Handicap fremadrettet - viden og faglige perspektiver

Developing the evidence base for social services

Udvikling af et evidensbaseret grundlag for social service

Professor Mike Fisher

Head of Quality and Research

Agenda

1. user and carer involvementinvolvering af brugere og pårørende

2. outcomes, outcomes, outcomesoutcomes, outcomes, outcomes

3. cost-effectivenessomkostningseffektivitet

4. practice research, research for practicepraksisforskning, forskning for praksis

1. User and carer involvement

• a global movement led by disabled people

• applies to research on service quality

• outcomes defined by people who use services

Assess what we can do, not what we can’t

Sources of evidence

THE EVIDENCE BASE FOR

SOCIAL SERVICES

Practitioner knowledge

Research Organisational knowledge

PolicyUser & carer knowledge

Involvement is the best way to…

• generate excitement and commitment to change

• overcome barriers to change

• increase the scientific quality of the work

A proposition

Assessment of scientific quality should include whether the research included people who use services, and their definition of outcomes.

2. Outcomes, outcomes, outcomes

• research investment much lower than in health

• ratio between 1:8 to 1:17

• 0.3% of expenditure, compared with 2.5 - 4.8%

Fewer More

controlled studies qualitative studies

economic studies studies of users’ and carers’ views

More effectiveness studies!

Shepherd, J., (2007) The production and management of evidence for public service reform. Evidence & Policy: A Journal of Research, Debate and Practice, 3: p. 231-251.

Stevens, M. et al. (2009) What do practitioners want from research, what do funders fund and what needs to be done to know more about what works in the new world of children's services?, Evidence & Policy: a Journal of Research, Debate and Practice, 5, 3, 281-294.

Practitioners want effectiveness studies

ASCOT – Adult Social care Outcomes Toolkit

Domain Definition Domain Definition

Personalcleanliness andcomfort

The service user feels he/she is personally clean and comfortable and looks presentable or, at best, is dressed and groomed in a way that reflects his/herpersonal preferences

Social participationand involvement

The service user is content with their social situation, where ‘social situation’ is taken to mean the sustenance of meaningful relationships with friends and family and feeling involved or part of a community should this be important to the service user

Accommodationcleanliness andcomfort

The service user feels their home environment, including all the rooms, is clean and comfortable

Occupation The service user is sufficiently occupied in a range of meaningful activitieswhether it be formal employment, unpaid work, caring for others or leisureactivities

Food and drink The service user feels he/she has a nutritious, varied and culturally appropriatediet with enough food and drink he/she enjoys at regular and timely intervals

Control over dailylife

The service user can choose what to do and when to do it, having control over his/her daily life and activities

Safety The service user feels safe and secure. This means being free from fear of abuse,falling or other physical harm and fear of being attacked or robbed

Dignity The negative and positive psychological impact of support and care on theservice user’s personal sense of significance

ASCOT - outcomes

www.pssru.ac.uk/ascot/

• controlled studies, using scales and validated measures • the benefits or disbenefits of the intervention

together with

• qualitative evaluation of acceptability and accessibility • the experience of intervention

Outcomes can be measured

3. Cost effectiveness

• effectiveness is of greater importance than ever before

• rationally reducing expenditure requires evidence on cost effectiveness

• cost effectiveness requires high quality effectiveness studies

The evidence cycle

Limited resources

Effectiveness

Cost-effectivene

ss

Evidence-based policy

Economics fit for social services

• a broad perspective, including all stakeholders

• user- and carer-defined outcomes

• the costs of unpaid care should be included

• use resource use data and modelling

• costs and benefits for different sub groups

Francis, J., Byford, S. (2011) SCIE’s approach to economic evaluation in social care. www.scie.org.uk/publications/reports/report52.pdf

The importance of costs and outcomes

‘...there was no statistically significant difference in the costs of all the services used by the reablement and comparison group over the 12 month study period.’

‘... the study has established a high probability of cost-effectiveness…’

Glendinning, C. et al. (2010). Home care re-ablement services: Investigating the longer-term impacts (prospective longitudinal study). York/Kent: Social Policy Research Unit, Personal Social Services Research Unit.

Outcome measures

• Perceived health

• Perceived quality of life

• Health related quality of life (EQ-5D)

• Social care outcomes (ASCOT)

What has gone wrong between research and practice?

4. Practice research, research for practice

• practitioners work without research-based knowledge

• one-way traffic

• practice is the passive receiver of research-based knowledge

research and practice

research practice

research on practice

practiceresearch

practiceresearch

research

practice

research in practice

Practice research, research for practice

• practitioners don’t want to know what works• wrong- they want effectiveness studies

• practitioners don’t do research• wrong – they don’t do formal research

• practitioners don’t read research• wrong – they read summaries, not original research

problem-solving knowledge that

• respects practice• rationality of practice, knowledge use in practice

• addresses practice concerns

• is feasible in everyday practice

• provides tested practice methods

Marsh, P. and Fisher, M. (2008) The development of problem-solving knowledge for social care practice, British Journal of Social Work, 38, 5, 971-987.Fisher, M. (2011) Practice literature research: turning the tables, Social Work & Society, 9,1.

an evidence base for the 21st century

• a strong evidence base enhances the best use of

scarce resources and gives the greatest benefit to

people who use services

• involve users and carers in producing evidence

• and in defining outcomes

• increase the focus on outcomes

• as well as acceptability and accessibility

• analyse costs and cost-effectiveness

• research relevant to practice

Contact mike.fisher@scie.org.uk