Outcomes Evaluation in Faith-based Social Services: Are We Evaluating Faith Accurately?

Transcription

1 / RESEARCH ON SOCIAL WORK PRACTICE Ferguson et al. / OUTCOMES EVALUATION IN FAITH-BASED SOCIAL SERVICES Outcomes Evaluation in Faith-based Social Services: Are We Evaluating Faith Accurately? Kristin M. Ferguson Qiabing Wu Donna Spruijt-Metz Grace Dyrness University of Southern California In response to a recent call for research on the effectiveness of faith-based organizations, this article synthesizes how effectiveness has been defined and measured in evaluation research of faith-based programs. Although evidence indicates that religion can have a positive impact on individuals well-being, no prior comprehensive review exists of the literature on the effectiveness of faith-based social service programs. Adopting the systematic review method, the authors explore how researchers have conceptualized and operationalized effectiveness and faith. The authors identify trends and limitations across studies and conclude with implications for researchers and practitioners interested in examining and delivering faith-based social services. Keywords: faith-based; FBO; religion; effectiveness; outcomes; systematic review method Since enactment of the Charitable Choice provision of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, there has been a growing interest in faith-based organizations (FBOs). From the White House Office of Faith-Based and Community Initiatives in the United States to the World Bank s development partnerships with local religious organizations around the world, FBOs are receiving increasing visibility for their role in the provision of diverse health, mental health, and social services (Chaves, 1999; R. Cnaan, 1999; DiIulio, 2002; Pipes & Ebaugh, 2002). The Compassion Capital Fund, run by the U.S. Department of Health and Human Services Administration for Children and Families, acknowledges that FBOs are uniquely situated to service vulnerable populations such as impoverished families, prisoners in their rehabilitation and reintegration processes, children of prisoners, homeless individuals, and high-risk youth (U.S. Department of Health and Human Services, 2002). Since the Compassion Capital Fund s inception 3 years ago, faith- and community-based organizations have secured $99.5 million to provide social services to those most in need and to increase their Authors Note: Correspondence may be addressed to Kristin M. Ferguson, Ph.D., University of Southern California, School of Social Work, 669 West 34th Street, Los Angeles, CA, or via using kmfergus@usc.edu Research on Social Work Practice, Vol. 16 No. X, Month DOI: / Sage Publications effectiveness in service delivery (U.S. Department of Health and Human Services, 2004). Notwithstanding the increasing interest in FBOs and their ubiquitous presence in the U.S. social service delivery system, documentation on why faith-based services are effective remains largely outstanding, especially in social work journals (B. R. Johnson, 2002; Kennedy & Bielefeld, 2003; Ragan, 2004). Lack of empirical research in outcomes evaluation of social service programs is certainly not unique to FBOs, as multiple authors suggest that there is a paucity of data about the impact of public and private social programs, and the existing data are often unreliable (Midgley, 1997; Monette, Sullivan, & DeJong, 2005). Other authors support this view with respect to faith-based program evaluation, proposing that not only are faith-based studies in general limited, but also, the research designs and methods used to date are questionable (DiIulio, 2002; B. R. Johnson et al., 2002). Considering the present limited knowledge base in evaluating faith- and non faith-based services, we are neither able to discern how faith-based programs measure up to their secular counterparts, nor to determine what specifically about faith-based efforts influences favorable client outcomes. Empirical precedents concerning the role of faith and client well-being nonetheless indicate that religious practices can serve as a key protective factor that shields individuals, especially youth, from harmful outcomes, such 1

2 2 RESEARCH ON SOCIAL WORK PRACTICE as drug and alcohol abuse, promiscuous sexual behavior, suicide, and delinquency (Bravender & Knight, 1998; Evans et al., 1996; Jang & Johnson, 2001; B. R. Johnson, Li, Larson, & McCollough, 2000; B. R. Johnson, Larson, Jang, & Li, 2001). Likewise, considerable evidence reveals that religious commitment can enhance favorable outcomes in clients, including increased levels of wellbeing, emotional adjustment, and academic attainment (Hangley & McClanahan, 2002; Brudenell, 2003; Kim, 2001; Winship & Reynolds, 2003). Although empirical precedents suggest a positive association between religious involvement and beneficial outcomes, existing outcomes research in faith-based settings have treated the faith in faith-based services as a contextual factor rather than a programmatic one. Multiple studies conclude that faith-based services are effective, yet relatively few aim to identify the specific faith components related to successful outcomes (Fischer, 2003; Ragan, 2004). It is vital to conceptually and operationally define the faith elements in faith-based services, which will allow researchers and practitioners to evaluate existing faith-based programs, to compare FBO service delivery outcomes to their public and secular counterparts, and to develop and improve faith-based programs based on indicators of effectiveness. This critical synthesis thus explores how effectiveness and faith within FBOs have been conceptually defined, operationalized, and measured. The article is divided into five sections. First, the authors describe the systematic review (SR) method, which was used to compile and synthesize existing literature related to faith-based program effectiveness. Next, reviewing the empirical precedents, the authors explore how effectiveness has been defined and measured in faith-based programs as well as how faith has been used in evaluating faith-based programs. In the third section, several trends are identified that are apparent across multiple studies, populations and geographical regions. The authors then discuss the limitations of