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or
Effective Services 2008=
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© Centre for Effective Services 2008
1
Future research needs
Michael Sieff Foundation Conference 2008
Cumberland Lodge, Windsor, UK
22-24th September 2008
Deborah Ghate
Centre for Effective Services
<=
/div>
Dublin, Ireland
![](3D"slide0001_image001.gif")
Centre for Effective Services
NCI
Mayor Street
Dublin 1
Republic of Ireland
www.effectiveservices.org
T: +353 (0) 1 6599 202
E: dghate@effectiveservices.org
C=
entre
for Effective Services
Connecting science, policy and practice to improve
outcomes for children
Why do we need research?
l<=
/span>Exploration
and investigation
o=
to
build theory, understand processes, understand behaviour
l<=
/span>Measurement
and testing
oto
test theory, measure outcomes, assess strength and direction of relationships
between variables
l<=
/span>Independent
validation
o=
of
policy, practice and public assumptions/observations
l<=
/span>Practice
development and policy formation
l=
l
2
What types of research?
=
lBasic
oTheory and
knowledge-building
l
=
lApplied
oAddressing a
specific social issue, or policy or practice question
o
=
lAction/participatory
research
oInvolving
stakeholders in the design and execution of investigations
l
=
lEvaluation
(applied to specific interventions)
oExploration and
measurement of outcomes
oExploration and
measurement of process and delivery factors
oTesting efficacy
(optimal conditions)
oTesting
effectiveness (real world conditions)
oAssessing costs=
and
benefits
l
l
l
l
3
What methods or technologies?
=
lQuantitative
measurement
osurvey researc=
h,
Randomised Controlled Trials (RCTs), observation, economic
(costs-benefits; cost-effectiveness)
o
=
lQualitative
exploration
ounstructured depth
interviews, ‘focus groups’, observation
o
=
lInterviewer-administered
=
lSelf-administered
=
lObservational
l
=
lCross-sectional
(one off or repeated)
=
lLongitudinal
(panels, cohorts)
l
l
4
What has research already
demonstrated?
Outcomes
Outcomes
=
lImportance
of pre-natal care and maternal health and wellbeing
=
lImportance
of perinatal and early experiences
l=
Supporting
parents improves self-confidence and self-efficacy
l=
Some
parent support interventions also associated with =
better
child development outcomes
=
lPositive
father involvement associated with better child and family outcom=
es
=
lChildren
are resilient
ohigh quality e=
arly
care can help offset deleterious effects of poor early
experiences or early disadvantage
=
lSome
social interventions are ‘cost-effective’ investments
o resulting in savings to the public=
purse
5
What has research already
demonstrated?
Implementati= on and Delivery
Implementati= on and Delivery
=
lDelivering
acceptable interven=
tions
is relatively easy
l
=
lDelivering
effective intervent=
ions
less so
l
=
lMany
services or programmes have been developed with:
oUnclear theoretical
bases
oPoorly articulated
mechanisms of change
oInadequate documentat=
ion
of what is delivered
=
lOn
the whole, these don’t work
oOr cannot be evaluated
– not the same thing
o
=
lInterventions
that work usually have strong theory basis and strong ‘programme
fidelity’ during delivery
6
What has research not yet demonstrate=
d?
=
lHow
to maximise reach a=
nd
minimise attrition
oThe ‘har=
dest
to reach’ – getting, keeping and engaging the most needy
in services
oDoes targeting
work better than universal services for this group? =
Is
compulsion an answer?
o
=
lWhy
some programmes help parents but don’t lead to measurable change in child outcomes
=
l
lHow long does it take? Longer term impacts and c=
osts
savings
l
=
lWhether
services and programmes that work with (mostly) white mothers a=
re equally effective for fat=
hers
and parents in other ethnic groups
l
7
What has research not yet
demonstrated?
The specific issues for ‘gold standard’ programmes
The specific issues for ‘gold standard’ programmes
l<=
/span>Whether
efficacious service=
s are
also effective
=
l=
lWhether
programmes that are effect=
ive in
one context are equally effective in others
o=
Weaker
effects with increasing distance from the centre
o=
Going
‘to scale’
o=
Transportability
of ‘gold standard’ programmes to other contexts
l<=
/span>How
much flexibility can
there be without loss of efficacy?
oHow
to accommodate local needs and local practice cultures and contexts
8
Priorities for future research: the
context
=
lResearch
can be a helpful pr=
ocess
in developing services
oElucidating appropria=
te
theory base
oClarifying expected and
appropriate mechanisms of change
oClarifying and
articulating service objectives
oIdentifying strategic
priorities
oEnabling reflective
practice
oEngaging users
oAdvocating with
policy makers and funders, and with public opinion
=
lResearch
can also undermine
service delivery and be a waste of resources
oCan be too early in t=
he
process
oDemands on scarce
resources
oWrong approach or
measures
oScientific principles
violated by external factors
l
l
9
Priorities for future (of) research:=
the
specifics
=
lMore
basic research on methods and technologies for researching outcomes
oThe problem of
‘fit’ between scientific orthodoxies and real world contexts:
especially gold standard experimental methods (RCTs) – exceptionally
hard to make these work in community settings?
oMore
development/dissemination of promising, robust quasi-experimental
methods that may be easier to implement
=
lFurther
development of methods for researching process =
and
delivery factors
oMany services
still not getting off the starting blocks in recruiting and
engaging neediest users
oQualitative,
descriptive ‘process
evaluations’ and case studies are not enough – we need
experimental research on what works
oNeed better
understanding of how practitioners apply knowledge in =
the
field
l
10
Priorities for future (of) research: =
the
specifics
lCapacity and training of research staff, especia=
lly
in quantitative methodologies and economic assessment
lImprove research literacy of practitioners and
service managers
oBetter
skills for interpreting research messages and interrogating =
research
conclusions
o=
To
use research skills for internal practice development purposes
lResearchers
to be better equipped to c=
ommunicate
complex rese=
arch
messages to non-researchers
oespecially
at the ‘higher science’ end of business – still far too =
many
outputs that fail to communicate the science intelligibly
11
Priorities for future (of) research: =
the
specifics
l<=
/span>More
strategic approach =
to
commissioning
oNot
every service is ‘evaluable’ using the current (limited) range=
of =
research
technologies
oNew
services and small/niche services may be too fragile to =
evaluate
oDevelop
a more sophisticated, integrated approach taking into account
the wider local/national context. See individual services and
programmes as parts of greater whole & evaluate accordingly
oA
frank discussion about whether and when we fund unproven and =
un-researched
services
12
Priorities for future (of) research: =
the
specifics
lMore basic and ‘synthetic’ research and
thinking to illuminate the big questions of principle:
<=
/span>
l
oHow much change can we reasonably expect from ea=
rly =
intervention
and is no change an acceptable outcome?
oWhat do we have to spend to achieve acceptable
levels of change?
oFor how long do we have to intervene and at what
level of intensity?
oWhat are the key interactions between deliver=
y and
outcomes?
oWhat is the pr=
oper
place of pluralism and div=
ersity
in service provision in the European context: ie of unprove=
n,
innovative or niche services and programmes vis a vis ‘g=
old
standard’ programmes
13
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