Every so often one reads a paper, presentation or blog that manages, with brevity and clarity, to hit a bag full of nails on the head. Once the slight annoyance and feelings of inadequacy arising from one’s own inability to produce such a statement recede, it becomes possible to enjoy the fact that someone grappling with familiar issues to you has been able to make useful sense of them. In this case the document is a foreword (though I highly recommend the whole paper) by Naomi Eisenstadt to a recent British Psychological Association paper titled, Technique Is Not Enough: A framework for ensuring that evidence-based parenting programmes are socially inclusive.
The paper, and foreword, address the issue of parenting courses, but in that context, Naomi summarises a number of keys contemporary issues in the social policy domain. This includes how to balance the arguments advanced in favour of evidence-based practice based primarily on experimental studies (e.g. randomised control trials), against the arguments raised with regards the importance of context i.e. local needs, appropriateness, co-design and co-production of services, etc. In interest of some form of disclosure I must admit to being more drawn to the latter camp (perhaps as a result of being one of those humanities graduates that Ben Goldacre warns people about), so its good to hear a perspective that recognises those concerns, but also stresses the importance of trial-based evidence and the warns of the dangers than can arise from well-intended but poorly designed interventions.
Anyway, I’ve attempted to summarise the key points of the Naomi’s foreword below, but I would highly encourage people to go to the source for an elegant and timely summary.
- Two camps exist – one emphasising randomised control trial evaluation and fidelity in implementation, the other emphasising the importance of context, including local knowledge and sensitivity to localised needs. The two positions need to be brought together.
- Common dilemma – those who most need support are those least likely to access it, and are also unlikely to be persuaded by logical arguments alone. Programmes will only engage families if they “speak to their needs and concerns.” (p5)
- Practical issues – its important to consider the practical barriers to participation e.g. transport, childcare, refreshments. (I particularly like Naomi’s suggestion that participation in parenting courses would rocket if venues offered free laundry facilities!)
- Barriers to scaling up – replication of RCT proven programmes requires that: 1) the programme is delivered with fidelity to the original design that was proven to work, 2) the delivery group needs to be similar to the original group. However, this present issues to repeating successful impact on a wider scale: 1) staff reluctance (for good and bad reasons) to exactly follow a programme designed elsewhere, and 2) difficulty in finding participants who closely resemble the original trial groups.
- Fidelity – is about adhering to key principals critical to effectiveness, rather than exact duplication (see also What we need in education is more integrity (and less fidelity) of implementation)
- Participation – the best programme will achieve little if no one takes part, so enabling participation is crucial (however, its also important to bear in mind that a bad programme that attracts participants could do harm and waste resources)
And finally in her own words:
“Whilst it is critically important to use programmes that are known to be effective, it is also crucial that such programmes and nuanced to local community circumstances.” (p6)
agentlephilanthropy 