prior studies in terms of research designs and measures of effectiveness. In light of these trends and limitations, the authors conclude with recommendations for researchers and practitioners involved in studying and delivering faith-based social services. SR Method To determine the scope of empirical literature related to program effectiveness and FBOs, the SR method was adopted, which is considered useful for reviewing underdeveloped or infrequently studied research issues (Larson, Pastro, Lyons, & Anthony, 1992). At present, there have been limited comprehensive reviews of effectiveness in FBOs (see DeHaven, Hunter, Wilder, Walton, & Berry, 2004) and none (to the authors knowledge) in the social work literature. For this reason, we chose to focus on findings within the social work literature base. Several social work databases were originally searched, yet because of the limited findings, we expanded our search to include other disciplines. Given DeHaven and colleagues (2004) recent review of the effectiveness of faith-based health programs, we did not include studies that evaluated health outcomes, unless the study assessed outcomes in addition to health that were pertinent to social work. The SR methodology employed here consisted of three steps. First, using keywords of program effectiveness and faith-based, we searched multiple databases from 1980 to the present, including ERIC, JSTOR, Ovid Full Text, PsycINFO, PsycARTICLES, ProQuest, Social Services Abstracts, Sociological Abstracts, and Social Work Abstracts. We intentionally selected faith-based organization as opposed to church or religious programs to guide our search, given the empirical precedents that have employed this term (see R. A. Cnaan & Boddie, 2002; DeHaven et al., 2004; DiIulio, 2002; Fischer, 2003; B. R. Johnson et al., 2002). Since the majority of the FBO literature has been generated during the past two decades, the selected bibliographic databases were searched from 1980 to the present to identify relevant peer-reviewed articles, institute publications, and government reports. Second, from the initial list of sources generated by the search, we examined the reference sections of all publications to identify additional, relevant articles by title. In the event that the title did not clearly indicate the article s content, the authors obtained the abstract to ensure that the content was consistent with our objectives. As a result of this search, new, pertinent citations were added to our list. The reference sections of these articles were similarly examined for additional sources, which were in turn added to our list. Finally, the Web sites and publications from several research institutes on religion and society were reviewed, including (a) the Center for Research on Religion and Urban Civil Society at the University of Pennsylvania; (b) the Community and Faith section of Public and Private Ventures, an action-based research, public policy, and program development organization; and (c) the research forum on the role of FBOs in the social welfare system held by Independent Sector, an inclusive society of citizens, communities, and institutions committed to strengthening nonprofit and philanthropic organizations.

3 Ferguson et al. / OUTCOMES EVALUATION IN FAITH-BASED SOCIAL SERVICES 3 The methodology adopted to distinguish between relevant and nonrelevant empirical literature concerning program effectiveness and FBOs consisted of four selection criteria. The study was included in the review cohort if (a) it examined a specific faith-based social service program that could be linked to a measurable client and program outcome; (b) it identified indicators of program effectiveness and faith as related to social service delivery; (c) it used quantitative, qualitative, and triangulation of research methods to evaluate program effectiveness in FBOs; and (d) it produced findings relevant to social work research and practice regarding the influence of faith and religion on client outcomes. The SR method produced 29 studies that complied with the selection criteria. All works were reviewed and discussed among the research team and tabulated to facilitate comparisons and contrasts among studies. To evaluate the quality of empirical research within the selected cohort, the studies were categorized according to the following criteria: region and year of study, purpose, population, research method used, sample size and sample method, target outcome, statistical analysis adopted, and results obtained. Review of Empirical Findings on Program Effectiveness in FBOs To facilitate the literature review on program effectiveness in FBOs, the findings will be compared and contrasted across the themes selected in Table 1 below. Study Population The target population for the majority of studies reviewed (25/29) consisted of clients receiving services at the respective programs. Various studies focused on specific vulnerable populations. Prisoners were included as subjects in seven studies (Florida Department of Corrections, 2000; B. R. Johnson, 1987, 2002; B. R. Johnson & Larson, 2003; B. R. Johnson, Larson, & Pitts, 1997; O Connor, Su, Ryan, Parikh, & Alexander, 1997; Young, Gartner, O Connor, Larson, & Wright, 1995), high-risk youth were the focus of 4 studies (Branch, 2002; Berrien, McRoberts, & Winship, 2000; C. L. Johnson, 2000; Jucovy, 2003), and youth and adults with problems of substance abuse were targeted in 3 studies (Bicknese, 1999; Hood, 2000; Thompson, 1994). Welfare recipients were also included as subjects in 5 studies (D. Campbell, Glunt, Bockman, Sirotnik, & Little, 2003; Kennedy & Bielefeld, 2003; Kim, 2001; Modesto, 2003; Monsma & Soper, 2003). Race and gender consist of other distinguishing characteristics of the target population in multiple studies. Two studies focused on African American adults in urban settings (Smith, 1992; Thomas, Quinn, Billingsley, & Caldwell, 1994), whereas 1 study targeted this population in rural environments (M. Campbell et al., 2000). Latino, African American and White adults in general were targeted in 1 study (Fox, Stein, Gonzales, Farrenkopf, & Dellinger, 1998). Finally, 1 study was conducted with each of the following target populations: adults (Chase-Ziolek & Gruca, 2000), African American male