How Do You Know It Works—and Are We Really Making Reasonable Efforts?

Hon. Cindy LedermanHon. Cindy S. Lederman, Juvenile Court, 11th Judicial District Miami-Dade

Summary: The author makes the case for the necessity of using evidence-based practices in fulfilling the legal mandate to make reasonable efforts to reunify families.        

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Every day judges order children and parents into services such as interventions to address substance abuse, parenting, domestic violence, mental health problems and more. What do we know about the quality and efficacy of these services?

How do we know they work? We know from scientific research that some services actually work. Some—referred to by researchers as the null hypothesis—make no difference whatsoever. Others actually harm the people they were designed to help.

How do we know the difference, so we can truly fulfull our legal mandate to make reasonable efforts to help reunify families? Before we require parents, at the risk of losing their children, to complete services, we have an obligation to make sure that the service is designed for the appropriate population and that the service has been proven to be effective with that specific population.  

We can no longer use one-size-fits-all programs for families who struggle with myriad—sometimes chronic—problems, who hail from different cultures and who possess differing strengths and risk factors. Services that have not been evaluated, are not research based and have no proof whatsoever of effectiveness have no place in the child welfare system.

Aren’t we endangering children by blindly relying on programs that may or may not work and reunifying based on that omnipresent certificate of completion that measures nothing more than attendance? How do we know the parent learned? How do we know if the parent was able to use what he learned to change his behavior? How do we measure a parent’s compliance with a service in a more responsible way than just monitoring attendance?

These are difficult questions that necessitate multi-system collaboration for reform. Judges and CASA volunteers need to take a leadership role in promoting and advancing that reform.

Judges and child welfare system partners who are not asking these questions may be jeopardizing the safety and well-being of children by returning them to parents who have faithfully attended services that may or may not have any value. Or reunifying upon attendance in services without having an accurate measure of learning and behavioral change.

Judges in child welfare cases must begin to demand the use of evidence-based practices to serve these most at-risk children and families. It bears repeating that some services help, some services are actually harmful (iatrogenic effects) and some services have no effect at all. It is critical for judges to know the difference. The services we use must be effective.

Evidence-based practices (EBP) are those that include research in a controlled clinical setting, standardized curriculum (typically in a manual form) and require adhering to standards of model fidelity to ensure consistent outcomes. Research suggests that families receiving EBP services will have less need for repeat referrals because of the greater effectiveness and efficacy of these well-studied interventions.

Judges have the responsibility to ask questions and demand that the services we order for children and families are well designed, well monitored, and well evaluated to determine whether they are beneficial.

In essence, “evidence-based practice” means using an intervention, program or treatment that has been established as effective through scientific research according to a set of explicit criteria. These are interventions that, when consistently applied, consistently improved client outcomes.

It is generally acknowledged that the strongest evidence is derived from randomized controlled trials—that is, experiments and research designs that have some degree of rigor. Evidence-based practice is rarely the result of a single study, but typically is derived from a number of studies that are integrated or synthesized into a body of evidence on an intervention’s effectiveness. Some researchers argue for inclusion of programs that have been less rigorously evaluated, but in general, replication of the program must have occurred.

Judges can and must begin to ask questions about outcomes for families who participate in court-ordered interventions and should demand evidence-based programs and practices in their child welfare communities. By doing this, the bench would be confident that the services families are ordered to complete are meaningful and effective. This will lead to better-informed decision-making by all of the partners, as well as better-served and ultimately safer, healthier children and families. Judges must take a leadership role in demanding that children and families receive quality services that actually help them. Evidence-based practice should become a part of the juvenile court judge’s daily vocabulary.

Lederman, C., Gomez-Kaifer, M., Katz, L. E., Thomlison, B., & Maze, C. L. (2009). An imperative: Evidence-Based Practice Within the Child Welfare System of Care. Juvenile and Family Justice Today, Fall, 22-25. 

 

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