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Implementing key worker services: a case study of promoting
evidence-based practice
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Mukherjee, S orcid.org/0000-0002-9012-0369, Sloper, P, Beresford, B
orcid.org/0000-0003-0716-2902 et al. (1 more author) (1999) Implementing key worker
services: a case study of promoting evidence-based practice. Joseph Rowntree
Foundation, York.
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a case st udy of promot ing
evidence-based pract ice
The failure of research findings to influence practice is well established,
particularly in the field of social care. Provision of information alone rarely
results in change. A project recently completed by the Social Policy Research
Unit, University of York, took an innovative approach to the issue of
translating research into practice. The project found:
On im plem en t in g cha n ge:
In co rpo ratin g w h at is kn o w n abo ut ch an ge m an agem en t an d th eo ries o n
suppo rtin g th e creatio n o f effectiv e w o rkin g gro ups w as essen tial to th e
success o f th e pro ject.
Th e im plem en tatio n o f m ulti-agen cy ch an ge w as assisted by : th e use o f
ex tern al facilitato rs; tim e o ut fo r plan n in g m eetin gs; draw in g up detailed
actio n plan s; co m m itm en t fro m m an agers in all agen cies; an d effectiv e
co m m un icatio n betw een all th o se in v o lv ed in th e pro ject.
On t he key w orker service:
Fo r fam ilies, th e distin guish in g features o f ‘go o d’ key w o rkers w ere: pro
-activ e co n tact; a suppo rtiv e, o pen relatio n sh ip; a h o listic fam ily -cen tred
appro ach ; w o rkin g acro ss agen cies; w o rkin g w ith fam ilies’ stren gth s an d
w ay s o f co pin g; an d w o rkin g fo r th e fam ily as o ppo sed to th e agen cy . Wh en
th ese elem en ts w ere in place, fam ilies clearly felt th e serv ice w as ben eficial
an d o ffered a differen t fo rm o f suppo rt fro m o th er serv ices th ey receiv ed.
Paren ts repo rted th at n o t all pro fessio n als iden tified as key w o rkers h ad truly
assum ed th e key w o rker ro le.
So m e practitio n ers ex perien ced difficulties in takin g o n th e key w o rker ro le.
A clear un derstan din g o f th e ro le an d pro tected tim e to carry it o ut w ere
im po rtan t.
A suppo rtiv e m ulti-agen cy o rgan isatio n al co n tex t, an d o n -go in g train in g,
superv isio n an d m o n ito rin g o f key w o rkers w ere th e im po rtan t elem en ts in
en surin g a co n sisten t serv ice.
J O S E P H R O W N T R E E
Background
Th e failu re o f research t o in flu en ce p ract ice is st rikin g. Effo rt s by research ers t o brin g abo u t evid en ce-based p ract ice h ave o ft en co n cen t rat ed o n d issem in at in g research fin d in gs, bu t in fo rm at io n alo n e is rarely su fficien t . A co n sid erable lit erat u re n o w exist s o n ch an ge m an agem en t , an d it is clear t h at effo rt s t o p ro m o t e evid en ce-based p ract ice can gain fro m in co rp o rat in g wh at is kn o wn abo u t im p lem en t in g ch an ge. Th is is p art icu larly relevan t t o t h e in t ro d u ct io n o f a m u lt i-agen cy service, sin ce it in vo lves ch an ge at t h e in d ivid u al, in t ra- an d in t er-o rgan isat ier-o n al levels.
In t h e area o f services fo r d isabled ch ild ren , fo r o ver 20 years bo t h research an d p o licy
reco m m en d at io n s h ave ackn o wled ged t h e n eed fo r fam ilies t o h ave a m u lt i-agen cy ‘key’ o r ‘lin k’ wo rker. Research h as sh o wn t h e p o sit ive effect s fo r fam ilies yet st ill less t h an a t h ird o f fam ilies o f d isabled ch ild ren h ave su ch a service. Even wh en su ch a service is available, it is o ft en o n an ad hoc basis, relyin g o n t h e in it iat ive o f an in d ivid u al p ro fessio n al.
