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CHAPTER EIGHT DECISION MAKING PROCESSES & LEARNING
8.1 Introduction
It is already known that decision making processes are a complex interplay of influences and evaluation of other complex initiatives shows that decision making is often based on a combination of factors that includes 'common sense' and experience and, rarely, research evidence alone (King's Fund, 2004). As has been shown in chapter four, Choose Life work is being taken forward through partnerships which are often large, diverse and evolving. Local decision making processes for Choose Life varied depending on the strategy group's locus, authority, links and membership.
With this in mind, the section considers the different stages of decision making for Choose Life and provides an outline and discussion of the learning resources used at each stage.
8.2 Descriptions of approaches to learning and planning/decision making
Key decision making stages were the initial planning process (and revisions to the initial plan), implementation and future planning. In line with other planning processes, learning resources and knowledge varied at each stage of the process. This is outlined in table 8.1.
Table 8.1 Stage of decision making/planning and types of knowledge and learning
Stage of Decision making | Type of knowledge and learning |
|---|
Stage O: Pre- Choose Life activities and learning/knowledge | Existing, e.g data already collected |
Stage One: Initial planning process | Needs assessment/service mapping
Consultation/open space
Local knowledge/stakeholder knowledge/input
Evidence of effectiveness
Suicide data
Choose Life strategy document and national guidance |
Stage Two: Revising initial plan | Negotiation and reflection by stakeholders |
Stage Three: Implementation | Monitoring, e.g. outputs/outcome data
Programme/project evaluation
Specifically commissioned resources, e.g. Resource toolkit or research reviews.
Sharing learning across local areas/nationally |
Stage Four: Future Planning | Monitoring e.g. outputs/outcome data
Programme/project evaluation |
We intend to illustrate below how different sources of learning are utilised at distinct decision making stages, and identify key issues and implications emerging from these.
8.2.1 Stage 0: pre-Choose Life activities and learning/knowledge
In many areas, there were existing resources in place to aid decision making, including existing data, local research evidence and learning infrastructures.
Use of data
A variety of sources routinely collected data prior to Choose Life. For example, GROS, the police, health boards and procurator fiscals were able to provide data on suicide and self-harm. Less commonly, suicide data that helped decision-making were collected locally from corporate personnel records, counselling services, drug related death records, records of hospital presentations, Local Authority, Psychiatric Liaison Service, Registrar and Suicide Review Groups (in one area each).
A key use of data, as stated by coordinators, was to provide a better picture of local prevalence and risk factors and to assist in the identification of gaps and priorities. Data were also used as an awareness raising tool. In some areas, data were specifically collected to inform the planning process. For example, in one area, procurator fiscal data on all local suicides and undetermined deaths were collected across a five year period. This fed into the decision making process by illustrating key themes in suicides around substance misuse, bereavement and mental health issues, resulting in a strong focus upon these priorities in the local action plan.
Some local debates reflected the challenges presented when there is an indication of high rates of suicide within small geographical areas. This could lead some partners to demand a strong focus on a localised approach to suicide prevention. Individuals in partnerships with skills in data interpretation expressed caution in the use of data alone in planning and highlighted concern regarding small numbers across local authority areas and fluctuating/unstable trends. More often in these areas, data were combined with other learning resources or were used in conjunction with national statistics. An early task for NIST was to provide local areas with standardised data.
Existing research and knowledge
There were some examples where research or consultation on particular risk groups (e.g. young men, children/young people) had been undertaken prior to Choose Life. In some cases suicide prevention partnerships that pre-dated Choose Life had already reached decisions about local priorities that then fed into the Choose Life planning process.
Box 8.1 Commentary Decision making was rarely based on data alone; other sources of knowledge were also accessed. Information as a resource was most effective where there were skills within the partnership that could advise on the most appropriate use of data and advise caution on its limitations. However, it was also evident on some occasions that data were used to back up and influence decision making in support of individual priority groups, even when numbers of suicides were low. The provision by NIST of standardised information and guidance has helped to improve local 'intelligence' in the planning process. Where work was underway or existing research on local priorities existed, this was helpful in developing a partnership for Choose Life and in setting priorities for action based upon locally identified need. It was important to ensure that partners did not use their position to favour particular groups, especially where evidence of local need was not lacking. |
8.2.2 Stage One: initial planning process
For planning/identification of priorities
Consultation/open space
Local stakeholder consultation was a key approach used across local areas in order to set priorities for implementation. Approaches taken to consultation varied from small stakeholder events to open space activities that generated interest from large numbers of stakeholders. This process generally explored the relevance of Choose Life priorities to the local area and highlighted gaps in service provision based on local practitioner expertise and knowledge. In only a few areas was consultation used to identify the foci for intervention. Consultation was also believed to have engaged local stakeholders in the planning process and to have raised awareness of Choose Life across local services and organisations.
