Shifting an assessment tool’s implementation vision over time to stop perpetuating illusions of impact

I was reading Standardized Tools: An Exploration of Implementation Barriers and Enablers, a guidance on implementation in organizations https://www.eenetconnect.ca/to…arriers-and-enablers and for sure found a lot of wisdom on the approach to implementation.  The description of the process in the first vignette rings so true to applying to everyday practice, so thanks for the inspiration.

Reading the implementation guidance document stirred me on the realization as a front line worker for more than a decade working with the OCAN, that this super complex and original vision has evolved and changed in its key purpose from versions 1,2, to 3. The premise and driver of the Ontario Common Assessment of Need (OCAN) was that “client’s don’t have to repeat their stories,” to have continuity of care beyond one organization.

OCAN 2

OCAN 3

 

(image of system flow “consumer at the centre of care”… “easy movement between community mental health services,”  from powerpoint on Overview https://iar.thinkingcap.com/OCAN_tool )

That promise has been removed and that is a credit to the implementers and system planners for being honest and making it more relevant to everyday practice.  It just sticks with the original promises of being relevant to communicating client and worker perspective on recovery planning (with the client’s own words) as well as for the organization’s outcome and performance measurement. But that’s it.  We’ve stopped perpetuating an illusion of the OCAN being integrated into everyday care in the broader health and social care system.

 

Ethics, analytics and duty of care: an online course of Stephen Downes

Though it’s focus is on “online learning,”  it reaches well into our work, actions and research/evaluation in social work and community health.   The process and format of the course is called a Massive Open Online Course (MOOC),  This course is free.

Introductory video is here:

Introductory video to the course

Register here: https://docs.google.com/forms/…qjyxhXLHz_Q/viewform

Introduction …

Ethics should make us joyful, not afraid. Ethics is not about what’s wrong, but what’s right. It speaks to us of the possibility of living our best life, of having aspirations that are noble and good, and gives us the means and tools to help realize that possibility. We spend so much more effort trying to prevent what’s bad and wrong when we should be trying to create something that is good and right.

Similarly, in learning analytics, the best outcome is achieved not by preventing harm, but rather by creating good. Technology can represent the best of us, embodying our hopes and dreams and aspirations. That is the reason for its existence. Yet, “classical philosophers of technology have painted an excessively gloomy picture of the role of technology in contemporary culture,” writes Verbeek (2005:4). What is it we put into technology and what do we expect when we use it? In analytics, we see this in sharp focus.

Ethics is based on perception, not principle. It springs from that warm and rewarding sensation that follows when we have done something good in the world. It reflects our feelings of compassion, of justice, of goodness. It is something that comes from inside, not something that results from a good argument or a stern talking-to. We spend so much effort drafting arguments and principles as though we could convince someone to be ethical, but the ethical person does not need them, and if a person is unethical, reason will not sway them.

We see the same effect in analytics. Today’s artificial intelligence engines are not based on cognitive rules or principles; they are trained using a mass of contextually relevant data. This makes them ethically agnostic; they defy simple statements of what they ought not do. And so the literature of ethics in analytics express the fears of alienation and subjugation common to traditional philosophy of technology. And we lose sight, not only of the good that analytics might produce, but also of the best means for preventing harm.

What, then, do we learn when we bring these considerations together? That is the topic of this essay. Analytics is a brand new field, coming into being only in the last few decades. Yet it wrestles with questions that have occupied philosophers for centuries. When we ask what is right and wrong, we ask also how we come to know what is right and wrong, how we come to learn the distinction, and to apply it in our daily lives. This is as true for the analytics engine as it is for the person using it.  …  https://downes.pressbooks.com/…matter/introduction/

Stephen Downes’ website is here: https://www.downes.ca/

Some approaches to research that help to bridge social workers individual abilities or not, with the collective

Many of us in front line social work are interested in how we can advance and improve our practice and the deploy social work values to support clients, families and their communities through the building of evidence and knowledge.  We are doing this while working within organizations and services and although no surprise of course that we need to negotiate the waves of organizational priorities, cultures, methodologies and disciplinary hierarchies, it sure can be a lonely business.

You do need to have individual fire in the belly on a topic to start the climb in what feels like to me at least, a fractured learning and research culture what ever organization you are, in, much less for the profession of social work itself.  There is little balance between a clinician’s individual need and ability vs. the collective.  When I say balance, it means to me is interconnectivity and actual cooperation. 

There are shards of light – connection, with ultimate common ground but oh boy, do you have to deploy a community development process for it to work.  A practice based research approach and hews therein of the idea of research: evaluation, quality improvement, outcome measurement, ongoing learning, application/implementation of interventions, social work values and the search for a hypothesis, surround the aims of research for me.

