On a chilly morning late last year, Dr. Jeffrey Kaczorowski spoke to about 100 of the city's most prominent leaders in government, education, health care, and business. Cordial conversation over freshly brewed coffee and flaky pastries was cut short when Kaczorowski began describing a young girl he examined recently. Upon lifting the 12-year-old child's clothing, he was shocked by what he saw.

"This little girl had 11 stab wounds all over her young body," he said, pausing for a moment. "We can do better. We have to do better."

Handsome and charismatic, Kaczorowski speaks about the serious challenges the area's children face with such urgency that at times he seems like he's running out of breath. The outspoken pediatrician and children's advocate is also the executive director of the Children's Agenda, a local nonpartisan think tank that studies data about intervention programs that are known to help children. His organization unapologetically parlays its research into influence on government policy.

Kaczorowski went on to say something equally provocative: county officials should make the purchase of children's services in 2010 contingent on rigorous reviews of each program's efficacy. And he took particular aim at the Hillside Work-Scholarship Connection and EnCompass programs. The two are designed to keep kids in school and graduate. Both were started with the help of prominent Rochester-area families, and have been touted by everyone from Mayor Bob Duffy to former governor Eliot Spitzer as model programs. And they receive the lion's share of county money for their services.

In the Rochester-area family and children's services scene, Hillside is at the top of the food chain. It's a mammoth organization that provides a variety of services throughout much of central New York. Questioning whether the Hillside Work-Scholarship Connection is an effective use of taxpayer dollars is to some people, slander approaching blasphemy.

At a time when a shortage of dollars has all of the area's nonprofits jittery, Kaczorowski's push for greater scrutiny has drawn him into the highest circles of government, with people like County Executive Maggie Brooks seeking his advice. Others wish he would tone his emotional rhetoric down.

That's unlikely, however. Kaczorowski is a rabid consumer of data and can recite it like the alphabet.

By nearly every standard, the situation for many Rochester-area children is depressing. Rochester has the highest rates of obesity, low birth weights, and infant mortality of any major metro in the state, including New York City. Forty-three percent of Rochester's children live in poverty and 68 percent live in single-parent households. The area's teen pregnancy rate is widely recognized as one of the highest in the country, and young black males between the ages of 15 and 29 fall victim to homicide at nearly twice the national average.

From January to October 2009, there were 482 reports of sexual abuse, 75 reports of physical abuse, and 7,300 reports of maltreatment against children in Monroe County. And there were 11 child fatalities as a result of violence.

Despite an increase in county funding for children's services, there's little indication that the condition of Rochester's children will improve significantly anytime soon.

Clearly, some of the things we're doing, Kaczorowski says, aren't working.

"What caused us to zero in and look specifically at a number of programs was the dollars spent on preventive services," Kaczorowski says. "We have a limited number of dollars that can be spent on preventive services. In that pool, Hillside Work-Scholarship and EnCompass take up nearly $8 million from a $20-million pool."

Kaczorowski says he has nothing against Hillside or EnCompass. Both may be good programs, he says, but no one knows for sure.

"It wasn't that I was saying that these are terrible programs and we should get rid of them," he says. "I was saying that we really should be as taxpayers, as community leaders, as government officials, looking closely at the outcomes of those programs."

If Roderick Green, Hillside Work-Scholarship's executive director, is troubled by Kaczorowski's intimations, he certainly doesn't show it.

"Jeff is a community agitator, but in a very good way," Green says. "He offers, and we need, constructive criticism. Look, in this field you don't get funded because it's a feel-good program. You don't get funded because people like you. You get funded because you show results."

The Hillside Work-Scholarship Connection got its start in 1987 with help from Wegmans. The program takes city students at risk of not graduating from high school and pairs them with paid, full-time adult mentors, what Hillside calls professional youth advocates. The advocates are located in the schools where they work with as many as 30 students at a time. The goal is to get students to perform well in school and keep them on the path to graduation - something that has weighed heavily on a succession of Rochester schools superintendents and mayors over the last 20 years. Improving graduation rates is even fueling the current community-wide debate over mayoral control.

If the students keep their grades up, an added carrot, with the help of the local business community, is getting paid after-school jobs.

"Before we place young people on a job, they have to meet triple-A standards, meaning good attitudes, attendance that is at least 93 percent, and no failures in core subjects," Green says.

In the process, he says, students learn a multitude of life skills - how to write a resume, cover letter, and how to ace a job interview. They also learn self-confidence, discipline, responsibility, and how to manage their money.

The Hillside Work-Scholarship program has undergone three evaluations by the Center for Governmental Research, a local nonprofit that specializes in governmental, business, and nonprofit research and analysis. A fourth will be released later this year.

CGR's first evaluation found that 65 percent of the students who participated in the 2004-2005 program graduated from high school. Students who weren't exposed to the program didn't fare as well, with only 35 percent graduating.

"Subsequently we've had CGR come in on two other occasions and what comes back consistently is that we are graduating young people at a two-to-one pace," Green says.

Research shows that many urban students will not graduate without some kind of added support system, Green says.

The Hillside Work-Scholarship program costs about $2,765 per student, he says. That includes the costs of the advocate's salary and benefits, as well as administration of the program. But that's a bargain compared to the cost to society when students don't graduate, Green says.

"Young people who complete high school and graduate are less likely to be incarcerated," he says. "When you think about the cost to New York State of keeping a person in prison, which goes anywhere from $85,000 to $90,000 per year, we've been able to show that there's a real return-on-investment here to the community."

