Randomised trials will drive better decisions for children

In a bid to establish hard evidence of what works, the Department for Education is backing two randomised controlled trials (RCTs) – one on school attainment in maths and science, the other on a child protection assessment tool. RCTs have been used for many decades to gauge the efficacy of medical treatments. Now they are being applied to drive social policy decisions. The DfE’s move is a response to recommendations from Bad Science author Dr Ben Goldacre to pursue the concept more energetically.

Randomised controlled trials compare the outcomes for people who receive a particular intervention with a “control group” of those who do not. The control group exists to provide a true barometer of the intervention’s impact. For example, a drug education programme with a group of 13-year-olds that results in drug use staying the same one year later, would suggest, taken in isolation, that the programme had no impact. If, however, drug use increased significantly over the year in a control group that did not receive the intervention, it leads to the conclusion that the programme in fact prevented significant drug use.

RCTs have formed the evidence base of many intervention programmes that started overseas, particularly North America. The Roots of Empathy programme in schools, which builds pupils’ emotional literacy and is now gathering pace across the UK, is among these. Trials of the programme on these shores show increased sharing, co-operating and volunteering, and decreased aggression.

The promise of more such trials on work with children, young people and families should be welcomed. Too often, senior professionals will say: “we know that” or “all the evidence shows”, with no qualification of these apparent certainties. Randomised trials can counter complacency and challenge a “gut feeling” about what actually works. They can also ensure money is not wasted on funding things that simply do not work. Indeed, some interventions might have a negative impact on its subjects rather than just no impact at all.

However, as the Early Intervention Foundation’s Leon Feinstein says, “social policy is not conducted in a laboratory”. Randomised controlled trials do not in themselves represent a brave new world on which to pin all social policy decisions. Their existence does not mean non-randomised research is bunk, particularly where separate studies on the same issue all point overwhelmingly in one direction. After all, RCTs are not cheap to run. Moreover, they can only realistically be applied to interventions with activities and objectives that are prescribed at the outset. Open-ended relationships-based work such as with families facing difficulty, or young people outside school settings, defies rigorous examination, but needs to be captured and valued nonetheless.

And for all politicians’ demands for harder evidence, the existence of RCTs does not prevent them making policy based on ideological whim – just ask the healthcare professions. Ultimately though, the growth of RCTs in children’s policy ought to lead to increased levels of confidence and certainty about what works. That would surely be a result.

ravi.chandiramani@markallengroup.com