www.nuffieldfoundation.org what can badgers teach us about implementing implementation science?...
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www.nuffieldfoundation.org
What can badgers teach us about implementing
implementation science? Science, politics and policies
Sharon WitherspoonDeputy Director
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The Nuffield Foundation• Endowed charitable trust, annual spend
£12m (about $18m)
• General objective:
“The advancement of social well-being particularly by means of scientific research”
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Randomised Badger Culling Trial Background:
• 25,000 cattle die of bovine TB each year in GB• Compensation of £100m p.a.• Half of all cattle infections come from badgers• Trial launched, 1998 -2007
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www.nuffieldfoundation.org
Randomised Badger Culling Trial Trial:
• Triplets of areas, 100km2 each– Proactive cull, each year– Reactive cull, only after TB outbreaks– Control zone, no cull
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Randomised Badger Culling Trial Results:• Reactive cull stopped as TB rates rose by 20% • Explanation: perturbation• Proactive cull: within zone, TB infections fell
by 25%, but rose in the 2km ring around culling zone, because of ‘perturbation’
• Had to think through system effect: link between size of zone and size of ring effect
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Randomised Badger Culling Trial Implications:• Larger rings (scaling up) would save money if
proactive cull• To enhance cost-effectiveness, killing method
changed (without new pilot)
• Now have “real world” trial (aka scaling up)
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Technical issues: fidelity, size of effects, scaling up, and value for money
But also controversy and values......
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Why relevant to human services implementation in UK?
• Experience of Multidimensional Treatment Foster Care
• Sure Start
• Youth justice reforms• School reforms
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Other badger issues
CONTEXT of TB in cattle in Southwest: • greater density of cattle, larger barns etc. • institutional organisation underestimated in
early discussions. • But given pressures (economics, population
growth etc), unlikely to change structures. • Implementation science needs to appreciate
structural issues too
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Implementation programs on continuum with evidence-based wider policy change?
• When is universal intervention a structural policy change?
• And how context specific is this?• Why we need to understand moderators and
mediators• UK family policy: shift from child outcomes to
family form
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A. Cherlin Dominian lecture
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Cherlin Dominian lecture
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Effects of interventions to promote marriage (or stability)
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Kiernan, Dominian lectureUK data
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Family situation at age 5 by birth status
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IFS study of selection and causality of ‘marriage effect’
• Actively commissioned by Foundation • Longitudinal data show that most differences
in 2 outcomes for children (cognitive and social/behavioural) between married and cohabiting parents in UK are selection effects
• Longer term analysis suggests virtually all difference due to pre-existing differences
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Some general issues in policy brokerage
• Size of effects usually modest ( tho’ meaningful )
• Greater effects more costly (up front at least): dose response
• Timescale for implementation vs. political cycle (ministerial career or parties)
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Some general issues in policy brokerage II
• Values, and disagreement about aims (much less means)
• Self-interest but also ideology
• Politics: intermediaries and stakeholders: advocates of change
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And some larger questions
• Is ultimate aim more and better interventions?
• Targeted or universal?
• If universal, is the game system change.... • And at what point does intervention
implementation require building capacity and internal drivers for improvement.....
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Two tough questions• Is there a ‘science’ of implementation or are
there some general abstract features we can understand but not predict a priori?
• Why would politicians ever relinquish control of means, or agree about aims when they are value-laden (as well as politically-important)?
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Political science not implementation science?
• Norway – longer-term commitment, development and funding
• Anglo Saxon countries more ideologically riven on aims ?
• Longer-term planning more difficult: US veto model, UK and other parliamentary systems have ‘pendulum swings’
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But not counsel of despairFeatures already know to be important• Centres of substantive expertise, with longer-
term engagement (foundation funders can help bridge)
• Intermediary bodies and strategic practitioners
• Political stakeholders (NGOs, parents, etc)• Active PUSH for scaling: and communication
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But not counsel of despairFeatures already know to be important – II• Government advisers on inside (civil service,
special advisers, research funding)• Culture of evaluation spending (mandate is
good: by law or political oversight)• Longer term capacity building of ‘humans’• Economic evaluations
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But....
Isn’t this just the politics of creating critical mass and drivers to make implementation science and use of evidence more self-sustaining?
Or at least ensuring that there is enough power to embarrass?
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