Using evidence better needs fresh thinking
Australia has made great strides on using evidence better. But we still have a lot of work – and some rethinking – to do if we truly want to make evidence-based practice a reality in child and family services.
This was a key theme at the Parenting Research Centre’s Practice reimagined events held in Melbourne and Sydney in June, which drew nearly 200 stakeholders from policy and practice in the child and family services sector.
CEO Warren Cann told the audience that while the value of evidence-based practice is not in dispute, the path to achieving it is littered with challenges.
There are resistant problems, he said, such as effective approaches not gaining traction, and ineffective and even harmful approaches persisting. “Our field is still prone to fads and pseudo science is an ever-present danger.”
Warren Cann at Practice reimagined Melbourne
Five key challenges
1. Evidence-based interventions for children and families don’t always exist for the population or outcome of interest
“It’s not just about what works but what is appropriate in the circumstances, something Aboriginal and Torres Strait Islander practitioners and families know only too well,” Mr Cann said.
2. Judging claims about what works is not always easy
Evidence-based practice is now a marketing strategy, and complex conflict of interest issues are at play, he said. “Far from being categorical and conclusive, evidence is always developing but also contested.”
3. Many interventions are well engineered but poorly designed
Interventions can be challenging to transport from one setting to another. And if not designed with the user experience in mind, they are difficult to implement.
4. The scientific process is slow
Evidence-based interventions aren’t practically useful if they don’t work at scale.
5. Program manuals have been treated as the unit of intervention
A manualised approach doesn’t support departure from the protocol — even when doing so better meets the needs of families.
A way forward on evidence
“We need a more expansive and inclusive view of evidence-based practice,” Mr Cann said.
“Often we equate evidence-based practice with products such as programs. Programs are very important and useful but they’re only one part of the story. Evidence based practice can also be understood as a process.
“If we wanted to look at things differently we could put aside our shopping trolley and begin with what exists. Using data informed decision making is critical if we are to develop learning systems with the potential to expand the evidence base.
“Becoming a system that routinely uses data to learn and improve effectiveness requires a different set of skills. It requires an innovation mindset, willingness to draw on multiple sources of knowledge and the capacity to continually adapt.”
Developing practice frameworks
Over the past decade of working with clients to achieve evidence-based practice we have found that developing and implementing practice frameworks is a practical way of ‘realising the vision’ of evidence-based practice, Mr Cann said. This is especially so when the client needs a tailored response.
Frameworks, adapted at the organisational level, can:
- Make how we work explicit
- Create a common language
- Make knowledge in one part of the organisation accessible to all
- Make systematic practice development possible.
Parenting Research Centre Director of Policy and Practice Annette Michaux told the audience that taking a practice framework approach had helped our clients work more sustainably by using goal-oriented, coaching approaches to building parents’ capacity. This helped parents and carers feel less overwhelmed because their goals felt achievable.
In the words of one practice lead at a child and family service:
“We are now focused on helping parents build real motivation towards child safety concerns; we have practices to raise important concerns in a way that does not flatten parent motivation.”
Annette Michaux at Practice reimagined Sydney
Other perspectives on using evidence better
Leading thinkers from policy, practice and academia joined us on stage at each of our events to further the discussion.
In Sydney, we heard from:
- Simone Walker, Deputy Secretary, Strategy, Policy and Commissioning for the NSW Department of Family and Services and Justice: “The evidence base is fundamental to practitioners’ work and language reframing is critical to the way practitioners are now talking about families”
- Kate Alexander, Executive Director, Office of the Senior Practitioner for the NSW Department of Family and Community Services and Justice: “Local contexts and solutions are very important”
- Rob Ryan, CEO of Key Assets: “You need a core vision about what you’re doing before you can implement a practice framework for working with children and families”
- Amy Conley Wright, Associate Professor of Social Work and Director of the Institute of Open Adoption Studies at The University of Sydney: “Evidence-based practice should be a democratic process”.
In Melbourne our guests were:
- Argiri Alisandratos, Deputy Secretary, Children and Families at the Department of Health and Human Services Victoria: “Given that from a policy perspective the evidence is contested and not always clear, we want to test, iterate and understand the Victorian context when using evidence”
- Lynette Buoy, CEO of Windermere Child and Family Services: “Capturing the hearts and minds of your staff when implementing evidence in your organisation is key”
- Helen Skouteris, Monash Warwick Professor in Healthcare Improvement and Implementation Science, Monash University: “We need to understand how to build capacity in the workforce around the knowledge that we create; It’s about building a bridge across the ‘valley of death’ between evidence and practice”.