Let's walk before we run
| Pages | 2-3 |
| DOI | https://doi.org/10.5042/jcs.2010.0690 |
| Published date | 02 December 2010 |
| Date | 02 December 2010 |
| Author | Nick Axford,Michael Little |
| Subject Matter | Education,Health & social care,Sociology |
Journal of Children’s Ser vices • V olume 5 Issue 4 • Dece mber 2010 © P ier Professional Ltd
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10.5042/jcs.2010.0690
programmes in local communities and schools and
so address locally identified needs.
There is also now much research underway to
find out how and why good ideas are (or are not)
translated into mainstream practice. By way of
example, in this edition Jacqueline Barnes examines
factors that are relevant to the implementation of
Nurse Family Partnership (NFP) through a national
system of care in the UK, namely the National
Health Service (NHS). NFP is one of the better-
known evidence-based programmes.
The article introduces the initially seemingly
counterintuitive idea that programmes with the
‘best’ evidence of impact should not necessarily
be prioritised for scale-up. She explains: ‘Building
a national initiative on the basis of evidence from
randomised trials provides little guidance on how to
replicate these models successfully; neither does it
provide the ability to generalise findings to diverse
populations and diverse contexts’ (p5). In other
words, programmes need to be ‘system ready’ as
well as effective.
Speaking at a recent seminar in London on
the subject of implementation, David Olds,
developer o f NFP, argued tha t evidence-based
programmes should only be ta ken to scale in
their pure form: ‘Anything l ess, and you jeopardise
the potent ial to i mprove chil d and f amily outco mes,
which is not only a moral issue, but also an economi c
one’ (Preve ntion Action, 20101). Why spend
precious re sources rolling out a watered-down
intervention for which, at b est, the effects are
likely to be greatly diminis hed and uneconomical
and, at worst, harmful?
The problem, given the aforementioned lack
of programmes on the ground, is that there is an
urgency to get implementing, and in the absence
of sufficient resources to do this well there is a
pressure to cut corners. As another contributor
to the seminar, Kate Billingham, National Project
Firector for NFP in the UK, put it: ‘It’s a hostile
world out there, ready to corrupt the purity of
Evidence-based programmes are interventions
that have a proven impact on children’s health and
development. All have been tested in experimental
conditions to see if the desired effect is achieved.
Most share several common features. They are
targeted at a clearly defined problem and population
and are underpinned by an articulated casual process,
comprising a statement of logic about what is to
be achieved, how and why. Some seek to prevent
impairment before it occurs, others intervene early in
its gestation, while others treat entrenched problems
or prevent them from getting worse.
Today there are enough evid ence-based
program mes spannin g most dom ains of
childre n’s health and develo pment to r equire
databas es of prov en models and bodies that
sponsor systematic reviews o f multiple trials of
program mes. Depend ing on whi ch standard s of
evidenc e are appl ied, there are easily between
50 and 200 evide nce-based p rogrammes f or
childre n in exist ence. But with a few exceptions ,
even t he best-kno wn programm es are not
widely implemented . Consequen tly, only a tiny
proport ion of chi ldren exper ience an e vidence-
based programme, and many t hat do hav e
done s o as subje cts in exp erimental t rials. Put
another way, no evidence-bas ed programm e has
succeed ed in beco ming core to a syste m, which
is whe re most st ate expendi ture is di spensed.
The reasons for this are plentiful. Many
programmes are simply unknown to policy-
makers and practitioners. A lot come from the
US, which in some quarters makes them taboo.
The requirements for implementation are all too
rarely specified. They can be expensive, or make
unrealistic expectations on human resources. The
perceived need to adhere religiously to a practice
manual raises fears among practitioners of being
deprofessionalised.
Some researchers have responded by trying
to get better at promoting their wares. Others
have sought to build support for evidence-based
Let’s walk before we run
Nick Axford and Michael Little
The Social Research Unit, Dartington, UK
Editorial
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