with
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with. Think Research: Evidence-Informed Planning and Commissioning for Children Keith Moultrie and Celia Atherton 20 April 2009. Institute of Public Care. Oxford Brookes University. Social care, primary care, education and specialist housing. - PowerPoint PPT PresentationTRANSCRIPT
Think Research: Evidence-
Informed Planning and
Commissioning for Children
Keith Moultrie and Celia Atherton
20 April 2009
with
April 2009 2
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.ukEmail [email protected]
April 2009 3
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.
April 2009 4
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
April 2009 5
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)
April 2009 6
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.
April 2009 7
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
April 2009 8
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
April 2009 9
Aligned Planning and Commissioning….…?
Patient/ public
Petitions
Published prospectus
Review service provision
Assessing needs
Seeking public and patient views
Managing performance
(quality, performance,
outcomes) Referrals, individual needs assessment; advice on choices; treatment/ activity
Managing demand
Shaping the structure of supply
Designing services
Deciding priorities
National targets
Patient/ public
Petitions
Published prospectus
Review service provision
Assessing needs
Seeking public and patient views
Managing performance
(quality, performance,
outcomes) Referrals, individual needs assessment; advice on choices; treatment/ activity
Managing demand
Shaping the structure of supply
Designing services
Deciding priorities
National targets
Phase 1: Needs assessment and Strategic Planning Phase 2: Shaping and Managing the Market Phase 3: Improving performance, monitoring and evaluating Phase 1: Needs assessment and Strategic Planning Phase 2: Shaping and Managing the Market Phase 3: Improving performance, monitoring and evaluating
Look at outcomes for children and young people Look at particular
groups of children and young people
Commission –including use of
pooled resources
Identify resources and set priorities
Decide how to commission
services efficiently
Monitor and review services and
process
Develop needs assessment with
user and staff views
Plan pattern of services and focus
on prevention
Plan for workforce and market
development Process for joint planning &
commissioning
Look at outcomes for children and young people Look at particular
groups of children and young people
Commission –including use of
pooled resources
Identify resources and set priorities
Decide how to commission
services efficiently
Monitor and review services and
process
Develop needs assessment with
user and staff views
Plan pattern of services and focus
on prevention
Plan for workforce and market
development Process for joint planning &
commissioning
Look at outcomes for children and young people Look at particular
groups of children and young people
Commission –including use of
pooled resources
Identify resources and set priorities
Decide how to commission
services efficiently
Monitor and review services and
process
Develop needs assessment with
user and staff views
Plan pattern of services and focus
on prevention
Plan for workforce and market
development Process for joint planning &
commissioning
April 2009 10
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.
April 2009 11
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…
April 2009 12
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’
April 2009 13
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
April 2009 14
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 protected]
April 2009 16
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 termsBuilding research capacityAppraising research evidenceSearching databases – basic guidanceEthical guidanceCase 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.
An Evidence-Informed Commissioning Cycle
Study grading tool
1. Positive reports from service users and Practitioners at follow up
2. Several positive pre‑post studies comparing performance at baseline to follow up
3. Positive evaluations by several studies featuring comparison groups
4. Positive evaluations by several randomised controlled trials
5. 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
Be SMART
Outcomes SMART Not SMARTSpecific Improve mobility,
behaviour, housingImprove ‘well-being’
Measurable Can be expressed numerically
Can only be expressed through narrative
Achievable Fewer exclusions of BME pupils
End oppression
Realistic A 10% decline in youth offending
A 90% decline in youth offending
Time-limited To be achieved within a stated time period
Objectives with no deadline
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
Additional on-line resources