• By Dartington SRU
  • Posted on Monday 10th January, 2011

The man who keeps providers “feet close to the fire”

Clay Yeager’s 37 years experience has taken him from the time he began his career as a probation officer, when the prevailing view was that nothing worked when it came to addressing the behaviors of young people reaching the juvenile justice system, to now, as a consultant, he has made a significant contribution to the use of evidence-based programs across the US.He is not a researcher, but has a deep respect for high quality evidence. These days he straddles the worlds of research, policy and practice, but his youthful eagerness to “change the world” as a probation officer was gradually eroded by working in a system that struggled to help the young people it served. At that time the scientific community had not established how to determine whether or not prevention worked and there was a general sense that it all cost too much.His career took a turn in the mid 1990s when he first came across evidence about the effectiveness of prevention work. He heard David Hawkins and Rico Catalano, the architects of Communities that Care (CtC), talk about the potential of evidence-based programs to promote the health development of children.Then, awareness of these types of programs was low and there was, as Yeager describes it, a tendency for “fad of the day” - ideas that sounded good and felt good, like boot camps, but had no evidence.After learning about CtC he began to advocate for a small amount of the Pennsylvania state budget spent on treating the adults who end up in prison to be diverted to fund prevention activity. He worked closely with the then Republican Governor Tom Ridge, to use CtC both to increase the use of evidence-based progams and to give local communities a voice in deciding how to spend prevention funds. Starting with eight sites in the mid 1990s, 128 sites were using the approach a decade later. It was this experience of working with state government that made him realize how critical it was to secure political backing for such innovations. He learnt this lesson the hard way. Without Ridge's commitment CtC would never have secured an investment of $16 million per year. When Ridge left office so did the political will to back the work. Funding for CtC has since been hit very hard and has been reduced to just over $1 million dollars a year.When reflecting on the growth of evidence-based programs Yeager identifies several triggers. He observed the politicization of the issue juvenile delinquents. Some academics, greatly assisted by the media, introduced the notion of a super predator – children who were the products of grossly deprived environments ravaged by drugs. At the same time, the public were horrified by high school shootings, most notably Columbine, where disaffected students killed their fellow students and then turned the gun on themselves. These concerns created a moral panic and a need to get “tough on crime”. For some this translated into more prisons and more punishment, for others the solution was a greater investment in prevention under the belief that it has to be “easier to build healthy children than fix broken adults”.In 2004 Yeager's involvement with evidence-based programs took a new turn. He was appointed chief executive for the Nurse Family Partnership and was given the challenge of getting the program out of the university. He knew of the program while working for Ridge in Pennsylvania and had secured $20 million to get the program into 20 counties in the state. Essentially, the challenge given to Yeager was to discover how to take a program that has been carefully refined and tested under the control of a university research team and develop a model that allows the program to be provided more widely without compromising its quality? Yeager saw this an issue of supply and demand. He knew that there was a healthy demand for the program and it was his job to build the organization and the infrastructure required to meet the demand. After two years with NFP the program was serving 20,000 families in 20 states in the US.When reflecting on his time with NFP he says that he spent about half of his time in Washington advocating on behalf of the program to try to secure the support of politicians to stimulate further demand for the program. For him, much of the work to promote these types of programs boils down to good, persistent communication efforts. When the evidence is so strong for their effectiveness this needs to be communicated in a way that is easily understood by the public and politicians. His work must, in part, have led to the very significant investment in home visiting made by the Obama administration, of which a good proportion is going to NFP.Although most of Yeager's career has been spent within the public sector, he has brought thinking more commonly associated with the private sector to the challenge of promoting evidence-based programs. This is best illustrated through his work with Evidence Based Associates, a for-profit company working to save the state of Florida millions of dollars through the implementation of a number of community-based programs. EBA has a contract with Florida to provide a menu of evidence-based programs to young people reaching juvenile court. Under normal circumstances judges would send these young people to high-cost residential facilities. Through EBA the judge has the option of selecting a program from the menu and allowing the young person to remain living in the community. There appears to be nothing unusual about this arrangement until you look closely at how EBA gets paid. If EBA fails to create better outcomes for young people, it simply doesn’t get paid. Yeager describes the idea as “very simple” and it surprises him that EBA is the only body doing this type of work in the US. The model differs from normal arrangements by introducing a middle man between the government agency and the providers of services. The middle man - in this case EBA - holds all the financial risk for the programmes but does not provide them. This is down to the providers whom EBA manages – or as Yeager puts it “holds their feet to the fire”. He continues to work with EBA and remains connected with the developers of CtC. He is clearly proud of what has been achieved in the US. His contribution should not be under-estimated. He was for example, the first recipient of the Visionary of Pennsylvania Award for his role as one of the principal architects of the state's far-reaching and coordinated evidence-based prevention strategies. Yeager is also quick to recognize the country's weaknesses. He acknowledges that there remains a long way to go to and is concerned that the economic argument in favor of investing in evidence-based programs will be lost when politicians have to choose where the axe should fall on public expenditure.

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