Th e research t eam wo rked in p art n ersh ip wit h rep resen t at ives fro m h ealt h , ed u cat io n , so cial services an d vo lu n t ary agen cies in t wo areas t o p lan ,
im p lem en t , m o n it o r an d evalu at e p ilo t key wo rker services. Man agers fro m t h e t wo areas were in t erest ed in d evelo p in g t h e key wo rker service an d t o o k resp o n sibilit y fo r it . Th e research t eam act ed as facilit at o rs.
The approach
Th e research t eam ’s ap p ro ach was n o n -p rescrip t ive an d facilit at ive. A m u lt i-agen cy st eerin g gro u p o f st aff in each sit e wo rked wit h t h e research t eam o ver t h e co u rse o f t wo years. Th e st eerin g gro u p s’ exp ert ise in d evelo p in g an d m an agin g services was st ressed . Th e research t eam wo rked wit h t h e sit es t h ro u gh a series o f fo u r wo rksh o p s, su p p lem en t ed by t elep h o n e co n t act an d o ccasio n al sit e visit s.
Th e t asks fo r t h e st eerin g gro u p s were:
•
to form m u lti-agen cy workin g grou p s an d d evelop p lan s for a p ilot key worker service;•
to review p rogress on p lan s, an d refin e th em for th e im p lem en tation of th e p ilot services;•
to review im p lem en tation an d wh at h ad been learn t;•
to d raw u p gu id elin es an d p lan for th e fu tu re.Th e p roject d efin ed a key worker as:
A named person whom the parent approaches for
advice about any problem related to the disabled
child. The key worker has responsibility for
collaborating with professionals from their own and
other services. Workers performing this role may
come from a number of different agencies, depending
on the particular needs of the child.
Each staff m em ber ch osen to act as a key worker worked with on e fam ily, in ad d ition to th eir n orm al role. Th ese staff m em bers cam e from a variety of backgrou n d s. Key workers worked in five m ain sp h eres of su p p ort: em otion al su p p ort; in form ation an d ad vice to th e fam ily; id en tifyin g an d ad d ressin g n eed s; ad vocacy; an d service co-ord in ation . In th ese activities, th is in volved liaisin g with oth er p rofession als both with in th eir own agen cy an d in oth er agen cies. Th e exten t to wh ich a key worker u n d ertook th ese activities d ep en d ed u p on th e fam ily’s n eed s an d stren gth s. Th is h igh ligh ts th e n eed for key workin g to ad op t a flexible, in d ivid u alistic ap p roach .
Research fin d in gs on key worker services - as well as on m an agin g ch an ge in organ isation s, facilitatin g join t workin g an d form in g effective grou p s - were u sed in p lan n in g an d ru n n in g worksh op s. In form ation was com m u n icated at th e p oin t it was relevan t an d m ean in gfu l. Particip an ts were en cou raged to take a learn in g ap p roach to im p lem en tation , reflectin g on p rogress an d reviewin g p lan s accord in gly.
Promot ing change and mult i-agency
w orking
Both sites p lan n ed an d im p lem en ted p ilot m u lti-agen cy key worker services. At th e en d of th e p roject, th e sites’ steerin g grou p s id en tified key factors wh ich con tribu ted to th e su ccess of th e p roject:
•
‘tim e ou t’ for p eop le from d ifferen t agen cies wh o will steer th e service to com e togeth er, get to kn ow each oth er, an d work togeth er as a grou p ;•
extern al facilitators to p rom ote th is an d to d raw atten tion to grou p p rocesses;•
d etailed action p lan s at an in d ivid u al an d agen cy level;•
com m itm en t from m an agers in all agen cies, in clu d in g: d irect in volvem en t in steerin g grou p s; ch am p ion in g an d p rom otin g th e service; an d d rivin g th e p roject forward ;•
effective com m u n ication with all th ose in volved in th e p roject th rou gh ou t th e d evelop m en t an d im p lem en tation of th e service.Parent s’ view s of t he service
Paren ts felt th at n ot all p rofession als iden tified as key workers h ad tru ly assu m ed th e role. Som e very con sisten t th em es em erged from paren ts’ accou n ts of wh at th ey saw as a positive exp erien ce of key workin g:
•
Pro-active regu lar con tact in itiated by th e key worker. Th is was h igh ly valu ed an d cen tral to wh eth er or n ot p aren ts p erceived th em selves as tru ly h avin g received a key worker service.•
A su p p ortive, op en relation sh ip between th e keyworker an d th e p aren ts.
