the real story: evidence informed practice in australia
TRANSCRIPT
The real story: evidence informed practice in Australia
PanelGreg Antcliff [email protected] Bromfield [email protected] Humphreys
[email protected] Mildon [email protected] Michaux [email protected] Shlonsky [email protected]
Session outlineIntro & purpose of panelDefinitions and conceptsOur approach in Australia - barriers to
Evidence Informed PracticeDoes EIP matter – the evidence for EIPsNew approaches to implementing Evidence
Informed Practice What next – new learning networks
What counts as evidence?Evidence-informed practice - an
integration of the best available research combined with real-world or tacit practice knowledge (Chaffin & Friedrich, 2004)
Evidence-based practice - that which provides practitioners with rigorous knowledge related to the best possible research (Chaffin & Friedrich, 2004)
Research utilisation - Using research to inform practice and policy
Engaging with the politics of knowledgeWho is allowed to speak, for whom and under
what conditions?
Whose knowledge is allowed to count?
How do we understand the uptake of some evidence/knowledge but not other forms of knowledge or evidence.
The evidence pyramid http://servers.medlib.hscbklyn.edu/ebm/2100.htm
A multi-dimensional evidence baseIdentifying the precise question to be
answered; articulating and summarising consumer based perspectives; identifying and summarising professional perspectives; identifying both qualitative and quantitative research studies, culminating with a value based critique of current best practice. Petr states:
The broadened notion of evidence based practice recognizes the importance of the professional and the consumer in determining the relevance of the evidence to the situation at hand (Petr 2009, p. 20)
The Three Cultures Model
Research Time frames for results
ﾷ usually long Language s for com m un ication
ﾷ highly te chn ical, e xpe rt language Priorities for know led ge
ﾷ the ory, m ethod ology, scien tifically answe rable questions
W ork environm en t ﾷ research rigour, p ressure to publish,
academ ic reputation
Practice Tim e fram e s for results
ﾷ usually short Language s for com m un ication
ﾷ guid e lin es and protocols Prioritie s for knowle dge
ﾷ e ffic iency and effective ne ss W ork e nvironm en t
ﾷ im m e diacy of se rvice d elivery
Policy Tim e fram e s for results
ﾷ usually short or m ed ium Languages for com m un ication
ﾷ issue briefs, govt re ports, m e d ia Prioritie s for knowle dge
ﾷ fe asibility, im plem en tation W ork e nvironm en t
ﾷ m ultiple de cision -m akers, political, econom ic and social force s
Research -policy gap
R esearch -practice gap
Source: Davie s, Nutle y & Sm ith (2000b); Lom as, 2000b; Pyra (2003); Shonkoff (2000).
Research Research EvidenceEvidence
PractitionePractitioner r
WisdomWisdom
Service User/Service User/
Consumer ExperienceConsumer Experience
Policy PerspectivesPolicy Perspectives
Legislation
Practice
Children & Family
OrganisationalPolicy/Procedure
Practice Culture
Policy Culture
Individual attributes
Organisational Culture
Pragmatics
Nature and Extent of the
EvidenceCompeting Sources of
Information and Influence
Research Culture
Linkage & Exchange Mechanisms
Types of knowledge
Holzer, Lewig, Bromfield & Arney, 2008
Knowledge translation metaphors Knowledge brokering is like……
A gardener
A Portuguese Man of War Jelly Fish
Surfing a wave(Metaphors from a knowledge brokering workshop
in Melbourne, March 2010)
CommonalitiesA social activity (even if virtual) which
involves communication and potentially relationship building
A change activity usually involving complex systems though often targeted at the individual front line worker or policy officer
The sifting of knowledge (however defined) to communicate key issues to others
Some agreement on what worksInteractivity (high level of discussion,
conversation, workshops, joint problem solving)
Time and resources
Cater to specific audience (Tsui 2006) – story telling, plain language, find the audience/community who cares about the issue
Robyn Mildon will develop with ideas from Dean Fixsen
Knowledge brokering on a continuumDissemination Implementation
Adoption
Or Diffusion of InnovationKnowledge/evidence/innovation
Persuasion (why this is a good thing?)