adolescents (C. L. Johnson, 2000), minority female youth (Winship & Reynolds, 2003), and school-aged children (Hangley & McClanahan, 2002). The populations of interest in the remaining 4 studies were service providers, program directors, and organization staff (Brudenell, 2003; Campbell et al., 2003; Ragan, 2004; Wuthnow, Hackett, & Hsu, 2004). In 1 of these studies, participants and key informants, in addition to organizational staff, were included as subjects (D. Campbell et al., 2003). Research Method The studies in the review cohort adopted various research methods. The most widely used research design consisted of quantitative studies, comprising 13 of the 29 review studies. Within this design, 4 studies used descriptive methods in evaluating changes in clients knowledge, behaviors, skills, or health status as a result of participation in specific faith-based programs (Hangley & McClanahan, 2002; Florida Department of Corrections, 2000; O Connor et al., 1997; Thompson, 1994). Three studies used survey designs to identify the effects of faithbased mentoring for children of prisoners (Jucovy, 2003), to determine the church characteristics associated with effective community health programs (Thomas et al., 1994), and to assess the relative effectiveness of five different types of welfare-to-work initiatives, including faith-based programs (Monsma & Soper, 2003). Three quantitative retrospective studies examined the degree to which participation in religious programs reduced rates of both recidivism for former prisoners (B. R. Johnson, 1987, 2002) and substance abuse for adolescents (Bicknese, 1999). Last, 3 prospective cohort studies assessed the extent to which involvement in churchbased, religious programs influenced recidivism rates in two matched groups of inmates (B. R. Johnson et al., 1997; Young et al., 1995) as well as improved awareness of hypertension among African Americans (Smith, 1992).

4 4 Table 1 Review of Empirical Literature on Program Effectiveness in Faith-Based Organizations: 1980 Present Study Study Population Sample Size Research Method Target Outcome(s) Results Obtained Youth 40 churches Qualitative Homicide rate Homicide rate dropped by 80% Berrien, McRoberts, & Winship (2000) Sobriety and full-time employment higher, and rates of returning to Tx lower for Tx group 1. Substance abuse 2. Treatment 3. Employment4. Depression and cravings Quantitative: Retrospective 59 (Tx)*118 Bicknese (1999) Substance abusers Improved literacy by an average of 1.4 grade levels; improved self-confidence and discipline School children 786 Quantitative 1. Number of children recruited and retained 2. Classroom results3. Fulfillment of program requirements Hangley & McClanahan (2002) Improved education and employment; reduced recidivism Branch (2002) High-risk youth 494 Qualitative 1. Education 2. Employment3. Recidivism of juvenile or criminal offenses Promoted health and increased accessibility to health care and congregational activities; positive effect on health and quality of life in congregations and the larger community; increased access to health promotion and disease prevention information; support for behavior change and healthier lifestyles 24 Qualitative 1. Health 2. Accessibility to health care and congregational activities Brudenell (2003) Community residents Successful in engaging the intended participants and in reaching the hardest-to-employ population 35 Mixed methods 1. Hope 2. Self-esteem 3. Sense of family within the program 4. Trust in the program 5. Overall performance of local workforce development systems Welfare recipients D. Campbell, Glunt, Bockman, Sirotnik, & Little, (2003) Greater fruit and vegetable intake 1,198 Mixed methods 1. Fruit and vegetable intake 2. Participation in action or maintenance stages of change 3. Self-efficacy Rural African American adults M. Campbell et al. (2000) Promoted feelings of peace and caring; services accessible and user friendly 11 Qualitative 1. Quality of nurse-client interactions 2. Feelings of peace and caring Parish nursing clients Chase-Ziolek & Gruca (2000) Less disciplinary problems; higher literacy level Quantitative 1. Disciplinary problems 2. Literacy level Prisoners 59 (Tx)741 Florida Department of Corrections (2000) Cancer awareness and health behavior of underscreened Hispanic women increased significantly 1,517 Clinical trial 1. Awareness of cancer 2. Health behavior Church members Fox, Stein, Gonzalez, Farrenkopf, & Dellinger (1998) 2 programs Qualitative No significant association between faith and program effectiveness Hood (2000) Substance abusers No significant difference between religious prisoners and nonreligious prisoners in institutional adjustment or recidivism 1. Institutional adjustment 2. Recidivism rate Prisoners 782 Quantitative: Retrospective B. R. Johnson (1987)

5 Recidivism rate Recidivism rate significantly lower during a 3-year follow-up period Quantitative: Retrospective Prisoners 247 (Tx)148 B. R. Johnson (2002) No significant difference in institutional adjustment and recidivism; lower recidivism rate among inmates most active in Bible studies 1. Institutional adjustment 2. Recidivism rate Quantitative: Prospective Prisoners 201 (Tx)201 B. R. Johnson, Larson, & Pitts (1997) Significant positive transformation for adolescents, mentors, parents or guardians and for the congregation Adolescents 20 Qualitative 1. Discipline 2. Self-image 3. Achievement C. L. Johnson (2000) Mixed methods Recidivism rate Largely reduced recidivism rate; five spiritual transformation themes consistent with offender during rehabilitation:(a) I m not who I used to be(b) Spiritual growth(c) God versus the prison code(d) Positive outlook on life(e) The need to give back to society Prisoners 177 (Tx)1,754 (Cntrl-1)1,083 (Cntrl-2)560 (Cntrl-3) B. R. Johnson & Larson (2003) Improved self-confidence, sense of future academic performance, and classroom behavior 556 Quantitative 1. Self-confidence 2. Sense of future 3. Academic performance 4. Behavior in school Children of prisoners Jucovy (2003) and Farley (2004) Faith-based job training and placement services are somewhat less effective than those of secular organizations; Faith-based and secular providers have the same rates of placement into jobs, and these jobs provide similar hourly wages; Clients of faith-based providers work fewer hours per week and are less likely to receive health insurance. 