The Innovative Role of an Embedded Researcher: Benefits and Learnings Shannon Winters

1. The Innovative Role of an Embedded Researcher: Benefits and Learnings Shannon Winters Embedded Researcher CHI Evaluation Platform& The Mental Health Crisis Response Centre Winnipeg Regional Health Authority With Contributions from: Susan Chipperfield Regional Director of Mental Health Programs (WRHA) Nancy Parker Director of Crisis Services (WRHA) Evaluation Platform

2. Objectives • Provide an overview of the Mental Health Crisis Response Centre • Rationale and Justification of the Embedded Researcher role • Provide insight regarding the experience of being an embedded researcher one year in.

3. Background Worldwide • Social, emotional and economic cost of Mental health problems are staggering • Rates of mental health concerns on the rise Canada falls behind much of the world in regard to funding allocated to Mental Health • at only 6% of total health funding • Falling below that of other developed countries • Australia at 6.8%, USA at 7.5%, UK at 12.1% • (Jacobs et al., 2008; Institute of Health Economics, 2007) Manitoba • 1 in 4 people will experience a mental illness diagnosis • Highest Aboriginal population in Canada • Higher suicide rates • Growing Immigrant and Refugee population • Unclear on how to best meet needs • (Rising to the Challenge Mental Health Strategy, 2011)

4. Mental Health Crisis Response Centre • The Mental Health Crisis Response Centre (CRC) intends to be a center of excellence in crisis resolution • Round-the-clock central point of access for adults requiring crisis mental health services • Staff provide short-term clinical support through: • walk-in services, mobile services and scheduled appointment services, • combined with planned linkage and referral to appropriate services and supports in the community. • Offers trauma informed services in a welcoming and supportive environment for individuals and their families in times of need. • Evidence informed practice is a priority

5. What is Embedded Research? • Embedded : To be an integral part of a surrounding whole; To incorporate or contain as an essential part or characteristic • Embedded Researcher Roles • Coordinates and undertakes research related activities on a range of research, evaluation and knowledge translation projects undertaken by the CRC • Supports operational and clinical leadership with reports and data to inform practice • Collaborates on external research and evaluation projects • Manages and manipulates data bases and data sets. • Develops reports out of data bases.

6. Current Projects • Supporting efforts to maximize use of our Collaborative Health Record (EMR) • Quality Appraisal of Data • Inform staff training for improving data entry • Liaise with computer programmers to ensure accurate data pulls • Development of operational reports • Development of mechanisms to support external researchers • Evaluation of Specific program components: screening process

7. Why Embedded Research • Why • Need to know if interventions are having the intended impacts • Historically services have been delivered blindly • Management may lack skillset and time to measure outcomes • Respond to critical and emergent issues as they happen • Make informed mid-course corrections and monitor over time • Knowledge Exchange • Apply existing evidence – evidence informed practice • Create new evidence- be on the bleeding edge

8. Justification for this Innovative Role “Research was something that we have not had funded in the past but we just felt that if we were going to be a centre of excellence it really is the make or break element. We wanted to ensure, that it wasn’t left up to external researchers to decide what to study based on their area of expertise, but that the system was going to have a role to play in identifying areas where there were gaps and where we are really trying to make a difference, and without an embedded researcher it is really hard to make that happen. On a number of occasions in the planning phase we were told to take out the research component, it was the most contentious issue; it was far more contentious than any other element. We stayed really strong and firm and were able to quote back to provincial documents, one of which was the mental health strategy to support innovation and research. We were able to show that we were doing both; we were innovating with the CRC and we needed to be able to research those outcomes on an on-going basis. So we just consistently went back to those same arguments and were able to keep it in the budget through all the various budget review processes. And… it worked!” Susan Chipperfield Regional Director

9. Insider Research and Reflexivity

10. Insider Research • My insider perspective: • can be a risky endeavor for a researcher to take on if not reflexive about his or her position (Richards & Morse, (2007) • Overall beneficial • Relationship building essential

11. Learnings (Three Hands Clapping: Chafe & Dobrow, 2008)

12. Three Hands Clapping (Chafe & Dobrow, 2008) Benefits • Increased interaction between decision-makers and researchers • Allows decision-makers easy access to researchers to support decision-making • Conduit for interactions with external health service research expertise • Helps foster innovation • Allows development of the more relevant research agenda • Greater potential for research findings to influence decision-making • Greater potential to draw on external research funding sources to support organization objectives • Facilitates development of researchers decision-maker collaborations required for many grant funding competitions • Facilitate access to organizational data sources

13. Three Hands Clapping (Chafe & Dobrow, 2008) Challenges • Resources may be used for projects that are not specifically focused on the organization • Researchers timelines are often too long to be useful for decision-makers • Requires organizational resources that could be used for other purposes, including service provision • Less control over research agenda • Dilemma between methodological rigor appropriate for academic audiences and relevance – timelines for decision-maker audiences • Involvement of decision-makers in research projects can result in more complex research ethics context • Confusion around performance assessment

14. Areas to Note • Complex and undefined position • Importance of fostering strong relationships with stakeholders • staff, decision makers, external researchers • Building trust • Acknowledging Position of Power • Part of leadership team • Reporting in to program researched/evaluated • Performance evaluation • Reporting out • Attend to “Illusions of Sameness” • Retain connection with research community

15. Acknowledgements Significant contributions: Susan Chipperfield Regional Director, Adult Mental Health Programs (WRHA) Nancy Parker Director of Crisis Services (WRHA)

16. References • Chafe, R., & Dobrow, M. (2008) Health Services Researchers Working within Healthcare Organizations: The Intriguing Sound of Three Hands Clapping. HealthCare Policy 4 (2), 37-45 • Finlay, L., & Ballinger, C. (2006). Qualitative research for allied health professionals: Challenging choices. Chichester, England; Hoboken, NJ: J. Wiley & Sons. • Government of Manitoba. (2012). Rising to the Challenge: A Strategic Plan for the Mental Health and Wellbeing of Manitobans. Winnipeg, MB. • Kincheloe, J., & McLaren, P. (2000) Rethinking critical theory and qualitative research. In N.K. Denzin & Y.S. Lincoln (Eds.), Handbook of qualitative research (3rd ed., pp. 303-342). Thousand Oaks, CA: Sage. • Institute of Health Economics (2007). Mental health economic statistics. Edmonton (AB): Institute of Health Economics • Mental Health Commission of Canada. (2012). Changing directions, changing lives: The mental health strategy for Canada. Calgary, AB: Author. • Overcash, J. A. (2003). Narrative research: A review of methodology and relevance to clinical practice. Critical Reviews in oncology/hematology, 48(2), 179-184. • Pitman, G. E. (2002). Outsider/insider: The politics of shifting identities in the research process. Feminism and Psychology, 12, 282-288. • Richards, L., & Morse, J. M. (2007). Readme first for a user’s guide to qualitative methods (2nd ed.). Thousand Oaks, CA: Sage.