Needs assessment
Around half of the local areas stated that some form of needs assessment was undertaken to identify local priorities in terms of risk groups and gaps in local services (e.g. information and awareness raising) and/or to inform overall planning. In some cases a needs assessment was undertaken to clarify evidence from other sources. For example, in one case study area a decision to fund a needs assessment was made because it was felt that while available data, evidence and stakeholder events had led to the identification of broad priorities, they had been less successful in pinpointing local community needs.
Local knowledge/stakeholder knowledge/input
In some areas planning was primarily focused upon the experiences and knowledge of those within the Choose Life partnership or was combined with the use of other resources (e.g. data) to inform decisions. This model relates to the role of infrastructures in decision making and the links that are in place to different structures and services.
Examples of this were where stakeholders identified priorities from working with a specific client group, or were aware of other local risk factors (e.g. substance misuse culture, or socio-economic inequalities). The dominance of partners representing certain priority groups or where research on a particular priority group existed could influence strategic direction. This was suggested in three case study areas in relation to a focus on children and young people.
The negative effects of strategy being influenced by personalities around the table were also apparent. For example, a lack of representation from substance misuse services led to lower prioritisation of this issue in some areas.
The role of local politicians and pressure groups working on suicide prevention varied and appeared to have been of most significance where there were high profile suicides in the locality. In one case study site the impact of media attention to suicides generated interest in the local action plan from stakeholders lobbying for suicide prevention and by local counsellors and senior managers who had questioned the priorities set and focus of implementation for the local action plan. Feedback from the case study workshop, however, indicated that awareness raising through Choose Life had improved local political understanding and support for the issue throughout the implementation process.
Box 8.2 Commentary The importance of neutrality in leadership of the partnership appeared to be key in ensuring that decisions were not biased in favour of particular agendas or priorities. Where a clear and transparent process had been undertaken this had also improved ownership and the commitment of partners to the strategy. Where areas had undertaken a process, e.g. through the use of consultation, this had helped to raise local awareness of Choose Life at an early stage (although it was also important for areas to continue to sustain this early interest throughout phase one and build partnerships with local services/organisations). It could be difficult to separate the decision making process from the impact of wider contextual influences. (In the case of children and young people, for example, it is difficult to separate out the impact of dominant partners from other concurrent national policy pressures in relation to this group.) |
The importance of neutrality in leadership of the partnership appeared to be key in ensuring that decisions were not biased in favour of particular agendas or priorities. Where a clear and transparent process had been undertaken this had also improved ownership and the commitment of partners to the strategy. Where areas had undertaken a process, e.g. through the use of consultation, this had helped to raise local awareness of Choose Life at an early stage (although it was also important for areas to continue to sustain this early interest throughout phase one and build partnerships with local services/organisations). It could be difficult to separate the decision making process from the impact of wider contextual influences. (In the case of children and young people, for example, it is difficult to separate out the impact of dominant partners from other concurrent national policy pressures in relation to this group.) For interventions
Interventions based upon practitioner/professional knowledge
Practitioner/professional led approaches were highlighted as a key resource in decision making about interventions in both coordinator surveys and case studies. This approach generally led to the allocation of Choose Life funding to pre-existing activities or to known local organisations which were piloting new approaches. Local stakeholders stated that such interventions (or organisations) were trusted by and familiar to professionals, and were considered to have a good track record (e.g. clients were already being referred to the service/organisation by local professionals). This approach was also influenced by issues of sustainability. That is, it was felt that funding existing local activities would contribute to building local and organisational capacity, e.g. by drawing upon existing skills and experience. A further issue influencing this approach was that it avoided the often lengthy start up period for new projects that could affect the potential to demonstrate impacts within the set funding period.
Stakeholders in some partnerships were encouraged to use local networks to identify interventions and approaches that would meet agreed priorities. In one case study area, the coordinator encouraged local partners to use their networks in order to identify ideas for community and voluntary activities that were then presented back to the group for review. Although feedback from local stakeholders emphasised that the decision making process had been transparent, one stakeholder was uncertain about the inclusiveness of the process.