1. Job retention rate 2. Income level 2,830 Secondary data analysis TANF (welfare) recipients Kennedy & Bielefeld (2003) Increased the retention rate of welfare recipients at the workplace; increased their social capital, self-sufficiency, quality of life, and self-esteem; increased the social capital of communities; facilitated civic participation and participation in local communities; promoted community development Qualitative 1. Job retention rate 2. Social capital 3. Self-sufficiency 4. Quality of life 5. Self-esteem 6. Social capital in community 7. Civic participatio 8. Participation in local communities 9. Community development 2 mentoring programs Kim (2001) Welfare recipients Poverty No influence on changing poverty situation Secondary data analysis 101 (Tx)78 Modesto (2003) Welfare recipients Client evaluation high on staff empathy; increased contacts with staff; increased maintenance of employment; increased clients sense of hope and optimism 436 Quantitative 1. Employment status 2. Wage level 3. Receipt of welfare assistance 4. Attitudinal optimism 5. Staff empathy 6. Client contact with staff following program 7. Clients instrumental evaluation Welfare recipients Monsma & Soper (2003) (continued) 5

6 Table 1 Continued Study Study Population Sample Size Research Method Target Outcome(s) Results Obtained O Connor, Su, Ryan, Parikh, & Alexander (1997) Prisoners 60 (Tx)60 Ragan (2004) Home health care agencies and nursing homes (Centers for Medicare and Medicaid Services) Smith (1992) African Americans Thomas et al. (1994) African Americans Thompson (1994) Substance abusers Winship & Reynolds (2003) Wuthnow, Hackett, & Hsu (2004) Minority youth, specifically minority females People of 15 inner-city census tracts with the lowest median household incomes 7,168 home health care agencies Quantitative Prison reentry rate Lower reentry rate to prison Secondary data analysis 32 Quantitative: Prospective Home Health Outcome and Assessment Information Set: 11 of 41 measures used 1. Awareness and knowledge of hypertension 2. Blood pressure 635 Quantitative healthy lifestyles Promoted healthy lifestyles 25 Quantitative 1. Attitude 2. Behavior 3. Lifestyle 4 to 5 girls from 4 programs Young et al. (1995) Prisoners 180 (Tx)185 2,077 Secondary data analysis Qualitative 1. Moral values 2. Identity 3. Life plans Quantitative: Prospective 1. Clients perceived effectiveness of the program 2. Clients perceived trustworthiness of the program Outcomes for patients of religiously affiliated agencies were on average better than those for secular agencies Improved awareness and knowledge of hypertension; no significant change in blood pressure Significant and long-lasting change in attitude, behavior, and lifestyle The most fully faith-infused programs are likely be successful in enhancing the effect of religion on individuals lives Mean effectiveness and trustworthiness scores relatively high for FBOs but not significantly higher than nongovernmental secular organizations Recidivism rate Significantly lower rate of recidivism *Tx = Treatment group; Cntrl = Control group. 6

7 Ferguson et al. / OUTCOMES EVALUATION IN FAITH-BASED SOCIAL SERVICES 7 Regarding a second research design, 8 studies adopted qualitative methods. Studies varied in their use of datacollection techniques, including direct and participant observation, documents and reports, photographs, and semistructured interviewing of key informants (Berrien et al., 2000; Branch, 2002; Brudenell, 2003; Chase- Ziolek & Gruca, 2000; Hood, 2000; C. L. Johnson, 2000; Kim, 2001; Winship & Reynolds, 2003). Furthermore, in 4 studies, mixed methods were used by D. Campbell and colleagues (2003) to evaluate the California Community and Faith Based Initiative and by M. Campbell and researchers (2000) to evaluate the North Carolina Black Churches United for Better Health project. Similarly, B. R. Johnson and Larson (2003) sought to critically assess the effectiveness of the Innerchange Freedom Initiative in Houston, whereas Wuthnow and colleagues (2004) aimed to examine effectiveness and trustworthiness in faith-based and secular organizations in northeastern Pennsylvania. Multiple data collection methods across these studies included: site visits, semistructured qualitative interviews, participant surveys, observations, church reports, and archival data analysis. Two studies used secondary data analysis of administrative records, financial management reports and monthly job placement reports to evaluate faith-based, welfare-to-work programs in North Carolina, Massachusetts, and Indiana (Kennedy & Bielefeld, 2003; Modesto, 2003). An additional study also used secondary data analysis of performance data on individual service providers of Medicaid- and Medicare-certified home health care agencies and nursing homes (Ragan, 2004). Finally, 1 study used experimental clinical trials in which subjects were randomized to diverse church and faith-based interventions and secular control conditions (Fox et al., 1998). Sample Size Sample sizes varied across the cohort of studies, ranging from small (11: Chase-Ziolek & Gruca, 2000; 18: Winship & Reynolds, 2003; and 20: Johnson, 2000) to well more than 2,000 (2,077: Wuthnow et al., 2004; 2,830: Kennedy & Bielefeld, 2003; and 3,574: B. R. Johnson & Larson, 2003). Of the 29 studies, 8 reported the use of a control group, whereas response rates were stated in only 1 of the studies (Thompson, 1994). Target Outcome All 29 studies used outcomes measurement to evaluate program effectiveness. Outcomes measurement includes the use of program logic models to identify and examine central outcomes, together with systematized data gathering, analysis, and reporting (Fischer, 2003). Across studies, the key effectiveness indicator for faith-based and religious programs consists of the participants progress in achieving one or more identified program outcomes. For instance, 7 studies assessed how religious programs affected a variety of health-related outcomes, ranging from increases in healthy lifestyles, hypertension awareness, and fruit and vegetable intake, to patients improvements in walking, dressing themselves, and taking