with Think Research: Evidence-Informed Planning and Commissioning for ChildrenKeith Moultrie and Celia Atherton20 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. Website http://ipc.brookes.ac.uk Email firstname.lastname@example.org
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.
Session outline • An overview of the challenges facing evidence-informed 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
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)
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.
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
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
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.
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…
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’
We need more rigour .. 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
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.
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@example.com
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
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.
Study grading tool • Positive reports from service users and Practitioners at follow up • Several positive pre‑post studies comparing performance at baseline to follow up • Positive evaluations by several studies featuring comparison groups • Positive evaluations by several randomised controlled trials • 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
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