Developing theories of change for social programmes: co-producing evidence-supported quality improvement

Abstract

For much of the past two decades, expensive and often imported evidencebased programmes (EBPs) developed by clinician-researchers have been much in vogue in the family and parenting support field, as in many other areas of social provision. With their elaborate infrastructures, voluminous research bases and strict licensing criteria, they have seemed to offer certainty of success over less packaged, less well-evidenced locally developed approaches. Yet recently, evaluation research is showing that success is not assured. EBPs can and regularly do fail, at substantial cost to the public purse. In times of severe resource pressure, a pressing question is, therefore, whether lower cost, home-grown, practitioner-developed programmes-the sort often overlooked by policy-makers-can deliver socially significant and scientifically convincing outcomes at lower cost and at least on a par with their better resourced cousins. This paper shows how the application of techniques increasingly used in implementation science (the science of effective delivery) could help level the playing field. Processes for doing this including co-produced theory of change development and validation are illustrated with reference to the Family Links Ten Week Nurturing Programme (FLNP-10), a popular manualised group-based parenting support programme, designed and disseminated since the 1990s by a UK-based purveyor organisation. The paper draws out general principles for formulating and structuring strong theories of change for practice improvement projects. The work shows that novel application of implementation science-informed techniques can help home-grown programmes to compete scientifically by strengthening their design and delivery, and preparing the ground for better and fairer evaluation.

Frameworks for supporting patient and public involvement in research: Systematic review and co‐design pilot

“…Ours is not the first study to grapple with the tension between an academic ideal and a local, pragmatic solution. Deborah Ghate recently described an attempt to co‐produce a parenting programme that was both “evidence‐based” (ie, drawing on the research literature, which in this case was characterized by intensive interventions that were difficult to replicate and prohibitively expensive) and “home‐grown” (ie, co‐produced by local practitioners and the groups they sought to serve, taking account of contextual realities and resource constraints) . Published research evidence was used to develop a sophisticated theory of change that was fed into local activities to produce what Ghate called “evidence‐supported design.”…”

“…"home-grown" (ie, co-produced by local practitioners and the groups they sought to serve, taking account of contextual realities and resource constraints). 105 Published research evidence was used to develop a sophisticated theory of change that was fed into local activities to produce what Ghate called "evidence-supported design. "…”

Supporting children who have a parent with a mental illness in Tyrol: a situational analysis for informing co-development and implementation of practice changes

“…According to the definition by Craig et al (2008 and [28,29], the practice approaches, SENSE and CVA that are planned to be implemented, can be defined as a complex intervention: (1) there are a number of interacting components, (2) there is a certain degree of difficulty of behaviours required by those delivering or receiving the intervention, (3) a high number of groups or organisational levels are targeted by the intervention, (4) there are a number of different outcomes, and (5) a degree of flexibility or tailoring of the intervention exists. It has been argued that complex interventions may unfold differently in different contexts [30] and replicating them in different jurisdictions without modifying according to context often leads to disappointing results [31]. Evidence from complexity and implementation science strongly suggests that external factors, governing practice within the service context, may be a major driver or barrier for successful implementation [32][33][34].…”

Supporting children who have a parent with a mental illness in Tyrol: A situational analysis for informing co-development and implementation of practice changes

“…According to the definition by Craig et al (2008 and [28,29], the practice approaches, SENSE and CVA that are planned to be implemented, can be defined as a complex intervention: (1) there are a number of interacting components, (2) there is a certain degree of difficulty of behaviours required by those delivering or receiving the intervention, (3) a high number of groups or organisational levels are targeted by the intervention, (4) there are a number of different outcomes, and (5) a degree of flexibility or tailoring of the intervention exists. It has been argued that complex interventions may unfold differently in different contexts [30] and replicating them in different jurisdictions without modifying according to context often leads to disappointing results [31]. Evidence from complexity and implementation science strongly suggests that external factors, governing practice within the service context, may be a major driver or barrier for successful implementation [32][33][34].…”