Transcript Document

with
Think Research: EvidenceInformed Planning and
Commissioning for Children
Keith Moultrie and Celia Atherton
20 April 2009
Institute of Public Care
 Oxford Brookes University.
 Social care, primary care, education and specialist
housing.
 Commissioning, performance management,
information management, and service quality.
 Applied research and consultancy, skills
development, and dissemination of knowledge.
April 2009
Website
http://ipc.brookes.ac.uk
Email
[email protected]
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The Institute of Public Care
 Commissioning strategy development and
implementation – LAC, vulnerable children, children
in need, CAMHS, substance misuse.
 SSIA Better Outcomes for Children in Need
Programme.
 DCSF Commissioning Support Programme
 IPC network.
 CSIP Commissioning EBook and Exemplar Projects.
 Post-graduate certificates in commissioning and
purchasing.
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Session outline
 An overview of the challenges facing evidenceinformed commissioning in children’s services
 An opportunity to discuss examples of good
practice
 The chance to consider some of the key resources
available to support evidence-informed
commissioning
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Children’s Trusts
‘The primary purpose of a Children’s Trust is to secure
integrated commissioning leading to more integrated
service delivery and better outcomes for children and
young people. Children’s Trusts will be formed through
the pooling of budgets and resources..’
(Every Child Matters: Next Steps 2005)
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Children’s Trust Statutory Guidance 2008
 Emphasis on narrowing the outcome gaps between
children from disadvantaged backgrounds, for example
children in care, and their peers.
 Focus rigorously on prevention and the early identification
of children with additional needs, including those at risk of
falling into anti-social behaviour or crime.
 Involve and empower parents, and become more
responsive to children and young people themselves;
 Drive effective integrated working between all
professionals working with children and young people;
and
 Overcome unnecessary barriers to sharing and using
information systematically.
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Role of commissioning
“Joint planning and commissioning is a tool for
children’s trusts – to build services around the needs
of children and young people – and to deliver their
outcomes most efficiently and effectively.”
Framework for joint planning and commissioning of children and young
people’s services, DfES, 2006
LA and PCT ‘THE driving relationship’ of CT Board,
should commission using best practice JSNA, joint
commissioning plans, budget transparency and joint
commissioning arrangements
Children’s Trust Statutory Guidance 2008
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National Support
 Guidance – Joint Panning and Commissioning
Framework, Child Health Strategy, Commissioning
Framework for Wales
 Support – Commissioning Support Programme and
World Class Commissioning, Cabinet Office Third
Sector Programme
 Evidence – Centre for Excellence and Outcomes
 Good practice –SSIA in Wales
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Aligned Planning and Commissioning….…?
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So what is going on?
 Big pressure on children’s trusts and partnerships
to meet needs of the population more effectively.
 Big pressure to focus on those most in need.
 Big pressure to be more systematic and clear
thinking about needs and services.
 Big pressure to secure efficiencies.
 Big pressure to use commissioning to help achieve
these changes.
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Where have we got to?
 Most of us get the basics
 Most CTs have established commissioning functions
and frameworks and processes
 Some CTs have used a commissioning approach to
deliver significant service reconfiguration
 Some CT Boards recognise the central importance
of commissioning to their role
 Many CTs still see commissioning as managing
contracts with external providers
 Commissioning practice is variable across the
country, with different degrees of rigour…
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Where have we got to?
 The danger – ineffective commissioning which is:
 Not evidence – based
 Has very little impact on service configuration
 Does not engage stakeholders
 Does not meet the future needs of the population
 ‘We have got lots of commissioning activity going
on, but not much real evidence about what works,
analysis, and not much real change in services.’
 ‘It’s the same old people making local deals and
protecting their empires – the just call it
commissioning now’
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We need more rigour ..
April 2009
A balance between:
 Evidence-based analysis
 National priorities/evidence base
 Needs analysis
 Market/service mapping
 Cost and quality analysis
 Consensus building and change management
 Commissioning agencies
 Providers
 Service users and carers
 Professionals
 The public
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A realistic balance of evidence sources
 National and international research as well as
government guidance and legislation.
