Presentation on theme: "RCTs in Children’s Services in the UK: history and prospects Nick Axford Dartington Social Research Unit -"— Presentation transcript:
RCTs in Children’s Services in the UK: history and prospects Nick Axford Dartington Social Research Unit -
Context Growing expectations about evaluation of children’s services to identify ‘what works’ Social experiments in the US used extensively but many demonstration projects Social experiments in the UK: limited use (e.g. labour market programmes) From social care to ‘children’s services’ (SSD, Youth Justice, Health, Education)
RCTs in social care for children Social care: child protection, family support, adoption, residential / foster care 10 research overviews, 109 studies, 3 RCTs (a) Approved schools / residential care (Cornish and Clarke 1975) (b) Therapy for sexually abused children (Monck et al 1995) (c) Parenting programme for ‘at risk’ 5-6-year- olds (Scott and Sylva 2004)
RCTs in the ‘new’ children’s services Youth justice: ISSP, Restorative justice, Youth at Risk Education: academic mentoring, language development Health: ADHD, health visiting, depression Social care: fostering
Why aren’t there more? (a) Moral imperatives - Concern with equity > effectiveness - Practitioner sabotage - Belief: ‘of course it works’ - Relationship: ‘it’s the way that you do it’ - Poor services for poor children?
Why aren’t there more? cont’d (b) Pragmatic constraints - Public funding of services - Rapid response to scandals - Solutions not about changing practice - Focus on doing not measuring - Lack of skills / knowledge among staff
Why aren’t there more? cont’d (c) User views - Popularity of ‘thin’ not ‘thick’ services - Flexible, responsive > tight, prescriptive - Localised, tailored > centralised, uniform - Lack of knowledge about evaluation - Common sense: everyone is an expert
Why aren’t there more? cont’d (d) Scientific method - Other evaluation pressures - Difficulty of obtaining samples - Interest in outputs not outcomes - Policy-specific evaluations - Complex problems and programmes
Encouraging more RCTs (a) Addressing ethical objections - Need to find out if services work - ‘First do no harm’ - Accurate estimate of effect - Consent, incentives, waiting-lists - Fairness of allocation by lottery
Encouraging more RCTs cont’d (b) Getting buy-in - Stressing feasibility - Influence, training, prestige - Reducing administrative burden - Data on demand and standard services - Involving practitioners in design - ‘Wild cards’ - A means to strengthen services
Encouraging more RCTs cont’d (c) Securing resources - Persuading the tax-paying citizen - Improving the programme - 0.1% of local children’s services budget? - Matching methods to purposes - Central government?!