How can research evidence support social care practice
Monday 29th July 2013
Professor Martin Knapp explains with reference to the Social Care Evidence in Practice (SCEiP) project, and a presentation made to it earlier this month by ADASS President Sandie Keene.
Local authorities are looking for evidence that will give them a better understanding of what they need to do to improve outcomes and to achieve value; 90% of research studies are addressing questions that policy makers/practitioners want answers to, such as how best to target resources, how to coordinate service delivery, how to fund services and how to measure outcomes.
Local authorities have experience on the ground about the day-to-day realities and knowledge of current priorities; researchers have a different perspective, with knowledge of the evidence from related areas, from other countries or from the past.
Local authorities hold by far the best sources of evidence and data; researchers can provide robust analysis and interpretation of that evidence.
Practice evidence can come from anecdotes. The value of anecdotes comes when there are many of them, and they are saying similar things; research can be seen as the accumulation, aggregation and analysis of individual anecdotes.
Evidence-informed practice can lead to better decision making, improved outcomes for individuals, greater confidence when making long-term investments and planning decisions (such as housing with care schemes), and stronger leadership and management. There are significant ways in which research and practice can work collaboratively to improve outcomes for social care.
These were just some of the key messages from an event organised by the Social Care Evidence in Practice (SCEiP) project on 17 July 2013 at which Sandie Keene, ADASS President, shared her thoughts on the role of research evidence in practice and offered her top three recommendations for improved collaboration.
The event sought to move towards developing a framework for improved knowledge exchange and collaborative working between research and practice. The event began with talks from Rachel Armstrong (Department of Health), Sandie Keene and myself (NIHR School for Social Care Research, based at the London School of Economics (LSE)). We were asked to address the question of what is the role of research evidence in practice from the policy, practice and research perspectives (respectively).
Participants then discussed research use in their own organisations. Gerry Nosowska (research in practice for adults), Jose-Luis Fernandez (Personal Social Services Research Unit, LSE) and Beth Anderson (Social Care Institute for Excellence) provided examples of what is working, followed by Francis Dickinson (Department of Health), Sandie and I setting out our top three recommendations for how research evidence can support adult social care practice. The event finished with participants stating one specific action that they would each take back as a result of the event.
Using research evidence in practice
There are, of course, obvious barriers. For example, the timescale of studies that collect new data and that follow people over time is often too long to be useful for practitioners, and publication of final research reports can be outside the policy timescale. Practitioners may see research as a luxury, feeling they do not have time to consult researchers, or not feeling confident in how to use research evidence.
Nevertheless there are also opportunities. As Rachel Armstrong noted, the Department of Health is committed to building links between policy and good solid robust academic research. Research findings can inform various stages of the policy cycle including the rationale behind new policy, choices between different options, and value for money considerations. In turn research can support local authorities in the implementation of policies. For example, the Care Bill 2013, the emphasis on integrated working, and the personalisation of services are together bringing major changes to health and social care in England. Each generates a need for research evidence to support the accompanying practice changes. For practitioners to feel confident and competent they need to know what works and to be able to justify their decisions, and this will be increasingly important as new developments take effect.
Sandie raised a number of important points at the event, including:
* The need for local authorities to commit themselves to creating the right environment for learning. For example, this could be through: providing time and resources; encouraging a learning culture rather than a blame culture; promoting activities such as practice learning clinics, team supervision, peer support; disseminating research; and contributing to research projects so that they come from the field and are not hypothetical; and
* The need for practitioners to be aware that the sources for evidence-based learning are many and varied, and to know how to use each appropriately.
Sandie also noted that there is a place for many types of research and a balance to be struck between them. For examples, local authorities already carry out surveys, small area studies, benchmarking clubs, mystery shopping exercises, individual studies and formal consultations. Some may question whether this is research or even evidence, but such activities meet the immediate needs of local authorities.
At the same time, there is further work to be done with research to move onto the front foot so that it leads and informs practice, and so researchers know the questions to ask now which will lead to the answers that will be vital when research studies conclude. Researchers need to be clear about who their main audiences are, and to involve them throughout the life of a research project. This means involving those people in the design of the research project; in the implementation of the research methods, so that the research is carried out in ways that are acceptable to the people that are participating in the project; and through involvement in the interpretation of the findings before dissemination.
A number of recommendations came out of the event. These included:
Asking the right research questions, including questions that will be timely or address priorities that are current when the research is completed;
Capturing evidence that is probably highly relevant to social care even if it may not be in a conventional research form, as well as harnessing the power of anecdotes;
Creating a strong partnership and underpinning co-production, particularly by not emphasising the separation between researchers and practitioners, but rather acknowledging shared goals (particularly improved outcomes for people who use social care) and working collaboratively together;
Understanding the career and financial reasons why people in practice settings are not doing/getting involved in research; and then aligning incentives to make it attractive to do so;
Tooling up practitioners in social care organisations with critical research appraisal skills;
Exploring new ways of putting research messages across;
Developing closer links between ADASS and the NIHR School for Social Care Research to support knowledge exchange activities.
A full report on the event will be available shortly on the Social Care Evidence in Practice project website at http://blogs.lse.ac.uk/socialcareevidenceinpractice/.
Developing a knowledge exchange framework
The discussions from the July 17 event are feeding into development of a knowledge exchange framework for adult social care. Improved outcomes in social care (for, among others, people who use services, carers, people who may need services in the future, commissioners, managers, frontline staff) need to be supported by improved knowledge exchange between research and practice, and greater evidence-based practice. The draft framework will provide recommendations, and hopefully some suggested solutions.
Consultation on the draft framework will take place in the coming months, and suggestions/thoughts can be emailed to Anji Mehta (firstname.lastname@example.org). The SCEiP project hopes to implement and evaluate the framework as far as possible.
Professor Martin Knapp
Director, NIHR School for Social Care Research
Director, Personal Social Services Research Unit, London School of Economics and Political Science