RESEARCH REPORTS Measuring outcomes in learning disability ...

Measuring outcomes in learning disability challenging behaviour servicesDiscussionThis study has described the use of force-field analysis toidentify barriers and drivers to the routine implementationof outcome measurement in learning disability challengingbehaviour teams. The analysis has shown that teams identifythe drivers and barriers that have the strongest effects, andthe biggest discrepancy between drivers and barriers, asbeing at the level of the individual clinician and individualclinical practice. Thus it seems likely that the most effectivepoints to intervene to change practice would be those at thelevel of the individual clinician.One of the most frequently cited barriers to change atthe individual level was a lack of knowledge and skillssurrounding the use of outcome measures. It is, therefore,suggested that regular training in the use of particularmeasures would be highly beneficial. It may be helpful todraw upon the existing knowledge and experience withinstaff teams. In this way, groups of clinicians could be trainedto use new measures on a regular basis, by members withinthe team who are familiar with and/or routinely useparticular measures. It is proposed that such methods wouldenhance the knowledge and skills of the clinicians, but alsothat observing examples of the use of measures by theircolleagues would build confidence and staff cohesion.Individual attitudes to change were identified as anintrapersonal barrier to improving routine outcomemeasurement. Thus, it may be useful for clinicians to beprovided with a forum in which to voice their concerns andfears (such as at the shared practice day at which thisresearch was conducted) and to discuss difficulties in usingoutcome measures with colleagues and peers. Theidentification of a named clinician with some knowledge, aparticular interest or significant experience in using outcomemeasures to which colleagues could bring queries andconcerns may help to overcome some of the negativeattitudes towards this particular change in practice.Factors at other psychosocial levels that mightparticularly merit intervention include further strengtheningof the driver “need to demonstrate effectiveness andefficiency” and challenging a perceived “lack of resourcesand funds”. It is possible that these two issues (both ofwhich score highly in terms of their impact upon the currentequilibrium) could be linked in helping the teams explorethe efficiencies possible as a result of good quality outcomeassessment that might demonstrate the “resource value” ofoutcome measurement systems.This paper has described the use of force-field analysis asa method to examine the challenges around theintroduction of effective outcome measurement. The paperhas provided important insights into clinical understandingof this issue. It is suggested that the method is a useful toolin developing understanding of organisational issues and inproducing implementation plans based upon the experienceof participants.AffiliationsJane Birrell, Clinical Psychologist, Cumbria Partnership NHSFoundation TrustProfessor Dave Dagnan, Consultant Clinical Psychologist &Clinical Director, The Learning Network, Cumbria PartnershipNHS Foundation TrustContact informationProfessor Dave Dagnan, dave.dagnan@cumbria.nhs.uk.Key ReferencesBritish Psychological Society (2004). Psychologicalinterventions for severely challenging behaviours shown bypeople with learning disabilities: Clinical Practice Guidelines.Leicester: BPSDagnan, D. (2007). Psychosocial interventions for peoplewith learning disabilities. Advances in Mental Health andLearning Disabilities, 2, 3-7.Darzi, A. (2008). High quality care for all: NHS next stagereview final report. London: Department of Health.Hatfield, D. R., & Ogles, B. M. (2004). The use of outcomemeasures by psychologists in clinical practice. ProfessionalPsychology, 35, 485-491.Lewin, K. (1951). Field theory in social science. New York:Harper & Row.Moulding, N. T., Silagy, C. A., & Weller, D. P. (1999). Aframework for effective management of change in clinicalpractice: Dissemination and implementation of clinicalpractice guidelines. Quality in Health Care, 8, 177-183.West, M. A., & Farr, J. L. (1989). Innovation at work:Psychological perspectives. Social Behaviour, 4, 15-30.8 The Cumbria Partnership Journal of Research, Practice and Learning 1(1)