Front Line Innovation and Trials

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Presentation transcript:

Front Line Innovation and Trials Dr Jemma Hawkins, Research Fellow DECIPHer Cardiff SHRN as a framework for co-production and identification of innovation Working with policy and practice partners to develop innovation in SHRN SHRN allows for integration into policy and practice context Take a partnership approach with stakeholders in research as well as in other parts of the network

Overview Developing and evaluating school-based interventions Trials research Examples of front-line innovation Identifying cases of best practice Understanding and evaluating to inform wider implementation Examples of co-production Developing interventions with key stakeholders Enhancing capacity Look at how SHRN offers a framework for developing and evaluating school-based interventions How we can use research trials to examine effectiveness and impact of interventions on their intended outcomes Examples of current studies that have been adopted by SHRN Demonstrate how it can facilitate conducting of trials, coproduction of new interventions and identification of innovation in practice.

Medical Research Council Framework Feasibility/Piloting 1. Testing procedures 2. Estimating recruitment/retention 3. Determining sample size Development 1. Identifying the evidence base 2. Identifying/developing theory 3. Modelling process and outcomes Evaluation 1. Assessing effectiveness 2. Understanding change process 3. Assessing cost-effectiveness Implementation 1. Dissemination 2. Surveillance and monitoring 3. Long term follow-up Processes involved with developing interventions and evidencing their effectiveness pre-implementation Examples to illustrate how the network approach facilitates smooth transition between phases and increased likelihood of implementation/sustainability Work may also take place outside of this cycle, for example in setting the agenda on important topics or areas of need to be focused on in intervention development. E.g. GW4 study – research team wanted to develop a self-harm prevention intervention but a SEQ supplement found that schools placed more emphasis on mental health prevention and wellbeing promotion more generally, as well as the need to improve treatment services. As a result, an application has been made for some funding to develop an intervention to improve CAMHS provision

Example #1 – The WISE study Feasibility/Piloting 1. Testing procedures 2. Estimating recruitment/retention 3. Determining sample size Development 1. Identifying the evidence base 2. Identifying/developing theory 3. Modelling process and outcomes Evaluation 1. Assessing effectiveness 2. Understanding change process 3. Assessing cost-effectiveness Wellbeing in Secondary Education Project [WISE] Existing intervention (Mental Health First Aid) Pilot trial in 6 schools = feasible Randomised controlled trial in 25 schools Implementation 1. Dissemination 2. Surveillance and monitoring 3. Long term follow-up The WISE study - An example of a research study that is progressing through the stages of the cycle and has benefitted from the SHRN infrastructure MHFA - train a % of teachers ito support each other and YP experiencing mental distress Pilot trial 2013-14 in 6 schools, intervention is feasible to implement and was well received Additional component added = mental health awareness session to staff who have not received the full training Effectiveness trial in 25 schools in England and Wales to examine the impact of the intervention on staff wellbeing, as well as student wellbeing, attendance and attainment Welsh arm of the study has benefitted from being part of the SHRN portfolio, Opportunity offered only to SHRN member schools = fast recruitment Retention of schools likely to be facilitated by supportive relationship between SHRN and its member schools. The study started in 2016 and results will be available in 2019 If intervention proceeds to wider implementation in other SHRN schools = assess impact on a longer-term via SHRN questionnaire

Example #2 – The WHISP study Feasibility/Piloting 1. Testing procedures 2. Estimating recruitment/retention 3. Determining sample size Development 1. Identifying the evidence base 2. Identifying/developing theory 3. Modelling process and outcomes Wellbeing and Health in Schools Project [WHISP] Existing delivery = best practice Theory informed No evidence of effectiveness Externally funded research Understand processes and outcomes Produce a replicable model for evaluation Evaluation 1. Assessing effectiveness 2. Understanding change process 3. Assessing cost-effectiveness Implementation 1. Dissemination 2. Surveillance and monitoring 3. Long term follow-up The WHISP study - Well-being and Health In Schools Project An example of a research study that has emerged from the identification of front line innovation Researchers approached by SHRN school to evaluate their approach to health and well-being Approach informed by evidence-based restorative approach, but no evidence of effectiveness, But sustainable (had been implemented for a number of years), and perceived to be acceptable to students/staff Explore ideas for evaluating impact of approach on student well-being and informing wider implementation Research team secured external funding Exploring existing approach with students and staff, understanding processes and intended/possible outcomes Consult research evidence to identify possible causal mechanisms that may underpin approach In order to articulate underpinning mechanisms of change, and the influence of contextual factors/implementation practices Aim to produce model of approach amenable to evaluation – needs to be replicable in other schools in order to do this