 Population data and prevalence rates.
 Referral, assessment and service activity data.
 Illustrative care pathway/case studies.
 Engagement activities with patients/service users
and carers, providers, professionals and other
stakeholders.
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research in practice
 Aims to promote the effective use of research in designing
and delivering services for vulnerable children and families
through a collaborative network of over 100 agencies
Change Projects, Learning Programme, Publications,
Website, joint work with ripfa
W: www.rip.org.uk E: [email protected]
research in practice
 DCSF C4EO (Centre for Excellence and Outcomes in
Children and Young People’s Services)
 Wales College + SSIA – promoting better use of
research in children’s services.
 LARC – Local Authority Research Consortium (33
local authorities; integrated working; CAF)
 RiP network
 DCSF Quality Matters research overview – launch of
report and implementation materials (films, leaflets,
e-learning) on 8 May 2009
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Working with the SETF to develop this guidance
 Social Exclusion Action Plan – named collaboration
partner
 Contribution – to assist in making resulting
guidance both relevant and accessible to the target
audience – you!
 LARC provided key testbed – December 06, October
07 and February 08 workshops
 Plus NFER and Barnardo’s
Think Research: what’s available?
 Hard copy:
The Guidance
 On-Line supporting resources:
Glossary of research terms
Building research capacity
Appraising research evidence
Searching databases – basic guidance
Ethical guidance
Case studies
Key Terms
 Evidence-informed practice means that decisions
made about how to support vulnerable groups are
informed by the best available and most relevant
research.
 By research evidence, we mean knowledge that has
been acquired through a systematic and transparent
process of enquiry.
An Evidence-Informed Commissioning Cycle
Assess local
need
Analyse
results and
apply
lessons
Formulate
research
questions
Evaluate
service
Decide on
most
effective
response
Commission
service
Study grading tool
1. Positive reports from service users and
Practitioners at follow up
2. Several positive pre-post studies comparing
performance at baseline to follow up
3. Positive evaluations by several studies featuring
comparison groups
4. Positive evaluations by several randomised
controlled trials
5. Intervention positively evaluated by at least one
systematic review or meta-analysis
To proceed or not to proceed?
 1-2: Proceed only when the possibility of harm is
very low
 3: Proceed with caution – seek stronger evidence
 4-5: Proceed with confidence but monitor changing
evidence base
The commissioner’s obligation is to …
 seek out the evidence currently available and invest
accordingly
 identify where the evidence base needs to be
strengthened
 design appropriate evaluation programmes
 review services as new knowledge becomes
available
Some key questions: Should we …
 innovate or improve what we have?
 Involve service users as commissioners?
 always look for a Randomised Control Trial (RCT)?
 What kind of work with teenage parents will support
their parenting best?
 Why do so many parents in our parenting classes drop
out at an early stage
Creating a process where useful evidence is …
 acquired – knowing where to locate research evidence
 assessed – being able to appraise the quality of the
evidence
 adapted – fitting the evidence into your own practice
situation
 applied – using the evidence to improve outcomes for
service users
Not for Sales
 Building more effective services through the use of
research evidence involves
 knowledge gathering
 being objective and adaptable
 treatment fidelity
 realising that there is rarely a final verdict
Outcome-focussed commissioning
 Questions always focus on the outcomes
 Pre-occupation with impact
 Focus on those outcomes that can be directly
attributable to what you – and now others – do
 Monitor and evaluate what you do, and act in
accordance with the results
Be SMART
Outcomes
SMART
Not SMART
Specific
Improve mobility,
behaviour, housing
Improve ‘well-being’
Measurable
Can be expressed
numerically
Can only be
expressed through
narrative
Achievable
Fewer exclusions of
BME pupils
End oppression
Realistic
A 10% decline in
youth offending
A 90% decline in
youth offending
Time-limited
To be achieved within
a stated time period
Objectives with no
deadline
Don’t keep what you know to yourself
Reports should:
 Be short
 Avoid unbroken slabs of text
 Use tables and graphs
 Use bullet points
 Be judgemental
 State conclusions clearly
Additional on-line resources