On the last two days the group visited Carolyn Webster-Stratton and her team to hear about the Incredible Years programme, and also the Social Development Research Group at the University of Washington to hear from David Hawkins, Kevin Haggerty and their team about the Communities that Care (CTC) prevention operating system and a series of evidence-based programmes that they have developed and tested.

This final group blog reports reflections from the group over these two days, focusing partly on these visits but more so on the main 'take-home' lessons from the study tour as a whole. The seven themes are illustrated with quotes from study tour participants.

First, it is possible to combine rigorous prevention science with community engagement and a passion for change.

“I’ve seen how science and community engagement can be linked. I didn’t think there was a model for this.”

“CTC makes me reflect on my community development days – building capacity to get communities to engage.”

“I’ve seen passion and rigour and integrity. It has been interesting to see a new take on community development. It’s re-invented what I saw 30 years ago.”

Second, fidelity of implementation is critical if programs are to be effective.

“I came here not really convinced about the fidelity stuff, seeing it as a constraint on judgment, but I’m going back with a less unsubtle understanding of what tailoring and adaptation means.”

Third, it is possible – and even necessary – to adapt programs but this needs to be done carefully if fidelity to the model is to be maintained.

“Adaptation is important to match the program to the unique needs of the community.”

Fourth, the process of delivering effective prevention and early intervention programs may not be rocket science but it is intensive, nitty-gritty work.

“The content of programs is important but the process of getting them delivered matters just as much – phone calls, persistence etc. makes a difference.”

Fifth, we need to think more about we make systems ready to support programmes while also developing programs that are ready for systems.

“You can’t think about just ‘taking and plonking’ programs. The system needs to be ready to accept program, and there is a need to develop programs with systems in mind.”

“As someone with lots of energy I can put something in place but I can’t stretch it without a system.”

Sixth, taking evidence-based programs to scale is a huge challenge that will likely require collaboration with marketing experts and the private sector while also maintaining scientific integrity.

“We need to engage seriously with the private sector; they do seem to have it nailed when it comes to doing things in a big way. But we need to figure out how to do this without losing our ideals.”

Seventh, there is a need for a significant change in the UK if evidence-based programs are to be adopted widely, implemented with quality, and sustained over time.

“In the English system how do we get a step change? All that we’ve done [in terms of initiatives to get research into policy and practice] doesn’t seem to be getting the idea of ‘evidence-based’ into the DNA.”

“We need the exposure of high-level people to cutting-edge programs. Steve Aos’ cost-benefit algorithm needs to come to the UK and stay in the public domain. We need a public database of proven programs. And we need to ensure the public ownership of these programs.”

“We need to find out where SCIE, ADCS, C4EO etc. are at. We need manifesto statements with a General Election coming up. There’s also social work training to think about, and a UK-wide support system for effective practice.”

“There are some quick things to influence nationally; for example, all 150 Directors of Children’s Services are about to be trained.”

“We shouldn’t underestimate how difficult it will be to achieve this step change. People have said all this before and met resistance from the research, policy and practice communities. So we need to be smart in how we get the message across and not over-egg the messages or get people’s backs up. For example: RCTs are not the only evaluation method, rather they should be used to test impact where practical, ethical and affordable; community engagement is critical it but needs to work alongside the science; fidelity requires great professionals.”