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Evidence and good Evidence and good practice in mental health practice in mental health
promotion – an area of promotion – an area of conflict between scientific conflict between scientific and practical demands?and practical demands?
Promotion of Mental Health – Improving Promotion of Mental Health – Improving Practice and PolicyPractice and Policy
8-9th of October 20098-9th of October 2009Ilse Julkunen Ilse Julkunen
[email protected]@thl.fi
21.04.2321.04.23 11THL Ilse JulkunenTHL Ilse Julkunen
Knowledge is the most valuable Knowledge is the most valuable resource available to policy resource available to policy makers to achieve improved makers to achieve improved
health and well-being around the health and well-being around the worldworld
Knowledge for DevelopmentKnowledge for DevelopmentWorld Bank´s 1999 World Development ReportWorld Bank´s 1999 World Development Report
Themes to adressThemes to adress
Practice and practical demandsPractice and practical demands Evidence of what?Evidence of what? Knowledge Challenges Knowledge Challenges Critical components in developingCritical components in developing
innovative learninginnovative learning - good practices- good practices
The virtue of having method-driven, objective, systematically produced general knowledge becomes a vice
when we are led to mistakenly believe that such knowledge is
sovereign with respect to practice.
(Thomas A Scwandt 2002, 198: Evaluation practice reconsidered)
Practical inquiryPractical inquiry
John Dewey ”pattern of inquiry” (1938); It is based on a pragmatic paradigm that sees commonsense as well as scientific knowledge as means to improve human practices. It emphasises that the scientific goal is to create knowledge of the practical that is practical to the practical.
PracticePracticeThe concept of practice is an assemblage comprising a variety of processes(Alexander Styhre, Gothenburg university)
Both early and and contemporary pragmatists reject the idea of a certain truth that can be discovered through logical analysis or revelation, and are more interested in knowledge gained through experiences.Because of this understanding knowledge is shaped by multiple experiences, and this becomes a central value (Pragmatist Feminism)
I seriously believe that a bit of fun helps thinking and tends to make it pragmatical (Charles Peirce 1922)
The main aim is to create scientific knowledge that has practical value
Another aim is to generate practical knowledge through empirical studies on a local level
Cf Göran Goldkuhl, Linköping university (What does it mean to serve the citizens in e-services?)
To do research is a practical activity
Even though the practice is uncertain, chaotic and changing, it is still the reality where we must solve central problems that appear.
The process is analogical whether we talk about everyday activities or research. In both situations it is a question of problemsolvingprocesses.
It is time to raise the value of the practical needs in knowledge production
said John Dewey already in 1929
Grasping the complexity..Grasping the complexity.. We pay too much attention towards how
the services SHOULD function Instaed we should focus on HOW the
services function
Invisible mechanisms; culture Providing a diagnosis is itself a miniature
treatment carrying its own effect and one that can shape the long term outcomes of illness (Brody & Waters 1980)
Hyvät käytännöt 10
Logical models as tools for Logical models as tools for grasping processesgrasping processes
Logical models: www.innonet.org , www.uwex.edu/ces/pdande/evaluation/evallogicmodel.html
http://www.onthepoint.ca/kec/know.htm Knowlton & Phillips: The Logic Model Guidebook
Some hints from Ray PawsonSome hints from Ray Pawson
Intensify evalaution of programme staged Intensify evalaution of programme staged (what are pre-ignition effects? Are eaiting-(what are pre-ignition effects? Are eaiting-lists a help or hindrance?)lists a help or hindrance?)
Study dropping-out (which occurs at all Study dropping-out (which occurs at all points in the chain) rather than outcome points in the chain) rather than outcome destinationsdestinations
Study mature programmes and their Study mature programmes and their historyhistory
3.10.20093.10.2009 Ilse JulkunenIlse Julkunen 1212
The innovative nature of The innovative nature of sciencescience
Popper concluded that scientific theories are only Popper concluded that scientific theories are only hypotheses and may be falsified and replaced any hypotheses and may be falsified and replaced any day. day.
Consequently, what is important for the growth of Consequently, what is important for the growth of science is not the confirmation but the attempted science is not the confirmation but the attempted falsification of theories.falsification of theories.
For the practitioner this means that he or she For the practitioner this means that he or she should always continue to test complex should always continue to test complex ramifications of theories and test them in as many ramifications of theories and test them in as many different types of situations as possible.different types of situations as possible.
