• By Dartington SRU
  • Posted on Thursday 14th November, 2013
Cost BenefitEuropeInterventionsStandards of Evidence

Prevention in Paris


This week sees Paris host the 4th Annual Conference of the European Society for Prevention Research. As an islander Brit, your centre of gravity changes when you hop across the Channel. The railway station departures board shows trains heading to cities in countries as diverse as Belgium, Germany, Italy, Luxembourg, Spain and Switzerland. It’s a useful reminder that there is life beyond the transatlantic axis.

Moreover, the Society’s very existence challenges the widely held notion that everything good in evidence-based prevention comes from America. Without doubt, a huge debt is owed to US pioneers in this field too numerous to mention. But EUSPR is just one indicator of a lively community of prevention scientists in Europe.

Three areas of work illustrate this European activity. First, programmes are being developed in Europe that have a good chance of meeting standards of evidence like those used for Investing in Children and Blueprints. Our early work for a European Commission project suggests there are over 100 home-grown programmes in Europe addressing social, educational and health outcomes in the 0-22 age range and evaluated using experimental or quasi-experimental methods. Some, like the Olweus bullying prevention programme (Norway) and the EFFEKT programme to reduce underage drunkenness (Sweden), are already approved by Blueprints. Others should join them in due course.

Second, there are several European clearinghouses of evidence-based programmes (EBPs). Some are country-specific, in that they focus on interventions used in a given country and/or are published in that country’s language. Examples include MOVISIE (Netherlands), Ungsinn (Norway) and PrevenciĆ³n basada en la evidencia (Spain). Others are ‘system-specific’, such as the Best Evidence Encyclopedia (UK), which focuses on education. Then there are clearinghouses that focus on a single subject, such as the European Exchange on Drug Demand Reduction Action (EDDRA). Our own Investing in Children database is international in scope, covers a range of outcome areas and is unusual in focusing so much on cost-benefit data.

Third, there is growing research into whether imported programmes work in Europe: do they transport well? So far, the picture is mixed. For example, Multisystemic Therapy was no more effective than regular services in England, whereas the Incredible Years BASIC parenting programme has been tested and found to be effective in many countries – including England, Wales, Ireland and Norway.

As prevention science matures in Europe, what is needed to promote the greater use of EBPs? At least four things come to mind. First, we need to understand better the differences between clearinghouses of EBPs and generate greater synergy between them. For example, some, such as MOVISIE, track innovation, whereas others, such as Blueprints, focus on proven programmes. Both are important, and they should feed off each other: the work of MOVISIE should contribute to Blueprints, with innovations eventually becoming approved EBPs; equally, Blueprints should be a rich source of ideas for innovation and so feed MOVISIE – for example, it can highlight outcomes for which there are few EBPs.

Second, we need to chart a more rigorous course from innovation to proven model. Europe is awash with innovation. But how many good ideas go on to become EBPs? Some never get evaluated rigorously, while others get evaluated too rigorously too soon: they are set up to fail. There is a need for structured methods to help practitioners move interventions along the innovation to impact pipeline. Helping innovators to move their interventions ‘up’ the standards of evidence, as the Social Research Unit’s Design & Refine guide seeks to do, is one approach.

Third, we need more research into why the transportability of programmes varies so much. One factor is likely to be whether the problem, and its risk and protective factors, are similar or different. Another is the degree of cultural similarity between countries, for instance in terms of type of welfare state or parenting norms. Transportability is also likely to be affected by the flexibility of the programme and whether careful programme adaptation is undertaken. The service delivery context of the new site is important too: the added value of an imported intervention is likely to be less if existing services are already good. So far transportability in European has mainly involved importing and adapting programmes from the US, but we can expect to see more exchange between European countries.

Fourth, we need consistent cost-benefit data for EBPs across European countries to help policy makers make informed choices about where to invest scarce resources. So far Investing in Children only provides cost-benefit data for the UK. It is based on a rigorous process of adapting the cost-benefit model developed by the Washington State Institute of Public Policy. We are interested in collaborating to adapt the model for other European countries.

A recent article in the Journal of Children’s Services by Hans Grietens discussed the resistance among some European practitioners and researchers to the idea of EBPs. Some points of resistance are instructive and highlight areas where Europe might have something to teach the wider field.

It is frequently pointed out that the US has a minimal welfare state whereas North European countries have more redistributive policies and provide universal welfare. There is a reluctance to adopt practices from a country (the US) that routinely performs poorly in league tables of child well-being in developed countries, particularly since many European countries, especially those in Scandinavia, perform relatively well. It is a timely reminder that even effective programmes will always be swimming against the tide in the absence of supportive wider policies.

Many European countries also invest heavily in professionalising children’s services staff, notably through social pedagogues who are trained in child development and work therapeutically with children and families in many settings. It is often contended that this offers an unsuitable context for structured programmes. Put bluntly, Europe doesn’t do programmes. However, a growing awareness of the skill required to deliver many programmes well and the requirements for ‘systematising’ such programmes – which includes having suitably qualified and well-trained staff – suggests that the fit might actually be rather good. This needs testing. 

Lastly, because European innovators tend to be based in mainstream public systems or NGOs that work to those systems, they are arguably closer to an understanding of the complex needs of children and the ways in which existing services can be re-channeled to meet those needs. Unlike much US innovation, which has been primed in universities, European innovation starts within the systems that will deliver the innovation at scale, thus increasing the likelihood of successful scale-up.

 

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