A group of academics has written an open letter to the children’s social care What Works Centre raising concerns over a new programme to evaluate family group conferences (FGCs).
The scheme, announced in May, is in partnership with the Department for Education (DfE) and will see £15 million of government money being spent in 40 council areas with the aim of keeping families together.
As well as family group conferences at the pre-proceedings stage, the study will also seek to test the Family Drug and Alcohol Court (FDAC) model, both by employing randomised control trials (RCTs).
But a letter co-signed by 14 leading academics, led by Sheffield University’s Kate Morris, called into question the RCT approach’s suitability for use around FGCs, which it noted offer “a rights-based opportunity for children and families to develop a plan for vulnerable family members”. It argued that FGCs ‘work’ simply by existing, thereby allowing rights and responsibilities to be exercised.
‘Curtailing rights in the name of evidence’
By randomly allocating access to FGCs, the letter added, “some families will be denied the opportunity to exercise their rights and responsibilities in order to produce evidence for professionals and policy makers”.
It added: “This is markedly different to experiencing uneven access to FGC services across the UK, instead this is curtailing the opportunity to exercise rights in the name of evidence.”
The letter said the ethics of using RCTs in this way were “unpalatable” and smacked of the need for generating evidence being prioritised over the need for families to have as much help as possible to stay together.
Morris told Community Care she did not disagree with trials around FGCs but that these should be funded comprehensively with all children and families given active options to participate or not.
“It’s important to hold the discussion – how do we explain this to children and families who don’t get the service,” she said. “If [money] is going into local authorities to fund FGCs pre-proceedings and we are going to randomly assign families – not who wants it and who doesn’t – it’s about discussing RCTs in the context of ethical practices.”
‘We are offering FGCs to more people’
But Mike Sanders, the executive director of the What Works Centre, defended the design of the programme, which he said would offer councils that would not otherwise have explored FGCs the option to do so.
“Rather than denying [FGCs] to half of families, we are offering them to more people than would otherwise have been,” he said.
“We should make sure we deliver the intervention, given that there is this rights advantage, to as many people as we can in the context of the evaluation, while not sacrificing the evaluation itself,” Sanders said.
“Conducting research badly, coming to the end and not learning the answers to questions, that would be unethical,” he added.
Sanders said that he hoped the trial would enable local authorities and social workers to make more informed decisions about the use of FGCs.
“Imagine we get to the end of the trial and find FGCs are hugely successful, both in terms of rights and outcomes – that strengthens the case for them being taken up more broadly,” he said.
“If we get more disappointing results – that FGCs have no effect on children’s outcomes, or a modest one – that would act as a spur for people to develop new ways to allow families to exercise their rights, leading to stronger and more positive outcomes for young people.”
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DfE should learn the lesson of The Dept Health when it tried to evaluate Individual Budgets via a Randomised Control Trial methodology. 2 years of data gathering gave an inconclusive result, the result the academics and practitioners involved told DH they would get.
Not only is RCT unethical when dealing with social issues it is also ineffective. RCTs work when researching a tightly defined symptom and when all other variables can be eliminated. People and their behaviours are by definition loosely defined with a virtually infinite set of variables.
£5 says the result in 2 years time will be inconclusive. Any takers.
Note I was lead for the Coventry Individual Budgets pilot and we refused to participate in the RCT, instead commissioning our own evaluation from Prof. Guy Daly at Coventry University. That was a much more interesting read, full of real stories about how choice and control had made a real difference to people’s lives.
In the world of psychotherapy research most well-controlled RCTs show that the treatment under investigation is no better, or only very modestly better, than other ‘treatment as usual’ or equivalent. The best recent summary of the evidence base is here:
https://www.amazon.co.uk/Great-Psychotherapy-Debate-Counseling/dp/0805857095/ref=sr_1_1?crid=1YAVCRNNQJJZE&keywords=the+great+psychotherapy+debate&qid=1561282240&s=gateway&sprefix=the+great+psychotherapy%2Caps%2C130&sr=8-1
These outcomes have the effect of curtailing professional hubris, injecting some humility into the field, and argues for a range of options to be available to those who use such services. This should also (1) act as a catalyst to try to improve interventions, (2) lead to more research about what works for whom, with the aim of increasing the effectiveness of services and (3) promote and underpin psychotherapy process and component studies:
https://www.researchgate.net/publication/333580465_Let%27s_Distinguish_Relative_and_Absolute_Efficacy_to_Move_Psychotherapy_Research_Forward
All of this applies equally to the debate about RCTs of FGCs.