Haluk Soydan 2007Haluk Soydan 2007
The challenge of timeThe challenge of time Social and behavioural change happens Social and behavioural change happens
slowly and painstakingly, a series of slowly and painstakingly, a series of measures is required to bring about measures is required to bring about profound and lasting changeprofound and lasting change
Methods of evaluation research are not Methods of evaluation research are not always up to scratch in being able to always up to scratch in being able to identify the crucial elements. identify the crucial elements.
Ray Pawson (2009) Reducing Plague by Drowning Ray Pawson (2009) Reducing Plague by Drowning Witches: Locating the Real Mechanisms of Change in Witches: Locating the Real Mechanisms of Change in Social and Health InterventionsSocial and Health Interventions
Hyvät käytännöt 14
The challenge of The challenge of capabilitiescapabilities
While the actual beings and doings as well as While the actual beings and doings as well as the changing of beings and doings are more or the changing of beings and doings are more or less directly measurable, the dimensions that less directly measurable, the dimensions that really counts ethically, the powers, freedoms, really counts ethically, the powers, freedoms, and agency of clients to live a life they have and agency of clients to live a life they have reason to value, is possibly rather latent, reason to value, is possibly rather latent, unobservable and interdependent. These unobservable and interdependent. These powers, the capabilites of people, are the powers, the capabilites of people, are the mechansims that indicate change.mechansims that indicate change.
If we take this perspective seriously, its is not If we take this perspective seriously, its is not programs that work. Rather what works is the programs that work. Rather what works is the underlying reasons and resources that they underlying reasons and resources that they offer subjects that generate change (Pawson offer subjects that generate change (Pawson 2002)2002)
How do we look at How do we look at knowledge creation?knowledge creation?
Do we look at knowledge as knowledge Do we look at knowledge as knowledge transfer or as co-production of knowledge?transfer or as co-production of knowledge?
For research to be useful it not only needs to For research to be useful it not only needs to be credible but be credible but actionableactionable as well as well
Knowledge cannot be apprehended solely as a Knowledge cannot be apprehended solely as a stocked market that can be transferred from one stocked market that can be transferred from one person to another irrespective from where it cameperson to another irrespective from where it came
The starting point is that knowledge forms The starting point is that knowledge forms through interaction with people when people have through interaction with people when people have the possibility to encounterthe possibility to encounter
16
Learning spacesLearning spaces
Reflective benchmarking is a question of Reflective benchmarking is a question of creating learning spaces (Nonaka et al creating learning spaces (Nonaka et al 2000). 2000).
Learning and adapting new knowledge Learning and adapting new knowledge requires a common shared ground (home requires a common shared ground (home base).base).
Learning does not happen in vacuum, but Learning does not happen in vacuum, but depends on the circumstances and the depends on the circumstances and the context where people meet (history is context where people meet (history is present).present).
Management Challenges for Management Challenges for Self-Renewing DevelopmentSelf-Renewing Development
KnowledgeCreation
ProcessesMental
Modelling
TeamLearning
PersonalMastery
SystemsThinkingShared
Vision
Strategic and VisionaryManagement
Management of Networks
KnowledgeManagement
ResourceManagement
Management ofWork Organization
© Markku Markkula
Actors
Netw
ork
s
Timing
Collabora
tion
Knowledge
Management
Leadership
Closeness, co-production an open innovation
Organising sustainable innovation is grounded in four principles (Steven Weber (2004)):
1. Mandating people to test; motivation and encouragement
2. Interchange of knowledge between actors; through e-processes
3. Splitting the process into parts (modularity), the parts are handled separately and the results are collated
4. Creating a flexible and well-organised adminstration; general rules, how to participate, how to do decisions and how to maintain the process
Services do not Services do not produce social produce social
outcomes; people dooutcomes; people doCummins & Miller Cummins & Miller
20072007
Users not just as informants but actively taking part in both developing
and evaluating the outcomeHyvät käytännöt 20
21 © 2005 Nokia V1-Filename.ppt / yyyy-mm-dd / Initials
A ”Living Lab” is a ...citizen-business-public partnership
operating in real life/work environmentproviding user-driven innovation service
PEOPLE
ACADEMY GOVERN.