Example #3 - The GMI_ALC study Feasibility/Piloting 1. Testing procedures 2. Estimating recruitment/retention 3. Determining sample size Development 1. Identifying the evidence base 2. Identifying/developing theory 3. Modelling process and outcomes Evaluation 1. Assessing effectiveness 2. Understanding change process 3. Assessing cost-effectiveness Implementation 1. Dissemination 2. Surveillance and monitoring 3. Long term follow-up The GMI_ALC study – Group Motivational Interviewing intervention to prevent alcohol misuse in secondary schools An example of a research study that has co-produced an intervention in collaboration with students and teachers and is now looking to progress to the pilot trial stage More detail of co-production process

The GMI_ALC study Developing a GMI intervention Feasibility/Piloting 1. Testing procedures 2. Estimating recruitment/retention 3. Determining sample size Developing a GMI intervention Identifying the evidence base: Lack of evidence for impact of curriculum approach to health promotion Competency-focused pedagogy emphasises processes internal to the learner Group Motivational Interviewing [GMI] facilitates active participation and exploration of personal goals Emerging evidence for use of GMI with young people Development 1. Identifying the evidence base 2. Identifying/developing theory 3. Modelling process and outcomes Evaluation 1. Assessing effectiveness 2. Understanding change process 3. Assessing cost-effectiveness Implementation 1. Dissemination 2. Surveillance and monitoring 3. Long term follow-up Curriculum approaches (e.g. PSE/PSHE) associated with changes in health-related knowledge Limited evidence for impact on behaviour, possibly due to delivery method Didactic approaches have low levels of student acceptability Competency-focused pedagogy emphasises development of cognitive, affective and motivational competencies GMI has number of commonalities with competency-focused pedagogy Offers alternative to didactic approaches through facilitation of active participation and exploration of personal goals Facilitator uses conversational style central to Motivational Interviewing. Emerging evidence for use with young people D’Amico et al (2013) GMI for young offenders = Reduced alcohol and drug use and recidivism (3 and 12 mths)

The GMI_ALC study Developing a GMI intervention Feasibility/Piloting 1. Testing procedures 2. Estimating recruitment/retention 3. Determining sample size Developing a GMI intervention Identifying/developing theory: Identify key components of a GMI approach to PSE lessons Identify key components of a teacher training package Modelling process and outcomes: Small scale testing of GMI intervention delivery Small scale testing of teacher training delivery Development 1. Identifying the evidence base 2. Identifying/developing theory 3. Modelling process and outcomes Evaluation 1. Assessing effectiveness 2. Understanding change process 3. Assessing cost-effectiveness Implementation 1. Dissemination 2. Surveillance and monitoring 3. Long term follow-up Worked with students and teachers to coproduce a GMI-based lesson for PSE Identified key issues with existing delivery (didactic messages met with resistance) Identified suggestions for content and format of a GMI-based approach (autonomy/responsibility) Developed a prototype of a GMI intervention lesson plan for PSE Tested delivery with two Y8 classes, lesson was found to be acceptable to students But delivered by very experienced MI facilitators which is not sustainable long-term THEN worked with students, teachers and HSCs to coproduce a training package to equip teachers with a responsibility for delivering PSE Recruited schools from SHRN, advertising the opportunity via SHRN regional events and the newsletter Tested delivery of training with 13 teachers 11 of the teachers went on to deliver the lesson to a class of Year 8 students Explored teacher experiences of delivery and student experiences of receiving the session

Moving forward to a pilot trial Feasibility/Piloting 1. Testing procedures 2. Estimating recruitment/retention 3. Determining sample size Development 1. Identifying the evidence base 2. Identifying/developing theory 3. Modelling process and outcomes Evaluation 1. Assessing effectiveness 2. Understanding change process 3. Assessing cost-effectiveness Consultation with stakeholders Consider results of testing and discuss key queries Refine training and lesson plan Identify resources needed to scale-up Finalise measurement tools Implementation 1. Dissemination 2. Surveillance and monitoring 3. Long term follow-up Findings suggest that it is feasible to train teachers to deliver a structured GMI educational intervention And delivery by a teacher is acceptable to students Teachers felt the GMI skills could be applied to other lessons within the PSE curriculum In order to move forward to a pilot trial of the intervention we have been consulting with key stakeholders (PH, WG, teachers) Refine training package and lesson plan based on the results of the development and testing work Identifying important topics that stakeholders would want the lesson to focus on Also finalising measurement tools that we would pilot in the trial. If funded, the pilot trial would recruit SHRN member schools, and would look to make use of SHRN data to monitor the impact of the intervention on health and wellbeing outcomes targeted by the intervention.