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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 works? agenda
  • introduction of a wide range of performance indicators

What are they and how do they differ?

Effectiveness 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.
Performance indicators 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

Context Effectiveness area Related Performance Indicators
Social care Ensuring that all children are securely attached to carers capable of providing safe and effective care for the duration childhood. 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.
Medical Improving the health status of the population Reduce the death rate from suicide in all ages by at least one-fifth (20%) by 2010
Education Raising educational standards Proportion of children achieving 5 GCSE/GNVQ passes with grade C or above.
Criminal Justice
Improving victim satisfaction in the work of Youth Offending Teams 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.

Increasing guidance

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 CEBSS.

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 work staff.

Centre for Evidence Based Social Services

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.

Evidence-based practice in social care is the conscientious, explicit and judicious use of current best evidence in making decisions regarding the welfare of service users and carers.

from CEBSS leaflet

1. To translate the results of existing research into service and practice development;

2. To ensure research findings are available to Social Services Departments when reviewing and changing service delivery, and are fed into the review process;

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 in Practice.

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