As a national expert on child welfare, Spears-Turner Distinguished Professor Mark Testa is familiar with political arguments from the left and right on what’s needed to tackle the country’s most pressing social challenges. One side argues for more government investment to improve the lives of struggling families. The opposite contends that millions of dollars spent on programs with good intentions have done little to move these same families forward. With both sides unwilling to bend—as often seems the case—policy stagnates and problems, such as poverty, domestic violence and inadequate mental health care, don’t get solved.
But what if, Testa often likes to challenge, there was a third solution? What if state and federal lawmakers agreed to invest taxpayer dollars in innovative programs and ideas that produce solid results and more importantly, have the rigorous evaluation and evidence to show for it?
“Instead of saying, we only have two choices—we either have cuts in government spending or we have to grow the welfare state —let’s get somewhere in the middle and ask, ‘What should we be spending our money on?’” Testa said. “And then let’s invest in what’s actually working.”
That idea has been gaining traction in recent years, including among elected officials on Capitol Hill. Moreover, scholars, economists, philanthropists and others are helping to lead the charge for change.
On the academic side, Testa is among a growing group of researchers, including other social work faculty at UNC-Chapel Hill, who are successfully contributing to evidence-based policy and practice to inform and influence social programs that improve the lives of children, families and communities at-large (See “UNC program to help people with mental illness expands across the state”). Their work has become part of a much larger national movement that has been dubbed the “age of evidence-based policymaking.”
For years, social and behavioral science researchers have helped expand knowledge and potential solutions to systemic social problems that challenge government and NGO agencies nationally and internationally. Yet, governments generally have not used researchers’ findings in the decision-making process, explained School Professor Michael Lambert.
“Typically, researchers, practitioners, and policymakers rarely talk to one another,” said Lambert, who is currently advising an international initiative examining violence in childhood to help policymakers identify effective preventative solutions. “As a result, a lot is lost in the translation between research and informing policy as well as informing practice decisions. So, it’s only been recent that people’s feet have been held to the fire in terms of providing services as well as creating policies that really might be rooted in evidence.”
Efforts to direct government spending toward social initiatives that work emerged with the Clinton and Bush administrations and have grown under President Obama, who has focused on innovative ideas targeting job training, career education, K-12 education, teen pregnancy, and maternal and infant well-being. The goal: Reduce wasteful spending; expand innovative programs that have shown promise and eliminate those that have had minimal, if any, impact; and strengthen program accountability.
In the nation’s capital where powerful constituencies often direct much of the political agenda, such an approach seems almost radical, especially given Washington’s history of funding programs that have delivered few results. For example, according to research cited by the nonpartisan Coalition for Evidence-Based Policy, federal and state agencies have supported youth programs such as Job Corps and Upward Bound for years despite evidence that they are doing little to help. Moreover, according to “rough calculations” from two former U.S. policy and budget officials under Republican and Democratic presidents, “less than $1 out of every $100 of government spending is backed by even the most basic evidence that the money is being spent wisely.”
The fiscal reality isn’t that surprising, said Lisa Zerden, a School of Social Work clinical associate professor and associate dean for academic affairs. After all, even when there is overwhelming evidence of ineffective policies, public perception can still be far more politically persuasive, especially when dealing with “morality-based,” policies, said Zerden, who has published on the issue.
For example, despite ample research, including from the Centers for Disease Control and Prevention, that supplying sterile syringes to people who inject drugs are cost effective and help prevent HIV, hepatitis and other blood-borne diseases, the federal government and most states continue to ban needle exchange programs, and federal funding is prohibited. Many opponents worry that these programs encourage drug use instead and send a contradictory message about drug policy.
“And yet, when you look at the public health and social work literature, we have findings that show that for every one dollar spent on a clean syringe, you can save over $300,000 on HIV care per year,” Zerden said. “So if you are dealing with very marginalized groups who are receiving Medicaid or any other subsidized health care, the question is how do you want to spend those very scarce resources?”
In fact, financial conundrums like these are why conversations are shifting ever so slightly toward a better understanding of how taxpayer dollars might best serve those in need and improve communities in the process, she said.
“The cost benefit approach is really the most powerful tool because it makes the most common sense, especially in a time of retrenched funding,” said Zerden, who has helped reform criminal drug policies involving accidental overdose in North Carolina and strengthened law enforcement training around these new laws. “It’s only getting harder to provide services to people, and the safety net is shrinking. So we have to figure out another way to provide services that are both effective and based on evidence.”
