Top Tier Evidence

 

A Validated Resource, Used By Congress / Executive Branch To Identify Social Programs Meeting “Top Tier” Evidence of Effectiveness

Purpose: To assist policy officials in identifying social program models (“interventions”) meeting the Congressional Top Tier evidence standard. The standard, set out in recent legislative provisions, is “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 Academies 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.

Status: The nonprofit, nonpartisan Coalition for Evidence-Based Policy launched the effort in 2008, engaging an Expert Panel to identify Top Tier interventions. Through a systematic review process, the Panel has thus far identified ten interventions as Top Tier, and five as “Near” Top Tier.  The initiative welcomes nominations of additional interventions as candidates for the Top Tier and Near Top Tier across all areas of social policy. (Definitions of “Top Tier” and “Near Top Tier,” and brief nomination instructions, are shown here).

Policy impact: Initiative findings are influencing legislation/policy; GAO report confirms its adherence to rigorous standards. Initiative findings have had an important influence on recent legislation and policy, including newly-enacted federal initiatives to scale up evidence-based home visitation and teen pregnancy prevention programs.  Furthermore, a 2009 Government Accountability Office (GAO) assessment confirmed the initiative’s adherence to rigorous standards and overall transparency.  We have prepared a one page summary of these developments, including a link to the GAO report.

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Interventions identified as Top Tier or Near Top Tier:

Early Childhood: 

• ^{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} 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.

Education (K-12):

• ^{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.

Youth Development:

• ^{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.

Crime/Violence Prevention:

• ^{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.

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.

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.

Housing/Homelessness:

• ^{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.

International Development:

• ^{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.

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The Coalition for Evidence-Based Policy is a nonprofit, nonpartisan organization, and has no affiliation with any programs or program models. Funding for this project has been provided by the MacArthur Foundation and the Edna McConnell Clark Foundation. Please contact us at: David Anderson, (202) 239-1248.