•
A fam ily-cen tred ap p roach , ackn owled gin g an d exp lorin g th e n eed s of all fam ily m em bers, n ot ju st th e ch ild .•
W orkin g across agen cies.•
W orkin g with fam ilies’ stren gth s an d p referred ways of cop in g, n egotiatin g th e in p u t n eed ed from th e key worker.•
W orkin g for th e fam ily rath er th an for an agen cy or with in a sp ecific p rofession al role. Th is was im p ortan t as it d eterm in ed th e key worker’s ability to act as an ad vocate for th e fam ily.Support ing a good key w orker service
Evalu ation of th e p ilot services sh owed th at th e service provided by key workers varied both between th e two sites and with in each area. Reason s wh y practition ers h ad difficu lty takin g on th e role in clu ded: n ot h avin g su fficien t tim e, p articu larly for m akin g h om e visits an d liaisin g with oth er p rofession als; p roblem s organ isin g cover du rin g m atern ity an d sick leave; th e con fu sion cau sed by bein g in volved with a fam ily as a key worker an d in an oth er profession al cap acity; an d n ot
u n derstan din g th e key worker role or th e type of su pp ort th ey were exp ected to offer to fam ilies. Key workers ackn owledged two advan tages to takin g on th e role; im provem en ts in m u lti-agen cy workin g an d in relation sh ips with fam ilies.
Man agers in volved in th e im plem en tation felt th at it h ad been an extrem ely valu able ven tu re an d learn in g exp erien ce. In both areas, th ey are com m itted to in corporatin g a key worker service as part of th e su pp ort th ey offer to fam ilies with a disabled ch ild.
It was clear th at th e ability of th e key worker to take on th e role dep en ded on two factors:
•
First, th ere n eeded to be som e existin g degree of join t workin g, an d a com m itm en t to prom ote an d su pp ort m u lti-agen cy workin g. W h ile key workin g m ay well m axim ise m u lti-agen cy workin g, it can n ot m ake it h ap p en .•
Secon d, key workers h ad in itial an d on goin g train in g an d su pervision n eeds. Th is was facilitated in on e site by appoin tin g a co-ordin ator of th e service. On reflection , both sites felt th at su ch a co-ordin ator was essen tial. Providin g som e su pervision in m u lti-agen cy grou ps was u sefu l in allowin g key workers to learn from each oth er.Lessons for best pract ice
Th e two areas took d ifferen t ap p roach es to
im p lem en tin g th e service. Drawin g on th e su ccesses an d d ifficu lties en cou n tered in th e two areas, th e research ers an d th e steerin g grou p s con clu d e th at oth ers wish in g to im p lem en t key worker services n eed to ad d ress th e followin g:
Cont ext s a nd resources
•
Som e d egree of join t workin g between key statu tory agen cies n eed s to be in p lace before settin g u p a m u lti-agen cy service.•
An y n ecessary fu n d in g n eed s to be secu red in th e early stages of im p lem en tation .•
All agen cies, an d d ep artm en ts with in relevan t agen cies, n eed to be com m itted to th e con cep t.Pla nning t he service
•
Steerin g grou p s n eed to be firm ly rooted with in th e organ isation s to en su re th at wh en on e p erson leaves th e grou p th eir p lace is taken by som eon e else.•
All th e key stakeh old ers n eed to be kep t fu llyin form ed an d , wh ere ap p rop riate, in volved in p lan n in g an d d evelop in g th e key worker service.
•
A very clear m od el of th e key worker service an d jobd escrip tion sh ou ld be d evelop ed .
•
Th e con strain ts th at certain occu p ation s or p rofession s p lace on an in d ivid u al’s ability to be a key worker sh ou ld be taken in to con sid eration .Support ing key w orking
•
A co-ordin ator with respon sibility for day-to-day m an agem en t of th e service, in clu din g th eorgan isation of train in g an d su pervision , is essen tial.
