Practitioners on evidence: Karen Field
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If granted a miracle, Drummond Street Services CEO Karen Field would like to know more about the lives of her organisation's vulnerable clients.
"The biggest gap in our understanding is the changing nature of the contexts of people's lives," she says.
Drummond Street Services deliver community-based services for children and families, including counselling and programs for vulnerable families, refugees, and LQBTI and youth communities.
"We also don't always understand how much of an 'intervention dose' is enough for people with 'clusters' of risk factors or how many services people can fit into their lives."
Field says this despite her organisation having an already advanced client information system allowing caseworkers to identify, track and target the changing needs of disadvantaged families and children.
"We use population data of local communities to help inform our programs and service planning, to really understand who is in our community and what their specific needs are from our programs and services. In addition, the collection of family-level data is essential in delivering Drummond Street's evidence informed interventions to individual clients and families."
Established in 2008, Drummond Street's client record system involves a centralised intake and assessment process allowing workers to prioritise needy clients and allocate services based on needs. It contrasts to its older way of working where staff would match individuals with single-focus clinicians based only on the client's presenting issue.
"We now think of it as a public health opportunity to screen for multiple health risks, then target them with goal oriented responses - we have the tools to select the right interventions," she says.
Drummond Street also conducts public health risk assessments across multiple health and wellbeing domains to ensure it can tailor evidence-informed interventions to meet the need of individual families.
"Screening maximises the opportunity to identify and ameliorate problems early and to ensure tertiary responses are timely and effective for the whole family."
The 130-year-old organisation has always had the dual purpose of delivering services and researching ways to improve the lives of disadvantaged people. Drummond Street Services currently has a significant research team consisting of a senior researcher, research assistants and consultants.
"The researchers aim to continue to improve services to be as responsive to client needs as possible," Field says. "The days of families just coming with one issue are long gone. We see families with multiple risk issues and research allows us to target those issues but also identify issues early."
And while Field considers the social services sector's move to evidence-informed programs as encouraging, she believes that services should be guided by community and client needs.
"Multiple risk assessments require multiple interventions and often a single-issue, evidence-based program does not fully meet the needs of an individual family or client. Evidence-informed therapeutic assessment and goal-oriented interventions ensure the right programs are matched and 'wrap around a family'," Field says. "We are committed to using the best evidence to ensure the right mix of interventions to respond to dynamic risk - that is the changing needs of clients."
Drummond Street's evidence-informed approaches assist its clinicians to respond to dynamic risk and include case management, outreach, home visiting and matching the right intervention "dose" to families' needs.
"The problem with stand-alone, off the shelf programs can be adapting them while still making sound judgments based on clinical assessment tools and consultation with practitioners and families.
In real life, when client demand for services is resulting in long waiting lists, using evidence-informed processes to make decisions about adapting the intensity of interventions is equally as important as deciding which programs should be used for each client."
Field is proud of Drummond Street's clinicians' openness to this approach.
"Workers see the value in these programs, but they know they have the flexibility to respond to risk as it arises. Given our strong assessment and intervention matching processes at the client intake stage, staff make good decisions about when families are in the best position to make the most out of evidence-based programs."
Despite this, Field still sees challenges in evaluating programs within community services organisations.
"Getting good data is tricky because clients do not always follow a set plan. For example, clients find it difficult to juggle services in their busy lives, particularly as their lives begin to feel better through interventions.
Clients see improvement in their lives as enough 'right now' and it can be a challenge for planned completion and follow-up for post-outcome surveys. There are issues with program evaluations within community services organisations just because of the nature of our client's lives," she says.
The way Drummond Street has tried to resolve this is by making data collection easier for staff through online pre- and post-surveys that can be accessed anywhere with clients.
While Field welcomes the government's aim of funding evidence-informed programs, she also thinks this requires a planned capacity-building approach with each organisation, assessing their capacity and readiness to adopt evidence-informed practice.
"It's a mistake to jump straight to evidence-based programs without strong evidence-informed processes to assess and match each client to the programs they need. This is where the scale-up of evidence-based programs often fails. We need to look at each organisation's prior readiness to change to this approach - some are only starting," she says. "It's like we have just jumped to the other end of the spectrum. People need to get used to collecting and using data to identify client needs and to inform programs. It's going to take organisations time to know how to do that well."
Instead, Field believes the focus should be on using data and engagement to understand communities, before being expected to implement and evaluate evidence-based programs matched to community needs.
"There a lot of evidence-based programs out there and it's confusing - our starting point should be to better understand the communities and families we work with and getting staff inspired about using evidence to address what we know about our clients. We also need to better acknowledge the increasing complexity of vulnerable families with multiple health risks, and therefore the need for matching multiple risk interventions."
As always, a key driver for Field is allowing services to make the best evidence-informed decisions for each client.
"The biggest learning we have had is to have evidence-gathering processes to allow good decisions, and in integrating the tools, practices and programs to make those decisions," she says. "This has meant having a sophisticated model of practice as a starting point rather than solely being driven by funding, which often takes a single-issue approach to responding to family needs."
This article is part of series of practitioner profiles originally published in Family Matters No.99: Research to Results.
Read the second article of the series: Practitioners on evidence: Wendy Field