Sorry, I had to mutter above,

Useful research resources, please consider sharing yours with us as well

• The Routledge Handbook of Social Work Practice Research

Available via hospital and university libraries, learn more here: https://socialhealthpracticeottawa.wordpress.com/2020/05/30/launch-of-handbook-of-social-work-practice-research/

• Martin Webber’s Social Work Research Podcast

…The podcast provides listeners with the opportunity to hear about research from researchers themselves and to find out a little more about them. It provides researchers with an opportunity to share their research findings with a wider audience and to highlight important features about it. A link to the full text of the research paper under discussion in each episode is provided for those wishing to extend their learning. …

https://martinwebber.net/socialworkresearchpodcast

• (The British), Advice for Social Workers on Mental Health Research

5 REASONS WHY SOCIAL WORKERS MAKE GOOD RESEARCHERS

1. Social issues are a big focus in mental health research now.
2. Our expansionist approach; we’re not looking for a diagnosis.
3. Our experience of services and how they are delivered is in demand on project advisory groups.
4. Co-production – a core principle in all applied health research now – is not new for us.
5. We have skills in asking questions about sensitive topics.

https://mentalhealthresearch.org.uk/advice-for-social-workers/

• Integration and Implementation Insights (also known as i2Insights)

   

• Blog posts cover 11 major topics that underpin these approaches:

  •  change
  • communication
  • context
  • decision support
  • diversity
  • integration
  • participation (phased out after August 2021)
  • research implementation
  • stakeholder engagement (phased in after August 2021)
  • stakeholders (phased out after August 2021)
  • systems
  • teamwork (phased in after August 2021)
  • unknowns.

https://i2insights.org/

Launch of “Handbook of Social Work Practice Research”

For those of us working in the field of social work, this research network supports us to engage with the “data” we generate everyday and in turn advance analysis of our practice.

” … If it doesn’t come from practice and engage with practice, it will not have impact on practice. …”

The Routledge Handbook of Social Work Practice Research is the first international handbook to focus on practice research for social work. Bringing together leading scholars in the field from Europe, the USA and the Asia Pacific region, it provides an up-to-the minute overview of the latest thinking in practice research whilst also providing practical advice on how to undertake practice research in the field.

It is divided into five sections:

• State of the art
• Methodologies
• Pedagogies
• Applications
• Expanding the frontiers

The range of topics discussed will enhance student development as well as increase the capacity of practitioners to conduct research; develop coordinating and leadership roles; and liaise with multiple stakeholders who will strengthen the context base for practice research.

Learn more here: https://martinwebber.net/

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… I see social work practice research in the future going wherever social work practice is happening. I think we have got to embrace new situations and think of different methodologies that would relate to working in this space and that will have impact back on this space. The Handbook directs thinking into that space. It says there are multiple ways in which you can engage with complexity. … 

Co-editor Lynette Joubert 

See the Table of Contents here: https://www.routledge.com/The-Routledge-Handbook-of-Social-Work-Practice-Research/Joubert-Webber/p/book/9780367189525

 

Embracing the idea we are working within a system, article from INTEGRATION AND IMPLEMENTATION INSIGHTS – helps us to move to long term action within our systems

Helpful article from INTEGRATION AND IMPLEMENTATION INSIGHTS for front line mental health workers trying to work in advancing… practices for the communities we serve. The authors put substance to the idea of thinking beyond the individual, ringing true of the breadth involved with care system change that aims for “the long term” instead of “quick changes.”

” move from a focus on separate dramatic events to a focus on the persistent, often almost continuous, pressures giving rise to the discrete events we see.”

Our mental health care system feels like a super tanker on the ocean that is trying to turn direction – but it needs a lot more than high level planners thinking of the long term.  Anyone in eenetconnect world had any experience with the kind of approach Richardson and Anderson offer to help groups map out decisions to advance practice change?

The fields of systems thinking and system dynamics modelling bring four important patterns of thought to such a group decision and negotiation:

1. thinking dynamically;
2. thinking in stocks and flows;
3. thinking in feedback loops; and,
4. thinking endogenously.

See the article here: https://i2insights.org/2019/07…for-group-decisions/

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I realize for system planners, my question about how people approach understanding systems may be a basic question,  I am curious how from a front line practice perspective, as a cog in the system workers are:

• engaging in framing  systems in their minds
• acting and interacting with planners on long term system change
• bridging our everyday care within a system model

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An example — gaps, unmet needs, planned actions, goals are embedded in our organizations and systems focus of care to advance the recovery model .  The Ontario Common Assessment of Need (OCAN) is framed as a key activity with individuals (clients) and posited by our care system to advance system change and measure performance. http://eenet.ca/tags/ocan

 

The two above images are from the eenetconnect.ca – OCAN Community of Interest (COI) which is a good example of creating a resource for thinking systems. https://www.ee

Thinking systems and collaboration in organizational use of ICT to achieve: accountability, governance and multidisciplinarity

ksenia cheinman‘s analysis of Information Communication Technology (ICT) content in organizations and government in the context of efforts towards an innovation, points to the need for a cooperative whole system approach. 

