Evidence Informed Best Practice

1. Evidence Informed Best Practice Dr. Richard Volpe Professor and Projects Director Life Span Adaptation Projects University of Toronto 45 Walmer Road, Toronto, Ontario, Canada email: richard.volpe@utoronto.ca April 24, 2007

2. Evidence-Based Practice “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients” requiring the “integration of best research evidence with clinical expertise and patient values” (Sackett, 2000)

3. Evidence-Based Decision Making(EBDM) “The systematic application of the best available evidence to the evaluation of options and to decision-making in clinical, management and policy settings.” (Prime Minister’s National Forum on Health in 1997)

4. The Challenge of Evidence-Based Practice to Injury Prevention Nature of Evidence Shortage of Evidence

5. ONF Strategic Funding Initiative Implement an evidence-based injury prevention practices in Ontario. Evaluate their effectiveness and potential in reducing the incidence of head and spinal cord injury. To assist communities and other interested stakeholders to go forward after the implementation evaluations and to secure long-term funding. Determine policy impact and implications of implementations. Inform and make recommendations to the provincial government and other stakeholders on the feasibility of this strategic initiative and any implications for future directions.

6. Objectives of the ONF Best Practice Reviews Survey the range of neurotrauma prevention strategies and programs. Identify examples of effective, evidence-based practice. Describe, analyze and evaluate these in terms of their effectiveness for diverse age groups. Develop and strengthen networks by mobilizing public support and encouraging the participation of stakeholders. Provide a casebooks of exemplary, evidence based neurotrauma prevention efforts. Create a means of distributing the casebooks, resource documents and field contacts.

7. Best Practice Nomination • Theoretical relevance (capable of conceptual elaboration) • Inclusion of at least three of the five Es (Education, Enactment, Engineering, Economics, Evaluation) • Life span orientation • Exhibition of innovative and effective strategies • Employment of mixed research methods and perspectives (triangulation) • Availability of sufficient documented evaluation research information • Strong evidence for the reduction of incidence • Replicability and adaptability • Effort to address communication and dissemination issues

8. Knowledge Transfer: Systematic Reviews Compendium of Effective, Evidenced Based Practices In the Prevention of Neurotrauma Preventing Neurotrauma: A Casebook of Evidenced Based Practices Road Safety Review Source book of Evidenced-Based Practices in the Prevention of Severe Injuries Science and Sustainability in Injury Prevention Preventing Severe Sports injuries

9. New South Wales Stay On Your Feet (SOYF) Senior Falls Prevention

10. SOYF in Ontario • Implement the SOYF Program in 3 trial communities • Evaluate its effectiveness in reducing senior falls across the three communities • Evaluate effectiveness of the program in the province • Determine the feasibility of implementing the mutifaceted intervention within Ontario • Determine policy impact and implications to seniors falls • Inform and make recommendations to the provincial government and other stakeholders on feasibility

11. Upstate New York

12. ONF Shaken Baby Syndrome Prevention Program Ontario Best Start Resource Centre North Bay North Bay General Hospital North Bay Public Health CCPIP Midwives of North Bay Sudbury Sudbury General Hospital Sudbury Public Health Midwives of Sudbury Kingston Better Beginnings Public Health Mississauga Credit Valley Hospital Oshawa Lakeridge Health Centre Hamilton McMaster University Public Health Services – Healthy Babies Toronto University of Toronto Life Span Adaptation Projects Institute of Child Study, OISE/UT

13. Safe Waitakere Community Injury Prevention Project(WCIPP)AUCKLAND, NEW ZEALAND

14. ONF Implementation of a Community-Systems Approach to Injury Prevention- North Bay, Ontario

15. SUSTAINABILITY & SCALE

16. The Challenge of Evidence-Based Practice to Injury Prevention Nature of Evidence Shortage of Evidence

17. Evidence and ActionEvidence and Prevention

18. Identified Knowledge DomainsofPublic Health Maternal & Child Health Public Health Nursing Disaster Control & Emergency Services Communicable Diseases HIV/AIDS Nutrition Chronic Diseases & Conditions Public Health Laboratory Sciences Public Health Informatics Global Health General Public Health Epidemiology Biostatistics Vital Statistics & Surveillance Environmental Health Occupational Health Health Services Administration Social & Behavioral Sciences Health Promotion & Education Community Health

19. Socio-cultural Interpersonal Language Secondary Relationship Values Primary Relationship Norms Artifacts (man-made objects) Cognition Biochemical Processes Natural Objects Physical Environment Internal States Genetic Processes The Life Space

20. We Know Enough: Injuries are not the result of accidental events but are predictable. Risk factors are identifiable and modifiable. Risk factors can substitute for understanding causes. Risk factors also point to protective factors. More than one risk factor usually needed to bring about an adverse outcome. More than one positive factor usually needed to produce a positive outcome.

21. Injury Prevention as Change in Complex Systems Life span transformations in individuals and groups that emerge in the process of adaptation.

22. Evidence Informed Practice

23. Wisdom “A wise person is one who uses his or her successful intelligence in order to seek a common good, by balancing intrapersonal, interpersonal, and extrapersonal interests; over the short and long terms; through the infusion of values; in order to adapt to, shape, and select environments.” (Sternberg, 1990)