Targeting innovation
Some local areas were keen to generate innovative approaches to suicide prevention and this affected the approach taken to decision making. For example, in one case study area, the priorities for the local action plan were agreed through consultation and use of existing commissioned research on suicide prevention. In order to generate innovation, invitations for all community and voluntary project bids were circulated across the city. Another approach was to combine support for innovation with the need to achieve 'quick wins' by drawing upon more 'trusted' approaches, e.g. funding to national organisations or existing local organisations.
Interventions based upon local evidence of effectivenes /evidence from elsewhere in Scotland
Local knowledge could also inform the development of interventions. It was believed that, if the intervention was developed in response to locally defined needs, it would be more likely to gain acceptance from the local community in which it operated. This also applied to interventions that had been undertaken in other areas of Scotland, e.g. through organisations with expertise in key Choose Life areas (e.g. self-harm, bereavement or crisis).
Research evidence
There appeared to be infrequent use of international research evidence in order to aid decision making about interventions. Challenges in using the evidence base were primarily attributed to an overall lack of evidence about effective suicide prevention interventions (see box 8.3 below). Lacking skills in being able to interpret evidence was also highlighted as a barrier to its use. In one case study area, the local coordinator considered international evidence as part of a local needs assessment but had felt that reviews of available interventions had reached disappointing conclusions about their effectiveness.
Typically, use of research evidence was highlighted in the case studies when stakeholders noted some knowledge of the evidence base for the intervention rather than a systematic approach to the use of evidence. Where local areas considered evidence, this generally arose when there were relevant skills in the partnership (e.g. public health background or where coordinators had specialised knowledge in suicide prevention). An issue raised both in local areas and identified from observation of national events was the perceived absence of evidence which was transferable to the Scottish context. In one area, for example, awareness raising and training for staff emerged as a priority following a survey of local practitioners. This led to a literature review commissioned locally, which highlighted cognitive behavioural therapy as an effective intervention but did not provide evidence of approaches known to be effective in meeting the locally defined needs of awareness raising and improving generic suicide prevention knowledge and skills. Subsequently, ASIST became an approach favoured by the Scottish Executive and the area became closely involved in piloting the course in Scotland.
At the level of national organisations there was a commitment to the use of evidence, but this commitment pre-dated or was independent of Choose Life. For example, SAMH was already considering crisis models used overseas and this information contributed to Choose Life developments both nationally and in a local area. The RCP had drawn upon information from New Zealand and Australian policy guidelines, but, again, this was independent of Choose Life. The NUJ was informed by the Australian guidelines and journalist networks both in Europe and elsewhere. Penumbra had learnt from UK National Inquiry into Self Harm Among Young People.
Box 8.3 Commentary Choose Life has fostered a commitment to draw upon "evidence of effective interventions" and to "shar[e] … practice experience' ( Choose Life, 2002). Recent reviews highlight that there is a lack of evidence on which to make firm recommendations about the most effective forms of interventions (Guo et al 2003; Hawton et al 2006; Mann et al 2005). Some interventions are noted to be promising but have been based upon interventions with small sample numbers. Hawton et al (2006) and Guo (2003) found: - Promising results for problem solving therapy
- Positive trends favouring provision of an emergency access card
- Promising results from a single study of dialectical behaviour therapy among small subgroup of female patients with borderline personality disorder who have a history of multiple episodes of DSH.
- Some very limited evidence of the benefit of cognitive behavioural therapy in a small controlled setting.
Mann et al (2005) suggest that the education of physicians and restricting access to lethal means help to reduce suicide. - Education of physicians increased numbers of diagnosed and treated depressed patients with apparent accompanying reduction in suicides (although effects on rates of suicide need to be measured)
- Restriction of access to lethal means (where method is common) has led to lower overall suicide rate
- However, other methods including public education, screening programs, and media education require further testing
- Programmes directed towards at-risk groups in student populations (e.g. skills training and social support) appear promising in reducing risk and increasing protective factors
- Guo et al (2003) highlight insufficient evidence about the effectiveness and safety of school-based prevention programmes for adolescents, although WHO (2004) concludes that schools based programs focusing on behaviour change and coping strategies in the general school population lower suicidal tendencies, and improve ego identification and coping skills
Intervention studies are often inconclusive because of small sample size. There is a need for larger-scale to assess effectiveness (Hawton et al, 2006, Guo, 2003). Serious methodological issues are also often noted in reviews of interventions (Guo, 2003). This can mean that, where there is some evidence of effectiveness, interventions may not be relevant for the Scottish context. Areas would further benefit from guidance about effective approaches to suicide prevention which have been tested in other contexts, and appropriate data to learn about innovation in their own areas. Both locally and nationally, there is also further opportunity to draw upon the expertise of organisations that possess knowledge of evidence in relation to their area of practice. |
8.2.3 Stage two: reflecting on and revising initial plan
A key challenge acknowledged both locally and nationally was the short timescale in which to develop the first action plan. It is evident that plans in local areas reflected a broad set of priorities that were then refined in the implementation stage.
