Chapter Summary

In summary, the publications demonstrate strengths of a high degree of what Snell (2003) identified as social and contextual fit validity, key factors in maximising the translation of research to practice. Factors Snell highlighted include the importance of the research goals to practitioners, the practicality of the intervention procedures and the value of the outcomes for the participants and society (p.144 -145). Nine of the ten publications included working with and through non- psychologists to deliver psychological interventions with the goals of relevance to them, practical

interventions seeking outcomes in line with policy. All nine have involved the collaborating staff in planning, delivery and evaluation.

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Contextual fit, as described by Snell (2003), included:

..... the involvement of practitioners in the design of the intervention and any assessment, match between intervention and values, skills and resources of those who implement the intervention. (p.145).

High contextual or ecological validity is further demonstrated by including

participants who were complex, clinical referrals and use of few exclusion criteria.

The high social and ecological validity demonstrated compares favourably with Snell’s review finding of a social validation in only 36% of the 114 studies in their review of intervention research, 1990 - 1996 with school-aged individuals with intellectual disabilities.

Professional practice journals have been the publication route of choice reflecting the high social and contextual validity and to maximise dissemination. The publications themselves illustrate the use of applied psychology through detailed yet concise descriptions of assessment, intervention and research methods, materials,

timetables to enable replication, and choice of journal to those which will reproduce the coloured visual examples of the accessible assessment and therapy materials.

The publications also fit the framework proposed by Burton and Chapman (2004) in considering problems of evidence based practice in community based services with people with learning disabilities, critiquing Evidence-Based Orthodoxy (EBO). They note that:

….. randomised clinical trials-the gold standard for EBO-in particular give us little understanding of why and when things do or do not work. p 59.

Burton and Chapman (2004) also suggest that useful, applicable research needs to take account of social, psychological and practical aspects of real life problems, in real settings, with staff who generally want to do a good job but may not have access to research, training or support. They argue that appropriate evidence which does do this can be conceptualised over three levels:

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 Micro evidence: from practice with individual people or small groups

 Meso evidence: from local studies, evaluations, audits

 Macro evidence: from published studies

Another change over time apparent from the chronological analysis of the presented publications was a decrease in the robustness of the methodology used. Reflecting on likely factors for this, possibilities include reduction in access to assistant

psychologists, narrowing of expectations of roles of psychologists driven by a need to maximise individual direct client contacts, pressures of reduced psychology resources and a decrease in the priority afforded to research by psychologists in general clinical work (by both psychology services and the services in which they are embedded). The publication of the Research Governance Framework for Health and Social Care (DH, 2001) increased the demands of the research governance

framework with the intention of driving up research quality. Good Practice Guidelines for the Conduct of Psychological Research within the NHS (BPS, 2005) noted that some of the framework’s impact was acting as a barrier to clinical psychologists undertaking research, one of our core skills. The conduct of Research Ethics

Committees, for example, was recognised of value in refining a project and ensuring that it is ethically acceptable, however, “… not infrequently the comments seem to reflect confusion and ignorance about the nature and value of psychological

research to the NHS” (p.5).Consequences for clinical psychologists included delays necessitating extension of periods for professional training and research projects which delay qualification, and clinical psychologists being discouraged from planning and applying for research because of the burdensome and inconsistent bureaucracy.

The involvement of service users within the publications increased over the time.

This reflects the recognition of the importance and value of service users in planning, undertaking and evaluating research (INVOLVE, 2004, 2009; DH, 2006). With links to consumer-focused and democratic concepts of involvement in policy, practice and service development (Beresford, 2002), service user involvement in research is characterised along a continuum from no involvement through consultation to collaboration and service user led research. Issues of diversity, communication, professional, institutional and social attitudes and power influence the nature of

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service user involvement and how collaborative or tokenistic it is. The involvement of services users in the publications presented includes feedback and individualised interventions developed onto date. The use of service user feedback enabled triangulation of data across quantitative and qualitative data and across multiple informants (i.e. both service users and carers). The role of user involvement in the two research developments I currently lead has increased. Service users have collaborated in the identification of the research questions, planning the design, preparing funding applications, development of materials (information, invitation, consent, and intervention resources) and will participate in evaluation and

dissemination (see Auto-ethnography, Appendix 2, 5.2).

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6 Conclusions, reflections and recommendations