Availability, Access, and Admission: Evaluating the Adoption and Reach of Evidence-Based Practices in Maryland Department of Juvenile Services

Background and Purpose: Recent research has highlighted the important role of case managers as “brokers” of evidence-based practices (EBPs) who assess youth/family needs and refer youth/families to services to meet those needs (Dorsey et al., 2012).  In Maryland’s Department of Juvenile Services (DJS), caseworker referrals are a critical link for accessing services.  The link also requires that services are available and service providers admit referred youth.  This presentation expands work on EBP brokers by examining three influences on RE-AIM outcomes of Adoption and Reach.  Specifically, it aims to answer the questions:

1. Availability: Are sufficient services available to meet the needs of the target population? (adoption, by institutions)
2. Access: Are target youth being referred to services? (adoption, by staff)
3. Admission: Are target youth receiving services? (reach)

Methods: This study is part of a larger initiative to evaluate EBP in Maryland.  It is a naturalistic observation of implementation outcomes as DJS pursues statewide implementation of Multisystemic Therapy and Family Functional Therapy. 

We conducted secondary analysis of two population-level data sources.  DJS’s Risk and Needs Assessment collects over 120 data elements across 10 domains; it is completed by case managers for all adjudicated delinquents (n=1,886).  EBP provider databases contain information about referrals, admissions, and discharges for all youth referred to EBP.  The target population was defined using the DJS referral protocol and Assessment data.  Descriptive analyses were used to answer each of the research questions.

1. Availability: calculate a shortage or surplus for every region.
2. Access: calculate the proportion of target youth referred for services.
3. Admission: calculate the proportion of target youth admitted into services.

 Results: Results presented in this abstract are using July-December 2011 data. 

1. Availability: Of 1,886 youth adjudicated delinquent, 581 (31%) met DJS criteria for the target population.  There was a surplus of 121 slots statewide, with regional variations ranging from a shortage of 77 to surplus of 123 slots.
2. Access:  175 target youth (30%) were referred to EBP by case managers.  Characteristics of youth referred to EBP are consistent with DJS criteria.
3. Admission: 133 target youth (23%) were admitted into EBP by service providers.  Characteristics of youth admitted parallel youth referred.  The most frequent reason that referred youth were not admitted is because parents were unwilling or unavailable (57%).  

Conclusions and Implications: Maryland has a sufficient number of slots to meet the needs of the target population.  These results have immediate policy implications for service allocation across the state of Maryland, including the potential re-distribution of EBP slots to regions with greater need.  Second, although case manager’s assessment and referral practice is generally consistent with DJS expectations, additional research is needed to better understand case manager decisions about referring youth who fell outside of the protocol and not referring youth who meet criteria for the target population.  Finally, EBP providers are generally accepting youth that are referred, unless they are unable to engage parents in treatment.  Further study is needed to better understand barriers to parental participation.