medications (Brudenell, 2003; M. Campbell et al., 2000; Chase-Ziolek & Gruca, 2000; Fox et al., 1998; Ragan, 2004; Smith, 1992; Thomas et al., 1994). Another frequent target outcome consists of the impact of faith-based programs on rates of recidivism, violence, and substance abuse. Seven studies evaluated whether participation in faith-based or religious programs influenced recidivism rates in former prisoners as compared to other populations who did not receive such services (Branch, 2002; B. R. Johnson, 1987, 2002; B. R. Johnson et al., 1997; B. R. Johnson & Larson, 2003; O Connor et al., 1997; Young et al., 1995). Similarly, 1 study (Florida Department of Corrections, 2000) explored whether current prisoners demonstrated changes in disciplinary problems and literacy levels following involvement in a faith-based program for Florida inmates. One study examined whether a faith-based, violence reduction program for youth in Boston was associated with a reduction in the homicide rate (Berrien et al., 2000). Additionally, 3 studies assessed whether religious programs were more effective than secular services in helping youth and adults achieve freedom from substance abuse (Bicknese, 1999; Hood, 2000; Thompson, 1994). Education, employment, and income generation were other common outcomes. Five studies evaluated the impact of faith-based educational programs on children, youth, and adults literacy levels and school achievement (Hangley & McClanahan, 2002; Branch, 2002; Florida Department of Corrections, 2000; C. L. Johnson, 2000; Jucovy, 2003). Five studies assessed the impact of FBOs on clients achievement of gainful employment (Bicknese, 1999; Branch, 2002; Kennedy & Bielefeld, 2003; Kim, 2001; Monsma & Soper, 2003), whereas 3 studies examined whether faith-based, welfare-to-work programs increased the likelihood of participants securing higher earnings (Kennedy & Bielefeld, 2003; Modesto, 2003; Monsma & Soper, 2003). Finally, various psychosocial outcomes were also explored in relation to participation in faith-based programs. D. Campbell and colleagues (2003) and M.

8 8 RESEARCH ON SOCIAL WORK PRACTICE Campbell and researchers (2000) examined whether faith-based practices, church attendance, and religious activities (i.e., talking with lay volunteers, attending pastors sermons, etc.) used by California faith-based initiatives and North Carolina Black churches were associated with positive emotional outcomes in clients, such as increases in hope, self-esteem, sense of belonging, and self-efficacy. Bill and Wendy (2002), C. L. Johnson (2000), Jucovy (2003), and Winship and Reynolds (2003) assessed whether faith-based mentoring and youth programs influenced children and youth s self-confidence, self-image, and identity. Furthermore, Brudenell (2003), Kim (2001) and Thompson (1994) sought to determine whether involvement in faith-based programs was related to an increase in the overall quality of life of the participants. Exploring the contribution of faith. Despite considerable empirical attention to diverse effectiveness indicators within faith-based programs in the abovementioned studies, only 5 of the 29 studies explored how faith and religion specifically contributed to particular program outcomes. Including faith and religion as predictor variables, these studies aimed to identify what particularly about expressions of faith and religion affects different client outcomes. Branch (2002), for example, examined how faith in faith-based programs was manifested as well as how the faith-based nature of programs affected participants attitudes, behaviors, and interactions with both program recipients and staff. Similarly, D. Campbell and colleagues (2003) assessed whether faith played a direct or indirect role in welfare-to-work programs run by California Community and Faith Based Initiative organizations. An earlier study by M. Campbell and researchers (2000) also explored how church attendance by rural African American adults in North Carolina and access to information disseminated by church members influenced subjects health and nutritional outcomes. In addition, Monsma and Soper (2003) examined whether welfare recipients church attendance was associated with changes in employment status, earnings, receipt of welfare assistance and attitudinal optimism. Last, Winship and Reynolds (2003) explored how religious beliefs, religious knowledge and understanding, and religious practices and prayer affect the moral values and life plans of minority adolescent girls enrolled in secular and faithbased programs. Results Obtained Outcomes across the cohort studies were generally assessed in six areas: health, criminal recidivism, substance abuse, education, employment and wages, and psychosocial skills. Four studies found no significant differences between program participants receiving faithbased services and those receiving secular services in criminal recidivism rates (B. R. Johnson, 1987), substance abuse (Hood, 2000), welfare recipients earnings (Modesto, 2003), and welfare recipients job placement rates and hourly wages (Kennedy & Bielefeld, 2003). In 2 studies, the for-profit sector was more effective than FBOs in helping welfare recipients secure employment (Monsma & Soper, 2003), whereas secular organizations had better results in placing welfare recipients in jobs that offered both more hours and health insurance (Kennedy & Bielefeld, 2003). All remaining studies reveal a positive influence of faith-based programs on a variety of outcomes. Regarding health-related outcomes, 4 studies found that participation in religious programs was associated with increased access to health care and disease prevention information (Brudenell, 2003; Chase-Ziolek & Gruca, 2000; Fox et al., 1998; Smith, 1992). Attendance at church- and religious-based programs was associated with improved nutrition for clients in 1 study (M. Campbell et al., 2000). An additional study revealed that faithbased programs, as compared to secular services, were effective in influencing overall positive health values and lifestyles (Thomas et al., 1994). Finally, Ragan (2004) found that in home health care agencies, the performance of religiously affiliated agencies was better than the average of other secular agencies across numerous patient outcomes