Forty Years of Evidence

The past 40 years have witnessed many concerted attempts to improve the lives of vulnerable children: more expenditure, new legislation and policy initiatives, countless reorganisations and, more recently, a drive towards evidence-based practice.

Why, then, are trends in aspects of child well-being still worrying us? (see Worrying Trends below).

A review of research, policy and practice in children’s services over the past 40 years offers some pointers and potential solutions that will help realise the five outcomes of the Children Act 2004.(1) In doing so it highlights for social care practitioners some weaknesses of the evidence that is available and some of the dilemmas and challenges for researchers.

The first message from the review is the requirement to develop services that better meet children’s needs. Effective services are likely if a more experimental approach is adopted, with greater innovation and creativity in service development and the rigorous evaluation of pilot projects (prior to their being rolled out), using randomised controlled trials whenever possible and suitable.(2) If there is no proven “off-the-shelf model”, a greater willingness among practitioners to test out different options is warranted.

A second and related set of messages for policy and practice concerns the requirement to develop needs-led and evidence-based services for groups that are poorly served by current approaches – including those children and young people about whom little is known and those who often fall into the gaps between administrative divisions or who are routinely failed or overlooked by services.

For example, more could be done for children living in poor housing and to reduce the high levels of self-harm and suicide among young people in secure accommodation.

Generally, there has been more interest in the past 40 years in processes than in child outcomes or the epidemiology of child development problems. The latter challenges the research and practice communities to take into account all children (not only service users). Much research in the children’s services field is constrained by its reliance on service populations that have a relatively small place in the continuum of services, such as children in care or those whose names are on the child protection register.(3)

Studies of service populations can scrutinise children’s common experience as service recipients but make it difficult to reach conclusions about other aspects of their lives. Methods to chart patterns of need at the community level exist but are underused.(4)

A third and critical theme concerning provision for children is the value of improving the often haphazard connections between research, policy and practice. Although dissemination is higher up the agenda of most social researchers and funders than ever before, there is still considerable scope for improving the use of evidence by those in power.(5) The question is how this can be done.

Several developments are suggested, including assertive planning using robust data and greater movement of individuals between policy, research and practice contexts. Also, creativity is required to produce approachable texts on dry topics. Who would have thought, for example, that it was possible as Lynne Truss proved in Eats, Shoots & Leaves to make punctuation accessible and interesting to a broad audience?

The fourth message for policy-makers and managers concerns the benefits of reflecting on the values that underpin children’s services. One aspect of this is the potential contradiction between needs-led and rights-based provision. It is easy, for instance, to become so concerned with meeting a child’s needs that one ignores their views. The opposite danger is to stress the importance of children’s right to participation and lose sight of whether their intervention improves services.(6)

A general criticism of child welfare research, which limits its value for practitioners, is that it is often insufficiently theoretical or sociological in outlook. So, child development research can easily become preoccupied with physical and psychological factors without considering their relation to questions of power and history. Sociologists, on the other hand, are prone to make categorical statements about the impact on well-being of, say, discrimination, without spelling out how, logically, it “gets into the body”. Both extremes are unhelpful.

A fifth and final challenge for children’s services professionals and policy-makers is to achieve the right balance between central and local control in the delivery of services. A tension exists, for instance, between the use of inspection, performance indicators and approved systems for identifying vulnerable children on the one hand, and the desire for local flexibility on the other.

As Sure Start has found, a local emphasis can also complicate evaluation; variations on a theme are attractive but at what point does a variation become a different programme?

In some areas and on some occasions over the past 40 years evidence has had a significant effect on both policy and practice in children’s services in the UK. But the take-up of research varies. Factors such as persuasive presentation, scandal, legal requirements, economic imperatives and moral and consumer views are important. These influences will not disappear but learning lessons from the past 40 years could help to strengthen the place of evidence in children’s services and improve child well-being in years to come.

For more information visit www.community care.co.uk and go to The Bigger Picture to find details on the Children Act 2004 and child protection.

Worrying trends
There has been a significant growth over the past 50 years in psychosocial disorders such as crime, suicidal behaviour, depression and drug abuse among young people in most developed countries.
The causes are unclear, as the same period has seen improved physical health and living standards, but probably they include family discord, parenting problems and pressures associated with school and appearance.
Today about one in 10 children aged five to 15 in Britain has a mental health disorder that causes them distress or affects their day-to-day life.

Nick Axford is a researcher at Dartington Social Research Unit. The unit belongs to the Warren House Group, which works in Europe and the US to improve social care for children and families through a combination of scientific research and innovative development, dissemination, training and design strategies.

Training and learning
The author has provided questions about this article to guide discussion in teams. These can be viewed at www.communitycare.co.uk/prtl and individuals’ learning from the discussion can be registered on a free, password-protected training log held on the site. This is a service from Community Care for all GSCC-registered professionals.

Abstract
This article reviews children’s services in the UK over the past 40 years. It advocates more sophisticated service development and evaluation, a more strategic approach to building the evidence base, greater use of robust epidemiological need data and innovative approaches to the dissemination and utilisation of research.

References
(1) N Axford et al, (eds) Forty Years of Research, Policy and Practice in Children’s Services: a festschrift for Roger Bullock, Wiley, 2005
(2) G Macdonald, “Evaluating the effectiveness of social interventions”, in A Oakley and H Roberts, (eds) Evaluating Social Interventions, Barnardo’s, 1996
(3) N Axford et al, “Mapping the data needed to plan integrated services: a case study of children’s services in one locality”, Journal of Integrated Care 12 (3), 3-10, 2004
(4) J Percy-Smith, (ed.) Needs Assessments in Public Policy, Open University Press, 1996
(5) Scie Knowledge Review 7, Improving the Use of Research in Social Care Practice, www.scie.org.uk/publications/knowledgereviews/kr07.asp
(6) C Danso et al, The Involvement of Children and Young People in Promoting Change and Enhancing the Quality of Social Care, Scie/NCB, 2003

Contact the author
naxford@dartington.org.uk