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Handicap fremadrettet - viden og faglige perspektiver

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. user and carer involvement involvering af brugere og pårørende

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Handicap fremadrettet - viden og faglige perspektiver

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  1. 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

  2. Agenda • user and carer involvement involvering af brugere og pårørende • outcomes, outcomes, outcomes outcomes, outcomes, outcomes • cost-effectiveness omkostningseffektivitet • practice research, research for practice praksisforskning, forskning for praksis

  3. 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

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

  5. Sources of evidence Practitioner knowledge User & carer knowledge Policy Research Organisational knowledge THE EVIDENCE BASE FOR SOCIAL SERVICES

  6. Involvement is the best way to… • generate excitement and commitment to change • overcome barriers to change • increase the scientific quality of the work

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

  8. 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%

  9. 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.

  10. Practitioners want effectiveness studies 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.

  11. ASCOT – Adult Social care Outcomes Toolkit

  12. ASCOT - outcomes www.pssru.ac.uk/ascot/

  13. Outcomes can be measured • 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

  14. 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

  15. The evidence cycle

  16. 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

  17. 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.

  18. Outcome measures • Perceived health • Perceived quality of life • Health related quality of life (EQ-5D) • Social care outcomes (ASCOT)

  19. What has gone wrong between research and practice?

  20. 4. Practice research, research for practice • practitioners work without research-based knowledge • one-way traffic • practice is the passive receiver of research-based knowledge

  21. research and practice research research practice practice research on practice research in practice practice research practice research

  22. 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

  23. 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.

  24. 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

  25. Contact mike.fisher@scie.org.uk

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