Rachel Herring and Mariana Bayley Drug and Alcohol Research Centre, School of Health and Education, Middlesex University SSA Symposium, York, 8-9 th Nov 2012

 ARUK/JRF jointly funded study  Since 1990s emphasis on Evidence Based Policy - ‘what counts is what works’  How do we decide ‘what works’?  How do we build the evidence base?  How do we support the development of new/innovative approaches & initiatives?

‘HARD’ Formal, explicit, ‘superior?’ ‘SOFT’ Informal, tacit, ‘inferior?’  Published international research literature – RCTs, systematic reviews, regarded as ‘gold’ standard  Grey literature (e.g. reports, unpublished papers)  Knowledge of stakeholders and practitioners who develop and deliver local alcohol policy and interventions EVIDENCEEVIDENCE

Type V EVIDENCE – SOFT Informal, tacit, Knowledge of practitioners, service users and stakeholders

 Theoretical evidence: ◦ Ideas, concepts and models used to describe and explain how an intervention works  Empirical evidence: ◦ Information about how the intervention is implemented, its effectives and outcomes.  Experiential: ◦ Tacit knowledge and ‘practical wisdom’ of frontline practitioners ◦ Lived experience of people using services Williams, I. and Glasby, J. (2010) Making ‘what works’ work: the use of knowledge in the UK health and social care decision-making, Policy and Society, 29:

 Comprehensive narrative review of international research literature (MCP, published since 2000)  Review of UK grey literature Primary source: ‘Local Initiatives’ (England & Wales) a web based resource (Alcohol Learning Centre)  Scoping exercise: ◦ questionnaire to key informants (e.g. alcohol leads, alcohol co-ordinators) to identify examples of what they regarded as promising initiatives (72 identified) ◦ follow up telephone interviews (26 projects)  Practitioner Workshop: drew together expertise and knowledge to think about what ‘works’, how to identify ‘promise’ & develop initiatives

Innovation Multi- component programmes Partnerships

 Partnership as a key mechanism  Innovation approach provides risk-free platform for piloting new initiatives  ‘Tacit’ knowledge  Evaluation regarded as valuable tool

 Example of an initiative grounded in practitioner knowledge/evidence base  Portsmouth Frequent Flyer Pilot project (Jan – April 2010) awarded £15,000 ‘High Impact Change’ grant from South East Alcohol Innovation Programme(SEAIP)  Original pilot set out to engage 20 most prolific FFs. Actually engaged 5  Service spec drawn up for next phase (used for Hastings etc) included provision for specialist community nurse to work with 10 most prolific FFs * clients with highest level of repeat alcohol related hospital admissions

 Best to engage patient while inpatient  Treatment on it own not enough – group has complex health and social needs  Requires intensive back up support from outreach and treatment services  Intensive supervision of worker required  Perseverance – not taking ‘no’ for an answer

 Project adapted – pilot extended  Stakeholders in SE invited to bid to replicate project model  Another 3 FF projects funded for 3 months – Brighton and Hove, Chichester, Hastings  By Feb 2011, pilot work is being mainstreamed

Practitioner and ‘stakeholder’ observations and hospital admissions data Project ‘success’ measured in terms of: Alcohol related admissions, Outcomes, Budget, Sustainability, Diffusion, Performance Learning Adaptations Project evaluation

 Value of initiatives needs to be understood not just in terms of financial savings  Need flexibility in responding to changes in problems, policy and society  Ensure mechanisms in place to support value of ‘tacit’ practitioner/user knowledge  Encourage generation of new ideas/improvements in practice  Provide ‘risk free’ opportunities to test ideas and provide pathways for further testing of promising initiatives  Enable learning to be shared