Using Research to Influence Policy and Practice

1. Using Research to Influence Policy and Practice Paula Goering, Health System Research & Consulting Unit, CAMH Change Foundation Paula_Goering@camh.net 1

3. Outline • Brief History of Knowledge Translation Scholarship • Conceptual Framework • Strategies • One Example of Knowledge Network • Lessons and Advice

4. Definitions Knowledge translation (KT) as defined by the CIHR: • “the exchange, synthesis and ethically-sound application of knowledge – within a complex system of interactions among researchers and users – to accelerate the capture of the benefits of research for Canadians through improved health, more effective services and products, and a strengthened healthcare system”. Includes end of grant and integrated types. Public policy – making and implementing collective ethical judgments

5. In the beginning McMaster created“evidence – based medicine” • Individuals • Randomized Clinical Trials • Systematic Reviews • Knowledge Transfer • Instrumental Use

6. When the world did not change • Evidence based policy • Evidence based management • Social science and epidemiology • Interactive knowledge translation • Conceptual / symbolic use

7. Learning to be humble • Evidence informed not evidence based • Research and policy making as social processes • “the art of the possible” often involves making tradeoffs in dynamic, contentious and non-rational environments Waddell et al 2002

8. Canadian Contributions to Knowledge Transfer & Exchange • Key Early Authors: • Lomas, Lavis, Landry • Key Funders: • CHSRF CIHR • Current evidence base • 55% of cases in recent synthesis of KTE strategies Mitton et al 2007

9. Conceptual Framework

10. Policy Maker’s Activities • Agenda setting • Policy Formulation • Policy Implementation • Policy Evaluation

11. Policy Levels • Government • national • provincial • regional • municipal • Administrative • Clinical

12. Key Strategies for Interaction • Face-to-face exchange (consultation, regular meetings) between decision makers and researchers • Education sessions for decision-makers • Networks and communities of practice • Facilitated meetings between decision makers and researchers • Interactive, multidisciplinary workshops • Capacity building within health services and health delivery organizations • Web-based information, electronic communications • Steering committees (to integrate views of local experts into design, conduct, and interpretation of research) Mitton et al 2007

13. SEEI and the Ontario Mental Healthand Addictions Knowledge Exchange Network (OMHAKEN)

14. System Enhancement Evaluation Initiative • Significant entry of new funds into community mental health system 2004-2007 • Federal accord $117 million - targeted ICM, ACT, crisis, EI • Service enhancement $50 million to support diversion of individuals with mental illness from criminal justice system – ICM, court support, crisis, safe beds, supportive housing • MOHLTC committed to assess impact of capacity enhancement through routine accountability reporting and evaluation research • MOHLTC requested a proposal from the Health Systems Research and Consulting Unit

15. SEEI: Three Components • 1. Two Phase I Research Studies • The Impact Study • The Matryoshka Project • 2. Seven Phase II Research Studies • Court outreach – Ottawa • Fidelity and Recovery ACT study - Hamilton • Police mobile crisis services-a review of three models-London • Crisis system network-Waterloo/Wellington • Integrated crisis-case management-Kingston • Service match (CCAR)-Kingston • Community-based discharge planning - Sarnia

16. SEEI: Three Components • Knowledge Exchange • Original proposal calls for a significant knowledge exchange component to be part of the Phase I and II studies • AND • the idea of a provincial knowledge exchange function extending beyond SEEI

17. Setting Up for Knowledge Exchange • SEEI has a budget allowance for KE personnel and expenses • High scientist commitment to KE • Research projects have high need for stakeholder involvement to inform research development at each stage

18. Developing a Network: Why? • General Purpose of a KE Network • To improve research project planning, • implementation, interpretation and • communication of results through stakeholder involvement • To improve access to research products, research advice and researchers for stakeholders • To increase stakeholder capacity to participate in research and interpret and utilize research findings

19. OMHAKEN Consultation • Desired Network Activities • Provide consultation, education - e.g., annual KE meeting and incentives to assist the producers and users of research-SEEI and other research- to participate effectively in knowledge exchange. • Establish mechanisms for dissemination and implementation of evidence-based advice to LHINs and systems planners • Advise on research priorities