•
Provid in g som e su p ervision in m u lti-agen cy grou p sis valu able.
•
Key workers n eed to be given p rotected tim e for th eir role. Staff wh o take on th e key worker role n eed to go th rou gh a selection p rocess to en su re th ey h ave ap p rop riate p erson al q u alities an d to id en tify an y train in g n eed s.•
Th ere n eeds to be an acceptan ce across allan d n ot con strain ed by an y oth er p rofession al or statu tory respon sibilities th ey m ay h ave.
Conclusion
Th is p roject su p p orts th e growin g argu m en t th at research evid en ce alon e - h owever attractively or p ersu asively p resen ted - is n ot en ou gh to p rom ote ch an ge even wh ere th at ch an ge is d esired . Oth er resou rces are eq u ally im p ortan t. In th e case of th is p roject resou rces su ch as ad eq u ate ‘tim e ou t’ for p lan n in g an d reviewin g p rogress, an awaren ess of (an d ad d ressin g) issu es su rrou n d in g m u lti-agen cy grou p workin g, an d th e in volvem en t of extern al facilitators were key to p u ttin g evid en ce in to p ractice. W h ile th ese sorts of resou rces m ay n ot always be available, th ere are oth er ways in wh ich research ers can m ore effectively brid ge th e research -p ractice gap . In p articu lar, p articip an ts in th is p roject su ggested p rovid in g resou rce p acks wh ich cou ld be u sed by a
local ‘ch am p ion ’ to p rom ote a sp ecific ch an ge. Th is p ack m igh t in clu d e d etails of relevan t research an d ch an ge m an agem en t; su ggested worksh op stru ctu res (in clu d in g m aterials su ch as overh ead s); tem p lates of action p lan s; an d a list of con tacts with au th orities wh o alread y h ave im p lem en ted th e d esired ch an ge. Su ch a p ack will be p rod u ced for th is p roject.
About t he st udy
Th e p roject took p lace over two years an d in volved research ers workin g with m an agers an d p ractition ers d rawn from h ealth , ed u cation , social services, an d volu n tary agen cies in Mid d lesbrou gh an d North East Lin coln sh ire. Pilot services, in volvin g a total 27 key workers, were d evelop ed an d im p lem en ted across th e two areas. Research ers m on itored th e im p lem en tation p rocess th rou gh ou t. Toward s th e en d of th e p roject, th e p ilot services were evalu ated via in terviews with key workers, p aren ts, an d m an agers.
Published by the
Joseph Rowntree Foundation
The Homestead, 40 Water End, York YO30 6WP Tel: 01904 629241 Fax: 01904 620072 http:/ / www.jrf.org.uk
ISSN0958 -3084
J O S E P H
R O W N T R E E
F O U N D AT I O N
The Joseph Rowntree Foundation is an independent, non-political body which has supported this project as part of its programme of research and innovative development projects, which it hopes will be of value to policy-makers, practitioners and service users. The findings presented here, however, are those of the authors and not necessarily those of the Foundation.
D39
D ECEM BER 1 9 9 9
Two reports on this project are available:
Real change not rhetoric: Putting research into practice in multi-agency services, by Patricia Sloper,
Suzanne M ukherjee, Bryony Beresford, Jane Lightfoot and Patricia Norris, is published for the Foundation in late November by The Policy Press (ISBN 1 86134 207 1, price £12.95). This describes the project’s innovative approach to implementing evidence-based change in a multi-agency context . This report will be of interest to those responsible for promoting and implementing service changes which involve inter-agency working, and researchers who wish to consider different ways of working with services to implement research findings.
Unlocking key working: An analysis and evaluation of key worker services for families with disabled children, by Suzanne M ukherjee, Bryony
Beresford and Patricia Sloper, is also published for the Foundation by The Policy Press as part of the
Community Care into Practice series in early December (ISBN 1 86134 208 X, price £13.95). It will be of interest to managers and practitioners concerned specifically with the development and implementation of key worker services.
