Evidence based practice and the evaluative agenda
The historical context
Over the last fifteen years there has been substantial movement to
increase the accountability of all forms of public services and with
it an increasing focus on two related and sometimes overlapping phenomena:
- measuring the effectiveness of services offered - the what
- introduction of a wide range of performance indicators
What are they and how do they differ?
||is both about the appropriateness and validity of
methods used by professionals in their day to day work to achieve
the basic aims of organisations and the overall ability of agencies
to deliver the services they are required to provide.
||are about agency achievement of predetermined targets that are
seen as determinants of quantity and quality of service delivery.
They are specific, time limited measurable activity related goals.
Performance indicators are discussed in more detail in the later
section on Monitoring and performance.
Here are some actual examples of performance indicators
||Related Performance Indicators
||Ensuring that all children are securely attached
to carers capable of providing safe and effective care for the duration
||Reduce to no more than 16% in all authorities, by
2001, the numbers of children looked after who have three or more
placements in any one year.
||Improving the health status of the population
||Reduce the death rate from suicide in all ages by
at least one-fifth (20%) by 2010
||Raising educational standards
||Proportion of children achieving 5 GCSE/GNVQ passes
with grade C or above.
||Improving victim satisfaction in the work of Youth
||Ensure that 70% of victims by 2004, who have been
consulted or who have participated in, restorative processes are
either satisfied or very satisfied with the outcome.
In both there is a dominant, but not exclusive, focus on outcome rather
than process, although these can overlap.
Origins - the three E's
A key driver for both effectiveness and performance indicators was
control of public expenditure through the 'triple E' initiatives of
Economy, Efficiency and Effectiveness during the 1980's. In social care
and health services public attention on child abuse and protection tragedies
culminated in the Cleveland enquiry. Increasingly questions were asked
about the effectiveness of assessment processes in child sexual abuse
enquiries and of interventions aimed at victims and perpetrators.
Social services departments and other social care agencies are increasingly
being held to account for the effectiveness service delivery at an organisational
level and of specific intervention programmes. In social care, as in
other arenas, information technology has provided the means by which
organisations can monitor their work and produce the information that
enables accountability to be achieved. The focus on effectiveness has
raised fundamental issues about the nature of social work research and
these are outlined further in the earlier section on
Theorising research. The 'Framework for Assessment for Children
in Need' reflects the trend in evidence-based practice.
In the National Health Service evidence emerged about massive variation
in health services not only between costs for similar treatments but
also variation in the provision and duration of different forms of treatment.
These differences could not be explained by different medical or social
needs and raised questions about the effectiveness of treatments. Questions
were asked about operations such as tonsillectomies (once routine in
childhood and now recognised as only relevant in limited medical conditions).
The creation of the National Institute for Clinical Excellence (NICE)
and the implementation of the Health of the Nation Target Indicators
for all health services set out originally in Saving Lives - Our
Healthier Nation are examples of initiatives designed to improve
provision across health providers using a shared knowledge base and
set of standards.
The impact of the effectiveness agenda can be can be seen in the proliferation
of policy and guidance documents and in specific initiatives such as
One response at a national level has been the development of detailed
guidance and practice manuals for social care staff and other professionals
on procedures for handling cases of suspected child abuse. Guidance
has extended to other areas of social care practice and aim to translate
best practice and research findings into general social care practice.
However they vary in the extent to which they are research based or
built round other priorities such as agency rather than child protection.
It can be argued that they erode the professional autonomy of social
|CEBSS at Exeter University is the most concrete manifestation
of the 'what works' approach in social care. The Centre for Evidence-Based
Social Services (CEBSS) was set up in 1997 with the main aim of
ensuring that decisions taken at all levels of Social Services are
informed by trends from good quality research. CEBSS' member organisations
receive support, training and advice from CEBSS about how this and
the aims below can be achieved. CEBSS is a unique partnership between
the Department of Health, Social Services Departments across England
and the University of Exeter. In 2003 CEBSS joined the Peninsula
Medical School (Institute of Health and Social Care). Initially
with 16 Social Services Departments as member authorities, CEBSS
has recently expanded to include Worcestershire, Coventry and the
Family Welfare Association (London). It has 6 key aims - see below.
from CEBSS leaflet
1. To translate the results of existing research into service and practice
2. To ensure research findings are available to Social Services Departments
when reviewing and changing service delivery, and are fed into the review
3. To collaborate with DipSW, Degree and PQ course providers to ensure
that education and training in social work incorporates the knowledge
available from existing research;
4. To improve the general dissemination of research findings to local
policy makers, managers, practitioners and service users and carers;
5. To commission new research where significant gaps are identified;
6. To work towards the inclusion of service-users and carers, as a particularly
valuable source of information on service-effectiveness projects.
The work of CEBSS is promoted through its web site and resource base
and by consultancy and training services to subscriber organisations.
This has included collaboration with the Public Health Resource Unit
at the Division
of Public Health & Primary Health Care (DPHPC) at Oxford.
Another important initiative is the SCIE initiative using Social
Care onLine (formerly the Electronic Library for Social Care - eLSC)
for promoting the dissemination of research findings through access
to Caredata Web and Caredata Abstracts and to Research