RPP 17 1 Celia Atherton Getting a GRIP

Research Policy and Planning: The journal of the Social Services Research Group – Vol 17 (1) 1999

Getting a GRIP

Celia Atherton

Director research in practice, Dartington

Introduction

Getting research into practice is rapidly becoming an end-of-millennium catchword. Use it and improve your chances of getting ajob, a pay rise, appreciation. Is it just a new fad, or a concept demanding serious attention? Public and individual confidence in our services is at least partly a function of our ability to articulate clearly the influences on our decision-making. Before we can do this publicly we need to practice it privately, with our professional colleagues. Our track record here, both within our profession and with other allied professions, is poor – why?

The context

The very idea of evidence-based practice is young. Its older sister, in medicine, still counts in years, not decades. Yet it is increasingly hard to remember how willingly our profession has worked with scant if any knowledge of the relevant evidence base. We now know that there is not always an evidence base to use – that some decisions have to be made without benefit of evidence. But for decades we have been prepared to practice without even knowing whether evidence existed to support or challenge our practice. And we did not worry overly – for we were more concerned with the value of our experience on the job, the power of our values, the requirements of our agency’s procedures and the services we believed to be available. All vital – but not sufficient.

Few feel able to justify the perpetuation of this state of affairs and yet a torrent of questions falls like boulders on a path. Where is the evidence? Can it be accessed? Can it be relied on? Does it answer the questions in the practitioner’s mind? Are its implications for policy and practice clear? There is a gulf between research and practice but responsibility is too easily laid at the door of social work alone. Explanations are found also within the research world – both those that do, and those that fund, research, and those who support research use. The annual NHS spend on dedicated library and knowledge systems is approximately £70m a year (soon to be £90m). The annual NHS spend on research and development activity in just one of 8 UK regions is approximately £8m a year. Social care invests a tiny fraction by comparison. A poor relation indeed.

Definitions

Increased talk about evidence-based child and family services might suggest confidence that we mean the same thing. This is unlikely. We still have no agreed definition and any roomful of people asked for a definition would give widely varying, if any, answers. research in practice uses this definition to bring together the various aspects of a professional’s developing expertise:

Evidence-based social care is the practice of a range of professionals grounded in sound knowledge about the needs of children and families informed by:

  • the best available evidence on what is effective;
  • the practice expertise of professionals;
  • the experiences and preferences of service users.

Without knowledge of the evidence any policy maker or practitioner risks being out of date. Not taking account of practice expertise risks practice and policy being ‘evidence tyrannised’. However apposite our proffered intervention, denying the importance of the user’s experience and preference is liable to see our offers ignored. While refuge may be taken in labelling the user ‘unco-operative’, the reality is that dictatorial practice of this kind is no longer ethical – and is certainly ineffective.

Support for evidence-based practice

Until recently anyone who wanted to know the research could become an expert in a matter of days – the combination of no interest from so many others and the lack of relevant, especially British, material made a good backdrop for instant expert status. Today the picture is very different. The growth in British research has been exponential. The sources have increased likewise but much remains to be done to make the research more accessible to those who most need to make use of it. Recent times show a changing picture. Both the Department of Health and local authorities themselves have initiatives to promote better use of the evidence base when planning and delivering services for the whole range of individuals and groups who may benefit from social care services.

‘Research in practice’ was formed in 1996 as an initiative of the Association of Directors of Social Services with the Dartington Social Research Unit. Twenty-five local authority social services departments formed its initial membership and a range of services is delivered at every level within the agencies from elected members to front line practitioners. These include workshops and seminars, written overviews of research studies, an internet based research directory, audio-tapes, assistance in the development of strategic processes for promoting evidence based services within member agencies, and a variety of developmental projects. In 1998 a one-off expansion enabled a further 25 agencies (including two large voluntary organisations) to join and a northern office to be opened within the Children and Families Research Group at the University of Sheffield .

Other initiatives exist too. The Centre for Evidence-Based Social Services, started in 1997 and based at the University of Exeter, provides 16 social services departments in south west England with a dissemination and research commissioning service covering all aspects of social care. It is funded jointly by the member authorities and the Department of Health. More recently, in 1998, a consortium of five universities created Making Research Count, providing dissemination services to approximately 30 social services departments. And for longer than all of these the National Institute of Social Work and National Children’s Bureau have both produced cd-roms of their databases which include substantial amounts of research information. Much of this, and other research information such as that provided by the Joseph Rowntree Foundation, are now freely available on the web. The NHS is committed to the development of a National Electronic Library. for Health (NeLH) and discussions are underway to develop a similar Electronic Library for Social Care (NeLSC). No doubt more initiatives will emerge as local authorities, voluntary organisations and independent agencies identify their needs to be better serviced by research. It is unlikely that growth will be managed centrally, as it is within the NHS. A consequent task for all these initiatives is to be clear between themselves, and to others, about what each offers, what is the same and what is different and to then be clear to potential users about what can be expected from each service.

If we are to make real progress in developing evidence based practice – where our appreciation and use of the evidence improve the outcomes for children and their families – then a number of challenges will have to be met.

Challenges for research in practice

With most services in place, and the research directory moving onto the web this year, the outcomes of our work need to be evaluated. Alongside this, member agencies will also identify their own targets for evidence-based practice and the role of research in practice within that.

A further development study will work with a number of member agencies to determine what effect workshops (well received at the time), and their prior and subsequent agency support, have on work with children and their families.

