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Teen Counselling 2013 Conference
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Designing and Implementing Effective ServicesCrosscare Teen Counselling Conference
Nuala Doherty - Director, Centre for Effective Services
Sarah Rochford - Intern27th September 2013
© The Centre for Effective Services 2013
Overview
1. Designing effective services
What is evidence?
Sourcing and Using evidence: Challenges and Benefits
Putting Evidence in Context
Outcomes
Logic Models
2. Implementing effective services
The Implementation Gap
Implementation Drivers
How CES Supports evidence into practice
3
A small organisation with charity status
Established in 2008
(5 year grant)
A multi-disciplinary staff team
Jointly funded by
Government
• Dept. Environment, Community and Local Government
• Dept. Children and Youth Affairs
Atlantic Philanthropies
All Island organisation
Belfast
Dublin
Introduction to CES
Part
ner
ship
s &
Co
llab
ora
tio
ns
Better Outcomes for Children, Young People, Families and Communities
EffectivePolicy
EfficientSystems
Good Practice
Evidence to Implementation
All-Islan
d
CES Mission
The Centre for Effective Services works with others to connect and support the
implementation of effective policy, efficient systems and good practice, using the best
available evidence, so that children, families and communities thrive.
5
1. What do we mean by Evidence?
Evidence-basedA programme, service or intervention that has consistently
been shown to produce positive results by independent research studies that have been conducted to a particular
degree of scientific quality.
Evidence-informedPractice based on the integration of experience, judgement and
expertise with the best available external evidence from systematic research.
Types of evidence
Consultation
Practice Wisdom
Policy
Research
What Works?
• For whom
• In what circumstances
• At what point in time
• Using which approach
• Under what conditions
Developing a shared understanding of the evidence journey
• Good Practice - A community of judgement of what works
• Promising Approaches - Some positive findings but findings are not
consistent or rigorous enough to be sure
• Research Based - Based on sound theory informed by a growing body
of empirical research
• Evidence Based - rigorously evaluated with consistent results
Evidence must be fit for purpose and take account of the complex nature of service delivery and social needs. It helps us to assess and make decisions on interventions with an ‘evidence lens’
What are the Benefits of Using Evidence?
It can improve
outcomes for children,
families and communities
It is Ethical –do no harm.
It can help us to understand how and why it worked and for whom, so
it we can develop service
delivery for the future
It can increase
chances of future
funding & sustainability
for organisations
Relating costs to
benefits can inform the
debate about policy
priorities and
resource allocation
Establishing what is not
known helps to identify
risks, limitations and grey areas for
new services.
What are the Challenges of Using Evidence?
• Be able to select, weigh and interpret evidence
• Contested definitions of evidence
• Limits to the evidence - Findings from different studies can sometimes be contradictory
• Dearth of research in some areas and can be incomplete
• Take into account the complexity and systemic nature of social problems and their underpinning issues
• The best evidence in the world will not result in better outcomes if poorly implemented
Evidence Needs a Context to be Useful
• Assess how ‘workable’ this approach will be for your area
• Understand the qualitative local experiences, needs and strengths in your
area
• Look carefully at the service delivery mechanism most likely to work for your
client group
• Attempts to distil out the ‘active ingredients’ of effective programmes to
identify effective practice and mainstream.
• Resources are important - think about sustainability from the start
• This will let you make an informed choice
Outcomes
• Outcomes are the changes for service users or other targets of change that happen as a result of an intervention or service being provided.
• There are levels of outcomes, i.e. individuals, families, specific groups, communities or organisations themselves.
• Outcomes can be conceptualised in various ways:• soft outcomes - changes in feelings, thinking and perceptions.
• Hard outcomes - changes in behaviours, attainment or status which can be measured.
• Short-term outcomes, medium or long-term.
• Being outcomes as opposed to outputs focused allows for the development of indicators of success and provides a common end for stakeholders.
• It provides a more direct, focused approach to service provision.
