A Framework for Disseminating Research Evidence to Child Health Clinicians & Policy Makers

1. A Framework for Disseminating Research Evidence to Child Health Clinicians & Policy Makers Susan Jack, RN, PhD, McMaster University, Hamilton, ON, Canada Lil Tonmyr, MSW, PhD, Public Health Agency of Canada, Ottawa, ON, Canada 1ST INTERNATIONAL SOCIETY FOR CHILD INDICATORS CONFERENCE, CHICAGO, IL June 2007

2. Workshop Objectives • Identify factors influencing the utilization of research evidence by decision-makers • Develop a knowledge transfer & exchange (KTE) strategy to disseminate research findings • Discuss a KTE strategy developed to disseminate findings from the Canadian Incidence Study of Reported Child Abuse & Neglect (2003)

3. A Knowledge Transfer Story….circa 1747 Time Elapsed from Lancaster to Adoption: 264 years 1497 Vasco da Gama Rounds Cape of Good Hope to find sea route to India. Of the 160 crew, 100 die of scurvy 1601 Captain Lancaster sails with 4 ships; Crew #1 given 3tsps lemon juice daily 1747 Dr. James Lind conducts random trial of six treatments for scorbutic sailors 1795 British Navy orders citrus fruit in diet for sailors 1865 British Board of Trade orders citrus on merchant marine vessels

4. Injury & Child Maltreatment SectionPublic Health Agency of Canada • Canadian Incidence Study of Reported Child Abuse & Neglect • National surveillance program • 5 year cycle of surveillance • Two cycles completed (1998 & 2003) • Strong collaboration between ICMS, Provincial/Territorial Directors of Child Welfare, steering committee & the study team.

5. CIS-2003 Objectives • determine investigation and maltreatment rates over time • assess the type and severity of maltreatment • examine selected determinants of health that may be associated with maltreatment • monitor short-term investigation outcomes

6. CIS-2003 • Data collected from investigating child protection workers after completion of investigation. • Data collected during fall and then used to develop weighted annual estimates • Does not capture unreported cases, cases only investigated by the police, and reports about already open cases

7. Data Analysis & Interpretation Data Collection/ Acquisition Communication of Information for Action National Child Health Surveillance adapted from McCarthy, 1992

8. Scope of CIS-2003

9. Knowledge Transfer and Exchange Framework Knowledge Persuasion Decision Implementation Confirmation Knowledge transfer strategies Evidence-informed Decision-making Knowledge Uptake Outcomes Adopt Reject Dissemination strategies Innovation characteristics Decision-makingefforts Implementation strategies Pt outcomes resource allocation expenditures organizational performance Organizational characteristics Individual characteristics Environmentalcharacteristics (Dobbins et al, 2002)

10. Knowledge Transfer and Exchange Framework Knowledge Persuasion Decision Implementation Confirmation Research Dissemination Evidence-informed Decision-making Research Utilization Outcomes (Dobbins, 2002)

11. Lesson # 1: You need a plan! Framework for Knowledge Transfer • Whatshould be transferred to decision makers? • To whom should research knowledge be transferred? • By whom should research knowledge be transferred? • How should research knowledge be transferred? • With what effect should research knowledge be transferred? (Lavis et al., 2003; Reardon, Lavis & Gibson, 2006)

12. Knowledge Transfer & Exchange Models • Producer-Push Models • User-Pull Models • Exchange Models • Relationships are built & nurtured • Researchers help build capacity for decision-makers to use research • Decision-makers help identify relevance of research & new research questions

13. Lesson #2: Put Together a Team! • Communications sub-committee • Stakeholder input & feedback • Social Development Canada • P/T Directors of Child Welfare • Centre of Excellence for Child Welfare • First Nations Child & Family Caring Society • CIS 2003 Steering Committee • PHAC Internal Communications • Develop ‘Dissemination’ & ‘Communication’ plans

14. Creating Key Messages • Type 1 Message • Credible facts & ideas • Type 2 Message • Due to strength or type of evidence, can’t direct decisions, but can be used to discuss issue • Type 3 Message • A body of evidence, expressed as an actionable idea, tailored to the decision-makers needs

15. Key Messages Type 1 Message “The rate of substantiated child maltreatment increased 125% between 1998 and 2003. These are likely due to increased vigilance on the part of policy makers, investigators, serviceproviders, and the general public.” Type 2 Message “Child maltreatment is an important health and social concern that requires organizational collaboration to prevent and treat”

16. Your Research: Create a Message • What type of message can be developed? • Is there sufficient evidence to develop an actionable message? • Who is the message relevant for? Reardon, Lavis & Gibson, 2006

17. Target Audiences • A message’s target audience must be clearly identified. • Multiple audience-specific messages are needed. • Research knowledge alone may not impact decisions.

18. The Challenge of Identifying Specific Target Audiences! • Who can act on the basis of the available research knowledge? • Who can influence those who can act? • With which of these target audience(s) can we expect to have the most success? • Which messages pertain most directly to them?