as measured by the Home Health Outcome and Assessment Information Set. With respect to outcomes related to recidivism, crime, and substance abuse, 5 studies found that inmates in faithbased prison programs as well as former prisoners in social readjustment programs had lower recidivism rates than inmates and former prisoners in comparison groups (B. R. Johnson, 2002; B. R. Johnson et al., 1997; B. R. Johnson & Larson, 2003; O Conner, 1997; Young et al., 1995). Also, results from 1 study indicate that faith-based partnerships in Boston between local Black churches and the city s police force and probation departments were instrumental in reducing the city s homicide rate during the 1990s (Berrien et al., 2000). Finally, 2 studies found that participants in faith-based drug treatment programs achieved sobriety and were more likely to remain sober over time than their comparison-group counterparts (Bicknese, 1999; Thompson, 1994). Regarding educational and employment outcomes, 4 studies identified improvements in reading levels in children as well as in inmates in a Florida correctional facility

9 Ferguson et al. / OUTCOMES EVALUATION IN FAITH-BASED SOCIAL SERVICES 9 who participated in faith-based literacy programs (Hangley & McClanahan, 2002; Florida Department of Corrections, 2000; C. L. Johnson, 2000; Jucovy, 2003). Three studies also found that participants in religious programs were more likely to maintain employment than individuals in the comparison groups (Bicknese, 1999; Kim, 2001; Monsma & Soper, 2003). Finally, with reference to psychosocial outcomes, findings from several studies reveal that participation in faith-based programs was also positively associated with increased self-confidence and self-concept for both children and adults (Hangley & McClanahan, 2002; C. L. Johnson, 2000; Jucovy, 2003; Kim, 2001; Winship & Reynolds, 2003). Other findings indicate that faith-based involvement is related to improvements in clients overall quality of life (Brudenell, 2003; Kim, 2001; Thompson, 1994). Discussion of SR and Program Effectiveness The study of program effectiveness within FBOs has uncovered three trends across studies that merit attention in future research. First, previous evaluation studies tend to define program effectiveness in terms of achieving expected client outcomes, as opposed to focusing on broader agency or community outcomes. Among the 29 studies reviewed, 26 focused on changes in client outcomes as the sole indicator for program effectiveness. Across studies, researchers conclude that faith-based programs are effective if the results show improvement in client outcomes. Of the 3 studies that adopted a more comprehensive view of effectiveness, Monsma and Soper (2003) employ as additional indicators of program effectiveness both changes in client outcomes as well as clients evaluation of the degree of staff empathy, the level of staff knowledge in working with clients, and the amount of client contact with staff after exiting the program. Likewise, Wuthnow, Hackett, and Hsu (2004) examine effectiveness by more subjective measures, asking clients to rate the program s effectiveness in meeting their needs and in having trustworthy staff. Second, previous evaluation studies demonstrate that faith-based programs are effective across diverse populations. Twenty three studies acknowledge various benefits to different groups as a result of participation in faithbased programs, ranging from reducing the homicide rate among youth and the recidivism rate among prisoners, to increasing self-confidence among high-risk youth and enhancing the attitudes, behavior, and lifestyle of drug addicts. Additional positive outcomes for other populations include facilitating health-related behaviors among minority populations and improving the situation of welfare recipients in terms of their employment status, wage levels, and attitudinal optimism. Regarding the third trend, previous evaluation studies tend to employ a quantitative survey design, using simplistic data analytic techniques such as descriptive statistics. This is evidenced across the descriptive, retrospective, and prospective cohort studies. Of the 13 quantitative studies, 10 used descriptive statistics, whereas the remaining 3 used more rigorous data analysis techniques such as logistic regression, chi-square, or survival analysis. In contrast, 8 studies adopted qualitative research methods and 1 study used clinical trials (i.e., a quasi-experimental design). Relatively rare was the mixed-method approach that integrates quantitative and qualitative data collection and analysis. Of the 29 review studies, only 4 attempted to compliment one research method with another. As a result of the limited methodological rigor across studies, the quality of findings from some previous evaluation studies on the effectiveness of faith-based programs remains questionable. Limitations of Previous Research Notwithstanding the multiple trends identified here, there were also several evident limitations. First, prior evaluation studies have focused almost exclusively on client outcome measurement in evaluating program effectiveness. This narrow focus fails to consider the impact of faith-based services on other aspects of the organization and surrounding milieu, which can also reflect program success. For instance, positive changes in staff s personal, professional, and spiritual lives as a result of employment in a faith-based organization remain unnoticed when the principal indicator of program effectiveness consists of client outcomes. Also, given the community-based location of many faith-based programs within churches, synagogues, temples, and mosques, local residents perceptions of the programs and clients may be influenced as a result of the programs work in the community. In this case, positive changes in public opinion regarding the organization s work with a particular client population or increases in volunteerism by local residents in the organization can also reflect program success. Previous findings on mentoring and volunteerism within FBOs indicate that faith-based projects can facilitate positive transformations in the lives of the mentors (C. L. Johnson, 2000) as well as increase civic participation within the community (Kim, 2001).

