What works for children and what works in research implementation? Experiences from a research and development project in the United Kingdom.

• Author: Liabo, Kristin

Abstract

Service planners increasingly recognise the need to develop more effective ways of implementing evidence-based practice and improving research utilisation. A key question is how we base services for children on the best available evidence in the context of competing and sometimes conflicting priorities and needs. For evidence-based research to make a difference to end-point users, those who plan and deliver services need to be in a position to apply research findings. While service planners are ever demanding evidence of need, less attention is paid to the evidence on what to do about the need once it has been identified. Influences such as practice experience, current priorities, pressures to spend funds in particular ways and common sense can be both more immediate and more easily available than research evidence on effectiveness. This paper draws on experiences from the What Works for Children? project, based in the United Kingdom, which seeks to influence policy and practice through (1) making relevant research evidence more accessible and usable to practitioners, and (2) exploring and identifying the research needs of service planners and practitioners. Some of the methods used by the What Works for Children? project to address potential barriers to implementation are discussed.

INTRODUCTION

Interventions in early childhood have been found to make a difference to important outcomes in later life (Hertzman and Wiens 1996, Roberts 1997). In the last few years, government programmes in the United Kingdom have increasingly paid attention to this research (Glass 1999) and have issued guidance that services be based on the best evidence of what works (Department of Health 1998, Nutley et al. 2003). However, it is one thing to advertise the "what works" message in publications, quite another matter to work out how to influence practice on the front line effectively. In an attempt to facilitate research use in practice and increase understanding of the processes of research implementation, various initiatives have been set up in the United Kingdom (CEBSS 2003, Making Research Count 2004, Research in Practice 2003).

The What Works for Children? project (WWfC) (1)--a collaboration between City University in London, the United Kingdom children's charity Barnardo's and the University of York--was established in 2001 with funding until March 2005 from the United Kingdom's Economic and Social Research Council (ESRC). The project was one of seven in the ESRC EvidenceNetwork, set up to facilitate developments in the evidence-based policy and practice field. This paper, by one of the research fellows working on the project, looks at some of the lessons learned and their relevance to the current social policy agenda. One finding is that to be successful, research implementation strategies must respond to the needs of service planners, who are caught between national priorities and local context issues. Also identified in this work is the need for national policy makers to base guidelines on research evidence and commission research studies that produce evidence relevant to practitioners on the ground.

WHAT WORKS FOR CHILDREN?

The research and development behind WWfC was in part built on findings from work on research implementation. They showed that if research is to have an impact on practice, dissemination needs to be targeted to suit practitioners' needs (Barnardo's Research and Development Team 2000, Kitson et al. 1998). Simply disseminating the message of "what works" may not be useful to practitioners, who need to know what works for whom, where and at what cost. With an emphasis on implementation rather than the primary-research production end of the evidence-based spectrum, we employed an implementation officer to work directly with practitioners and service planners. Her remit was to work with the practitioners on issues related to the adaptation and replication of interventions recommended by research. At the same time, a research team was set up to facilitate access to and understanding of research through a range of paper, face-to-face and web-based materials, including evidence summaries, a guide to the evidence, and training days (www.whatworksforchildren.org.uk). The implementation officer and the researchers worked in partnership, as one team, but the implementation officer also worked directly with practitioners and service planners on a day-to-day basis, and shared offices with some of them. With a background in both education and research, she held a key position in terms of bridging the traditional gap between research and practice (Stevens et al. 2005).

To facilitate the direct implementation work, we knew that we were more likely to succeed if we were pushing on a door that was at least partly ajar. In this respect, we were fortunate that our project coincided with a new policy initiative--the Children's Fund--which gave us an opportunity to work with multi-disciplinary teams charged with setting up new services. Links were established with six Children's Fund programmes in the North of England.

CHILDREN'S FUNDS: LOCAL INITIATIVES, NATIONAL PRIORITIES

Children's Fund programmes were set up to manage earmarked government funding to develop local services for children aged 5-13. They aim to reduce poverty and increase opportunities for children and young people who live in deprived neighbourhoods. The Children's Fund partnership boards are made up of local representatives from both voluntary and statutory sectors in health, education and social care. Potential Children's Fund projects apply for funding to work directly with children and young people in a variety of ways, Children's Fund programmes help projects prepare proposals and evaluation, and the Children's Fund partnership boards make funding decisions (see Table 1).

The Children's Fund programmes received guidance from central government on how to design proposals for services (Children and Young People's Unit 2001). Key requirements were that projects would:

* focus on those service users perceived to be at most risk of social exclusion

* build on existing services and fill in service gaps

* promote participation of service users in the design and working of programmes

* build on existing partnerships

* be sensitive to local needs.

The guidance stated:

Partnerships are not confined to evidence-based services, but if a service is included in your proposal that has not been evaluated we would like to know the basis on which you believe it will be successful. (Children and Young People's Unit 2001) Over time, it was hoped that services would focus both on what children and families say they need and have an evidence base developed by each service to show why their work makes a difference.

Like any initiative set up by central government and implemented locally, the Children's Fund programmes were operating between two sets of priorities. Service plans had to incorporate key national priorities, for example 25% of the services had to be targeted at young people at risk of or involved in offending. At the same time, they had to build their service plans on findings from local needs assessments. Once projects were up and running, service evaluation was next on the agenda. Evidence-based practice, in the academic sense of choosing services on the basis of systematic reviews and randomised trials demonstrating an effect, was not high on the list of their priorities.

In this situation, the WWfC team was faced with two major challenges. First, how do we support the use of research evidence when the practice priorities have already been set...