Trials and Tribulations: Challenges and Prospects for Randomised Controlled Trials of Social Work with Children

Abstract

Randomised controlled trials (RCTs) have rarely been used in evaluations of social work interventions with children in the UK. This article discusses the use of an RCT in the national evaluation of Multi-dimensional Treatment Foster Care for adolescents (MTFC-A) in the English care system. A number of challenges were encountered in recruiting young people to the trial. These included professional anxieties about randomisation, concerns about accountability, a wish to maintain managerial control over allocations to expensive resources, and the small number of MTFC-A places available in each local area, which meant that new placements became available infrequently. We discuss the challenges to the trial and the strategies developed to address these, including the adaptation of the design to take account of both professional concerns and of the particular circumstances of the children involved. Thirty four children were eventually randomised either to an offer of an MTFC-A placement or to the 'treatment as usual,' an alternative placement selected by their social workers. A further 185 were included in the parallel observational arm of the study.Recommendations are made for the conduct of future trials in children's social care.

Systematic review of educational interventions for looked‐after children and young people: Recommendations for intervention development and evaluation

“…The utilisation of RCTs within educational and social care settings have been plagued by a wealth of problems that have arguably contributed to their poor conduct, with this issue being further compounded by the declining quality of reporting (Torgerson et al ., ; Flynn et al ., ; Dixon et al ., ; Mezey et al ., ). As Dixon et al .…”

“…Indeed, debates have abounded about the perceived unequitable or unethical assignment of individuals to control groups (Gueron, ; Dixon et al ., ; Mezey et al ., ), as though the expenditure of public resources on interventions without evidence of effectiveness does not pose its own ethical challenges. Further, more pragmatic limitations have included insufficient recruitment to ensure statistical power, practitioners circumventing randomisation processes by the introduction of their own rationing strategies, and the struggle to secure funding for the conduct of the trial itself (Gueron, ; Dixon et al ., ; Mezey et al ., ). However, regardless of these challenges, RCTs within educational and social care settings are increasingly gaining traction, and the research community has openly called for a stronger culture around this evaluation design (Gueron, ).…”

“…As Dixon et al . (, p. 1564) surmise, controversy over trials are derived from the interpretation that they are ‘unethical, positivist, uncritically imported from other disciplines, and unable to yield the certainty they promise’. Indeed, debates have abounded about the perceived unequitable or unethical assignment of individuals to control groups (Gueron, ; Dixon et al ., ; Mezey et al ., ), as though the expenditure of public resources on interventions without evidence of effectiveness does not pose its own ethical challenges.…”

“…(, p. 1564) surmise, controversy over trials are derived from the interpretation that they are ‘unethical, positivist, uncritically imported from other disciplines, and unable to yield the certainty they promise’. Indeed, debates have abounded about the perceived unequitable or unethical assignment of individuals to control groups (Gueron, ; Dixon et al ., ; Mezey et al ., ), as though the expenditure of public resources on interventions without evidence of effectiveness does not pose its own ethical challenges. Further, more pragmatic limitations have included insufficient recruitment to ensure statistical power, practitioners circumventing randomisation processes by the introduction of their own rationing strategies, and the struggle to secure funding for the conduct of the trial itself (Gueron, ; Dixon et al ., ; Mezey et al ., ).…”

Literature review: Foster carer attraction, recruitment, support and retention

“…Strict criteria for inclusion of reviews or studies based on high levels of research rigour, for example, were not applied. There is a widely noted lack of availability of reviews/studies undertaken with strict gold standard review or research designs in these topic areas (Dixon et al, 2013;Munro & Hardy, 2006). Had we included only those meeting high levels of evidence on the evidence hierarchies, we would have identified one or two practices which are clearly effective in one particular social and political context and missed emerging or promising practices.…”