What’s in a Name?

What out-of-home care managers think ‘evidence-based practice’ really means!

Deirdre Cheers ACWA Conference - 2nd September 2002

• Senior Managers and Team Leaders thoughts and ideas about evidence-based practice

• How evidence-based practice impacts on direct work with children and young people in out-of-home care care

Looking After Children (LAC)

• A case management system for children and young people in out-of-home care

• Developed in the early 1990’s by UK Department of Health

• Based on extensive research into outcomes for children and young people in care

Out-of-Home Care: Past and Present

• Changes in how care is provided

• Emerging trends

• Impact of research

“ there are considerable pressures on professionals to adopt evidence - based practice, that is, action which is grounded in sound knowledge of the needs of children & families and latest evidence about what works for whom, when and why”

(Little, 1997)

The Research

An investigation into knowledge held by Senior Managers and Team Leaders, and barriers to implementation of evidence-based systems,

in three Australian States/Territories.

The UK Looking After Children system is used as a case example.

The Research (cont.)

• 9 out-of-home care agencies(government and non government)

• 3 states/territories - NSW, ACT, WA

• 19 participants (10 Senior Managers and 9 Team Leaders)

Research Aims

• Explore definitions of evidence- based practice

• Consider the influence of research

• Look at barriers to implementation of evidence- based systems

Two Associated Areas Explored

• Comparison of government and non-government agencies

• Similarities and differences between agencies on a state/territory basis

The Interviews: Senior Managers

• Understanding and definition of the terms “evidence-based practice” and “guided practice”

• Relationship between employed position and ability to undertake professional reading/training/updating of knowledge base

The Interviews: Senior Managers (cont.)

• Knowledge of Looking After Children

• Individual reservations and agency barriers to the use of Looking After Children

• Decision making process in agency

The Interviews: Team Leaders

Additional questions about the use of

LAC as a tool for supervision

Senior Managers

• Eight Senior Managers reported active and conscientious use of research to inform practice

• Nine offered theoretical definitions of evidence-based practice

Senior Managers (cont’d)

• Only one could not offer a definition of evidence-based practice

• Four talked about increased knowledge of outcomes for children and young people in care as a result of examining research-informed practice interventions

Senior Managers (cont’d)

• One Senior Manager talked about the integration of theory with research and practice, forming a “feedback loop”

• Three felt the terminology “evidence-based practice” to be increasingly commonplace in social work literature and practice

Team Leaders

• Only one of nine reported using research knowledge in day-to-day practice

• Two said evidence-based practice was a term that they had never heard of before

• No Team Leaders were able to give a theoretical definition of evidence-based practice

Team Leaders (cont.)

• Three said research is important to increase knowledge of outcomes for children and young people in care

• Two said research is useful as a means of providing feedback and increasing accountability to clients

General Findings

• Senior Managers had a better understanding of terminology and made links between research and practice

• Both groups found difficulty in conceptualising a link between care outcomes and guidance for practice

Evidence-Based Practice, LAC and Out-of-Home Care

• Both Senior Managers and Team Leaders spoke of the benefits of evidence-based practice in bringing consistency of approach to collection of information when children and young people enter care

Senior Managers were more likely than

Team Leaders to be open to

implementation of evidence-based

systems such as LAC

Expressed Reservations About the Use of Evidence-Based Practice

• Restriction on professional autonomy

• Reduction of worker independence

• Impediment to practice creativity

• Political and bureaucratic “hidden agendas” -

fear of reduction of resources, and avoidance

by governments of fiscal responsibility for

children and young people in care

Expressed Reservations About the Use of Evidence-Based Practice cont’d

CHILD PROTECTION

Messages from Research(the “ blue book”)

UK Department of Health, HMSO, 1995

• Overview of 20 research studies

• brought together findings & themes from a range of reports and worked them into strong clear messages

• aimed to get professionals to evaluate their own practice and attitudes, not just to increase their knowledge

• High profile ministerial launch

• Extensive circulation of free copies

• Series of regional day conferences

• High profile at national events

Improving the Spread of “Evidence”

(Weyts, Morpeth, Bullock in Child and Family Social Work, Vol 5, Issue 3, August 2000)

•Publicity

•Training

•Guidance on implementation of the findings

Guided Practice

Practice tools that assist

professionals to deliver evidence-

based services and provide

effective case work and case

management

“ To be successful such tools should also have the capacity to convey ideas as well as information and in doing so should reinvigorate the original research.”

(Weyts, Morpeth and Bullock, 2000)

Evidence-Based Practice is Guided Practice?

Closely related concepts

but not interchangeable terms

Evidence-Based Practice is Guided Practice?

Evidence-based practice:

Practice shaped and informed

by research

Evidence-Based Practice is Guided Practice?

Guided practice:

Prescribed tasks and recommended processes contained

within a practice framework

The Looking After Children (LAC)

a case management system that is

evidence-based, guided practice

Evidence-Based Practice in out-of-home care

Grounded in good knowledge about: • The needs of children and families

• The latest research findings about what works for which groups of children, when, and why

• Takes into account the known costs and benefits of interventions

• places evidence in a wider context of related concerns eg legal, community, consumer

• provides a common conceptual framework into which new ideas, new research and new projects can be fitted

Evidence-Based Practice in out-of-home care

LAC - Guiding the Journey Through Care