She provides useful resources on how to improve our approaches to knowledge/content sharing, no matter how basic the task. 

For most health and social involved organizations the resource capacity to manage such an approach dissuades bothering to read these ideas.  It is worth the time though if we are seeking accountability, governance and multidisciplinarity, the title of Cheinman’s article. 

… Innovation in the government can often seem like a symptom of wanting to prove that we are not years behind the private sector, an internal competition or a way to strategically launch one’s career. It is a means to the wrong ends. It operates under the guise of genuine service improvement, but if you look closely and more importantly broadly, in a sweeping gesture, across the whole organization ecosystem, more often than not every individual innovation breaks something else along the way. In fact, sometimes it creates irreparable large-scale damage and it spreads and propagates the same mentality across the organization, creating more of the same.

Gerry McGovern describes this production-first mindset very accurately:

Everyone wants to produce. Nobody wants to service and maintain. If you’re a new manager you must do something new. You must initiate new projects. You must produce. You must produce. […]

In 99 out of 100 conversations I have about digital, management only cares about volume. More. More. More. New. New. New. Innovative. Innovative. Innovative. It is so incredibly rare to find a manager who will invest time and money in helping people find stuff more easily. And, once a customer has found something, helping them understand it more easily. …

See the article here: https://medium.com/@altspaces/digital-content-needs-accountability-governance-and-multidisciplinarity-48212ba03e2a

A guide to Politics and Coalitions in the dance of neutrality in —contested policy making activities

Karin Ingold’s post explains the role of scientific knowledge brokering in coalitions  in Integration and Implementation Insights https://i2insights.org/     In Ottawa, we have had various examples of this, be it the  Alliance to End Homelessness or  harm reduction networks.  I find it useful to reflect on Ingold’s point that suggests that the loss of neutrality in Adversarial advocacy results in, ” no possibility for knowledge brokerage exists.” and need to become “non neutral actors.”

What roles can science and scientific experts adopt in policymaking? One way of examining this is through the Advocacy Coalition Framework (Sabatier and Jenkins-Smith 1993). This framework highlights that policymaking and the negotiations regarding a political issue—such as reform of the health system, or the introduction of an energy tax on fossil fuels—is dominated by advocacy coalitions in opposition. Advocacy coalitions are groups of actors sharing the same opinion about how a policy should be designed and implemented. Each coalition has its own beliefs and ideologies and each wants to see its preferences translated into policies.

via When are scientists neutral experts or strategic policy makers?

“Developing a framework to evaluate knowledge into action interventions”

A logic model to help think and measure knowledge mobilization for practice change from BMC Health Services Research December 2018, 18:133| Cite as

 

There are many challenges in delivering and evaluating knowledge for healthcare, but the lack of clear routes from knowledge to practice is a root cause of failures in safety within healthcare. Various types and sources of knowledge are relevant at different levels within the healthcare system. These need to be delivered in a timely way that is useful and actionable for those providing services or developing policies. How knowledge is taken up and used through networks and relationships, and the difficulties in attributing change to knowledge-based interventions, present challenges to understanding how knowledge into action (K2A) work influences healthcare outcomes. …

See the article here: https://link.springer.com/article/10.1186/s12913-018-2930-3

Some tools to help us think about implementing evidence in our practice

Health Evidence www.healthevidence.org shares tools that guide practice evidence, developed in collaboration with local public health organizations.  While targeted at public health some of the tools provide useful approaches for emerging front line projects.

photo by: Spitfire^Tally-ho! / Spitfire at en.wikipedia

Looking for tools to help you find and use research evidence? Use the Health Evidence™ practice tools to help you work through the evidence-informed decision making process; search for evidence, track your search, and share lessons learned with your public health organization.

Example of tools:

• Evidence-Informed Decision Making (EIDM) Checklist
• Developing an Efficient Search Strategy Using PICO
• Levels & Sources of Public Health Evidence
• Resources to Guide & Track Your Search
• Keeping Track of Search Results: A Flowchart
• Briefing Note: Decisions, Rationale and Key Findings Summary
• Improving Future Decisions: Optimizing the Decision Process from Lessons Learned

See the current tools at their site here: http://www.healthevidence.org/practice-tools.aspx

Architecture to keep track of the big picture of health learning and the ensuing interventions

From the journal of Implementation Science, https://implementationscience.biomedcentral.com/articles/10.1186/s13012-017-0607-7

…In this paper, we propose the use of architectural frameworks to develop LHSs that adhere to a recognized vision while being adapted to their specific organizational context. Architectural frameworks are high-level descriptions of an organization as a system; they capture the structure of its main components at varied levels, the interrelationships among these components, and the principles that guide their evolution.