Different factors influenced reflection and revision of initial plans. In some instances, lack of clarity about initial priorities and focus resulted in funding allocation to needs assessment or research (see above).
Where initial planning had stayed primarily within the confines of the Choose Life partnership (without wider consultation) some stakeholders expressed unease about the transparency of the decision making process. In two case study areas, for example, there were concerns that the plan had not been consulted upon widely enough or that the process was not informed by evidence of what worked or a local needs assessment. Each area undertook a different process to revise their initial plans. In area one, consultation was held across the local authority area with a variety of stakeholders, including service users. This led to new emerging priorities that were acknowledged in the revised action plan. In the second area, conflict within the partnership was overcome through negotiation with senior partners and in consultation with NIST. This led to a scaling down of the initial plan in a manner that was thought to be equitable to all interested parties.
8.2.4 Stage Three: Implementation
The implementation stage resulted in new processes being designed to share learning and knowledge. In relation to Choose Life, there is an opportunity to share knowledge or 'learning' at different levels, as illustrated in figure 8.1.
Figure 8.1 Levels where knowledge or learning can be shared
Sharing information between local areas, e.g. at national events or though regional networks, led to instances of learning and uptake of training across different areas. In one area, in response to national recommendations, ASIST was initially implemented as a universal training approach for professions and the community. Local implementation revealed that this approach was felt to be less suitable for those who provided ongoing support and care management to people at risk of suicide. The local coordinator attended the NIST summit in December 2005 and learnt about the STORM training from a presentation made by the Highland coordinator. The evidence base for STORM is stated to have influenced decision making.
National organisations have undertaken coordinated approaches to evaluation of local projects and are starting to learn from activities. For example, implementation of one SPS project demonstrated that this had been less successful and resulted in the discontinuation of funding support. However, the successful pilot of another SPS project had helped achieve substantial new funding for vulnerable prisoners ( discussed in chapter seven). For another national organisation, implementation activities have provided evidence in relation to self-harm and suicide risk and interest from local areas in supporting these issues.
8.2.5 National support for learning
NIST support to local areas
As highlighted in chapter four, there were a number of dimensions to NIST's role in supporting local implementation, including the provision of guidance and advice and advocating for Choose Life objectives and priorities with local decision makers. Substantial hands-on support was provided by NIST to local partnerships throughout the planning and implementation process. This is illustrated by case study examples:
- Planning stages: for example, in preventing funding allocation to activities not supporting suicide prevention; supporting areas that had become 'stuck' in the local action planning process; mediation at times of conflict in the partnership.
- Implementation: development of infrastructures to support learning; continuation of advice and support, e.g. raising attention to mainstreaming/ evaluation or particular priorities on local partnerships; participating in feedback events; and consultations/performance management.
An example of how NIST responded to local coordinators is highlighted in approaches to information sharing. Feedback from coordinators at an early stage of phase one that the level of information circulated by NIST was potentially overwhelming resulted in NIST refining information sharing. Subsequently, NIST has produced a newsletter in response to further requests for further information.
Supporting the objective of 'Knowing what works'
'Knowing what works' (improving the quality, collection and availability of information on issues relating to suicide and suicidal behaviour and on effective interventions) is a key objective of Choose Life. This section documents planned and implemented activities in order to support work towards achieving this objective in phase one.
Commissioning research reviews
Researchers in the Scottish Executive Health Department Analytical Services Division ( HDASD) are responsible for developing and managing a programme of research and evaluation to support delivery of the National Programme for Improving Mental Health and Well-being. Links were established between NIST and researchers in the Health Department, including HDASD, to interpret findings and help with research and information strategy. HDASD has commissioned, and continues to commission, research reviews to help ensure that the implementation of Choose Life is supported by a reliable and relevant evidence base.
To date, an initial scoping study reported on how a series of reviews could most usefully coordinate the evidence base, identify gaps and inform thinking and activity in the prevention of suicide and deliberate self-harm (McLean et al, 2004). A review on 'Effectiveness of interventions to prevent suicide and suicide behaviour' has been commissioned and an epidemiological analysis of recent trends in suicide in Scotland has reported to the Scottish Executive. Reviews relating to the determinants of suicidal behaviour will be carried out before April 2007.
