Think Research: Evidence-

Informed Planning and

Commissioning for Children

Keith Moultrie and Celia Atherton

20 April 2009

with

April 2009 2

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.ukEmail ipc@brookes.ac.uk

April 2009 3

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.

April 2009 4

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 5

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 6

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 7

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 8

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 9

Aligned Planning and Commissioning….…?

Patient/ public

Petitions

Published prospectus

Review service provision

Assessing needs

Seeking public and patient views

Managing performance

(quality, performance,

outcomes) Referrals, individual needs assessment; advice on choices; treatment/ activity

Managing demand

Shaping the structure of supply

Designing services

Deciding priorities

National targets

Patient/ public

Petitions

Published prospectus

Review service provision

Assessing needs

Seeking public and patient views

Managing performance

(quality, performance,

outcomes) Referrals, individual needs assessment; advice on choices; treatment/ activity

Managing demand

Shaping the structure of supply

Designing services

Deciding priorities

National targets

Phase 1: Needs assessment and Strategic Planning Phase 2: Shaping and Managing the Market Phase 3: Improving performance, monitoring and evaluating Phase 1: Needs assessment and Strategic Planning Phase 2: Shaping and Managing the Market Phase 3: Improving performance, monitoring and evaluating

Look at outcomes for children and young people Look at particular

groups of children and young people

Commission –including use of

pooled resources

Identify resources and set priorities

Decide how to commission

services efficiently

Monitor and review services and

process

Develop needs assessment with

user and staff views

Plan pattern of services and focus

on prevention

Plan for workforce and market

development Process for joint planning &

commissioning

Look at outcomes for children and young people Look at particular

groups of children and young people

Commission –including use of

pooled resources

Identify resources and set priorities

Decide how to commission

services efficiently

Monitor and review services and

process

Develop needs assessment with

user and staff views

Plan pattern of services and focus

on prevention

Plan for workforce and market

development Process for joint planning &

commissioning

Look at outcomes for children and young people Look at particular

groups of children and young people

Commission –including use of

pooled resources

Identify resources and set priorities

Decide how to commission

services efficiently

Monitor and review services and

process

Develop needs assessment with

user and staff views

Plan pattern of services and focus

on prevention

Plan for workforce and market

development Process for joint planning &

commissioning

April 2009 10

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 11

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 12

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 13

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

April 2009 14

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.

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

April 2009 16

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

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 termsBuilding research capacityAppraising research evidenceSearching databases – basic guidanceEthical guidanceCase 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

Study grading tool

1. Positive reports from service users and Practitioners at follow up

2. Several positive pre‑post studies comparing performance at baseline to follow up

3. Positive evaluations by several studies featuring comparison groups

4. Positive evaluations by several randomised controlled trials

5. 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

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 SMARTSpecific Improve mobility,

behaviour, housingImprove ‘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

Additional on-line resources