EBP For Older People’s Services : An Initiative In Fife Council Social Work
Evidence-based practice (EBP) has gradually been accepted by different professional groups as a central tenet of professionalism. Within the care-related professions, Medicine, Nursing and Psychology are well ahead of Social Work; but now Changing Lives has put EBP onto the SW agenda as an essential condition for the development of a strong, autonomous and accountable workforce.
BASW’s Code of Ethics lists, under Section3.5 on Competence, Social Workers’ duty to
• Identify, develop, use and disseminate knowledge, theory and skill for SW practice
• Maintain and expand their competence in order to provide quality service and accountable practice, appraising new approaches and methodologies in order to extend their expertise
A related concept, that of the Learning Organisation, has gained currency in SW services. This means broadly that organisations will organise themselves in such a way that the learning of individuals is shared systematically so that the whole organisation is able to benefit. Senge focuses clearly on whole-systems thinking as the fifth, but overriding discipline, in bringing about a learning – hence, successful – organisation. A further concept widely used in SW is that of the reflective practitioner (Schon, 1983) . EBP therefore, by taking a whole-systems approach and supporting the development of reflective practitioners, ought to be able to fit into existing aspirations and practices to enable the growth of the learning organisation.
And yet, given ongoing operational pressures for better, faster and more person-centred service delivery, EBP can seem like a luxury, fancy stuff for easier times, and maybe after all best left in the hands of academics who have a vested interest.
This article examines work carried out in Fife Council to introduce a culture of EBP to Older People’s Services (OPS), with a view to OPS becoming, within the wider council structure, a mini-learning organisation.
Within the Learning and Development Section there is a small group of staff with lead responsibility for Continuing Professional Development of particular services, and I have led EBP initiatives as the Learning Development Officer with lead responsibility for the Older People’s Service (OPS). OPS in Fife includes fieldwork, residential and day care, and home care – a total of 2,000+ staff. Although not an expert, I have previous experience in carrying out research relating to older people. Graded at Senior Practitioner level, this post is well understood as ‘specialist’, and promoting the learning of others (rather different from a more traditional understanding of ‘training’ – filling empty vessels with received wisdom – which I reject).
As the first post-holder of this CPD role I have had the opportunity to shape the work, in consultation with stakeholders, according to my strengths. The appearance on the local authority agenda of EBP was timely for me and on the whole my EBP efforts have been welcomed by practitioners and managers as a way of resourcing staff to achieve wider goals. Additionally, the support of IRISS (Institute for Research and Innovation in Social Sciences) has been a great enabler, both in personal terms and in highlighting at a strategic level the need for services to develop EBP systems.
‘Evidence’ for practice is about research awareness; but also about ‘practice wisdom’ – the grounded and reflected-on experiences of practitioners – and about taking account of the views of service users and carers. In promoting EBP in OPS I had in mind the following goals:
1. to help practitioners to access and critically appraise relevant published research, so that they could be better informed about developments in their own field
2. to help practitioners to recognise the data potential for aspects of their own work, so that they could be more systematic in reviewing and analysing their own practice
3. to involve other stakeholders as appropriate, including NHS, independent sector, and critically, service users and carers
4. to assert the position of practitioner-researchers and thereby begin to influence the research agenda so that it is not always led by academics
An EBP-OPS group was set up, meeting every six weeks for two hours, with termed stand-alone sessions. This is an open group which staff can attend or not, according to their interests. I devised the first four sessions by speaking to managers and practitioners to determine practice interests, and drew on my networks for speakers to present their research. These sessions included speakers on
• Regeneration areas and hearing the voice of service users (Colin Morrison, TASC Agency )
• The impact of dementia on marital and sexual relationships in later life (Liz Baikie )
• The experience of being a patient in delayed discharge situations (Angela Kydd ), with an examination of our own delayed discharge challenges presented by my operational colleague Fraser Mitchell
• Design for dementia (Richard Pollock ) – this was undertaken alongside a visit to the simulated apartment at the Iris Murdoch Centre, Stirling University
I sent out electronic evaluation sheets for each, pointing out to attendees that this was my ‘evidence for practice’, and achieved an approx 33% return rate, nearly all of which was highly positive, with practitioners reporting ways in which they were able to use their learning in practice. I recruited a steering group who helped put a second programme together; this is now under way. Topics on this occasion include:
• Annual reviews of people in long-term care homes
• Presentation of a literature review on dementia care in Scotland
• Telecare – what we know about good practice from elsewhere
• National Outcome Measures and how they can be used as evidence to improve practice
• Carers’ assessments
Significantly, in this second session we are not relying on outside speakers but on people from our own organisation or close at hand. The first session on Annual Reviews was used to set up a small-scale study to be carried out by our Reviewing Officer colleagues. I presented a paper by Peter Scourfield which was critical of reviewing practice generally, and will facilitate the Reviewing Officers in carrying out their study. They will present their findings back to the group next year. Part of the impetus for this was their difficulty in identifying appropriate CPD activity for their SSSC re-registration; the study will provide them with at least five days’ of highly appropriate learning activity, and furthermore is likely to make an immediate impact on reviewing practice.