The argument against RCTs of FGCs, on the basis that FGCs are a right, risks limiting the field of available interventions. Nothing works for everyone, but if opponents of RCTs of FGCs argue for families’ right to access a particular and prescribed form of meeting then those families (and their children) for whom this is not a helpful intervention may not be offered an alternative.
The rights based argument needs some unpicking. It has the structure of inference by contraposition: if A then B, and if not-B then not-A, and can be summarised narratively as a family has certain rights, which are enacted via an FGC, so denying the family an FGC denies them their rights.
Contrapositive arguments are not logically fallacies – reasonable conclusions can be drawn from them – but they are susceptible to certain risks, and the propositional content needs to be carefully tracked. In this case, the inferential claim is that the link between rights and services (FGCs) is not one of sufficiency but one of necessity: if A then B, if and only if not(C, D, E, F … ad infinitum).
The claim is that there is only one way in which rights can be enacted, so that if this one way of enacting rights is withheld, the rights are lost. Now this is a very difficult threshold to meet: I need to acknowledge the rights that families make claim to (in this case it is professionals making the claim on their behalf, but that’s fine), and then I try to imagine more than one way of putting these rights into practice. I can do this quite easily with a few minutes of quiet contemplation. Now it follows that FGCs are a sufficient way of enacting rights, not a necessary way.
The argument has to be: if A then B and/or C and/or D … , so, if not-B but C and/or D … then A.
There is more than one way to involve (extended) families in decision making about children. Different ways may be more or less effective for different families.
There are two problems with the contrapositive argument as has been made by opponents of RCTS for FGCs. Firstly, the claim made cannot be supported – there is no necessary link between family rights and the FGC process. Opponents who have the laudable aim of standing alongside families and seek to act as guardians of families’ interests need to make better arguments if they are to meet this goal. Secondly, the contrapositive argument has as a consequence that opponents of RCTs are questioning the ethical intent or ethical thinking of the proponents of RCTs. The argument implies that proponents of RCTs are reckless or thoughtless in regard to the rights of families, or do not value or prioritise these rights. This sets a very dangerous precedent in the professional debate. It also has the effect of undermining what I take to be the first aim, as such an (implicit) accusation does not invite a response or encourage refection.
Mike Sanders, in his contribution to this piece and in responding to the concerns made, makes broadly utilitarian arguments for the proposed RCT. It is no surprise that someone trained as an economist would be inclined take this approach, and I do not assume that these are the only arguments he would make. Utilitarian arguments are consequentialist, while the rights-based arguments of opponents to the proposed RCT are anti-consequentialist – here is the relevant statement of this position as it is made in the article: “It argued that FGCs ‘work’ simply by existing, thereby allowing rights and responsibilities to be exercised.” It is not surprising that social workers, concerned with the moral absolutes of child abuse, etc., would naturally adopt and propose anti-consequentialist arguments.
Anti-consequentialist ethical arguments are most associated with Immanuel Kant, consequentialist arguments with British utilitarians of the 1700s and 1800s, and so both have been well-rehearsed in the relevant literature over a long period. Sometimes ethical debates can be conducted without attention to the type of arguments being made, and so interlocutors can end up talking past each other, feeling the other is not listening or is being unreasonable, all the while failing to notice that each side is making different kinds of arguments. Consequentialist arguments work well in some situations (usually, but not always, those more clearly specified) and anti-consequentialist in others (usually, but not always, those which are a more general and more amenable to principled positions). There is a place for both.
In my view the profession as a whole should acknowledge the good intentions of all those who participate in this debate. In my view the progress made in psychotherapy research via RCTs has ended the argument about whether they have a role in the investigation of social and psychological interventions, including in the social work field. There is a need for basic research, to answer basic questions, which helps a field move forward, to innovate and be more effective, and to ask more complex research questions.
If there are specific arguments to be made in relation to RCTs of FGCs, that this particular intervention should be made a special case and immune to such investigations, they have not been made to date.