INDUSTRY
(The term ”Living Lab” was created by Bill Michell, MIT, around 1995)
5.Levittäminen,käyttöönotto
4.Dialoginenvalidointi
3.Kuvaaminen
2.Arviointi
1.Tunnistaminen
Hyvän käytännönoppimis-verkosto
Good practice processwww.goodpractice.fi
1.1. How is practice identified and How is practice identified and conceptualised?conceptualised?
2. How is practice evaluatedHow is practice evaluated in its context?in its context?
3. How is practice How is practice condensed and publishedcondensed and published?
5. How is the disseminationHow is the disseminationof the practice promoted?of the practice promoted?
4. How is practice tested in How is practice tested in the learning network?the learning network?
The hybrid natureThe hybrid nature
The good practice process is about identifying, The good practice process is about identifying, evaluating and condensing good practice, evaluating and condensing good practice, analysing it critically and validating it through analysing it critically and validating it through dialogue and promoting its implementation. This dialogue and promoting its implementation. This is not always a linear process. That is why the is not always a linear process. That is why the figure describing the good practice process, is a figure describing the good practice process, is a hybrid presentation.hybrid presentation.
An example of the hybrid nature of the process is An example of the hybrid nature of the process is that you can start to describe good practice even that you can start to describe good practice even before it has been assessed. Ideas of good before it has been assessed. Ideas of good practice can also start to spread to a wider practice can also start to spread to a wider audience from a local level.audience from a local level.
Ilse JulkunenIlse Julkunen 2323
Good practice – program theory
Effectivity through dialogues
THL's good practice process is built upon the framework THL's good practice process is built upon the framework of democracy-driven dialogue. It enhances bottom-up of democracy-driven dialogue. It enhances bottom-up knowledge creation. It builds on creating research-knowledge creation. It builds on creating research-mindedness among practitioners and on enhancing mindedness among practitioners and on enhancing knowledge creation on different levels. knowledge creation on different levels.
The holistic process consists of different elements such The holistic process consists of different elements such as identification, evaluation, condensation, validation and as identification, evaluation, condensation, validation and dissemination.dissemination.
Hyvät käytännöt 24
Knowledge about practiceKnowledge about practice
It is not the practice itself but rather knowledge It is not the practice itself but rather knowledge about it that can be transferred (such as about it that can be transferred (such as descriptions of good practices). descriptions of good practices).
If a practice is to be applied elsewhere, this If a practice is to be applied elsewhere, this should take place in a context that is sufficiently should take place in a context that is sufficiently similar to the context where the practice similar to the context where the practice originally proved to be functional and effective. originally proved to be functional and effective.
To implement and apply a practice is a process To implement and apply a practice is a process where the practice and its context are co-where the practice and its context are co-produced. The more humans and other elements produced. The more humans and other elements a practice is constituted by, the more likely a practice is constituted by, the more likely it changes when it is applied elsewhereit changes when it is applied elsewhere
Ilse JulkunenIlse Julkunen 2525
21.04.23 26
KIOSKI
OPISTO-tuutorit-kirjasto
PANKKI
TORI
ORGANISATION
Inno village
VILLAGERS SERVICES
VILLAGE SUPPORT ACTIVITIES
INFOR
MATIO
N
NEWSERVICES EVALU
ATION
TECNICAL
PLATFORMMULTIFORM NETWORKS
Inno-collegeInno-college Knowledge and competenceKnowledge and competence Coordiantion of different good practice Coordiantion of different good practice
paradigms paradigms Inno tutorsInno tutors: a competence community : a competence community
accessible for all accessible for all Organises development, evaluation, Organises development, evaluation,
condensation and implementationcondensation and implementation Learning network supportLearning network support
Inno libraryInno library Continuously updating methods for Continuously updating methods for
evaluation, development and evaluation, development and implementationimplementation
21.04.23 29
Future good practiceFuture good practice
The Good practice process is possible to The Good practice process is possible to enlarge and build to a manylevel, dynamic enlarge and build to a manylevel, dynamic process. process.
Collecting and creating knowledge and Collecting and creating knowledge and sharing knowledge is essentialsharing knowledge is essential
This requires development of an electronic This requires development of an electronic innovation environment and development innovation environment and development of learning networks. of learning networks.
The platform serves as a support for The platform serves as a support for producing innovations and applying new producing innovations and applying new innovations. innovations.
To concludeTo concludeThe aims of knowledge management are to collect all relevant information and intellectual capital into a common system, and provide equal access to that information, ensuring that it can be synthesized with local needs. Such a system enables members of the public health community directly with thier peers on matters of mutual interest (effective practices).
Public health practitioners should share and exploit experiental knowledge in a much direct way through communities of practice – informal networks linking individuals and groups who share common professional interests and who benefit from frequent exchanges of knowledge.
Edward Mullen (2008) Evidence-Based Policy and social work in health and mental health.