20. OMHAKEN Consultation • Grow Organically • Build from the ground up, start with Phase 1 and 2 studies and their K/E needs, put those pieces in place and….. • …at the same time consider the broader, more general knowledge exchange needs of the field and the extent to which a provincial network might meet those needs • l • Link the two

21. OMHAKEN Consultation • Knowledge Exchange through a Network of Networks • “The surest way to add value to a network is to connect it to another network”-CHSRF • The knowledge exchange ‘network of networks’ concept is a linked body of Ontario’s mental health stakeholders- planning tables, researchers and existing networks- • supported by the SEEI Coordinating Centre, and its provincial partners • organized to engage in knowledge exchange at the provincial and local levels.

22. SEEI: Knowledge Broker • Knowledge Brokers - Definition • links between different entities or individuals that otherwise would not have any relationship • core function is connecting people to share and exchange knowledge • do so by bringing together people with common interests who rarely interact with each other • Canadian Health Services Research Foundation, The Theory and Practice of Knowledge Brokering in Canada’s Health System, 2003.

23. SEEI: Knowledge Broker • Expectations: • Develop and support OMHAKEN, including a provincial consultation • Develop communications plan for SEEI • Coordinate reports and communications to the field • Design, organize and evaluate interactive forums for researchers and stakeholders • Link scientists and individuals in the field through advisory groups, feedback sessions, internet etc.

24. OMHAKEN The Ontario Mental Health and Addictions Knowledge Exchange Network will improve the quality of mental health research, services, supports and policy by linking researchers, providers, planners, decision-makers, consumers and families and engaging them in knowledge sharing, knowledge creation, and knowledge translation activities.

25. Key Questions for the SEEI Knowledge Exchange Network • What is the Vision? - a provincial knowledge exchange network that links research, provider, consumer, family, decision-maker communities • Why is it needed? - do not have a formal knowledge exchange network for mental health and addictions in the province • What is the infrastructure? - a ‘network of networks’ initiated and maintained by the Coordinating Centre, championed by the EAC, in collaboration with the field

26. Key Questions Continued 4. What are the key elements?-Knowledge exchange leads at each of the 14 LHINS-based MH&A planning tables, provincial researchers, provincial organizations and specialized networks-EI network, consumer networks, Provincial Human Services and Justice Coordinating Committee and others 5. What can be local?-local participation, interpretation and dissemination of research; identification of local KE needs; local networks 6. What needs to be centrally driven?-exchange across local/LHINS boundaries; broad communication strategy

27. Key Questions Continued 7. Who needs to have an investment?-provincial organizations, MOHLTC, local bodies, provider agencies, consumers and families 8. How does it fit in with the system?-the KE function is integrated into the other functions of EXISTING groups and connected to the KE driver which at present is the SEEI research and the CC 9. What is the value?-meets an identified need; will result in higher quality research and better understanding of and application of research findings - ultimately leading to higher quality services and better client outcomes

28. OMHAKEN’s First Year of Operation • Topic-based approach; Year 1 Theme – Employment and Education • Sample Activities • KT Supplement Awards & Events for SEEI researchers to support local dissemination and KE of research findings • List of ON researchers doing health services research in MH&A • OMHAKEN Newsletter 4-6 times/year • Profiling Promising Practices (e.g. Fresh Start – • consumer-run business) • Expanding the Reach of Research – clear language • reports on academic events • Developed OMHAKEN and SEEI websites

29. OMHAKEN’s First Year of Operation • Sample Activities Continued • OMHAKEN in Action – examples of activities and successes of the Network • Emerging Research – profiles of student research or research underway (not at findings stage) • Annotated bibliography of Ontario research on • Employment and Education for people with SMI • 3 Research-to-Policy Dialogues held (to date) with Ontario government • Disseminate through widely subscribed e-newsletter (CMHA-ON MH notes)

