International Seminar SCIE’s approach to good practice 15 April 2009 Amanda Edwards, Deputy Chief Executive Patricia Kearney, Head of Children’s Services Mike Fisher, Head of Quality & Research

Summary  Context  Good practice  Promotion  Evidence  Some Observations

Why is it important?  Ambitious policy and practice agenda in children’s and adult’s services  “Social Care Institute for Excellence (SCIE) will be expected to promote, identify, and disseminate best practice and innovation, acting as a catalyst for systemwide transformation.” Putting People First - A shared vision and commitment to the transformation of Adult Social Care, December 2007  Help people make better decisions

Context  Demand for a relevant, swift response  Particular nature of central/local government relationship  Role is not always clear  Customer needs are very diverse  Wide range of stakeholders

Delivery channels  Maximum use of the web, new media and ICT  Video as well as text based materials  Knowledge hubs/gateways  Mobile technology  Social networking  Regional  Working with partners and regional networks and in Wales and Northern Ireland to support implementation and improvement  Differentiated  Work with independent sector – specific products, expert seminar  In partnership  Regulators  Joint guidelines with NICE  Centre for Excellence and outcomes in children’s services

Evidence  May not answer the question  Gaps in the evidence base  Uncertain findings  Means different things to different people  What counts as evidence is contested

Five sources of knowledge Organisational knowledge Practitioner knowledge A KNOWLEDGE BASE FOR SOCIAL CARE User knowledge Research Policy

Good practice SCIE guides resource and services (Self) reported good practice Advice and guidance Good Practice

Good practice – some principles and challenges  Extent to which practice is linked to the intended outcome  Strength of the evidence  Explicit about how recommendations are reached  Clear presentation  Degree of realism  Apply to SCIE work – but do we also apply to good practice advice on Social Care Online or to self reported good practice?

Next steps  Framework for identifying good practice  Assessing/rating evidence underpinning SCIE products  Learning from work with other partners  Centre for Excellence and Outcomes in Children’s Services (C4EO) – validated practice  NHS Evidence (portal) – accreditation of guidance producers  Recommendations  Should we be more explicit about the process?  And should we include costs?

Economic evaluation  So far, SCIE’s reviews do not include economic evaluation  incorporate economic studies into searching, mapping and reviews  A societal perspective  takes account of costs and benefits to all services, and to users and carers  Initial focus on costs

Rating good practice  practice that is effective in achieving the services stakeholders want, at a price they are willing to afford  processes that are accessible and acceptable to users, and that can be implemented in daily practice  outcomes that stakeholders want  research evidence is often unavailable or does not answer these questions

Research evidence lacking  investment in social care research is low  many areas lack high quality evidence and outcomes-based evidence  very few controlled trials or economic evidence  user accounts are lacking  research runs 2+ years behind practice  publication lead times are often 18 months

EBP definition: example

Good practice: factors What is the practice?A description Why is it seen as good practice? A case for the practice 1. What do people think about it? An account of processes, acceptability and accessibility (a) for people who use services, (b) for providers 2. What happened as a result of the practice? An account of outcomes and whether stakeholders want them 3. Will it work in day to day services? Whether the practice is feasible in daily practice (e.g. do we have the skills, treatment locations?) 4. What will people do differently as a result? What we have learned from the practice? 5. Can we afford it?Is the practice affordable? Information on costs and savings.

Good practice: rating OVERALL RATINGDescription and case plus: 1. GoodEvidence in all five dimensions supports the practice. Evidence on outcomes includes that they are wanted by users as well as providers 2. Very promisingOutcomes are wanted by both users and providers, feasible in daily practice, and no other factor suggests the practice is ineffective or damaging. 3. PromisingOutcomes are wanted by either users or providers, one other dimension supports the practice and none suggests the practice is ineffective or damaging. 4. Proven ineffective and/or damaging Evidence in one or more dimensions is that the practice is ineffective, unacceptable, inaccessible, or damaging. 5. UnprovenThere is a case for the practice, but no evidence.

International seminar: good practice  Is there a sufficiently robust evidence base to identify good practice?  What are the political issues that need to be addressed in developing good practice?  What are the practice delivery mechanisms to promote the adoption of good practice?