By Georgia Marett
With evaluation becoming more integrated into the way projects and programs are undertaken, it can seem that there is a lot of evidence being generated about what specific programs and techniques work. However, this specific evidence is often not combined to understand what works more broadly. The ‘common elements approach’ attempts to rectify this. At a recent lecture by Assistant Professor Bryce McLeod and others run by the Monash University Department of Social Work, I learnt about common elements, how the common elements approach has been used in therapeutic practice, and how it can be applied to issues facing governments and businesses.
What is the common elements approach?
Common elements (also called practice elements) are components or techniques which, on their own, have evidence to suggest that they are effective. The common elements approach attempts to gather these components and apply them to new problems. For instance, if a particular therapeutic technique (e.g. group therapy) has been found to be effective when counselling adolescents with anxiety, it could also be tried with adolescents with depression as part of a common elements approach. The therapeutic technique is the common element, which is combined with other evidence-based components, to create a new way of approaching treatment.
In a non-therapeutic environment, the common elements or ‘building-blocks’ are used to craft a service that may not resemble any program that has been used elsewhere but is entirely underpinned by evidence. There is much literature around how common elements are distinguished, selected and combined. One way of identifying and incorporating common elements is the Distillation and Matching Model (DMM), which allows researchers to empirically accumulate a map of the treatment practices underpinned by evidence, understand the underlying relationships between treatment practices and client or context variables, and form hypotheses as to how the common elements could function together.
Why common elements?
Dr Jessica Hateley-Browne of the Centre for Evidence and Implementation outlined some key reasons why the common elements approach can be beneficial for solving complex problems.
Where did it come from?
The common elements approach has its roots in clinical and therapeutic practice (especially psychology) where the focus is shifting from programs to practice elements—individual components of a program that have been validated and proven to be effective. Practitioners are turning away from bundles of treatments billed as programs and towards pinpointing the parts that work.
This is where recent work by Professor McLeod comes in; he has focused on finding the common elements which work when treating adolescent substance abuse. Professor McLeod and his team used empirical distillation—existing family therapy programs were evaluated by listening to sessions in which these techniques were implemented. The outcomes were then coded and specific elements of the therapies were disentangled and evaluated. Several common elements were distinguished and ready to be tested. The next step would be to implement the common elements in a clinical setting and evaluate their effectiveness.
How can it be used in public policy?
Using this approach in public policy can be a little more complicated than in a therapeutic setting, but it is still possible. There is not a lot of research in this area as this method is still relatively young. However, there is increasing interest in the common elements approach in the human services—where the similarities of issues are not necessarily acknowledged, and different solutions are constantly being invented. There is a trial currently underway at multiple human services sites around Victoria, looking at both common elements for practice and common elements for implementation.
How does evaluation fit in?
Evaluation is implicit in the common elements approach—there must be evaluation of some kind in order to figure out whether practices are effective. As the common elements approach filters through the public service, evaluations will form a large part of the evidence base from which elements are distinguished. Theory-based evaluation can support the identification of common elements. In particular, realist approaches have long advocated the need to focus on what it is about programs that makes them work, for whom, in what contexts and why. This requires dissecting an intervention to reveal the underlying mechanisms that generate outcomes, and in doing so distilling down the critical ingredients for success. Mechanisms are not program strategies or activities but the cognitive-affective responses generated by participants’ interactions with one or more program strategies. Framing ‘common elements’ as mechanisms offers the possibility to extend and sharpen the search for causal levers that might be germane across many types of interventions. Engaging in regular evaluation will mean that new evidence is constantly filtering through and elements can be combined and re-combined to tackle new or existing problems.