30. Range of Dissemination & KT&E Tools/Activities for SEEI • Released variety of reports (32 to date) including: • SEEI Interim report and Final report – focussing on main messages • and integrating results from across projects using non academic • language • Research study reports released at various points during research • project including study final reports • Provided results to stakeholders in as-needed fashion • Tailored short supplemental reports on specific topics of interest • Academic (on-going) • Funding for Special Issue of CJCMH • Creating special session at provincial conference that has broad range of attendees • Conference presentations 30

31. Communicating Through OMHAKEN • Face-to-Face Interactions • Annual OMHAKEN Leads Forum • Research to Policy Forums w/ government • Conference workshops (e.g. Making Gains) • Funded 4 KE events for local dissemination/feedback from SEEI researchers • Electronically • Listserve (OMHAKEN and others) • E-Newsletter • CMHA, ON’s mental health notes • E-Health Portal www.ehealthontario.ca

32. Communicating Through OMHAKEN • Paper 32 Reports Released To Date: • SEEI interim and final reports – focussing on main messages and integrating results across projects with non-academic language Research to Policy Forums w/ government • Research study reports (11+ final/supplemental and several interim) • Results provided to stakeholders in as-needed fashion (emerging priorities) • Tailored short supplemental reports on specific topics of interest (e.g. police/criminal justice)

33. Evaluating OMHAKEN 3-Pronged Evaluation • Specific initiatives (e.g. newsletter) • Indicators • Purpose, structure and impact • Methods: • Web Survey • Key informant interviews • Communications/dissemination tracking spreadsheet

34. Impacts to Date • 100 out of 300 community agencies participated directly in the research • Approx. 200 people subscribe to OMHAKEN list serve UPTAKE BY RANGE OF AUDIENCES International: Japan (system planners); Special Needs Offenders conference National: MHCC Provincial Policy: Ontario Minister’s Advisory Group, Select Committee, Input into CAMH positions for various strategies, Data used in response to Auditor’s Report (Deputy Minister) DM used in Select Committee presentation CAMH presentation to select committee

35. Impacts to Date UPTAKE BY RANGE OF AUDIENCES Regional Planning: LHINs are using report for health service planning Local Planning: Resulted in local pockets of ongoing activities and improvements (e.g. regions continue to use findings for local quality improvement and organization – WW crisis services; Frontenac crisis services)

36. Knowledge Networks Key Characteristics: Clear and shared sense of purpose – members united by a clear and shared sense of purpose, helping them to appropriately scope their domain, realistically set objectives and carefully manage expectations. Community of experts – participation usually by invitation based on merit or expertise. Active communication – organized to maximize the flow of information as well as the creation and transfer of knowledge: often have a highly developed communications infrastructure that includes face-to-face interactions and ongoing exchanges.

37. Knowledge Networks Key Characteristics: cont’d Transcend barriers between various sectors – encompass more than one community (or area of specialty) so they must also be able to overcome and bridge the boundaries between these communities Governance – while guided by members, knowledge networks require some sense of structure and development in order to flourish

38. What have we learned? • Electronic information flow is a necessary but insufficient • condition for success • Knowledge broker talent and persistence are key • Joint action / progress enliven the networks • Well targeted seed funding bears fruit

39. For Further Reading • The utilisation of health research in policy-making: concepts, examples and • methods of assessment, 2003Hanney S. et. al, Health Research Policy and • Systems (1): 1-28 www.health-policy-systems.com/content/1/1/2 • When Health services researchers and policy Makers Interact; Tales from the • Tectonic Plates, 2005, Martens P and Roos N, Healthcare Policy1(1): 72-84 • www.chsrf.ca/other documents/insight_action • Knowledge Transfer and Exchange: Review and Synthesis of the Literature,2007 • Mitton C. et.alMilbank Quarterly vol.85 No.4 729-768 • Research-based consulting as a strategy for Knowledge Transfer, 2005, Jacobson, N • et al., Milbank Quarterly 83(2): 299-321 • Developing a Community of Practice Model for Cancer and Chronic Disease Prevention, • 2008, Barwick M. Toronto, Ontario, Canada. • Understanding Networks: The Functions of Research Policy Networks, Enrique • Mendizabal2006 unpublished manuscript • Learning modules on CIHR website