ihv regional conf: dr karen whittaker - the evaluation of health visiting practice
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Evaluation of Health Visiting Practice
How should we go forward?
Dr Karen Whittaker, Senior Lecturer, University of Central Lancashire. Fellow iHV
Thanks to Prof. Sally Kendall, Associate Dean Research and Director, CRIPACC, University of
Hertfordshire
Trustee iHV
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+Current Policy: Why health visiting matters
In 2011 the Department of Health for England launched the
‘Health Visiting Implementation Plan’
Updated as ‘The Plan’ (2013)
The Government believes that strong and stable
families are the bedrock of a strong and stable
society.
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+The Healthy Child Programme
The Healthy Child Programme (HCP) is led by
Health Visitors and consists of a programme of
evidence based activities across the pregnancy
and 0-5 year period
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+Effective HCP should lead to…..
strong parent–child attachment and positive parenting, resulting in better social and emotional wellbeing among children;
care that helps to keep children healthy and safe;
healthy eating and increased activity, leading to a reduction in obesity; prevention of some serious and communicable diseases;
increased rates of initiation and continuation of breastfeeding;
readiness for school and improved learning; early recognition of growth disorders and risk factors for obesity;
early detection of – and action to address – developmental delay, abnormalities and ill health, and concerns about safety; • identification of factors that could influence health and wellbeing in families; and
better short- and long-term outcomes for children who are at risk of social exclusion.
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How do we evaluate effectiveness?
Six High Impact Areas for Health Visiting
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+Public Health Outcomes Framework:
What is it?
https://www.gov.uk/government/publications/healthy-lives-healthy-people-improving-outcomes-and-supporting-transparency
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+Public Health outcomes Framework
http://www.phoutcomes.info/
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Travelling on a journey with a family
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+ Enhancing quality standards through evaluation
Evaluation
What? Intervention or change in practice
Who? Family, child, parents, community
How? What is involved? Break it down to component parts
When? At what stage, time, level
Where? What is the context, home, community, clinic
Measures? Do they already exist? Where can they be found?
Changes? Can the change be associated with the intervention or practice development?
Dissemination and communication?
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+Ask Questions, Be Curious
“Be vigilant, curious and ask the ‘why’questions, because it’s when you stop asking
questions that things start to go wrong.”
Mary Mumvuri, Head of Nursing and Patient Safety at
Hertfordshire Partnership University NHS Foundation
Trust (HPFT), told nursing students at the University of
Hertfordshire.
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Improvement Science
What is improvement science?
Improvement Science is a body of knowledge that
describes how to improve safely and consistently.
Improvement Science is not the same as
Research. Research is designed to find out what
is possible. Improvement Science is not the same
as Audit. Audit is designed to find out what is
actual. Improvement Science describes how to
reduce the gap between what is actual and what
is possible.
• The overriding goal…. to ensure that quality improvement efforts are based as much on evidence as
the best practices they seek to implementShojania & Grimshaw (2005) Health Affairs 24(1):138-50.
• It aims to create practical learning that can be applied in real-life situations.
• Concerns how to make quality improvement. Marshall et al (2013); The Lancet
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+ Terms used for improvement science
implementation science
science of improvement
translational research
translational science
measurement for improvement
quality improvement methods
quality improvement science
science of quality improvement
evidence-based practice
knowledge translation
research utilisation
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+Evaluation approaches
Kirkpatrick (1988) Framework for Evaluation 4 stages
Reaction – how do people react, feel, behave in relation to the
process?
Learning – what have people learned from it and what would they do
differently?
Impact – what has been the impact on their lives, behaviour,
relationships,
Results – what change has occurred, is it measurable?
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+How would you do this?
Posing the question
E.g How effective has my breastfeeding support group been in
enabling breastfeeding to continue?
Reaction
How did you feel about the breastfeeding support group? What made
you want to continue with it?
What was challenging?
Learning
What have you learned from the group?
What supported your learning?
What would you want to do differently?
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+How would you do this?
Posing the question
E.g How effective has my breastfeeding support group been in
enabling breastfeeding to continue?
Impact - What difference has attending the group made to your
experience of breastfeeding?
How has it affected your family’s approach to breastfeeding?
How confident are you about continuing to breastfeed?
Results – what has changed as a a result of the programme?
Before and after measures – breastfeeding rates, confidence, self-
efficacy, attachment,
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Programme Logic Model
Programme objective
• Are programme objectives clearly defined?
• e.g. reduce child speech and language referrals; increase breastfeeding initiation and duration
Population
• Describe characteristics of target population
• Classify needs levels, risks, strengths
Theory of change
• Is there a programme theory of change? E.g. social learning theory
• Is it based on an understanding of vulnerabilities (& strengths) in the population and mechanisms to interrupt and achieve desired outcomes?
Programme components
• As designed, does it reflect the theory of change?
• As implemented, does it reflect design? Is it adequately resourced? If there a QA process?
Success
• Consider carefully how to define programme success
• Is there a process to monitor progress and incorporate feedback in programme redesign
Segal et al. (2012). A Systematic Review. Milbank Quarterly, 90, 47-106.
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+How can you contribute?
By being curious about health visiting practice, what makes a difference and why?
Be systematic and methodical!
Through engagement with NHS and public health organisations and identifying areas of local and national concern
By considering how to implement what is already known and identifying gaps in knowledge
Taking part in research events such as master-classes, seminars and conferences – getting ‘out there’
Engaging with families and the public – how can improvement science address their concerns?
Building experience and knowledge through professional development (Masters, PhDs) and working with teams
Disseminating your work in good quality journals, conferences and the e-Community of Practice
Applying for grants that will stimulate and grow new areas
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+Disseminate your findings
Write for a journal
or local newsletter
Conference or seminars
Blogs, twitter, facebook – use social media!
Use the e-Community of Practice for Health Visitors
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+On-line Community of Practice
The CoP is built around the 6 high impact areas, enabling HVs to build and
share evidence and knowledge in each of the 6 areas within an
on-line community
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+Future possibilities
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+The challenge
Shonkoff 2014
The time has now come for a different approach to early childhood
investment that catalyzes innovation, seeks far greater impacts, and views
best practices as a baseline, not a solution.
Evidence for parental change is not enough – we need evidence of the
actual impact on children – their outcomes and achievements.
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+Pride