For Testa, this new era really isn’t all that new. He’s long been a champion of translating evidence-base interventions into more effective policies and practices that enhance the safety, stability and well-being of abused and neglected children nationwide. He also has a track record to show for it.
As the former director of the Children and Family Research Center at the University of Illinois at Urbana-Champaign, Testa’s research work in the fields of child protection and foster care led to a significant overhaul of that state’s Department of Children and Family Services. In fact, his intervention research helped decrease the number of children in foster care in Illinois by 62 percent and saved the state an estimated $90 million.
Furthermore, one specific reform in Illinois—subsidized guardianship—was successfully replicated in Tennessee and Wisconsin and eventually resulted in national legislation that among other things, now allows states to offer kinship guardianship assistance payments, helping family members to more affordably care for related children.
Since arriving at UNC, Testa’s efforts to reform and influence child welfare policies have intensified, leading to the creation of the “Wicked Problems of Child Welfare Institutes.” These novel conferences, which have been hosted in Chapel Hill, Chicago and twice in Washington, D.C., were developed with the understanding that the problem of child maltreatment is complex, lacks any single solution and that solid scientific evidence must be used to inform direct practice and public policy.
Testa, the School of Social Work’s Jordan Institute for Families and the Children’s Home Society of America have collaborated to use these institutes to assemble child welfare experts, service providers and government officials all to the same table. Among the goals: Encourage and disseminate sustainable solutions that are grounded in evidence that positively affect young lives that come into contact with state child protective systems.
More simply, Testa sees the work with Wicked Problems as an opportunity to address the grand challenges of child welfare and to move the country’s social policies forward.
“We’re trying to build a 21st century child welfare system that’s built on the whole idea that every child deserves a safe and permanent home,” Testa said. “The trouble is because of political gridlock, all of our resources are still tied up with that old 20th century foster care system that says you can cure the ills of child abuse simply by removing kids from families and placing them in foster care. But the evidence indicates that removal and long-term foster care often compound the problem. We have to figure out evidence-informed ways to redirect that investment to more effective treatments that address the trauma of child maltreatment within the context of safe and permanent family relationships.”
Still, for all the advocates behind the evidence-based policy movement, others are reluctant to embrace it, partly because they worry that critical assessments will lead to funding cuts. Traditional rigorous evaluations can also be expensive and especially intimidating for small nonprofit groups that manage shoestring budgets and operate on goodwill grounded in compelling anecdotal evidence.
“You will often hear nonprofits push back against evaluation and evidence-based practice by saying, ‘You can’t really measure what we do and the impact we have,’” said Mat Despard, Ph.D. ’15, a former clinical associate professor at UNC’s School of Social Work. “Nonprofits are capable of evaluating their efforts, as long as they consider a full range of methods appropriate for the questions they are trying to answer. For some, this may mean using semi-structured interviews to assess highly complex issues. For others, use of a control or comparison group and standardized measures or analysis of administrative data may be feasible. The point is to discern in some systematic way whether the people engaging in the nonprofit’s services are experiencing quality of life improvements.”
Randomized controlled trials, also known as RCTs, are gaining more attention, including bipartisan support for low-cost RCTs, as a less expensive way for determining an intervention’s effectiveness. Low-cost RCTs track outcomes for a group of people who receive treatment and a comparison group that does not. These low-cost studies are considered more affordable than traditional RCTs because they rely on data that public, private or nonprofit agencies already collect, such as emergency room visits, the number of children in foster care, or graduation rates.
Testa is among those who think low-cost RCTs can offer states more flexibility for testing promising ideas and for increasing the amount of sound evidence in public child welfare. This spring, he was awarded a $96,000 grant from the Laura and John Arnold Foundation to conduct a low-cost RCT for Safe Families for Children. The national nonprofit recruits and oversees a voluntary network of host families with whom parents in crisis can briefly place their children in times of need to prevent them from falling into the foster care system.
Because the nonprofit helps to reunite children with their parents usually in less than two months, supporters say the program saves taxpayer dollars by avoiding the costs of foster care, which in Illinois, averages $41,000 per child over a typical two-year length of stay. Testa’s study could offer evidence Safe Families for Children needs to demonstrate that its program is just as safe as foster care to justify future funding.
Ultimately, evaluations can help nonprofits better understand what is working—a goal all should be aiming for, added Despard, now an assistant professor at the School of Social Work at the University of Michigan.
