Time is ripe for the barefoot preventionist

Researchers have been examining the right topics but not the questions practitioners want to know the answers to, according to a study by a prestigious group drawn from UK universities, charities and funders.

The analysts assembled research carried out between 1995 and 2004, and asked social care practitioners what avenues they felt might have been most usefully explored. Then they compared answers: what had been wanted, and what had actually been funded.

Although the areas that interested practitioners and those covered by practitioners were broadly similar, there was a lack of overlap between the questions they asked. Half of the practitioner questions were about “what works;” only 13% of the studies had that focus.

Research during the period – funded by the ESRC, Joseph Rowntree Foundation, Nuffield Foundation, Gatsby Foundation and the Community Fund – showed a heavy bias toward the causes and characteristics of an issue. The proportion was nearly two-thirds; equivalent practitioner interest was only 16%.

Throughout the ten-year period qualitative methods dominated; only two per cent of effectiveness studies used a randomized controlled trial design.

The results mirror the changing dynamics inside the children’s services professions. The 1995-2004 interval covers the years in which the “what works” terminology and practice culture emerged.

Practitioners are readier than they were to rely on research to tell them what is is the best course of action given certain circumstances. Research has struggled to measure up to that requirement . “We lack the evidence to give even rough probabilistic guidance on what to do in many situations,” concede the report’s authors.

Practitioners are also hungrier for evidence that might help them plan services, particularly in terms of comparing the costs and benefits of different strategies. There is as yet very little information available about the impact of different interventions on costs and outcomes for children.

The authors attribute the dominance of qualitative research in the 1980s and early 1990s to the poor state of knowledge. Descriptive research was needed to shed light on an understudied area. Research needs have evolved, say the authors.

On the other side of the argument, despite their calls for better information about “what works,” practitioners have been unwilling to help researchers construct the evidence. The report notes their reluctance to collaborate in recent randomized trials in the UK. Researchers have struggled to recruit participants; practitioners have made unprincipled demands, for example insisting that certain cases must receive new interventions.

As to remedies, Madeleine Stevens and her co-authors argue that longer-term government funding is needed to finance the studies that will fulfill the needs of practitioners.

They suggest investment in the development of "research intermediaries" who have hands-on experience of social care. They also call for the recruitment of researchers from other disciplines, such as psychology, economics, sociology and social policy to augment the social care researchers’ knowledge of statutory processes and practice.

See: Stevens M, Liabo K, Witherspoon S and Roberts H (2009), “What do practitioners want from research, what do funders fund and what needs to be done to know more about what works in the new world of children’s services?”, Evidence & Policy, 5, 3, pp 281-294