We know that children and families who receive rigorously tested interventions are shown to have improved outcomes and are more likely to benefit, and to a greater degree, than those who receive other services. However, there is often a gap between what the evidence tells us is effective and what is being commissioned for children and families locally. This research gathered interview, focus group, and survey data from local authority and partner agency staff across nine local areas, to explore what factors influence decision-making, and the barriers and enablers to adopting evidence-based practice. The findings demonstrate that commissioners want to use evidence to inform their practice, giving insight on decision-making in commissioning and service design, and the barriers and enablers to commissioing evidence-based programmes and interventions.
The purpose of the research was to investigate and provide insights on the range of factors that influence decision-making and what the barriers and enablers might be to adopting evidence-based practice.
The findings from this research project will also help to ensure that the series of Practice Guides are relevant and useful for the sector.
This was a mixed-methods study which conducted one-to-one semi-structured interviews, focus groups conducted online, and a short online survey with a mixed sample of nine local authorities in England. Participants were professionals who worked in commissioning, service design and practice development roles, and representatives from partner organisations including integrated care boards, the voluntary and community sector, and the police. Data was triangulated from interviews, focus groups, and a survey, using a thematic analysis approach to draw out the key findings.
Approaches to service design and commissioning for children and families varied considerably between the local authorities in the sample. Some had structured and planned processes which followed a commissioning cycle. Others described their approach as “messy and reactive”, and that it “didn’t always happen by the book”. This was felt to reflect the multiple challenges local authorities face including high staff turnover, and budgetary pressures.
When making commissioning and service design decisions, participants were influenced by a range of factors: including children and families, their own staff – both practitioners and senior managers – and partner agencies.
The was a mixed response regarding using research evidence about what works. Some local authorities and health partners said it was an important factor that was part of their intelligence gathering in the ‘analysis’ stage of the commissioning cycle and was expected to be included in business cases. However, for others, things that were of greater interest included the resource available, what would suit the local context, and the views of children and families.
Most significant barriers to designing and commissioning evidence-based programmes were said to be:
Conversely, the enablers they thought might help the most included:
When it came to using toolkits and practice guidance, some of those commonly mentioned by participants included NICE guidelines, the Local Government Association (LGA) Knowledge Hub, the Public Health Outcomes Framework, and Research in Practice resources.
