisis seep into the public sector, there is increasing interest in new financing arrangements. The language used by the business people, economists and accountants responsible for emerging products may jar against the scientific and child focused commitment of prevention advocates, but the significant compensation may be that performance-based contracting gives prevention science a passport to the heart of the system. See: Office of Program Policy Analysis and Government Accountability, Report No 09-27, May 2009, Tallahassee, Florida

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