10 10 RESEARCH ON SOCIAL WORK PRACTICE A second limitation across the cohort of review studies consists of the depth of analyses conducted and the accompanying conclusions drawn from them. Prior research demonstrates that faith-based programs are effective in achieving their stated target outcomes. However, rarely do extant studies explicate why the programs are effective; that is, what, specifically about the nature of faith in faith-based programs facilitates the attainment of positive client outcomes? Fischer (2003) refers to this distinction as one of the role of faith as a programmatic factor (e.g., prayer as one program component) versus a contextual factor (e.g., general faith-based environment of the program). Across studies, the role of faith is overwhelmingly assessed as a contextual factor rather than as a programmatic one. It is speculated that more specific conclusions regarding faith as a programmatic factor remain outstanding given the lack of apparent theoretical frameworks to guide both the design of previous evaluation studies and the selection of relevant variables. As such, faith, spirituality, and religion are rarely included as predictor variables in evaluation studies to explore their specific effects on client outcomes. Of the 29 studies reviewed, only 5 provide specific measures for faith. Nonetheless, these studies lack not only the supporting information on the validity and reliability of selected measures but also any explanation regarding how faith influences positive client outcomes. Regarding the third limitation, several methodological concerns can be identified across FBO outcomes evaluation research. First, reliance on cross-sectional data has hindered the study of the effects of time on client outcomes and has consequently created a focus on shortterm outcomes within the extant literature. Second, among the studies reviewed here, less than one third used comparison groups. Needless to say, even with the use of control groups to compare faith-based programs to their secular counterparts, existing studies failed to identify appropriate mediating and moderating variables, such as budget, staff size, and resources. The omission of such variables could have confounded the explanation of the true mechanisms by which faith-based programs operate. Furthermore, the most prevalent data analysis technique among the cohort of studies was descriptive statistics, which do not allow for more advanced models to explain how faith-based programs operate nor what specifically contributes to their effectiveness. In the absence of valid and reliable measures of faith and consistent definitions of relevant faith components and longitudinal data to explore sustainable changes in client outcomes over time, comparisons across studies and across time remain questionable at best. Comparisons of FBOs to secular programs are also difficult, given that such methodological shortcomings in evaluation research are not confined to FBOs but prevalent across outcomes evaluation of social service programs in general. In light of these methodological limitations, findings from the SR method provide a baseline of the current status of outcomes evaluation in FBOs. As research on FBOs more fully develops, questions regarding how faith-based programs work and why they are effective can be more readily explored and answered. Applications for Social Work Research and Practice The advent of new federal funding opportunities for FBOs under the Charitable Choice provision creates new grounds for researchers and practitioners alike. As research informs and improves practice, so too does practice inform and improve research. Faith-based interventions with vulnerable populations provide researchers with opportunities to explore complementary dimensions of clients lives (e.g., spirituality) as well as to examine the unique role that faith plays in promoting positive client outcomes. Meanwhile, new data indicating the influence of faith and religion as a programmatic factor (i.e., predictor variable) that influences positive client and program outcomes can alert practitioners of best practices and crucial program components to improve service delivery. The following recommendations for future research are offered to guide subsequent studies in measuring effectiveness in FBOs. In turn, this can inform the improvement of existing services as well as the design of new services based on empirical evidence. 1. Broaden Existing Effectiveness Indicators in Outcomes Measurement With FBOs Existing measures of effectiveness in FBOs have overwhelmingly focused on short-term, individual client outcomes. To obtain a more comprehensive view of the success of faith-based programs, as compared to other religious programs as well as to their secular counterparts, researchers should consider additional outcome measures in their models from the design stage such as changes in agency-oriented characteristics (e.g., longevity of staff tenure, program impact on staff development, staff morale, and commitment) as well as community-oriented characteristics (e.g., changes in public opinion, volunteerism rates, community involvement). The

11 Ferguson et al. / OUTCOMES EVALUATION IN FAITH-BASED SOCIAL SERVICES 11 impact on staff of working in an environment in which one s religious beliefs are fostered will continue to go unnoticed as long as client outcomes remain the central focus of program evaluation models. Also, the relationship between staff characteristics and client outcomes will continue to be overlooked until such agency-oriented outcomes are incorporated into evaluation models. Similarly, one-dimensional outcome models also fail to account for any influence that FBOs have on residents of the surrounding community and parish or that these residents have on clients. Often, community and parish members work with program clients in their treatment processes and continue in mentoring roles for clients who exit the programs and return to live in the community and attend religious services associated with the FBO. On a research level, a multidimensional and multidirectional outcome model that incorporates client-oriented, agency-oriented, and community-oriented outcomes will allow us to answer questions such as Do staff morale, commitment, and longevity influence client outcomes? and Do community involvement, volunteerism and perceptions of client populations affect changes in clients behavior or status? Likewise, on a practice level, a more comprehensive definition of program effectiveness can assist program personnel in training and supervising staff, allocating resources to different program components, determining program goals and objectives, and using formative and summative evaluation data to improve services for clients. 