Evidence-based programs (EBPs) can help change the world—but only if they reach the world.
Some interventions, which might reasonably be termed EBPs—such as the polio vaccine or some of the products and methods that produced the Green Revolution in agriculture—have achieved remarkable reach and impact. Others—such as the housing first approach for homeless individuals, or the Nurse-Family Partnership, which works to improve maternal and child outcomes—haven’t achieved anything like universal reach, but are nevertheless changing outcomes for significant numbers of people in the United States. However, research suggests that most EBPs reach only a small fraction of those who would benefit, and in some areas their use has stalled.1 For example, in the juvenile justice field, Scott Henggeler and Sonja Schoenwald find that only 5 percent of high-risk offenders are treated with evidence-based interventions annually.2
What stands in the way of increasing the use of EBPs to solve some of our most challenging social problems? The question involves supply (the extent to which EBPs can reach the "market"), demand (the extent to which, once in the market, they are used and scaled), and other elements such as infrastructure.
This research—produced by The Bridgespan Group for the Annie E. Casey Foundation—focuses on the supply side. In particular, we wanted to look at that critical group known as “purveyors”—the organizations that have taken on the job of disseminating EBPs. In some cases, the purveyor is the original developer of the EBP; in others, it is a separate organization. You can think of the spread of EBPs—somewhat like innovations in the private sector—as requiring a chain that involves the original developer (who thinks up and tests the idea), the disseminator (or purveyor), the implementing organizations, and eventually the end user. Purveyors are therefore a critical link in the chain—and one we wanted to understand better. Without the purveyor, or someone performing the purveyor role, the EBP—no matter how effective the intervention, no matter how strong the evidence—will remain stuck on the shelf and never reach those it is intended to help.
In our research, we analyzed 46 purveyor organizations which support 46 EBPs in child welfare and juvenile justice—fields of particular interest to the Foundation. See the sidebar, How we conducted our research). Indeed, we found that most EBPs do, in essence, remain stuck on the shelf. While most purveyors are working to ensure their EBPs are effective and replicable, most are not working to expand their reach. Indeed, purveyors themselves identified a lack of growth efforts as the biggest challenge for the spread of EBPs. We found that three particular things are standing in the way: lack of resources, lack of expertise, and lack of incentive to expand the reach of their EBPs. We also found that when EBPs do spread significantly—and some do—this has been mainly driven by external forces that created a demand.
This paper is mainly about purveyors, their role in the spread of EBPs, and their own views of what may be standing in the way—but it is by no means only for them. Based on what we found, we make recommendations not only for purveyors but also for other critical links in the chain that can lead from evidence to impact—developers, funders, implementers, and supporting organizations such as clearinghouses.
How we conducted our research
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We gathered data on 46 evidence-based programs (EBPs) in juvenile justice and child welfare. We selected this group from 107 EBPs in those fields listed as promising or evidence-based by one of three clearinghouses: Blueprints, CEBC, and Crimesolutions.gov. We did not have enough resources to conduct research on all 107 EBPs, so we focused on a subset of 46, seeking a balance between the juvenile justice and child welfare fields. For each EBP, we sought to understand its scale, ambitions, organizational structure, activities, capabilities, barriers, and enablers of growth.
We then selected four programs for in-depth case studies, two in child welfare and two in juvenile justice: HOMEBUILDERS®, KEEP, Multisystemic Therapy, and PATHS®. These programs are used as examples throughout the paper, and the full case studies are included as appendices. For the case studies, we sought programs that had significant experience with growth, both in terms of number of years growing and absolute size. Please see Appendix A for additional detail on our research methods.
1. See, for example: Bruns EJ, Kerns SEU, Pullmann MD, et al. Research, data, and evidence-based
treatment use in state behavioral health systems, 2001-2012. Psychiatric Services, 67-5:496-503
2. Scott W. Henggeler and Sonja J. Schoenwald, “Evidence-Based Interventions for Juvenile
Offenders and Juvenile Justice Policies that Support Them
,” Social Policy Report, Vol. 25, No. 1