A Validated Resource Used By Congressional & Executive Branch Officials To Distinguish Research-Proven Social Programs from Everything Else
Problem: U.S. social programs, set up to address important problems, often fall short by funding specific models/strategies (“interventions”) that are not effective. When evaluated in scientifically-rigorous studies, social interventions in K-12 education, job training, crime prevention, and other areas are frequently found ineffective or marginally effective. Interventions that produce sizable, sustained effects on important life outcomes tend to be the exception. Meanwhile, respected government measures show that the United States has made little progress over the past 40 years in key areas such as reducing poverty1 and increasing K-12 educational achievement.2
Purpose: To assist policy officials in identifying interventions meeting the Congressional Top Tier evidence standard, defined in recent legislative provisions as “well-designed randomized controlled trials [showing] sizeable, sustained effects on important…outcomes” [e.g., Public Laws 110-161 and 111-8]. This standard is consistent with (i) criteria recommended in a recent National Academy of Sciences report for establishing definitive evidence of effectiveness, and (ii) the standard long used in medicine by the FDA as a condition for licensing a new pharmaceutical drug or medical device. In both social policy and medicine, findings in more preliminary studies – while valuable for identifying promising approaches – too often are not confirmed in more rigorous randomized trials.
Process: Through a systematic review effort launched in 2008, the initiative’s expert panel identifies interventions meeting “Top Tier” or “Near Top Tier” (see list below). Definitions of “Top Tier” and “Near Top Tier” are shown in the right sidebar. Review panel members are listed here. The review process, including guidance on nominating an intervention for review, is summarized here.
Impartiality: The initiative is administered by the nonprofit, nonpartisan Coalition for Evidence-Based Policy, a national leader in evidence-based reform with no affiliation to any program. The Coalition’s work, including the Top Tier Evidence initiative, has had an important impact on federal policy and enacted legislation (as summarized here), and been cited in the national press (e.g., , , ) and numerous policy documents/publications (e.g., , , ).
Interventions identified as Top Tier or Near Top Tier
- Top Tier Nurse-Family Partnership (A nurse home visitation program for low-income, pregnant women). See evidence summary here, including effects on child maltreatment, mothers’ subsequent births, and children’s cognitive/educational outcomes.
- Near Top Tier Child FIRST (A home visitation program for low-income families with young children at risk of emotional, behavioral, or developmental problems, or child maltreatment.) See evidence summary here, including effects on child maltreatment, and child conduct and language development.
- Near Top Tier Triple P System (A system of parenting programs for families with children age 0-8, designed to prevent child maltreatment). See evidence summary here, including effects on child maltreatment and foster care placements.
- Top Tier Career Academies (Small learning communities in low-income high schools, combining academic and technical/ career curricula, and offering workplace opportunities through partnership with local employers). See evidence summary here, including effects on long-term earnings.
- Top Tier Success for All for grades K-2 (A school-wide reform program, primarily for high-poverty elementary schools, with a strong emphasis on reading instruction). See evidence summary here, including effects on school-wide reading ability in second grade.
- Near Top Tier Annual Book Fairs for High-Poverty Elementary Schools (Book fairs providing summer reading over three consecutive years, starting at the end of first or second grade). See evidence summary here, including effects on reading achievement.
- Near Top Tier First-Grade Classroom Prevention Program (Combination of a classroom management strategy – the Good Behavior Game – and an enhanced academic curriculum in language arts and math). See evidence summary here, including effects on substance use, high school graduation, and college enrollment.
- Near Top Tier Promise Academy Charter Middle School (A charter middle school in New York City, serving mainly low-income, minority students). See evidence summary here, including effects on math and English language arts achievement over a three year period.
- Top Tier H&R Block College Financial Aid Application Assistance Streamlined personal assistance in the application process, for low and moderate income families with a dependent child near college age). See evidence summary here, including effects on college attendance and persistence.
- Top Tier Carrera Adolescent Pregnancy Prevention Program (A comprehensive, year-round youth development program for economically disadvantaged teens). See evidence summary here, including effects on pregnancies and births.
- Top Tier Multidimensional Treatment Foster Care (A foster care program for severely delinquent youth). See evidence summary here, including effects on criminal activity and girls’ pregnancies.
- Near Top Tier Parent Management Training – the Oregon Model (A parent training program for recently separated, single mothers with boys aged 6-10). See evidence summary here, including effects on criminal activity of the boys over nine years.
Health Care Financing and Delivery:
- Top Tier Transitional Care Model (A nurse-led hospital discharge and home follow-up program for chronically ill older adults). See evidence summary here, including effects on rehospitalizations and health care costs.
- Near Top Tier Healthy Living Partnerships to Prevent Diabetes (HELP PD) (A community-based lifestyle weight-loss program for overweight or obese adults with prediabetes). See evidence summary here, including effects on weight and fasting blood glucose over two years.
Substance Abuse Prevention and Treatment:
- Top Tier LifeSkills Training (A middle-school substance abuse prevention program). See evidence summary here, including effects on smoking initiation and drunkenness.
- Top Tier Staying Free (A low-cost smoking cessation program for hospitalized smokers who are willing to make a quit attempt). See evidence summary here, including effects on confirmed abstinence from smoking.
- Top Tier Critical Time Intervention (A case management program to prevent recurrent homelessness in people with severe mental illness). See evidence summary here, including effects on rate of homelessness.
- Near Top Tier Child Immunization Campaign With Incentives (Monthly immunization camps in poor Indian villages, combined with small incentives for parents to have their children immunized – e.g., $1 bag of lentils). See evidence summary here, including effects on child immunization rates.
1 Carmen DeNavas-Walt, Bernadette D. Proctor, and Jessica C. Smith, U.S. Census Bureau, Current Population Reports, P60-239, Income, Poverty, and Health Insurance Coverage in the United States: 2010, U.S. Government Printing Office, Washington, DC, 2011. U.S. Census Bureau, Official and National Academy of Sciences (NAS) Based Poverty Rates: 1999 to 2010, 2011. Kathleen Short, U.S. Census Bureau, HHES Division, Estimating Resources for Poverty Measurement, 1993 – 2003, 2005.
2 Rampey, B.D., G.S. Dion, and P.L. Donahue, P.L. NAEP 2008 Trends in Academic Progress, NCES 2009–479, National Center for Education Statistics, Institute of Education Sciences, U.S. Department of Education, Washington, D.C., 2009.