2. Include the Role of Faith as a Dimension of the Program Model Extant studies on effectiveness of faith-based programs largely view faith as a contextual factor rather than as a programmatic one. A first step for researchers in this area involves establishing conceptual definitions and valid and reliable measures of key faith-based predictor variables, such as staff and client religiosity and religious beliefs, spiritual practices and meditation, participation in religious ceremonies and festivals, agency religious teachings and tolerance, and agency ministry and outreach. Definitions should aim to be inclusive of multiple denominations so that effective comparisons across religious traditions can be made. One method for eliciting client and staff input in defining key variables evident in faith-based services is through focus groups. Focus group discussions of clients, staff, and key informants (e.g., clergy from diverse religious groups, community residents, agency volunteers) can provide researchers with vital information regarding how these groups define faith-related concepts and how these are manifested within faith-based services. By clearly defining faith-based predictor variables and identifying and examining the role of faith in FBOs across diverse religious traditions, the underlying mechanisms by which faith-based programs operate and succeed as compared to secular programs can be understood. Only then can we move from discussing whether faith-based programs are effective to identifying what specifically about faith-based programs makes them effective. With this knowledge, practitioners will have empirical findings to assist in developing new and strengthening existing faith-based program components associated with success. In an age of results-based accountability and outcomes-based funding, it is vital not only to demonstrate whether a program is effective but also to determine which specific program elements contribute to such effectiveness. 3. Develop a Valid and Reliable Instrument That Incorporates Faith-Based Predictor Variables to Evaluate the Effectiveness of FBOs Review of the literature reveals the lack of an existing instrument that assesses the role of faith in achieving successful outcomes in faith-based programs. An instrument that incorporates faith-based predictor variables to examine their influence on client, agency, and community outcomes will facilitate the identification of how faith is used in FBOs and whether such components are associated with program effectiveness. This instrument should include the key faith-based predictor variables discussed earlier as well as indicators of client-, agency-, and community-oriented outcomes. Indicators should also reflect distinct religious traditions and beliefs so as to facilitate comparisons across diverse religious denominations. Recognizing that program evaluation is not analogous to simply counting outputs, measurable changes in client outcomes can be observed in behavior, skills, knowledge, attitudes, values, or conditions (Hatry, Van Houten, Plantz, & Greenway, 1996). Rapp and Poertner (1992) suggest a similar outcomes approach, which includes measuring changes in clients affect, knowledge, behavior, status, or environment. These outcomes measurement models can be adapted to include indicators of agency and community changes as well.

12 12 RESEARCH ON SOCIAL WORK PRACTICE 4. Strengthen Future Evaluation Studies by Employing More Rigorous Research Methods Prior research in FBOs has been largely descriptive in nature and has disproportionately focused both on clients perspectives and short-term outcomes. Integration of both quantitative and qualitative methods is encouraged in future studies to provide a more comprehensive view of client, agency, and community outcomes. In addition to clients perspectives of services, input from other sources (e.g., program directors, staff, key informants, volunteers, community members) will elucidate the different roles of those involved in the work of FBOs and increase the overall validity of the study. Personal narratives from multiple sources will also be helpful in establishing definitions of key terms such as success, faith commitment, and religiosity. Multiple methods to crosscheck the results, together with discussions of similarities and differences that arise among data collected via different methods would add further internal rigor to future studies in this field. Finally, incorporating longitudinal studies into the extant faith-based literature will allow researchers to better distinguish between short- and longterm client, agency and community outcomes. With longitudinal data, researchers can explore the sustained effects of faith-based initiatives over time, something that has not been possible to date with cross-sectional studies. With the existing knowledge base, it no longer suffices to simply conclude that FBOs are successful; we need to explore what specifically about faith in FBOs is associated with desired outcomes. Once studies begin to focus on faith as a predictor variable, more sophisticated statistical models will be necessary to examine and explain the relationships among multiple components that operate together to produce success. Questions to guide future research in this area include How is effectiveness defined in programs by staff and clients?, How is faith manifested in faith-based programs?, and What are the key faith-based variables associated with program effectiveness? Faith-based programs are an ideal setting to explore these and other questions, given their use of the faith component in services. Efforts to generate new waves of valid and reliable data within the extant FBO literature will not only counter the diverse criticisms of the soundness of prior research but also guide the practice community in designing and improving faith-based services that include specific faith components associated with positive client, agency, and community outcomes. 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