19. CIS-2003 Target Audiences • Broad spectrum of stakeholders: • policy makers • professionals • civil society organizations • women’s shelters • academics & researchers • media & general public • Decision-makers in these sectors: • Social Development (Child Welfare), Public Health, Health, Education, Justice, Indian & Northern Affairs Canada • Aboriginal populations • Youth populations

20. Understand Your Audience • What decisions does the audience own that this evidence might influence? • Who is a credible messenger to this audience? • Is the audience connected to existing knowledge pathways?

21. Identify Barriers & Facilitators • For the audience, what is the magnitude of change suggested by the message? • Is there a cost to this change? • Does the change require resources or expertise?

22. Messengers • Credibility of messenger is important • Who is perceived to be credible varies by target audience • Researchers, with skills & experience, to act as messenger viewed as credible. • Time consuming and skill-intensive process • Work with & through trusted intermediaries

23. Lesson #3: Identify the right people when targeting specific audiences • ICMS • Study team • CIS Steering committee • P/T Directors of Child Welfare • Representatives from Aboriginal & Youth Stakeholder Groups

24. Process of Knowledge Transfer • If goal is uptake & utilization: • Passive processes are ineffective • Interactive engagement most effective • Interaction between researchers & target audience is important • Supporting infrastructure can augment interactive efforts • Target to clearly identified audience • General information in searchable form Grol & Grimshaw, 1999

25. KTE Strategies • Generally effective • Academic detailing/ education outreach • Interactive education sessions • Reminder prompts or messages • Interventions tailored to overcome identified barriers (Grimshaw, 2001)

26. KTE Strategies • Variable Effectiveness • Audit & feedback • Opinion leaders • Formal opinion leaders • Informal opinion leaders • Patient-mediated intervention (Grimshaw, 2001)

27. KTE Strategies • Generally Ineffective as ‘stand alone’ • Lectures • Educational materials • No evidence of effectiveness • Electronic communication • Media

28. Process of Knowledge Transfer Communication Strategy • National launch; media & communication strategy Dissemination Strategies • Producer Push: Conference presentations, broad distribution of report, submission to peer reviewed journals • Exchange Model: Discussion of findings, facilitated by study team, at all study centre sites • User Pull Model: Development of CIS-2003 web-pages

29. Transfer Mechanisms • For different transfer mechanisms, assess: • Availability • Resources • Feasibility

30. Lesson #4: Effective transfer takes time and resources • Resources required to develop strategies • Messengers & financial resources required to support interactive transfer strategies • Identify existing personal relationships between ‘messengers’ and members of ‘target audience’…encourage integration of CIS-2003 findings into discussions • Issue of child maltreatment will continually arise….keep evidence readily available

31. Evaluate the KTE Impact • Indirect use • Changes in knowledge, awareness or attitudes • Direct use • Behavioural changes • Tactical use • Validation or legitimization of decision that is already made

32. Acknowledgments • Injury & Child Maltreatment Section, Public Health Agency of Canada • During this work, Dr. Jack was supported through a Canadian Health Services Research Foundation Post Doctoral Fellowship

33. Contacts Dr. Susan Jack jacksm@mcmaster.ca Dr. Lil Tonmyr Lil_tonmyr@phac-aspc.gc.ca

34. References Dobbins, M., Ciliska, D., & DiCenso, A. (2002). Dissemination and use of research evidence for policy and practice. Online J Knowledge Synthesis Nurs, 9, Document 7. Grimshaw, J. et al. (2001). Changing provider behaviour: An overview of systematic reviews of interventions. Medical Care, 38, 8, Supp 2. Grol, R., & Grimshaw, J. (1999). Evidence-based implementation of evidence-based medicine. Journal of Quality Improvement, 25(10), 503-513. Lavis, J., N., Robertson, D.M., Woodside, J.M., McLeod, C.B., Abelson, J., & the Knowledge Transfer Study Group (2003). How can research organizations more effectively transfer research knowledge to decision makers? The Milbank Quarterly, 81(2), 221-248. McCarthy B. The risk approach revisited: a critical review of developing country experience and its use in health planning. In: Liljestrand J, Povey WG (Eds). Maternal Health Care in an International Perspective. Proceedings of the XXII Berzelius Symposium, 1991 May 27-29, Stockholm, Sweden. Sweden: Uppsala University, 1992:107-24. Reardon, R., Lavis, J., & Gibson, J. (2006). From research to practice: A knowledge transfer planning guide. Toronto, ON: Institute for Work and Health. www.iwh.on.ca Trocmé, N., Fallon, B., MacLaurin, B., Daciuk, J., Felstiner, C., Black, T., Tonmyr, L., Blackstock, C., Barter, K., Turcotte, D., & Cloutier, R. Canadian Incidence Study of Reported Child Abuse and Neglect, CIS-2003: Major Findings Report. Ottawa: Minister of Public Works and Government Canada, 2005.