Evidence-Based Practices in Residentially-Based Programs: Results from a U.S. Survey

Purpose: Evidence-based practices (EBPs) and residential care are seldom used in the same sentence. In fact, EBPs are a direct response or alternative to what are considered to be costly and ineffective treatment modalities such as residential care. Yet there is evidence that residentially-based programs (RBPs) are wrestling with the increasing demand for EBPs by child-serving systems, prompting some experts to argue that the focus needs to shift to transporting such treatments into RBPs (AACRC, 2009). To date, very little is known empirically about the types of EBPs used by RBPs, the perceptions and attitudes of RBP providers toward EBPs and their experiences in implementing them. This presentation will discuss results of a survey, conducted in the US in early 2014 to address these questions.

Method: The web-based survey was developed, pilot tested and edited, and subsequently emailed to administrators in 118 RBPs that are members of the primary national RBP association. The 20-30 minute survey consisted of close-ended questions and a few open-ended items. Measures included the Evidence-Based Practices Attitude Scale (EBPAS), a 15-item measure with established national norms and psychometric properties that assesses provider attitudes toward adopting EBPs (Aarons et al., 2010). Other items asked about types of EBPs used in the facility, reasons for the adoption of each EBP, training, supervision and monitoring, modifications of EBPs, and perceived barriers and successes with the EBP. Data were collected within a one-month period and upon closure of the survey readied for analysis.

Findings: Preliminary key findings indicate that 89% of RBP administrators find EBPs useful or very useful and that the vast majority are open to implementing manualized interventions. Respondents identified 51 different interventions of which about half have promising to strong research support, as defined by two prominent clearinghouses (SAMHSA National Registry, California Evidence-based Clearinghouse for Child Welfare). The top-four most utilized EBPs (40% of all indicated interventions) included cognitive-behavioral approaches, such as Trauma-Focused CBT and Dialectical Behavior Therapy. Primary reasons for adoption of an EBP were its research base and a perception of effectiveness. Comparatively few respondents indicated being “mandated” to use an EBP. However, findings also suggest that only few EBPs were implemented with fidelity. In the majority of cases, administrators reporting making adaptations to the EBP or using the general principles of an EBP. With regard to barriers to EBP implementation, the two primary reasons given were training and supervision of staff (51%) and staff turnover (35%).

Implications and Conclusion: Findings support growing openness among RBP providers toward EBPs, and show that EBPs are indeed being implemented in RBPs, in particular behaviorally-based EBPs. However, questions remain about conceptual definitions of evidence-based practices among different stakeholders (RBP staff, researchers) and the implications for an adherent implementation of an EBP. Barriers to the implementation of EBP will be discussed in the context of the organizational environment and challenges for RBPs. Lastly, implications of these findings will be addressed in light of RBPs' continued role in the continuum of services for children with emotional and behavioral problems.