There are currently 2,400 students in the Hillside Work-Scholarship program, but Green wants to grow the program to almost double its current size by 2013. If that were the case - 6,000 out of the city school district's approximately 11,000 middle- and high-school students would be in the program. Hillside, Green says, could help the district reach a tipping point in a graduation rate that has remained stubbornly low for years.

However, at least one of CGR's evaluations of the Hillside Work-Scholarship program has raised red flags about that possibility. The 2006 graduation rate for students in the program, though still higher than the comparison group, dipped from the previous year. And more than half of the kids enrolled in Hillside Work-Scholarship in 2006 dropped out of the program.

CGR also pointed out that the number of city schools students with socioeconomic factors putting them at risk of not graduating was increasing. This supports the argument that many community leaders have been making for years: that improving student performance is not a question of whether children from poor families are capable of learning; it's that extreme poverty creates conditions that hinder learning.

In a written statement, Hillside said it has addressed all of the concerns that CGR referenced.

Other questions have been raised about Hillside, however. For example: the city gave Hillside $400,000 to fund a summer jobs program for about 150 students last year, but Hillside only enrolled 59. And only 13 of the 59 went on to enroll in the Work-Scholarship program, even though that was a goal of the summer program.

Kaczorowski is trying to persuade community leaders to shift their approach to family and child services in two fundamental ways. He wants more emphasis on prevention, and he wants programs, particularly those that are funded by taxpayers, to stand up to what academics call evidence-based review. That is rigorous and repeated scientific evaluation by peers in the field that prove the results are directly attributed to the program. To Kaczorowski and advocates of the Children's Agenda, this should be the gold seal of approval and should influence which programs are initiated and expanded.

"The standard of care for more than 100 years in this country, the number-one therapy was bloodletting," Kaczorowski says. "That was because people agreed that it was a good thing to do. I'm saying that it's just not enough to say that we think that this program is doing the right thing. It's just not enough that we asked some local leaders to look at the program. We really have to apply rigorous measurement and science."

One of the programs that stands up to scrutiny, Kaczorowski says, is the Nurse-Family Partnership program. The program pairs professional health-care providers with teenage parents - often single mothers unprepared for the costs and stresses of parenthood. Kaczorowski would like to see the county expand the program, called by the Washington Institute for Public Policy "the most effective program for vulnerable children and families ever created." But that would probably mean pulling money from something else, like Hillside.

"There are 30 years of peer-reviewed literature on the Nurse-Family Partnership, publications reviewed by independent expert coalitions that focus on good government, social programs, education, and crime," Kaczorowski says. "They've looked at it again and again, and we know it reduces the incidences of child abuse and neglect by 50 percent in high-risk families. I tell my students, if we already know what works, don't reinvent the wheel and repeat mistakes."

EnCompass works withelementary and secondary students at risk of not graduating from Rochester, East Irondequoit, and Greece schools. The program provides academic intervention in the form of intensive tutoring and coaching, says Joe Martino, the agency's vice president of public affairs. And, he says, the EnCompass model is evidence-based.

"We're looking for improvements in academic-performance, school engagement, and better behavior," he says.

Kaczorowski, however, advocates programs like NFP because they intervene early in a child's life, beginning with prenatal care. No offense to homegrown programs like Hillside Work-Scholarship and EnCompass, he says, but the prevention component of services has to come sooner.

"I feel like with kids we're dealing a lot with substance abuse, crime, mental-health problems or school failure," Kaczorowski says. "But a lot of the things that we treat categorically have a common root. In making sure that kids get the right nurturing early in life, we can prevent kids from ending up with those problems. It's much more effective and far less expensive."

Kaczorowski's points are well-taken, says Kent Gardner, president of the Center for Governmental Research. But he defends CGR's evaluations of the Hillside Work-Scholarship program.

"I understand where Jeff is coming from," Gardner says. "I hate to use a manufacturing analogy, but Work-Scholarship takes the students on pretty late in the production process. But CGR's evaluation of the program is evidence-based."

CGR's evaluations have compared one group of students who participate in the program to a control group which doesn't. The methodology isn't perfect, Gardner says, but that is the problem with social science research.

"Research in the social science setting is more difficult in some ways than determining efficacy in something like a drug trial," Gardner says.

Eugene Fram, emeritus professor at RIT, agrees with Gardner. Fram recently co-authored "Using Imperfect Metrics Well: Tracking Progress and Driving Change," an article that examines how nonprofits measure success.

"Measuring behavior change for most nonprofits takes time," he says. "We're dealing with people and we're waiting to see how they respond. Sometimes imperfect metrics are reasonable given the situation. But you begin with imperfect measurements and build on them."

That's the reason we should be adopting and funding programs that are evidence-based, rather than creating homegrown programs where evidence still needs to be gathered, says Sarah Liebschutz, emeritus professor at SUNY Brockport. An evaluation that is what she calls post-hoc is not as valid. Liebschutz is a member of the Children's Agenda's board of directors. CGR's evaluations, she adds, are not the type of scientific, peer-reviewed studies that the Children's Agenda is advocating.

"There is real truth about what we know that will reduce problems like child abuse," Kaczorowski says. "The disconnect isn't that we aren't aware of them. It's that we fail to make them a part of what we do in terms of policies and practices."

This failure to connect, Kaczorowski says, is one reason why parents become frustrated and suspicious of the agencies, schools, and community leaders who are trying to help.

"I think parents have a right to be suspicious," he says. "Because we haven't delivered for them."