Top Tier Evidence

Top Tier Evidence Initiative:

Identifying Social Programs Backed By Strong Evidence of Important Impacts on People’s Lives

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 since the late 1970s in key areas such as reducing poverty¹ and increasing K-12 educational achievement.²

Purpose: This initiative seeks 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., [1], [2], [3]) and numerous policy documents/publications (e.g., [4], [5], [6]).

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 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.

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 New York City’s Small Schools of Choice (Small public high schools created citywide in mostly high-poverty communities to replace large, low-performing high schools). See evidence summary here, including effects in the rates of the four-year high school graduation and receipt of a New York State Regents diploma.
• 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.

Employment/Training:

• Near Top Tier Nevada’s Reemployment and Eligibility Assessment Program (A program for Unemployment Insurance (UI) claimants, providing review of their UI eligibility and personalized reemployment services). See evidence summary here, including effects on earnings and net savings to the taxpayer.

Postsecondary Education:

• 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.

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 Treatment Foster Care Oregon (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.

Obesity and Disease Prevention:

• 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 other diabetes risk factors 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 over five to six years.
• 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.
• Near Top Tier PROSPER (Partnership between universities and community teams to implement evidence-based programs for youth substance abuse prevention.) See evidence summary here, including effects on substance use over 6.5 years.

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.
• Near Top Tier Teacher Performance Pay in India (A low-cost performance pay program for primary school teachers in rural India). See evidence summary here, including effects on students’ math, language, science, and social studies achievement.