Social Work - Theses
Permanent URI for this collection
Search Results
1 - 2 of 2
-
ItemImplementation frameworks – their usability and limitations within child, youth and family services( 2020)Purpose This thesis is located at the nexus of research-supported interventions (RSIs) in child and family services, evidence-based practice and implementation science. Within the context of Australian child and family services, it focuses on the implementation problem, i.e. the sector’s persistent problems with integrating evidence in routine practice. Its overarching goal is to examine how implementation frameworks have been and can be used to understand efforts to implement RSIs in this sector, and how these frameworks, and potentially any other implementation science concept, may be more effectively moved into routine child and family services in the future. Methods This research builds on a mixed-methods design and was conducted in three phases. During phase one, the scoping review method was used to identify studies conducted within child and family services and explore how implementation frameworks were used in the sector. In phase two, one particular implementation framework, the Consolidated Framework for Implementation Research, was applied to understand the barriers to the Australian implementation of multiple RSIs developed in the United States. The examination of the failed implementation of Multisystemic Therapy-Emerging Adults in New South Wales built on a case study design, whereas the early implementation of multiple US-based RSIs in Victoria was evaluated using mixed methods. Finally, during phase three, in developing a proposal for how to better bridge the implementation research-practice divide, the systematic integrative review method was instrumental for the development of a program logic for the role of implementation support practitioners. Results The use of implementation frameworks in child and family services studies has been cursory, and limited guidance is available on how to operationalize them in contexts of routine practice. The Australian experience with implementing US-based RSIs reflects that implementation frameworks insufficiently mirror the implementation challenges these interventions impose on stakeholders. While frameworks map implementation as a tidy and linear collection of determinants, real-world implementation occurs as a dynamic, both concurrent and recurrent interaction between multiple implementation factors. Particularly limited are the insights that frameworks provide to understand the role of the outer setting, containing, for example, policy dynamics, in an implementation. The role of implementation support practitioners may be a relevant strategy for integrating implementation research in routine child and family services, but the evidence surrounding their work and effectiveness is scarce and will require further consolidation. A first program logic outlining how ISPs may build implementation capacity in child and family services is presented. Conclusion To solve the implementation problem, strategies are needed that can help to create a new normal. One in which research-minded decisionmakers, operating in the child and family services sector, constantly request and use evidence in their daily routines, and practice-minded scientists work to spur this use in all areas of policy and practice. Implementation support practitioners may be one such strategy. To better understand the characteristics, activities, and contexts required for this role to be effective will be a key task for the decade ahead – both for the child and family services sector and the field of implementation science.
-
ItemInforming NDIS market stewardship through consumers’ information preferences: An exploratory study( 2020)Australia’s policies have historically seen many people with disability (PWD) confined to institutions, abused, neglected and systemically denied the right to self-determination (Barnes & Sheldon, 2010; Oliver, 1992). It follows that many PWD have typically lacked choice over which services are involved in their lives. An ideology of choice has emerged in the context of publicly funded disability services, influenced by ideas associated with neoliberalism and new public management (Fotaki et al., 2008). Some welfare-state services have been “personalised” (Needham, 2011), such as Australia’s National Disability Insurance Scheme (NDIS), which uses a marketplace model to offer consumers choice about what support to purchase (Fawcett & Plath, 2014). The NDIS is not a conventional market in a neoclassical sense – it is a quasi-market, seeking a way to manage considerations of both efficiency and equity. Within this context, there is an important role for “market stewardship” to balance these tensions (Carey, Reeders, et al., 2018). Choice can create not only self-determination for consumers, but a burden (Glendinning, 2008), and information is required to support the process of NDIS decision-making. However, there is limited evidence about what information is required. In this regard, a significant gap exists in the market stewardship literature, especially around knowledge that is driven by consumer preferences rather than provider or government priorities. This research explores what information is required for NDIS consumers to feel informed when choosing service providers. It is a social work practice research study, examining a problem identified through practice with the aim of addressing it (Sim et al., 2018). Data was collected in two phases. The first utilised semi-structured interviews (n=23) to explore informational issues in depth while gathering data to inform the construction of a survey. This survey comprises the second phase, extending the sample to test the generalisability of the results (n=201). Results show that word of mouth information from trusted interpersonal relationships is valued, as is information from and about professionals. This suggests that decades of oppression of PWD and professionalisation of service navigation have resulted in consumers’ mistrust regarding information from service providers and government (Walsh, Wilson, Baines, & Martin, 2012), which is compounded by the complexity of the new NDIS system (Malbon, Carey, & Reeders, 2018). Participants therefore rely on trusted peers and professionals for reliable information. This reliance is problematic because it stalls capacity building for both consumers and providers and decreases the urgency to implement market stewardship interventions. Furthermore, it can lead to riskier decision-making and poorer outcomes (Hakansson & Witmer, 2015; Schul & Peri, 2015) and relies on consumers having strong social networks, which puts equity outcomes at risk as well as the success of the insurance scheme. This thesis contributes new knowledge to the market stewardship literature and also to practice. Academic findings are described above. Practical recommendations include deprofessionalising service navigation in order to decrease the information asymmetry that exists; using peer advisors to distribute information throughout the sector; helping providers create trustworthy information through their marketing collateral; creating sector-wide metrics; investing in shared digital solutions in order to collate and distribute information; and localising NDIS governance so as to create rich local information.