Challenges for individuals and teams

Knowing what evidence-based practice would look like is central to all these questions. One of research in practice’s development projects – Evidence Based Team Working – seeks to identify a model of team working which described how practitioners would function, both individually and together, in order to make best use of the available evidence. The project started with recognition that cultural change, within individuals as well as teams, was required. The underlying principles include the need to manage new practice within normal work routines, to take personal responsibility for at least some part of ongoing learning and to have management support, both moral and tangible. Methods include the conscious promotion of discussion about research in supervision, structured team meetings and meetings with service users and structured recording of evidence used from ‘research libraries’ and in case files and external reports.

Challenges for managers and policy makers

The first and perhaps greatest challenge is for managers and policy makers to become evidence based themselves. Until very recently the tendency was to see this as an issue for those in the front line – to be supportive but not to lead by example. Change is required and many of the recent national child care initiatives will propel such change. Quality Protects will alter radically the way decisions at a senior level are made, and elected members will find themselves amassing a vast amount of information, most particularly about the progress of looked after children and work to reduce anti-social behaviour. Knowing how to assess and build upon this ‘management’ information is key.

Beyond this, managers and policy makers will need to ensure that their staff have the right resources – finance to buy books and journals, libraries in which to read and be assisted in searches, computer equipment to access the material prepared by others. They may want to encourage teams to develop action plans, as some agencies already do, which include how they will increase their use of the evidence base. This in turn will require managers to encourage a more reflective atmosphere in busy teams – one where staff can and do read and discuss the evidence. Success would be more likely if managers set standards for the use of evidence in decision-making and supported staff who followed those standards. This will severely challenge some of the established hierarchies within and between agencies. As new staff are required, recruitment, induction and training strategies could usefully incorporate requirements about evidence based practice. In this way, over time, the nature of the workforce will change.

An understanding of the necessary dynamic relationship between individuals and the organisations for which they work is critical:

Individuals shape organisations
Individuals who practice evidence based decision making Evidence based organisations
Organisations facilitate thedevelopment of individuals

All of this is best held within a strategic framework – one which sets the need for evidence-based practice within the overall objectives of the agency and which is common knowledge to all staff and to other agencies in the locality.

Challenges for researchers and funders

Whilst there is much for service agencies to do, real change will only come about when all parties to the research process change. The challenges to researchers and those who fund research are immense. The research must speak to the concerns of those who seek to help vulnerable members of our community. It must address their concerns and deliver the results in a manner that is both understandable and cognisant of the way in which the findings may be used most effectively. For too long most of the national research has been driven by a central government agenda or by the particular interests of the researchers themselves. Frequently there is a happy coincidence between those interests and the requirements of local agencies and their practitioners. But not often enough. We do not even know what research is most needed by practitioners. Funders do little to identify and respond to these needs. A study currently underway for research in practice, Any Questions?, will identify those needs from within its 55 members agencies.

Furthermore, if the research world is to respond positively to the demand from practitioners for help in understanding the importance and application of research, more will need to be communicated about the relative strengths and weaknesses both of individual studies and collections of studies. It has been suggested` that in future the reliability of research could be identified according to three criteria:

  • tentative – where the user would pause, take stock and ask questions;
  • indicative – where the findings are not of highest quality, and the user is urged to proceed with caution;
  • conclusive – where findings have a high level of scientific rigour and reliability.

Currently, few studies in social care meet the highest levels of reliability. Herein lies the true meaning of using ‘the best available’ evidence. However, when findings are replicated across a number of studies they do merit a greater degree of reliability. Roy Parker’s finding, first published in 1966, of a clear association between placement breakdown and the presence of the foster carers’ own children in the home has since been reinforced by a range of other studies. Sadly this highly reliable finding also provides an unwelcome example of how our service agencies continue at times to ignore the evidence and so do more harm than good.

Conclusion

Getting research into practice is an idea whose time has come. Every player has a role. Meeting the resulting challenges will be hard for everyone. Clarity and agreement about what should be done are essential. Having a common definition of evidence-based practice is clearly a pre-requisite. As is the need more generally for a common language between all those working in child welfare so that we can more easily access and understand what research can offer to those who design and deliver services.

Notes

Research in practice, Warren House, Warren Lane, Dartington, Totnes TQ9 6EG. Tel 01803 867692 Fax: 01803 866783 E.mai1:celia@rip.co.uk. research in practice, Children and Families Research Group, University of Sheffield, Elmfield, Sheffield S10 2TU. Tel: 0142229; Fax: xxxx ;Email: j.m.cooke@sheffield.ac.uk.

Centre for Evidence-Based Social Services, Amory Building,University of Exeter, Exeter EX4 4RJ. Tel: 0192 263323 Fax: 01392 263324 E.mail: s.e.bosley@exeter.ac.uk.

Making Research Count, Sue Bailey, School of Social Work, Elizabeth Fry Building, University of East Anglia, Norwich NR4 7TL Tel: 01603 593557 Fax: 01603 593552 E.mail: s.e.bailey@uea.ac.uk.

National Institute for Social Work, 5 Tavistock Place, London WC1H 9SN. Tel: 0171 387 9681 Fax: 0171 387 7968 E.mail: info@,nisw.org.uk Web: www.nisw.org.uk.

National Children’s Bureau, 8 Wakley Street, London ECIV 7QE. Tel: 0171 843 6008 Fax: 0171 843 6007 E.mail:library@ncb.org.uk Web: www.ncb.org.uk.

Joseph Rowntree Foundation, The Homestead, 40 Water End, York Y03 6LP. Tel: 01904 629241 Fax: 01904 620072 Web:www.jrf.org.uk.

Quality Protects: Objectives for Social Services, and Framework for Action, September 1998, Department of Health.

LA. Muir Gray (1997) Evidence-Based Healthcare, Churchill Livingstone.

Roy Parker, in a paper to DSRU child care seminar in October 1998.

Roy Parker (1966). Decisions in Child Care, Alien and Unwin.