As well as the EBP-OPS group various other initiatives are in place which use EBP principles. One of these is reviewing our dementia learning strategy, with the intention of resourcing our dementia ‘experts’ or ‘specialists’ – those who have completed Masters modules on the Dementia Services Development Centre programme – to take a systematic role in devising and delivering appropriate learning opportunities to colleagues. Also, since our Telecare initiative is very new, we are setting up an Action Learning Set of ‘Telecare Champions’ – early enthusiasts – to work on developing practice wisdom on good Telecare practice
In order to embed EBP (or any other strategy) in the organisation it is necessary to work at a systems level and therefore make a range of interventions which impact on the service in different ways. We held a full-day workshop in January 08 for all the SW services in Fife Council, giving Senior Practitioners from the Children and Family, Criminal Justice and Adults services, as well as OPS, the opportunity to explore how they might adopt an EBP approach in their own work. More recently a colleague from IRISS came to our team and spent a day with us looking at EBP approaches for Learning and Development. This was very well received and ought to have a system-wide impact, supporting us in modelling good EBP practice and helping us explore ways of disseminating evidence-based learning and development throughout the service.
The literature on EBP indicates that practitioner research is under-developed and, more specifically, under-reported (Mitchell et al, 2008) so I am encouraging my colleagues to write up and present their findings at appropriate opportunities such as conferences. This involves a certain restructuring of professional identity as on the whole, this field is populated by academics. Clearly there is a need for more collaborative activity but in the meantime practitioners (including myself) need to gain skill and confidence to enter the conversation.
ARE THESE INITIATIVES ACHIEVING THEIR AIMS?
The EBP agenda has been under way for only nine months so any claims at present have to be modest. However it is possible to review developments and gain a sense of what appears to be working and what isn’t.
Aim 1: to help practitioners to access and critically appraise relevant published research, so that they could be better informed about developments in their own field
There is an average attendance of 16 people at each EBP-OPS event, about a third of whom tell me in feedback that this is the case; but of course further evidence is needed. I have yet to devise a means of exploring this and will welcome suggestions from readers.
Aim 2: to help practitioners to recognise the data potential for aspects of their own work, so that they could be more systematic in reviewing and analysing their own practice
So far we have had one session (on Delayed Discharge) which began to explore this, and one session which specifically set up a practitioner-research initiative. The modelling impact of this on other practitioners should, I imagine, be apparent – I expect other practitioners to be attracted to similar ways of extending knowledge. I would say we have started to gain some results here but as would be expected these are modest at present.
Aim 3: to involve other stakeholders as appropriate, including NHS, independent sector, and critically, service users and carers
Some NHS and independent sector colleagues have attended EBP-OPS sessions according to their interests and this needs to be sustained. As yet we have not had a service-user or carer focus and need to work on this. We will however be working on participative ways of involving service users and carers in the Long-term Care Reviews project, the Telecare Champions project, and the Carers’ Assessments EBP-OPS session.
Aim 4: to assert the position of practitioner-researchers and thereby begin to influence the research agenda so that it is not always led by academics
Two abstracts have been submitted for a forthcoming dementia conference; I am working with Council and NHS colleagues in putting together the next programme for the ‘KnowFife Research Fair’, which will provide opportunities for dissemination of ongoing projects; I have presented a poster on these activities at two national conferences. This is a longer-term goal so small beginnings are still a matter for celebration.
WHAT IS NEEDED FOR EBP TO FLOURISH
Work carried out by Research in Practice (need ref) indicates that in order for EBP to flourish, it needs to be built into the systems and structures of an organisation. The agenda needs to be owned by all staff, but specifically led by senior management. We have had strong support from senior management in Fife and there is interest in taking EBP beyond OPS. However it is early days; the practice case is only beginning to be made. From my own ‘reflection on practice’, I feel the following factors are significant for success:
• An infrastructure which supports practitioner research (Fife Council has a strong base here, in collaboration with NHS Fife, and this has been enormously helpful in supporting Social Work EBP initiatives)
• A champion with appropriate skills and knowledge, who is given time and scope to work with practitioners in a developmental way, and do the desk research in identifying relevant current research for practice
• A committed supporter within the organisation for EBP efforts on behalf of the champion – in my case, my Team Leader
• Access (e.g. via online library and information systems) to research articles relevant to the immediate needs of practitioners
• A strong national steer – this has been provided by IRISS, which is taking forward the EBP agenda for the Scottish Government
1. Continue with the EBP-OPS programme as before, ensuring opportunities for service user and carer involvement
2. Continue to support practitioner-researcher initiatives
3. Continue to support practitioners in dissemination activities
4. Seek academic collaboration as appropriate
5. Seek annual review and forward planning exercise with Service Managers from OPS and Learning and Development
Learning Development Officer
Fife Council Social Work Service