What next for evidence?
- Replicating successful evidence-based systems and interventions doesn’t always work. But the chances of success may be increased if we keep in mind four important strands as we develop new forms of support and services.
- Tim Hobbs PhD, Chief Executive, Dartington Service Design Lab.
It has been almost six years to the day since the team and I at the Dartington Service Design Lab first worked closely with the chief architects of A Better Start, the £215 million programme focused on promoting good early childhood development, funded by The National Lottery Community Fund. I know this because I have an honorary A Better Start baby – my first child arrived whilst we were in the depths of our initial work, and the first cohort of A Better Start babies were being born.
So, what did we do at Dartington during this time? Our role was to provide a strong evidential foundation for the initiative, and the strategies developed by 15 shortlisted sites vying to be the five that were eventually funded.
It was a whirlwind of activity, with the associated late nights and early starts an excellent preparation for the sharp reduction in sleep I’d get as my little one arrived in the midst of it all.
In just a few months we:
- Summarised the latest evidence about early child development in The Science Within;
- Gathered epidemiological data from almost 12,000 parents of young children across the 15 sites, and mapped financial expenditure;
- Helped create governance structures and strategy development teams which included local system leadership, practitioners and members of the local communities;
- Facilitated the co-design of 15 different strategies, which helped the Fund identify the five final ABS sites.
Our changing understanding of evidence?
Evidence was at the heart of the initiative, alongside co-design with local communities and local systems change. How has the evidential landscape changed over the years of A Better Start?
There continues to be great strides forward in our understanding of positive child development, resilience, and the influences upon this. Our partners at the Harvard Center on the Developing Child help us keep abreast of this.
That said, translating these insights into effective local practice has been more challenging.
Many (but not all) evidence-based interventions have struggled to replicate their impact across time and in different places. Evaluation suggest this reflects – in part – an insufficient attention to the importance of creating the conditions for good quality implementation, learning and improvement. It also probably reflects a limited tailoring of practice to the local community contexts and systems.
I’ve previously argued that whilst science and evidence are critical in efforts to improve child outcomes, without a solid grounding in local contexts and the perspectives of those ultimately using a service, it’ll only get you so far. Similarly, efforts to improve outcomes grounded firmly in family and community contexts without any evidential underpinning will also be limited in their impact.
Working at these intersections of community-based change, evidence and systems change has no doubt been a challenge for the A Better Start sites. Given the shifting nature of evidence, I’m sure the balance has not always been easy to strike.
Four avenues for exploration
There are four areas that our experience at Dartington convinces us are crucial for the future and which we think A Better Start sites are uniquely placed to explore:
- Segmentation of needs: Many services and support for families are offered pretty fast and loose. Families may be provided the same service, whatever their needs, wants or circumstances. We can better understand need in a more nuanced way through various forms of data-driven insight or prediction, or by simply talking and listening to families (ideally both).
- Personalisation: Once we are clearer and more nuanced about varying needs, we can get smarter about how those needs are met. In healthcare, fields such as genomics and digital technology are revolutionising approaches to personalised care. There is scope to vary what is provided, to whom, in what intensity or duration.
- From programmes to common elements: Given the challenges in replicating the impact of much existing evidence-based practice – in part due to poor segmentation and personalisation - there is an interesting trend towards a ‘common elements’ approach. Rather than delivering a fully-packaged, manualised programme, evidence is accumulating about the potential for distilling common elements of effective practice, that are delivered flexibly according to need and context. A common elements approach sits nicely with segmentation and personalisation.
- From services to systems: Considering complexity and systems change has become a hot topic these last five years. There is a growing acknowledgement that services are just one part of complex, inter-dependent systems around children, families and communities. Our friends at Shift write about it eloquently here. To really make a dent in early years outcomes in a local population requires coordinated, mutually reinforcing and adaptive activities operating at numerous levels (family, community, services and practice, policy, mindsets, etc). This in turn demands a holistic view of the system, its inherent dynamics as well as adaptable strategies to help it continually adjust.
None of this is easy, of course! But to help, in October of this year, we are strengthening our collaboration with the Harvard Center on the Developing Child – which all started six years ago with the inception of A Better Start. We’ll be co-delivering the Frontiers of Innovation approach to support early years programmes, practitioners, and evaluators. We hope all working in early years – especially the A Better Start sites - can join us and help lead the charge.
About A Better Start
A Better Start is a ten-year (2015-2025), £215 million programme set-up by The National Lottery Community Fund, the largest funder of community activity in the UK. Five A Better Start partnerships based in Blackpool, Bradford, Lambeth, Nottingham and Southend are supporting families to give their babies and very young children the best possible start in life. Working with local parents, the A Better Start partnerships are developing and testing ways to improve their children’s diet and nutrition, social and emotional development, and speech, language and communication. The work of the programme is grounded in scientific evidence and research. A Better Start is place-based and enabling systems change. It aims to improve the way that organisations work together and with families to shift attitudes and spending towards preventing problems that can start in early life. It is one of five major programmes set up by The National Lottery Community Fund to test and learn from new approaches to designing services which aim to make people’s lives healthier and happier
The National Children’s Bureau is coordinating an ambitious programme of shared learning for A Better Start, disseminating the partnerships’ experiences in creating innovative services far and wide, so that others working in early childhood development or place-based systems change can benefit.
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