Evaluation stakeholders reported some dissatisfaction that the commissioning of these reviews was delayed in phase one of Choose Life. The delay resulted from a lack of capacity within the HDASD.
Resource database
NIST commissioned work to develop a web-based resource database of existing resources/materials relevant to activity in suicide prevention, intervention and postvention. This was developed as an on-line resource and was in direct response to requests from those working in the field.
Some concern was reported at the national evaluation workshop that the resource database was not being used to maximum effect. This led to NIST to raise awareness of different resources available in the database as part of a Choose Life newsletter.
)SIRENSuicide Information Evidence and Research Network (
Although still in its infancy, SIREN was perceived by national interviewees as key to the successful implementation of learning networks. An inaugural conference has been organised for autumn 2006 that will bring together those with an interest in suicide and suicide prevention.
Independent national evaluation of Choose Life
The Scottish Executive's commitment to a strategic process evaluation of a suicide prevention strategy is relatively uncommon (from an international perspective). Some national and local stakeholders reported a lack of clarity about the purpose of the national evaluation and concern that there had not been significant opportunities to share good ideas or receive feedback. The national evaluation team and NIST have agreed to deliver a series of local road shows across Scotland in November 2006, in order to disseminate findings to relevant stakeholders and encourage discussion of the their implications for local suicide prevention partnerships.
Box 8.4 Commentary Structures that support the objective 'knowing what works' have developed in phase one. National stakeholders need to ensure that new resources and information are used to improve future planning and that dissemination of information is timely, accessible and of relevance to decision makers and planners. Scotland is unique in its commitment to a strategic and national level process evaluation. This approach will help to provide a clearer picture of the early impacts of the strategy in its first three years, which in turn will inform both future implementation of Choose Life and contribute to international learning and understanding of suicide prevention strategies. |
8.2.6 Stage four: future planning
NIST has highlighted a strong commitment to, and emphasised the importance of, evaluation. However, as a result of the delay to the establishment of NIST and a lack of capacity within the national team, a national framework for evaluation remains to be completed. Nationally and locally there is demand for an evaluation framework and work is underway to pilot a Scottish version of an Australian instrument. In the second survey, local areas highlighted that they intended to use the instrument to plan future evaluation activity.
Local approaches
Different levels of priority and attention have been attached to evaluation in local areas. For example, some areas have ring-fenced funding for research, needs assessment and evaluation, while in other areas only basic monitoring information is collected.
To a limited extent, areas have adopted a strategic approach to learning from phase one. Learning about local need and priorities and learning from pilot activity were highlighted as a key goal for the short-term in only a few areas. In one area, for example, there is commitment to ensure that lessons learnt from pilot activity in phase one is mainstreamed in statutory activity. It was evident from the case studies, however, that local areas were reflecting and refining work underway in phase one in order to shape future planning for phase two. A number of areas had, for example, held specific events/sessions in order to consider progress and emerging priorities.
In some areas, funding was ring-fenced to support research and evaluation, through the employment of a research assistant or to fund support for evaluation training/expertise. Since the first survey, a few areas have planned to establish a research/evaluation post or expressed the intention of commissioning evaluation expertise to support local evaluation activities in phase two. This development arose because it was recognised that a more rigorous approach to local evaluation was required. In the case study examples, ring-fencing research monies, however, did not always result in significant activity. Key challenges identified were a loss of local capacity (e.g. departure of postholder) and a lack of clarity around local evaluation needs and how these linked to national support for evaluation.
Challenges in evaluating local action plans were identified by both local and national informants, particularly in understanding how effectiveness of interventions should be evaluated. A lack of capacity locally to develop evaluation (in terms of time, resources and skills) was also noted.
Highland STORM Training STORM is a suicide prevention training package for all healthcare, social care, criminal justice staff and volunteers, particularly for those working with individuals vulnerable to feeling suicidal. Process Outcome: Increased staff skills Description: Staff more confident that they could recognise potential suicide risk. How known: The main providers of STORM training are based in the University of Manchester who train locally based facilitators in the delivery of STORM. There is a commitment to the evaluation of STORM and in exploring the dissemination of STORM by the providers. Trained STORM facilitators are asked to hand out pre and post questionnaires to participants during training. The questionnaires assess confidence and attitudes and telephone interviews are used in order to understand the dissemination process. Data were based upon a sample size of 149 participants who attended STORM training |
Collection of monitoring information
Feedback from coordinators and project case study examples indicated that most monitoring information was collected on community and voluntary practice examples and least information was collected about innovative approaches to working. The sixteen case study projects identified a number of outputs that were being used as evidence of local progress towards achieving aims and objectives. These can be categorised as outputs related to individuals, 'developing infrastructure' and information and promotional work.
