Evidence based programs give better outcomes for children

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Before her thirteenth birthday, Jane* had already spent six years in foster care in ten different homes and even spent months living in a serviced apartment, where different youth workers would supervise her every day. As a result, Jane suffered from the effects of trauma and developed some challenging behaviours.

Jane's behaviour meant life wasn't easy for her carers. She would often refuse to attend school and stayed up all night watching endless TV and playing Xbox, her mind unable to rest. Her diet and sleep were poor, and she was often angry, shouting and having meltdowns. Her many foster homes and long-term trauma meant she had little trust in adults and would struggle with following instructions and accepting boundaries.

Finally, Jane was introduced to OzChild's specialised foster care program, Treatment Foster Care Oregon (TFCO) a last chance at moving to a stable family environment. At first, it was difficult for the foster family to adjust, however with the help of the TFCO team, Jane's specially-trained carers were taught how to manage her behaviour.

Over time, she settled into a better routine with weekly sessions with an individual therapist, skills coach and a teacher. With the stability of a caring home and the support of the TFCO model and team, Jane began to show signs of improved behaviour. As she continued through the program, her school teachers and carers began to see sustained positive change. Jane started to regularly go to school, joined the local softball team, and discovered a love of music which gave her a new creative outlet.

Meanwhile, Jane’s mother Gwen* worked weekly with the TFCO Family Therapist on how to best support Jane. Gwen learnt improved parenting and received support to help her manage better. Jane started to spend days and then weekends with her mother, something she hadn't done for more than six years!

After ten months in the TFCO program, Jane was reunited with her mother and a transition to her new home began. TFCO provided three months of aftercare visits to ensure stability and then slowly withdrew. Although it has not been an easy journey, Jane's progress has been remarkable since being placed in the TFCO program. Today, Jane is loving school, has friends and a new-found relationship with her mum.

What are evidence-based programs?

Jane's story shows how evidence-based programs (EBPs) are changing the future for young Australians. But what are EBPs and how do they work?

EBPs are part of the evolution of child welfare reform, as organisations develop new ways to interact with children. Crucially, to create a program that's considered ‘best practice’ for child welfare, the program must gather evidence to measure the effectiveness of an interaction against expected outcomes, often in controlled settings.

While different jurisdictions and organisations have different standards for measuring data, the NSW Department of Family and Community Services defines EBPs as meeting the following criteria: 

“A program is ‘evidence based’ when it has been evaluated robustly, typically by randomised controlled trial (RCT) or quasi-experimental design (QED) and found unequivocally to have a positive effect on one or more relevant child outcomes.”[1]

For what is a very human industry, this sort of testing, evaluation and peer-review means EBPs are not just what an organisation feels is the right approach.

While the work involved in creating an EBP might seem overwhelming, for child welfare organisations looking to implement new ways to work with children, they have many advantages, including:

  • Sense of confidence that a program will work before it is implemented
  • Apply limited organisation resources to proven programs
  • Focus efforts (and costs) on program implementation and training, rather than development

How OzChild introduced evidence-based programs

OzChild are one of Australia’s most renowned child welfare organisations, having been operating since 1851. Today, they are Australia’s largest provider of evidence-based and evidence-informed programs in the country.

“We learnt a lot from overseas – including New York City and in particular their experience during drug epidemics in the 1990s. Around this time up to 50,000 children there were placed in out of home care,” says Dr Lisa J. Griffiths, Chief Executive Officer of OzChild.

“What they said there was enough is enough. They took an evidence-based approach to prevent kids going into care, stabilise kids already in care and get them out of care,” Dr Griffiths added.

In New York, community organisations were invited to trial different EBPs, a number of those had randomised control trials showing great promise to tackle the ever-growing number of children and youth entering care.

“Over 10 years implementing various EBPs, they reduced the number of kids in care to 7,800.”

New York City has a population of around 20 million, or nearly three times that of NSW and Victoria. However, Victoria has 12,000 children in out of home care – and in NSW it’s 17,000.

“Clearly we’re not addressing the right problems,” said Dr Griffiths. “One program that ran for six years in New York with great results was ‘Functional Family Therapy – Child Welfare’, so we tested it here for two years and had an absolutely outstanding result of 90% of kids staying safely with family – and still remaining with family four years on.”

“We shifted the organisation’s focus so that everything OzChild does, needs to have an impact. It needed to understand who we are working with and what the outcomes we need to have – and therefore what will the impact be.”

As a result, OzChild brought in other programs that were successful overseas, such as Treatment Foster Care Oregon to support children with complex behaviours. 

“Our whole approach now is about using evidence and data to make sure we can increase the likelihood of an improved outcome,” said Dr Griffiths. “We live and breathe these approaches and train all our staff in them. We encourage other organisations to take up these models as well.” 

Perpetual support for OzChild the TFCO program
Perpetual is a strong supporter for Australian not-for-profits and the work they do with the disadvantaged in society, including our youth.
This year, we were pleased to support OzChild and the great work they do through the TFCO program with a grant of nearly $96,000 for a case coordinator role for the TFCO team in Victoria. This grant will help OzChild continue to help more children in welfare, well in 2022.

Introducing evidence-based programs to your organisation

Evidence-based programs have faced rigorous evaluation and testing in different regions and populations around the world. Unfortunately, this doesn't automatically mean they will be successful for your organisation and the people you are providing your services for.

There are some guiding principles, however, that are more likely to lead to better program selection and implementation and, therefore, more positive outcomes for participants.

1. Identify the program that is most likely to succeed based on the strength of the models and analysis of the data. Understanding what worked originally, and where the barriers are to replicating that success will help identify what changes might be needed to the program. It's important to take enough time before any program is implemented to ensure the right program is selected.

One tool available and used by OzChild is The Hexagon Tool from the National Research Implementation Network (US), which measures the evidence-based program against six criteria:
  • Needs
  • Fit
  • Resource availability 
  • Evidence 
  • Readiness for application
  • Capacity to implement

2. Preparing your organisation. Having the resources, skills and qualifications within your organisation to implement the program is vital, whether that is the IT department, finance staff, trainers and program staff. It is also important to consider the training and implementation requirements.

3. Stakeholder engagement. Training staff is just one element; introducing the program to other organisations and relevant government agencies is also important.

4. Referral pathways and quantitative analysis. Post implementation, referral pathways will help families and children be referred to, and enter, the program. Like the original programs, it is also important to establish outcome measures and an evaluation framework to determine the success of the program.

Evidence-based programs in child welfare are gaining momentum as more studies and data collected helps organisations understand ‘what works’. While implementing a program – and maintaining model fidelity – can be challenging, the positive outcomes are clear to see, and for many Australian charities they’re worth a look.

To find out more about OzChild’s implementation of evidence-based programs, visit ozchild.org.au or contact OzChild on hello@ozchild.org.au

Dr Lisa Griffiths holds a Doctor of Business Leadership and is available to present on introducing and implementing evidence-based models to achieve real and measurable outcomes. Contact Martin Murley to discuss mmurley@ozchild.org.au

*Names have been changed to protect the identity of the family  


1.https://www.facs.nsw.gov.au/__data/assets/file/0010/388333/3890_FACS_Evidence-based-programs.pdf



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