1. What do we mean by evidence-informed practice? Alison Petch What works in dementia care? April 8 2008

2. What works in dementia care? Will extracare housing support someone with dementia for the rest of their life ? How will the acute hospital ward manage the person with dementia admitted for a heart operation ? Does reminiscence therapy make a difference ? What forms of support really help carers ? Which design features assist people with dementia ? Do short term breaks assist people with dementia and their carers ?

3. Definition the best available research evidence about what is effective practice wisdom (the fruits of operational experience) the views of service users

4. Terminology Why we refer to evidence- informed practice rather than evidence-based practice ‘evidence does not take decisions, people do’

5. 5 The nature of ‘evidence’ – Taylor, 2008 Evidence-based practice Health care Simple interventions Hierarchy of evidence Evidence-informed practice Social care Complex, multi-faceted interventions A variety of evidence The user voice

6. 6 The nature of ‘evidence’ – Taylor, 2008 Evidence-based hierarchy Guidelines Systematic reviews RCTs Other experiments Descriptive Expert consensus Respected opinion Evidence-informed range Organisational knowledge Practitioner knowledge User knowledge Research knowledge Policy knowledge

7. 7 But … Different questions need different types of evidence All evidence needs to be critically appraised and reviewed

8. Evidence-informed practice Implies Asking challenging questions about practice Knowing how and where to find research Understanding key messages about what works Reflecting on experiences in order to learn

9. Evidence-informed practice (2) Implies Measuring the impact your work is having for users Listening to what users have to say about services Being explicit about how all these factors affect proposals and decisions Sharing knowledge and best practice with others

10. Knowledge management Knowledge Management is the ‘creation and subsequent management of an environment which encourages knowledge to be created, shared, learnt, enhanced, organised and utilised for the benefit of the organisation and its customers’ (Specialist Library for Knowledge Management Aug 2005)

11. Knowledge management … is about getting the right information to the right people at the right time …

12. Why is KM important ‘ Time and resources are often wasted because different organisations, teams, individuals, repeat practices and develop new methods over and over again rather than sharing what they know through reliable local regional and national networks !’

13. Evidence Story One

14. Types of evidence National research Nationally identified good practice models Local / in-house evaluations Data on short-term outcomes for users Data on long-term outcomes for users Views of service users Results against national PIs Results against local PIs Views of professional social care colleagues Views of other professional colleagues

15. Common obstacles Inadequate access to research Lack of knowledge/skills about accessing research Low levels of critical appraisal skills and lack of guidance on research quality Lack of IT skills and access Lack of or limited resources

16. Common obstacles 2 Lack of support from colleagues – failure to value research at an organisational level Culture of acting before reflecting Poor communication of research Perceived threats to professional autonomy, practitioner skills and experience Beliefs and attitudes

17. Common obstacles 3 Lack of professional credit for disseminating research Lack of relevant and timely evidence Practitioners’ perceptions of research Higher value placed on other sources of information Statutory requirements/policies Barnardo’s Evidence Guide

18. Common enablers Accessible, user friendly research evidence focused on practice questions Active and timely dissemination of relevant research evidence (eg information-sharing networks) Opportunities for discussion of research findings (eg journal clubs) Development of resources to make research more accessible to practitioners (eg e-alerts, pre-appraised research summaries)

19. Common enablers 2 Training and staff development including opportunities for interaction with colleagues and experts Collaboration between practice and producers of research Practitioners engaging in continuing professional development and reflective practice

20. Common enablers 3 Support for practitioners to ‘try out’ research findings and conduct their own research Culture of support and enthusiasm Strong leadership and commitment to working in an evidence-informed way Barnardo’s Evidence Guide

21. RiPfA – an approach to evidence embedding evidence at the heart of policy and practice focus on outcomes important to service users partnership working – with other professions and other agencies involvement of service users

22.  Six strands Learning events Publications Network exchange Change projects www.ripfa.org.uk Joint activity with research in practice

24. ‘Firm Foundations’ for EiP Giving a strategic lead Setting expectations that policy and practice will be evidence-informed Encouraging learning from research Improving access to research Providing support to agency research

25. Evidence Story Two

26. Outcomes … Providing the options most likely to be effective Having confidence that what is being provided is likely to have the desired impact Being able to share with individuals and their carers the evidence on effectiveness, enabling them to make informed choices Empowering front-line practitioners in their support practices Enhancing well-being for all living with dementia