Harvard Mental Health Letter

In Brief: Efficacious, yet ineffective

In Brief

Efficacious, yet ineffective

Will it work in the real world? That's the issue often raised by the favorable outcome of a formal clinical trial. It's so important that a special terminology has been developed for it: the gap between efficacy and effectiveness — efficacy meaning proof in a carefully controlled trial, and effectiveness meaning success in the messy circumstances of everyday life. A new study of a model program for delinquent youth shows how great the gap is. When the program was conducted in an ordinary school environment, without close monitoring and specially trained professionals, it not only failed to replicate earlier successes but even made things worse in some ways.

Reconnecting Youth is a program for potential dropouts and other troubled high school students that has been in existence since about 1996. It consists chiefly of a special one-semester class, with a dozen students to a teacher, aimed at improving school attendance and performance, mood and self-esteem, and discouraging illegal drug use. In controlled trials involving more than 200 youths, researchers had found that the program reduced truancy and drug abuse, raised grades, enhanced self-esteem, and improved social lives. Reconnecting Youth has been designated a "model program" by the Substance Abuse and Mental Health Services Administration and a "research-based drug abuse prevention program" by the National Institute on Drug Abuse.

The participants in the new study were 1,370 9th to 11th graders from nine high schools, most of them black, Hispanic, or Pacific Islanders. Some were invited because of truancy or poor grades; others were referred by a teacher or counselor. Half were assigned to the Reconnecting Youth classes, which were conducted by their regular teachers, and the other half continued usual schooling.

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