Wednesday, 5 March 2014

Getting the Word Out: A Journey in the Science and Practice of Bringing Evidence to Application and Impact

CRFR is delighted to welcome Melanie Barwick to Scotland in May to deliver the extremely successful Knowledge Exchange: Concept + Planning + Evaluation = Impact Workshop. Here, Melanie gives an insight into what will be discussed and practiced during the workshop, and what has motivated her professional career over the last decade.

Early in my career, I set out to become a child psychologist and researcher in child and youth mental health, and I did. Along the way, serendipitously, I fell into the world of knowledge translation/knowledge exchange when I took on the leadership of Ontario’s outcome measurement initiative in 2000. Together with my team, we set out to train child and youth mental health practitioners in 120 provider organizations to use a level of functioning measure called the CAFAS, thereby creating a common metric for functioning across the province’s system of care. We were naïve, approaching the task with one-off training workshops to convey the rationale, knowledge of the CAFAS tool, and support practitioners to achieve rater reliability and to consequently use the tool in their practice. I reiterate: we were naïve. Some months into the task the light bulb illuminated, and we realized that effective practice change required more than translating evidence-based practice in a traditional didactic manner; it required a different approach altogether.

The outcome measurement initiative is in its 14th and final year, and will metamorphose into other developments as the system enters into clinical transformation dictated by Ontario’s policy framework for child and youth mental health. During this time, I’ve been funded to study practice change in several studies, and have expanded my enquiry beyond child and youth mental health into education, health, and global health. This rich and contextual research program has taught me a lot along the way, about practice change, implementation, and knowledge translation.

In a nutshell, this is what I now know.

Knowledge translation and implementation are complimentary but different constructs. Knowledge translation involves helping others to understand the evidence; implementation involves supporting them to make the changes needed to apply the evidence. Impact means capturing that people knew what to do with the knowledge you shared.

Practice change is not one-off. It’s a complex process that has many moving parts, some of which are likely universal but some that are unique to the particular context, and we are still learning what those are. There is alchemy in the practice change recipe. Every context calls for different amounts of the more universal ingredients, and a dash or two or other key elements that are necessary for that particular context. The practice change recipe for child and youth mental health, for health, or education will (I hypothesize) look different from one another.

Practice change calls for structure and an approach that is both adaptive and incremental. There is a method to the madness, and the application of good project management combined with the application of implementation teams, stages, drivers, and cycles will lead to more effective implementation, whatever the context.

The road to practice change – the implementation journey – has far better signage and lighting than it did 14 years ago. As implementation frameworks and theories become more refined, we are digging below the surface of categorical frameworks to identify the ‘what’ and the ‘how’ of changing practice. It is no longer sufficient to direct implementers to identify barriers and facilitators, tailor interventions to populations, facilitate the change endeavor, and measure outcomes without specifying how they are to accomplish these things. We are beginning to identify key factors that are implicated in effective implementation of evidence in practice across different sectors, and we are focusing on how to measure these key elements in a standardized way so that a common story can be told across case studies and contexts. Lastly, there is a growing library of openly accessible resources to help practitioners map their own implementation journey. Researchers are endeavoring to produce both scientific outputs whilst also developing resources and tools that can be of real and practical use in the field. It has never been a more fascinating and illuminating time, and the journey continues.

Melanie Barwick, PhD, CPsych
Senior Associate Scientist
Community Health Systems Resource Group, Psychiatry
Child Health Evaluative Sciences, Research Institute
The Hospital for Sick Children
Associate Professor, Departments of Psychiatry and Dalla Lana School of Public Health
University of Toronto

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