What are the problems with conducting an RCT in children’s social care services?
Although RCTs are now recognised as being the ‘gold standard’, they are still not often conducted in social care settings for a range of reasons. One of the most prominent is to do with perceptions about the ethics involved in randomly assigning participants to receive either the treatment we are testing or standard care.
There is often a belief among service providers and people who refer families to services such as Parents Under Pressure™ that these services are superior to standard care because they involve innovative and more in depth methods of working with families. Many people feel that all eligible families should receive the service, and that it’s unethical to randomly deny some families access to it.
However, RCTs are conducted because we don’t yet know how well a programme works. So we don’t know for certain whether the families who are selected to be in the ‘treatment as normal’ group will be worse off than the others. In today’s world of limited resources in the social care sector, many services use some form of selection criteria to make sure that the people taking part are likely to get maximum benefit. RCTs use one of the most equal forms of rationing - randomisation - because everyone has an equal chance of receiving the service.
So one of the first things we had to overcome as part of the RCT for Parents Under Pressure™ was that some of our practitioners were uncomfortable with the idea of randomly selecting who was going to take part in the programme. The practitioners expressed feelings of anger and anxiety about this, and we needed to help them to understand that this approach to evaluation isn’t unethical.
Many of the service providers for Parents Under Pressure™ hadn’t taken part in an RCT before so practitioners were understandably concerned about what was involved. In addition we needed to make some changes to the way we selected participants in the initial stages of the RCT, and this didn’t help with these difficulties. The learning for us as evaluators was that we should pilot all our methods before introducing them to the practitioners involved in the trial.