Outcomes for individuals included suicide prevention, personal skills and increasing self esteem/coping skills.
Outcomes for interventions included the development of staff skills, capacity and awareness. At this stage, most information was available on outputs and process outcomes that included the nature of the intervention e.g. increased capacity for earlier intervention; previously unmet need now met; learning, partnerships and sustainability.
Approaches to measuring success of interventions were variable. In some cases, local stakeholder workshops highlighted some uncertainty about the actual outcomes towards which interventions were working. There were few instances where validated tools were used to measure success. Case study workshops, the surveys and national workshops often provided anecdotal feedback about the ways in which unmet need was targeted and how capacity for suicide prevention was increasing. However, such feedback was not consistently based on demonstrable evidence.
Evaluation of projects
A range of approaches was used to evaluate projects, including both well known approaches (e.g. Learning Evaluation and Planning [ LEAP]) and locally developed tools. Evaluation generally occurred where independent evaluations were to be commissioned (as reported through the NIST template) or, as described above, national organisations working locally undertook systematic approaches to monitoring and evaluation. Existing activities (or activities hosted by established organisations) were often collecting monitoring information or had planned evaluation as a consequence of reporting requirements by other funders. Rigorous information collection was evident where there was a desire to 'prove' the worth or need for a service and to provide evidence that would make the case for an intervention with mainstream organisations or for continuation of existing funding. An example of this occurred in a case study area where it was hoped that a student counselling service would become mainstreamed in the local college.
In the survey, coordinators highlighted that they intended to use the results of evaluations of practice examples (key steps) to assess progress and plan for the future: reviewing implementation and funding allocation; identifying needs/gaps in implementation; and supporting and encouraging mainstreaming and in sharing learning. However, as highlighted above, the quality of information collected was not consistent across or between local areas.
Box 8.5 Commentary The issues identified above are common to other local evaluations. Although experiential learning is continually being used to shape practice across individual projects and local areas, it is being less commonly formally embedded within local policy and practice. It is clear that local areas are supportive of future national tools/frameworks to support the local evaluation process. The challenge will be to ensure that these are taken up in local areas. This has to remain in doubt, given deficits in evaluation capacity and skills and the scant use of existing evaluation tools at the present time. |
8.3 Reflections on decision making and learning
Table 8.2 summarises progress in respect of decision making and learning.
Table 8.2 Progress made in decision making and learning
| Progress | Issue/gap |
|---|
Decision making processes | Local areas are refining planning processes, e.g. wider consultation, more transparent bid processes, improved reporting and monitoring structures Local developments informed by (local) evidence and by sharing of practical experience | Approaches to planning and decision making remain highly variable across local areas (this also has implications for equity in process). Local decision making processes varied depending on the strategy group's locus, authority, links and membership Lack of local capacity to analyse and make full use of available data. Uncertainties in how existing evidence should be interpreted in the Scottish context. |
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National support | Good progress reported locally and nationally in standardising statistics and suicide data (national milestone 5). Helpful contact from NIST (local milestone 9) included evaluation and research input, information, regular meetings and support from individual team members. Information was available for a range of sources, including Health Scotland, SDC, Scottish Health on the Web website and local Public Health departments Convergence of understanding between the evaluation team and NIST, for example, with respect to links to clinical services, continued awareness raising and strengthening of the approach to generating learning | Some criticism that the research reviews had been delayed. Lack of clarity about the purpose of the national evaluation and concerns that there have not been significant opportunities to share good ideas or receive feedback in relation to activity |
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Knowing what works | Support for this objective demonstrated by work such as research reviews and national evaluation. NIST has shown commitment to learning and sharing of information through website, summits, research database, SIREN and newsletter | Ensuring that learning and new information are disseminated in a timely and accessible manner |
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Monitoring and evaluation | Information is being collected by local areas, but is variable across and within local areas and types of projects. | Needs identified by coordinators were for guidance about evaluation using a tool adaptable for local needs , information about indicators, outputs and outcomes and on types of existing resources/tools available; training for organisations which are implementing Choose Life activities |
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