Musing – Evidence-Based People by John Robertson

As the fight for public dollars intensifies, and the ideological divide fractures further, the only way to function effectively in the human services field is to support and defend preferred methodologies through objective research and constant evaluation. These important safeguards prevent the infection of services by harmful at worse, or ineffective at best, practice models that would endanger our commitment to do no harm to those we serve. Disastrous results emerge from treatment models and policies founded on catch-phrases and personal opinion. I think of Martin Lee Anderson, lying dead in the yard under supervision of a nurse at a Florida Boot Camp. Conversion-therapy practices that attempt to change a person’s sexual orientation or gender identity have a nightmare legacy of abuse leading to debilitating anxiety, depression, and suicide. There really is no more room for debate. Any professional human services operation must be held accountable to a standard of practice that demonstrates, through empirical evidence that it yields results that benefit clients who may or may not have the choice to participate in services. For this essential goal we sacrifice some independence in our choices of methodology, and rightfully so. Ours is not a freelance profession.

My concern is that with enough financial backing and promotional acumen, any practice can be presented as founded in research and objectively verified. I sometimes suspect that “evidence-based” is actually code for “liability-shared” which is the unspoken desire of organizations exposing themselves to public scrutiny and the guarantee of tragedy that is inevitable in every human service field that works with the marginalized, the fragile, and the vulnerable among us. When something bad happens, we need to prove we were doing things by the book. Evidence-Based Practice is the current definition of by the book.

Less discussed are the individuals implementing these evidence-based strategies– the professional skill, and unteachable attributes, that deliver positive, life-changing outcomes for those we serve, or mitigate the unintended consequences of our best, recommended, evidence-based practices. Beyond background screening and suitability assessments which reduce the risk of allowing the bad actors or ill-equipped into our organizations, recruiting and retaining the right talent is based on intuition as much as evidence. The only way to truly know if a person can handle the pressures encountered working with runaway, homeless, or ungovernable youth is to experience it with them. If I may, please indulge me some qualitative evidence.

A 16-year-old girl is referred to a crisis shelter at the end of a 72-hour observation period at a psychiatric hospital. She is determined to not be a danger to herself or others, but she does have a well-demonstrated diagnosis of multiple personality disorder. The direct care staff of the shelter express a lack of confidence that they can safely monitor her for the requested 48 hours until she can be discharged to her legal guardian. Rather than deny her placement the Director of Counseling, a 30-year veteran of the field, spends the next 48 hours in the shelter becoming acquainted with the young woman through the different characters presenting as manifestations of her personality. The unique combination of his training, experience, and gentle nature enabled the organization to offer a compassionate yes rather than a no. She is discharged after a successful respite in shelter.

A Youth Care Worker on the full-time 4-12 shift takes it upon herself to make each youth a scrapbook of their time spent at the shelter with pictures and notes she writes about the specific strengths and gifts she sees in each of them.

Another makes handmade passports for kids living in shelter and they watch foreign-movies together. After watching fifteen films from around the world and discussing them as a group, he helps them all get their real passports and inspires them to trek beyond their own neighborhoods and see the world.

The staff on duty monitored the weather with 15 kids at Anchorage Children’s Home in Panama City, FL. Forecast to be a category 1 hurricane, their emergency plan prescribed sheltering in place at their building, rated to withstand a category 3 storm. Overnight Hurricane Michael escalated to become the most powerful hurricane to hit the area in modern recorded history. As the weather deteriorated and the building began to take damage to the roof and windows, the youth workers lashed doors shut with extension cords or held them closed with their own hands, while their colleagues continued to administer medications on time, prepare food, and document conditions in the log book. Once the storm passed, two of them ventured out into the destruction to find the Executive Director and bring him back to headquarters.

I have so many stories like this I could tell them for days, and gladly will to anyone who is interested to hear more, but the real truth is that the everyday heroism of working with kids in crisis is in the mundane details of guiding and serving kids and families in crisis. Trusting their training and intuition to help them know what need is most acute in an environment of constant need is just another day on the job for a Youth Care Worker. They must understand the systems of care in which we operate, the rigorous protocols for every contingency, and how to gently correct and teach teenagers who are on the brink of homelessness and calamity.

There are no longitudinal studies measuring these individual acts of grace, nor are they necessary. As human beings who share the same innate needs of the kids and families that we serve we are amply qualified to identify evidence-based practice conducted by evidence-based people.

As we continue to take giant strides in understanding and developing evidence-based interventions that guide families towards hope and away from despair, we must also keep pace by investing in those who provide so much evidence that we could never do the job without them.

John serves the Network as its Program Services Director