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. Commissioning, performance management, information management, and service quality. Applied research and consultancy, skills development, and dissemination of knowledge. Website http://ipc.brookes.ac.uk Email ipc@brookes.ac.uk University: IPC formed in 2001, formally SSRADU and ODC plus some housing work. Areas: works at the interface of 3 areas. Mission: is to improve the quality and management of services to users of public welfare organisations regardless of who provides that care, by working on projects that: Promote evidence based practice for managers and practitioners via the dissemination of knowledge. Have a focus on improving thinking and planning before action. Concentrate on the outcomes that public care should be achieving regardless of who provides that care. Passion and specialisms: Commissioning, PM & BP, IM and service quality. Methods: Applied or implementable research, consultancy to central and local govt, training, bespoke IT, MOPS: 29 Organisations. Sharing approaches that work in performance management. Applied projects, joint research, information sharing April 2009

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. Above current or recent children's projects Draw on these to share our reflections on joint commissioning Our role often as honest broker, independent external eye on stretched stressed services Focus particularly on vulnerable and in need children rather than the whole population Also HEIF bid just received £ to develop managing commissioning research and development network – share approaches that work April 2009

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

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

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

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

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

Aligned Planning and Commissioning….…? April 2009

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

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

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

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 Myth: You must start with a clear, agreed, long- term joint direction from the senior managers involved to be able to develop a commissioning strategy. Reality: Short-term performance indicators. High senior executive turn-over. Different populations. Different national and local agendas. Loads of existing plans. Our approach: There are plenty of general statements already. Commissioners must draw together existing separate strategy and purpose statements and test them, don’t create new ones. Develop hypotheses to be tested by commissioning strategy. April 2009

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. Summary of don’t have to do all of this from scratch – a mix needed April 2009

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: ask@rip.org.uk

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 Above current or recent children's projects Draw on these to share our reflections on joint commissioning Our role often as honest broker, independent external eye on stretched stressed services Focus particularly on vulnerable and in need children rather than the whole population Also HEIF bid just received £ to develop managing commissioning research and development network – share approaches that work April 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 terms Building research capacity Appraising research evidence Searching databases – basic guidance Ethical guidance Case 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 Assess local need Formulate research questions Decide on most effective response Commission service Evaluate service Analyse results and apply lessons

Study grading tool Positive reports from service users and Practitioners at follow up Several positive pre‑post studies comparing performance at baseline to follow up Positive evaluations by several studies featuring comparison groups Positive evaluations by several randomised controlled trials 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 building on what we already know, and amending our knowledge base accordingly • being objective and adaptable – when we have a particularly strong investment in a certain approach, we may be reluctant to acknowledge that it could be less effective than we have claimed, or that an approach we believed to be highly ineffective actually works; • treatment fidelity – delivering the programme the way it was designed is crucial. It is important to ensure that a service based on a specific model does not begin to incorporate ad hoc amendments; and • 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 SMART Specific Improve mobility, behaviour, housing Improve ‘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

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