Jul 16 2013

Can we develop an Evidence-based Preventions Framework?

Ten months into the Social Care Evidence in Practice (SCEiP) project, two successful events, discussions with 100 senior leaders, and one important suggestion – there should be an evidence-based preventions framework. This is what we are now exploring, and we are seeking your support and suggestions in doing so.

Focusing on prevention

Reablement has been a hot topic for the SCEiP project since we began in August 2012. We held a successful workshop in Birmingham in January with a group of over 45 senior managers and assistant directors from social services departments in the West Midlands.

What became clear at the end of this workshop was the need to refine outcome measuring in local authorities, so that data can be used for both internal and external research, and can feed into analysis of the cost-effectiveness of, in this instance, prevention services.

These issues were further  at a Leaders’ Forum hosted jointly with research in practice for adults. The Forum took place on 8 and 9 May in Dartington and welcomed 50 senior leaders and managers from across 16 local authorities to discuss how best research and practice can work together in the area of prevention. At the outset participants were asked to outline what they wanted to gain from the Forum. Responses included:

• A definition of ‘prevention’;

• Outline of the evidence base – what works, what doesn’t work, for who and when;

• Answers to questions such as how does joint working and integration work best in prevention and how can the available research best inform practice;

• Sharing of best practice examples;

• Outline of a whole system approach/strategy, rather than piecemeal parts; and

• Support on how to respond to funding cuts, and whether to take a statutory services only or a preventative approach.

Acknowledging the ambitious aims above, the Forum went on to hear from Professor Caroline Glendinning (University of York) and Gerald Pilkington (Gerald Pilkington Associates) on their research in the area, particularly homecare reablement, and from Dr Martin Webber on his School for Social Care Research-funded study on social care interventions that promote social participation and well-being. This was followed by talks from Martin Knapp and Anji Mehta on cost-effectiveness evaluation and Ann Netten on outcome measurement.

The first day of this Leaders’ Forum came to a close with the following key lessons:

• “There is a good evidence base for reablement, but we now need granularity of evidence, which practice can help to gather;

• There are ways of addressing complex, expensive needs through social capital, but we now need to apply this knowledge;

• There are good approaches to evaluating and improving prevention – this is not‘rocket science’ but is logical, pragmatic and doable;

• Research cannot answer political issues, but can allow for transparent and informed discussion.”

The following day saw participants spending time in groups outlining the barriers and enablers to setting and measuring outcomes, initiating prevention structures and using research evidence to support practice development.

Call for action

The Leaders’ Forum led to a call for an evidence-based preventions framework to include: a definition of prevention; a standardised approach to prevention for local authorities; and a standardised approach to evaluating outcomes and cost-effectiveness for prevention services.

For the SCEiP project this was a call to support development of a shared understanding of what prevention is, identify what is already in place to achieve outcomes and measure against these, and trial an agreed approach to evaluation drawing on the evidence base available to us.

Developing a framework

Working closely with research in practice for adults and SSRG, we are now taking forward an audit of data and prevention services across those local authorities who have expressed interest in this work and others who may be interested. An online survey – which will be circulated later this month for completion by August 2013 – will capture, for example, the approach taken to prevention services, the procedures currently in place for measuring outcomes and any procedures used to evaluate the cost-effectiveness of prevention strategies. We will then map the responses local authorities provide, draw together evidence on prevention, and develop a discussion paper to inform a further action-based workshop in September 2013.

Our discussion paper – and the subsequent September workshop – will try to provide recommended action plans for local authorities on outcome measuring and cost-effectiveness in prevention for open discussion. They will also aim to formalise a definition of prevention and finalise an index of prevention strategies currently in use by participating authorities. The outcome of the workshop will hopefully be the development of a provisional prevention framework. Those local authorities involved in this process will be supported to pilot and implement the framework (working closely with our researchers) and draw together lessons to support further activities.

We would welcome comments and suggestion on the audit itself, information to feed into the discussion paper, as well as contact from anyone wishing to take part in this work; please do contact Laura Clohessy via email (l.m.clohessy@lse.ac.uk).


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