Where’s The Evidence For Evidence Based Practice In Your Organisation?

The use of the term “evidence based practices” by organisations to promote and differentiate themselves from other service providers is almost the norm these days. No doubt with the coming of the NDIS we’ll be bombarded with another round of me to ism’s, along with the other favourite; “world’s best practice”.

But the question for me is whether you can provide the actual “evidence” that your business practices are indeed evidence based. Let’s look at the current cause célèbre; “person centred practice”

Now you might ask what’s the issue, particularly given that most if not all government funded programs must be person centred centred. Mel Schlaeger in her blog wrote that person centred simply meant being responsive to the person and what they’d like. Mel also wrote that it meant providing support that is flexible in nature and meaningful to the person with a disability.

The principles behind person centredness have been around for over fifty years. Carl Rogers in the fifties announced his theories which are centred on the therapeutic capacity to provide clients with an opportunity to develop a sense of self wherein they can realise how their attitudes, feelings and behavior are being negatively affected and make an effort to find their true positive potential (early stages of self determination?).

In terms of disability service delivery, person centred planning was created in response to some specific problems with the way in which society responds to people with disabilities. It was initially described as responding to the processes and the effects that ‘services’ can have on people’s lives. Person centred planning is based on the social model of disability that places the emphasis on transforming the options available to the person, rather than on ‘fixing’ or changing the person.

The principles which underpin most person centred service provision were crystallised by John O’Brien and Connie Lyle O’Brien in their ‘Framework for Accomplishment’ which lists five key areas important in shaping a person’s quality of life, and asserts that services should be judged by the extent to which they enable people to:

• Share ordinary places
• Make choices
• Develop abilities
• Be treated with respect and have a valued social role
• Grow in relationships

Now you might ask, what’s the problem? Well, let me draw your attention to one of John O’Brien’s quotes regarding service delivery models.

“Many human service settings are zones of compliance in which relationships are subordinated to and constrained by complex and detailed rules. In those environments, unless staff commit themselves to be people’s allies and treat the rules and boundaries and structures as constraints to be creatively engaged as opposed to simply conforming, person centred work will be limited to improving the conditions of people’s confinement in services”

There’s an inbuilt tension between staff and service organisations in delivering person centred services. On one hand you want what’s best for the client, on the other hand the resources are limited and the compliance costs are high.

Now person centred practice implies an individualised approach to service delivery, but how can an organisation meet it’s compliance and funding requirements and still provide a service that truly honors person centred principles? Where’s the evidence that it actually delivers a person centred service? Surely not by meeting funding compliance models?

Given that individuals are unique – well aren’t we? – how can a standardised approach actually work and what’s the evidence to say that it does?

Person Centredness is essentially a philosophy in action, rather than a set of concrete rules. Sure we have guiding principles, but organisations that provide person centred services must be providing individualised services, not one based on organisational operating procedures.

A number of years ago I witnessed an organisation that was about to undertake its regular government audit of its practices, systematically replicate all its client person centred plans based on a cookie cutter formula. Once completed, a senior staffer interviewed all the clients to ensure that they agreed with what was in their plan. Compliant with the audit procedure but not exactly person centred, however it does fit with John O’Brien’s previously mention quote.

So how does this fit with evidence based practice and more importantly the actual evidence of practice? With the NDIS ringing in my ears and the possibility that 80% of participants will not self manage, but potentially engage their previous supplier of services, it’s important that we shift from a compliance based regime of service delivery to a real person centred system, where the clients needs are front and centre and that compliance isn’t the real driver of service delivery.

How do we do this? Well, we could start with service providers actually putting together teams to document and collect evidence from the clients and developing practices that are innovative and that are truly client centred. Innovation doesn’t come from one or two people but from a company that provides opportunities for all staff to innovate. Take off the compliance shackles and let staff who are working with clients document what they do and how effective it is in meeting clients needs. Two things might happen; 1) If staff are allies of the client and help the client to push the boundaries, then innovation and imagination work to create new ways of delivering what the client wants, 2) person centred practice actually does become a philosophy in action. The outcome of this will be evidence of what actually works and what doesn’t work.

Create a person centred culture from the ground up, not based on an edict from up high. Right now organisations are spending up big on attending person centred workshops to train management on what to do within the NDIS “person centred framework”.

That’s a mistake! Train the staff at the ground level and allow them to work with the client, document, learn and innovate from the shop floor.

Back to my original proposition about where’s the evidence. Where is it? Well it’s out there, but instead of waiting for someone to point it out to us in a journal or workshop, start by collecting it yourself, analysing it and letting your organisation use evidence based practices that are truly person centred and reflect the unique clients and environment that you operate in.

What are you waiting for?

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About Peter Smith

Disability practitioner at Praxis Disability Consulting, PhD researcher - Sydney Medical School, Research affiliate - Centre for Disability Studies, Sydney. Lecturer in Counselling and Case Management - ACAP. Counsellor and Psychotherapist at Praxis Counselling and Therapy. Interests: Disability employment, person centred practice, self determination theory, existential therapy, personal counselling
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