Q and A PANEL

1. Q and A PANEL The real story: evidence informed practice in Australia

2. Panel • Greg Antcliff grega@bensoc.org.au • Leah Bromfield leah.bromfield@unisa.edu.au • Cathy Humphreys cathy.humphreys@unimelb.edu.au • Robyn Mildon RMildon@parentingrc.org.au • Annette Michaux annettem@bensoc.org.au • Aron Shlonsky aron.shlonsky@utoronto.ca

3. Session outline • Intro & purpose of panel • Definitions and concepts • Our approach in Australia - barriers to Evidence Informed Practice • Does EIP matter – the evidence for EIPs • New approaches to implementing Evidence Informed Practice • What next – new learning networks

4. 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

5. Engaging with the politics of knowledge • Who 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.

6. The evidence pyramid http://servers.medlib.hscbklyn.edu/ebm/2100.htm

7. A multi-dimensional evidence base • Identifying 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)

8. The Three Cultures Model

9. The Knowledge Diamond • Service User/ Consumer Experience Research Evidence • Policy Perspectives • Practitioner Wisdom

10. Practice Culture Individual attributes PolicyCulture Organisational Culture Legislation Pragmatics Practice Research Culture Children & Family Nature and Extent of the Evidence Competing Sources of Information and Influence Organisational Policy/Procedure Linkage & Exchange Mechanisms Cultures in context model Types of knowledge Holzer, Lewig, Bromfield & Arney, 2008

11. 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)

12. Commonalities • A 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

13. Some agreement on what works • Interactivity (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

14. Knowledge brokering on a continuum • Dissemination • Implementation • Adoption

15. Or Diffusion of Innovation • Knowledge/evidence/innovation • Persuasion (why this is a good thing?) • Decision making and Implementation (agreement to implement) • Confirmation or adoption Each stage requires different KB strategies

16. Implementation As 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 Implementation Full Implementation Fixsen, Naoom, Blase, Friedman, & Wallace, 2005 2 - 4 Years 17

18. 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 18

19. Implementation Processes Implementation Teams Child, Student, Family, Adult Outcomes Teachers and School Personnel MST Therapists DBT Therapists Health Practitioners Intervention Processes Intervention Fidelity Implementation Fidelity 19

20. Kinark Leadership Team Clinical Excellence Committee Clinical Transformation Steering Committee 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. Working Group Topic Specific Installation Team for Transformation Zone INSTALLATION: Team develops the 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. Implementation Teams for Transformation Zone 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. 20

21. Bottom line from implementation science Implementation 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 21

22. 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

23. 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

24. 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