www.nuffieldfoundation.org what can badgers teach us about implementing implementation science?...

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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