“If given the choice of understanding whether your programs are achieving their intended outcomes and impacting the people you are trying to help versus choosing not to understand, the choice is pretty simple,” he said. “If you assert that you care about the community you serve, then it follows that you would want to know that your efforts are making a difference.”
The same can be said in public government, including in North Carolina, where lawmakers have required that state agencies take a more critical look at spending, especially during lean budget years. School of Social Work faculty, including within the Jordan Institute’s Family and Children’s Resource Program (FCRP), are among those who regularly evaluate state programs, helping to connect research to practice and inform policy decisions.
For example, FCRP assessed the state’s foster parent training system a couple of years ago and found that county governments and private agencies that recruit and serve foster families needed to work better together and strengthen their support services. From that evaluation, the N.C. Division of Social Services contracted with FCRP to develop a toolkit to assist counties on how to work more effectively together and with the private sector to ensure foster children have the best opportunity of being placed in loving and stable homes.
“The goal was to give agencies in all 100 counties a way to evaluate their options and to select foster care providers based on quality of care and the outcomes they achieve,” said Mellicent Blythe, a clinical assistant professor and education specialist with FCRP. Without such measures, frontline workers run the risk of placing children where they can find empty beds, she added.
“Given that the research shows that states save money by finding safe and permanent homes for foster children and that the overall well-being of these children greatly improves, it just makes sense that we would want proven programs and practices that serve the best interests of children and the foster families who care for them,” Blythe said.
Gary Nelson understands the desire to ensure that social programs are providing something of value, especially during such austere times. Still, the social work professor worries that too many may weigh evidence of success with an all-or-nothing point of view. That approach could limit other possible solutions for more complex problems, such as issues around race, poverty, and gender, he said.
“If you start with evidence only, you’re often closed to seeing anything that may be different that doesn’t fit your model,” said Nelson, UNC’s Thomas Willis Lambeth Distinguished Chair in Public Policy. “Then you force your model on things that it shouldn’t be forced on. So I think there’s a risk of overselling evidence-based policymaking simply because people want predictability and control. During periods of great change, when the institutions, the culture and the approach to change are themselves changing, it’s important to take the risk, innovate and follow the path that has not been taken with an eye toward improving the welfare of those you serve. So, for me, it’s how do you remain open to innovation and use evidence to inform.”
Even with current bipartisan support for evidence-based policymaking, its political fate remains uncertain given recent efforts in Congress to cut Obama’s six major initiatives.
Still, social work researchers such as Associate Professor Gina Chowa are optimistic that this new dawn of government decision-making will progress just as it has over the years internationally. Chowa, whose research focuses on the effects of asset ownership on youth and families in resource-limited countries, has seen organizations in many of these nations also struggle for the most efficient way to create the biggest impact.
“For example, so much money has been thrown at poverty in Africa, but we still have the poor,” Chowa said. “Why? Because we’ve been doing things that are not putting a dent in poverty. And so from that angle, it is important for us to provide evidence that will really make a difference in people’s lives.”
Chowa’s work on the financial inclusion project, YouthSave, is helping to do just that and is challenging traditional thinking about youth in low-income families. She is particularly interested in learning how accumulating savings impact a youth’s educational, economic, psychosocial, physical and mental well-being.
Historically, banks in resource-limited countries have been unwilling to work with low-income people and have barred youth under 18 from applying for an account. YouthSave has helped open those doors and has the potential to influence broader financial policies in Africa to ensure that more young people have access to banking services and thus, more opportunities to help lift themselves out of poverty, Chowa said. The study is already showing some promising results among young savers, including an improved attitude on life, she added.
“The success of this project has changed a lot of financial institutions perspectives on working with low savers,” she said. “More and more banks are doing this out of corporate social responsibility. They understand that they will not make any profit up front, but if they allow these kids to open accounts, they will stick with them for the long haul. So banks are finally beginning to see these youth as an opportunity to build clientele for the future.”
Chowa said researchers in this country must continue to pursue evidence in a similar opportunistic manner—as the most effective way to influence U.S. policies that produce meaningful impact on people’s lives and guarantee a better future for everyone.
“After all, evidence for the sake of evidence will not help the field of research,” she said. “I am in this work to improve people’s well-being. And if I’m doing research that doesn’t really influence the interventions that are being put into place for poor people and toward their well-being, then I am not doing what is supposed to be done. At the same time, if our programs and interventions in this country are not based on evidence, then we are not doing any favors to the clients and to the populations we are serving.”