Decision making and Implementation (agreement to implement)
Confirmation or adoptionEach stage requires different KB strategies
ImplementationAs anyone knows who has worked in the field, implementation of new practice is the biggest
challenge of all
Hollin and McMurran 2001 cited in nirn Implementation Brief Jan 2009
The failure to utilize research rests in large part on a faulty or non-existent implementation infrastructure
nirn Implementation Brief Jan 2009
17
Stages of Implementation Implementation occurs in
stages:
Exploration Installation Initial
ImplementationFull ImplementationFixsen, Naoom, Blase, Friedman, & Wallace,
2005
2 - 4 Years
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The Big Ideas Science matters – for interventions
AND for implementation You need competent Implementation
Teams to be successful. Implementation takes time and there
is a lot of up front work We have to pay attention to changing
the behavior of adults:• Building Competence and Confidence• Organizational and Systems Change• Leadership
Fidelity Matters• For intervention strategies• For implementation strategies
Fixsen Joining the Dots Conference Canada 2010
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Child, Student, Family, Adult
Outcomes
InterventionProcesses
Teachers and School Personnel
MST Therapists
DBT Therapists
Health Practitioners
Implementation Teams
ImplementationProcesses
ImplementationFidelity
InterventionFidelity
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Kinark Leadership Team
Working GroupTopic Specific
Installation Team for
Transformation Zone
ImplementationTeams for
Transformation Zone
CHANGE MANAGEMENT STRUCTURE
Clinical decisions and process design is managed by these 3 groups
EXPLORATION: The process through which potential EBPs are determined. Groups involve all managers and some direct service staff.
INSTALLATION: Team developsthe preliminary implementation plan. Team comprises all perspectives
IMPLEMENTATION Team works the implementation plan, modifying as required, and develops sustainability plan. Membership includes front line managers affected.
Clinical Excellence Committee
ClinicalTransformation
Steering Committee
FULL IMPLEMENTATION
Fidelity to new practices maintained and monitored through clinical supervision, practice leader system, and program management..
INNOVATION:
Research and Evaluation Department will provide support for innovations identified by •practitioners using evaluation results and other data, often in in partnership with other •institutions such as Universities, the Centre of Excellence and Community Research departments .
SUSTAINABILITY: The process is demonstrating that ongoing changes in many support systems need to occur to ensure sustainability. Training and education processes, clinical supervision processes, data collection processes, HR and Finance processes are all being revised to support the new practices and processes.
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Bottom line from implementation scienceImplementation not generally funded –
but implications of not doing …..
17 year gap between science to service
With good implementation 80% uptake of EBP’s in 3 years
No implementation team – after 17 years 14% uptake
Fixsen presentation. Joining the Dots Conference Canada 2010
Australian– knowledge brokering book
Bridging the ‘know-do’ gap: knowledge brokering to improve child wellbeing. 2010
Edited by Gabriele Bammer with Annette Michaux and Ann Sanson. ANU e-press
Resources Petr G 2009 Ed. Multidimensional evidence-based practice.
Synthesizing knowledge, research and values Tsui L 2006 A Handbook on Knowledge Sharing: Strategies and
Recommendations for Researchers, Policymakers, and Service Providers. Community University Partnership for the Study of Children, Young and Families
Gambrill E 2003 Evidence-Based Practice: Sea Change or the Emperor’s New Clothes?
National Implementation Research Network http://nirn.fpg.unc.edu
Fixsen D, Blasé K, Naoom S, Wallace F. 2009. Core Implementation Components. Research on Social Work Practice. Volume 19 Number 5 September 2009 531 - 540
www.aracy.org.au
www.bensoc.org.au
www.parentingrc.org.au
https://nirn.fpg.unc.edu
www.aifs.org.au
http://www.campbellcollaboration.org/
http://www.scie.org.uk/
www.rip.org.uk
http://www.chsrf.ca/home_e.php#3