August 31, 2018

In this OPEN Exchange we explore the concept of Evidence-Informed Practice Elements and how these are employed to promote better outcomes.

Each edition of OPEN Exchange focuses on a new topic to support evidence-informed practice across our child and family service system.

Evidence-informed practice is a holistic approach to service design and delivery, incorporating the best research evidence with client values and practice wisdom. Being evidence-informed means working with clients to identify their goals and selecting the program models, strategies and practices that will work best to achieve these. It is not a static framework but instead a continuous process based on unique service contexts and clients.

Practice Elements Explained

Previously we have looked at Evidence-Based Programs (EBPs); specific and structured program models that demonstrate positive outcomes for their intended client group backed by a high standard of evidence. Just like EBPs, practice elements are part of an integrated Victorian child and family services system that is underpinned by the best available evidence.

What are evidence-informed practice elements?

Evidence-informed practice elements are discrete techniques or brief procedures used intentionally within a service delivery to influence a client’s attitudes or behaviour. They are evidence-informed because they are commonly found within a number of different EBPs and reputable studies of effective practice [1]. While they can be used independently, they are usually used in small sets or ‘modules’- as part of a larger intervention plan.

What are modules?

A module is a set of evidence-informed practice elements that are grouped together for the purpose of influencing a specific change in a client’s knowledge, attitudes or behaviour. Examples of modules that would be used commonly across child and family services include: family or child engagement, behaviour change, problem-solving skills, and parenting skills (shaping the child’s behaviour).

How are evidence-informed practice elements and modules used?

Most child and family practitioners already use evidence-informed practice elements in their day-to-day practice. While common, they may not be well described or delivered consistently within or across services e.g. practitioners may have different ways that they approach an improvement in parenting skills, and multiple understandings of ‘time out’ should be practiced.

A strong evidence-informed practice elements approach involves describing them through tools such as practice guidelines [2] so that practitioners have a common understanding of what they are delivering.

When evidence-informed practice elements are implemented well, they offer a high level of flexibility as they may be selected and organised according to client need. However, ‘real time’ bundling of evidence-informed practice elements to develop an appropriate response to client needs requires coaching, training and experience. The delivery of pre-arranged modules may be helpful for less-experienced practitioners.

Some of the potential Benefits of using evidence-informed practice elements and modules

  • Ready integration into existing practice — The practice elements approach recognises and builds upon the strengths of existing practice rather than attempting to replace it.
  • Cost efficiencies in training and support — Training and support can focus on practice elements that are underdeveloped within the skillset of workers.
  • Communication between staff and service integration — A common language around evidence-informed practice elements can enable practitioners across services to build a shared understanding of interventions that are common across settings and support a collaborative approach to care planning.

What does the evidence say?

The idea of practice elements and using modular design principles to tailor individualised interventions first emerged in child and adolescent mental health services research only 15 years ago. Several studies have demonstrated the approach’s:

  • feasibility and high acceptability to practitioners;
  • greater satisfaction among practitioners using a modular protocol compared to those delivering EBPs or usual care;
  • greater flexibility in individualising treatment to clients with multiple and complex needs;
  • consistent use of the newly introduced practices by service providers, and
  • improved quality of services.

Evidence-informed modules and practice elements in the field

While there is no universally recognised set of practice elements that must be included in any particular module, some examples relevant to child and family services include:

  • Client engagement — Active listening (Open-ended questions, Affirmations, Reflections, Summaries, evoking and working with the clients’ own views of change, rolling with resistance and avoiding argument, joining (matching the language and style to suit the client.
  • Problem solving skills — Recognising a problem, defining a problem, generating alternative solutions, deciding on one solution, evaluating the outcome.
  • Parenting skills — Observing, identifying desired behaviours, identifying unwanted behaviours, discouraging unwanted behaviours, evaluating the outcome.

Download OPEN’s Practice Elements 101 Fact Sheet here

[1] Evidence Based Programs (EBPs) are highly structured treatment programs, usually documented in manuals, and supported by empirical evidence. The evidence base for EBPs involves rigorous evaluation using an experimental or quasi-experimental design demonstrating that the program is significantly more effective than usual care on at least one relevant child or family outcome.

[2] The Benevolent Society has examples of practice guidelines for evidence-informed practice elements available here.

Sector Spotlight

“We started with a question: What practices do we want to see?”

OPEN Exchange caught up with Dr Kerry Bull, Senior Manager of Services at Noah’s Ark to hear about evidence-informed practices in action and their coaching strategy to support better outcomes.

“We know that the effectiveness of early childhood intervention services for children with developmental disabilities depends upon key workers using evidence-based strategies and engaging effectively with parents to help them meet their children’s needs”, Kerry told us.

This resulted in the Noah’s Ark Practice Manual, an online resource that provides information and resources on how to deliver evidence-informed strategies.

“The Practice Manual and coaching are implementation approaches for ensuring Noah’s Ark can remain a flexible, inclusive organisation while feeling assured that evidence-informed approaches are being delivered consistently to children and families.”

Read the full interview with Dr Kerry Bull here.