Logic Models
A Logic model is key in the design phase in ensuring your services or intervention is outcomes focused, and helps us to be accountable.
It is a depiction of a programme/intervention showing what it will do and what it is to accomplish.
A series of “if-then” relationships that, if implemented as intended, lead to the desired outcomes.
Research shows logic models can improve communication, clarify programme purpose, improve service delivery, provide coherence across complex tasks and diverse environments, and help us do better evaluation (what variables to measure).
14© Centre for Effective Services 2013
What
we do
Who we
reachWhat results
INPUTS OUTPUTS OUTCOMES
Program commitments
Activities Participation Short Medium Long-term
What we
invest
More specifically….
Evidence
Monitoring and evaluation
15
The “Implementation Gap”
2. Implementing Effective Services
16
Understanding Implementation
Implementation involves
— a specified set of purposeful activities
— at the practice, programme and systems levels
— putting into practice a programme, intervention or service with established and recognisable processes that are necessary to achieve desired outcomes.
At its simplest, implementation can be described as the carrying out of a plan for doing something. It focuses on operationalising
the plan – the How , rather than the What
Science to Service
Best EvidenceService
GapIMPLEMENTATION
Source: Implementation Masterclass, Dublin, May 2011, K. Blase and D. Fixsen
17
Bridging the Gap
What Works?
Fidelity is important.
Fidelity is the degree to which the activities undertaken in a programme are true to the design of the original programme
on which it is based.
Implementing properly matters!
Higher Fidelity is correlated with better outcomes across a wide range of programmes and practices
19
Implementation Drivers
Leadership
Staff capacity to support clients with the selected practices
Organisational capacity to support staff in implementing practices with fidelity
Capacity to provide direction, vision, & the“right” leadership approach
Improved Fidelity and Outcomes
Source: Adapted from Implementation Masterclass, Dublin, May 2011, K. Blase and D. Fixsen
20
Implementation Drivers: Improved Fidelity & Outcomes
Staff capacity to support clients with the
selected practices
Selection
Training
Coaching
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Implementation Drivers: Organisational support
Organisational capacity to support
staff in implementing practices with fidelity
Improved Fidelity and Outcomes
Systems Intervention
Facilitative Administration
Decision Support Data System
22
Implementation Drivers: Leadership
Leadership
Capacity to provide direction, vision, & the
“right” leadership approach
• Adaptive challenges cannot be solved by existing systems.• Adaptive leadership involves finding solutions that are new and break away from normal approaches. This involves convening staff, developing plans & reaching a consensus.
• Technical challenges are those which can be solved by existing organisational systems.• Technical leadership involves managing these challenges by knowing what needs to be done and doing it.
Improved Fidelity and Outcomes
TechnicalAdaptive
Practitioners and Implementation
Need support
Need to feel their work
and contributions
are valued
Need to feel involved and
that their opinions are
heard
Need to be empowered to use their
skills and wisdom
How CES Promotes Evidence in Practice
Prevention and Early Intervention
Projects
Practice Seminars e.g. Sourcing
Useable Evidence
Strategic Advice and Support
The What Works Process
CES Library Online Resource for Youth Workers
Evidence Route Map for Youth Work
To Conclude…..
• In the Design phase, factors to consider are:
o The Evidence
o Local context and need
o Logic Models to focus outcomes and accompanying indicators
• During Implementation, key ingredients are:
o Building staff competency
o Organisational Readiness
o Leadership to match the challenge and Championing of the new approach
Effective InterventionsThe “WHAT”
Effective Implementation
The “HOW”
Positive Outcomes for
Children
Source: Implementation Masterclass, Dublin, May 2011, K. Blase and D. Fixsen
Evidence + Implementation = Better Outcomes for Children
Designing Implementing Effective Services
If you are interested in ‘evidence based/informed practice’
• www.effectiveservices.org
• www.iriss.org.uk
• www.ceni.org
• www.scie.org
• www.cssp.org
